People living in rural settings generally have a longer life expectancy and stay healthier for longer compared to their urban counterparts. But making generalisations about rural places hides the nuances and unique nature of challenges facing these areas, including the inequalities that exist within rural and coastal areas.
"When you've seen one rural place, you’ve seen one rural place" - Professor Roger Strasser, University of Waikato
The National Centre for Rural Health and Care (NCRHC) was formed in 2017 to advocate on behalf of rural trusts in England, largely in response to frustrations related to challenging funding models.
At the time, the NHS Advisory Committee of Resource Allocation described small, rural acute trusts as "unavoidably small due to remoteness." NCRHC commissioned research into the funding model for small acute trusts, which found that six of the seven trusts with "unavoidably small" hospitals ended 2017/18 in deficit. Their combined financial position also amounted to a quarter of a billion pounds. Although they made up only 3% of all trusts, this represented almost a quarter (23%) of the overall deficit for trusts in England at the time.
This small group of trusts continue to have among the most challenged performance of all acute trusts. In 2023, there were significant deficits across the acute sector, including in each of the six rural trusts identified in 2017/18. With the new government's focus on performance and productivity, now more than ever the NCRHC stands ready to support the needs of rural trusts.
Understanding the challenges and inequalities facing rural areas
Between 2020 and 2022 we ran an inquiry into rural health and care for the All-Party Parliamentary Group on Rural Health and Care. Drawing on evidence from over 120 witnesses, including national and international experts, we identified 12 recommendations covering four key themes:
- Better understanding of the distinctive health and care needs of rural areas
- Delivery of services that are better suited to the needs of rural places
- Develop a structural and regulatory framework that fosters adaptation and innovation through a rural lens
- Develop integrated services that provide holistic person-centred care.
Delivering action against these recommendations has been the principal challenge in the intervening years. The Chief Medical Officer's 2021 Annual Report on health in coastal communities highlighted the significant health inequalities that exist in these areas. This was a game changer. It provided significant external endorsement that rural places were not homogenous. Those living furthest from healthcare services in rural and coastal areas are most at risk of experiencing inequalities, particularly where there are poor and unaffordable transport connections.
Our priorities for improving rural health and care
We have since focused our action on four key areas for improving outcomes in rural and coastal areas.
Firstly, in terms of research, we have influenced and encouraged studies linked to the issue of rural health inequalities, including securing a £10.9 million UK Research and Innovation (UKRI) grant supporting the work of the Institute of Rural and Coastal Health at the University of Lincoln.
On data, we have worked with the University of East Anglia on the development and application of the Rural Deprivation Index which supports a greater understanding of rural deprivation than the English Indices of Deprivation.
In terms of technology, we have engaged with the Health Innovation Networks about the application of technology in rural health settings.
Finally, on workforce, we developed the rural proofing health and care toolkit for practitioners in 2022. This has been an essential proofing guide for NHS trusts and wider organisations in the delivery of services in rural settings. We also responded to the government's consultation on the Long Term Workforce Plan arguing for place-based approaches to implementation, with a particular focus on recruitment challenges for rural trusts. Workforce challenges around recruitment and retention across all elements of the health and care system represent a core challenge in rural and coastal locations and must be a priority for the new government.
What can trusts do?
We are looking to learn from trusts about their experiences delivering care in rural and coastal areas – building on the webinar we delivered with NHS Providers about tackling the inequalities facing rural and coastal areas.
We are currently developing a workforce toolkit, which covers key issues facing rural and coastal areas. This includes, education, training, career development and progression, seasonal demand for services, travel time for home visiting services, networking and peer support opportunities, and knowledge and evidence on the burden of disease in rural areas.
We would love to hear from other rural and coastal trusts about their experiences, to help share examples of good practice among our members. Trusts can become members of NCRHC and join our mission to improve rural healthcare services and there are also opportunities to join our editorial panel at NCRHC. Get in touch if you’d like more information about our membership scheme.
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