Spotlight on Rural Health & Social Care - February 2019

This newsletter is provided by the Rural Health Network, part of the Rural Services Network.
It includes a roundup of rural health & social care news, research, learning and best practice.

Snow raises red alert for rural care workers

Vulnerable people are being made a priority home care call as snow hits much of the UK, with a red alert issued for care workers to attend.

One company has used its red, amber and green system ensures bedbound people living at home alone are the designated the first priority because they are the most vulnerable.

‘Sandwich generation’ are vulnerable

The Office for National Statistics has published data on the ‘Sandwich Generation’ – those who care for both their parents and dependent children.

The report found that they are more likely to suffer from mental ill-health, feel less satisfied with life and face financial struggles than the rest of the population.

NHS long term plan launched

The 10-year plan for the future of the NHS was announced last week, it outlines how the NHS budget will be spent over the next five years.

Broadly, its stated aims are to: enable everyone to get the best start in life, help communities to live well and help people to age well.

The plan focuses on prevention as a way of reducing financial pressures on healthcare, after Health Secretary Matt Hancock made prevention one of his top three priorities during his first speech in the role last year.

Smart homes to help the elderly

New ‘smart homes’ are to be created to help elderly and disabled people tackle loneliness in rural areas, according to Open Access Government.

The pilot, to take place in West Essex, will train residents to develop digital skills so they can become experts in a technology called ‘digital buddies’.

They will then open their homes for older people to visit and learn about smart technology, for example showing them how to control household appliances, book doctor’s appointments online, video chat with friends, and order online shopping.

Rural Health and Social Care in the NEWS

Rural GP transport service saved by councillors (6 Feb 2019)

A voluntary scheme which offers transport to a rural west Suffolk health centre will now be able to continue after five councillors “answered a call for help”.  (East Anglian Daily Times)

'Chatty buses’ launched to fight loneliness (29 Jan 2019)

Passengers are being encouraged to talk to someone new on some Yorkshire Coast buses.  East Yorkshire Motor Services has launched a "chatty bus" campaign on a few of its Scarborough and District services.  The company is increasing its efforts in the fight against loneliness and social isolation. (Yorkshire Coast Radio)

Elderly care difficulties(19 Dec 2019)

An elderly resident in the Harrogate district has been stuck in a care home for six months, after eight care companies were unable to provide services.

Michael Harrison, the lead councillor for adult services in North Yorkshire, has told Stray FM about two of the worst cases unable to get social care at home.

One of the biggest challenges in North Yorkshire is finding care companies who can afford to send carers into rural areas. (Stray FM)

Rural and remote health services lose out on NHS funding according to research

Nuffield Report
A study by think tank The Nuffield Trust says the way the NHS distributes funding is “unclear, unfair and fails to fully compensate remote and rural areas for the extra costs they face”.

As a result, patients in isolated areas are faced to wait longer for treatment, and are far more likely to fall victim to bedblocking, the analysis finds.

The research found that the funding situation has become so precarious that six of England’s smallest and most remote hospital trusts now account for nearly a quarter of the £1bn NHS provider deficit.

And it said funding formulas failed to take proper account of the fact those living in rural areas were likely to be older and sicker than the average population.

On average, at small remote hospitals just 84 per cent of patients were treated in Accident and Emergency within four hours, compared with 90 per cent of those in other trusts, the analysis found.

Just 79 per cent of those needing treatment began it within 18 weeks, compared with 85 per cent of those elsewhere.

The number of days lost to bedblocking was far higher in remote small hospitals, the analysis found, with 118 per 1,000 admissions, compared with 81 per 1,000 admissions in other trusts. And their average deficit was four times that of other trusts, the study found.

Researchers said NHS trusts in rural areas were facing cost pressures which were not properly compensated.

This included difficulties recruiting staff, meaning higher reliance on costly agency staff, the study commissioned by the National Centre for Rural Health and Care found.


A Report published by the University of Birmingham and Rose Regeneration has examined Rural Workforce Issues in Health and Care.  It aimed to apply a rural lens to the workforce challenges facing the NHS and social care in England in recognition that  securing the supply of staff that the health and care system needs to deliver high quality care now and in the future is crucial


In summary, the main challenges facing rural areas face in securing the supply of staff that the health and care service needs are that:

  1. Rural areas are characterised by disproportionate out-migration of young adults and inmigration of families and older adults.
  2. This means that the population is older than average in rural areas - this has implications for demand for health and care services and for labour supply
  3. Relatively high employment rates and low rates of unemployment and economic inactivity mean that the labour market in rural areas is relatively tight
  4. There are fewer NHS staff per head in rural areas than in urban areas.
  5. A rural component in workforce planning is lacking.
  6. The universalism at the heart of the NHS can have negative implications for provision of adequate, but different, services in rural areas and also means that rural residents can be reluctant to accept that some services cannot be provided locally.
  7. The conventional service delivery model is one of a pyramid of services with fully-staffed specialist services in central (generally major urban) locations – which are particularly attractive to workers who wish to specialise and advance their careers.
  8. Rural residents need access to general services locally and to specialist services in central locations to provide best health and care outcomes.
  9. Examples of innovation and good practice are not routinely mapped and analysed, so hindering sharing and learning across areas.

The main opportunities for securing workforce supply and maximising impact are:

  1. Realising the status and attractiveness of the NHS as a large employer in rural areas (especially in areas where there are few other large employers)
  2. This means highlighting the varied job roles and opportunities for career development available and that rural areas are attractive locations for clinical staff with generalist skills.
  3. This means developing ‘centres of excellence’ in particular specialities or ways of working in rural areas that are attractive to workers.
  4. This requires developing innovative solutions to service delivery and recruitment, retention and workforce development challenges.
  5. This may provide opportunities for people who need or want a ‘second chance’ – perhaps because the educational system has failed them, or because they want to change direction; their ‘life experiences’ should be seen as an asset.
  6. Finding new ways to inspire young people about possible job roles and careers in health and care.
  7. Drawing on the voluntary and community sector, including local groups, to play a role in the design and delivery of services, as well as achieving good health outcomes for rural residents.
  8. Promoting local solutions foster prevention and early intervention and enhance service delivery.
  9. Using technology so face-to-face staff resources are concentrated where they are most effective.


The Rural Services APPG has for some months been carrying out an Inquiry into the future funding of Adult Social Care in the rural context.

The Inquiry was limited to England and has been conducted to enable the APPG to submit evidence to, and to respond to the specific issues contained in, the Government’s Proposed Green Paper on the subject to be published later in 2018.

The Rural Services Network provides the Secretariat for the APPG on Rural Services.

Rebecca Pow MP, one of the Joint Chairs of the APPG is submitting the Interim report as a result of the Inquiry to Matt Hancock, Secretary of State for Health and Social Care.

The report sets out a number of Overarching Recommendations, Resource Distributional Recommendations and Workforce Planning Recommendations.

The overarching Recommendations include:

  • The present system of funding both Adult and Children’s Social Care Services needs to be changed urgently and ahead of new legislation flowing from the Green Paper’s wider considerations. The present system is unsustainable and, moreover, is very unfair and inequitable for providers operating across rural areas (and the Council Tax payers in those areas) when compared to their urban counterparts. There needs to be a substantial re -balancing to those areas which have the oldest populations in both the 65+ and 85+ age categories.
  • Social Care is a national issue – and at present is in crisis nationally. It should be 100% funded by central government in terms of a national core level(s) of service available (at the same cost if personal financial contributions are to be required) to all, irrespective of where they live. The Service should continue to be delivered at the present level of County/Unitary local authorities with sufficient discretion to determine how that core level(s) of services should be provided in their local context. Council Tax is not a suitable taxation vehicle for demand responsive services and produces a postcode lottery of supply which is able to be funded.
  • Council Tax should only be used to fund any exercise of discretion by the local authority to provide a service above the national core level(s).
  • A future system of dealing with care needs must address, and properly fund, the “prevention” services” provided by County and Unitary Councils through Public Health funding and also those services provided by District/Borough Councils which are aimed at enabling people to live healthily and safely in their own homes (if necessary, with support) as long as possible.

The Rural Services Network has long campaigned for Fairer Funding for Rural Areas. Central Government has historically and systematically underfunded rural areas giving them less grant per head than urban areas – despite the fact that it costs more to provide the services. Rural residents earn less on average than those in urban areas and pay more Council Tax for fewer local government services. Government policy, implicitly, is that council services in rural areas are more reliant on funding through council tax than their urban counterparts. We demand fairer funding for all public services serving rural areas and wait to see what relief the Green Paper on Social Care will bring!

RURAL Seminar Programme 2019

We are launching the RSN Seminar Programme for 2019 with 7 seminars in regions around England, each focusing on a different subject. The South East Seminar due to be held in April focuses on Rural Vulnerability and the July Seminar in the East Midlands focuses on health and wellbeing.  All paying members of the RSN which includes the RHCA are able to attend the seminars and more information is available here

There will also be two additional seminars run by the National Centre for Rural Health and Care focusing on rural health and further details will be released in due course.

APPG for Rural Health and Care Parliamentary Inquiry has been established

The APPG for Rural Health and Care Parliamentary Inquiry has been established to look at the key issues facing the country in terms of providing good quality and effective health and social care in rural settings. The Inquiry   will explore how England has developed its systems post-Beveridge, testing  whether we now have a one size fits all model focused   more on the needs of urban  areas than rural communities.

The Inquiry is focusing on current practice and what needs to change  to meet  the specific challenges facing rural populations . Over the next 2 years it will hold 8 evidence sessions. The Inquiry is co-chaired by Anne Morris Morris, M.P. for Newton Abbot, and The Right Reverend and Right Honourable Dame Sarah Mullally Bishop of London. 2 sessions have already been held a further six are scheduled to cover:

What is not working in rural communities and why? Can the new centralising hub spoke models of care across primary, secondary and social care work with such dispersed communities with great variety of footfall between winter and summer seasons?  Do the family and the third sector fill the gaps? Does the funding formula meet rural needs?

What are the workforce challenges and opportunities? Is rural working less attractive? How many unfilled vacancies are there in rural areas – around 70%? Do the golden hello handshakes to GPs work? Can health and care nurses work across their professional boundaries? Are the higher rates of dementia being met? What is the role of volunteers?

What are the education and training challenges and opportunities? Should rural experience be a mandatory part of training? Should we train more specialist generalists, like physician associates? Should Royal Colleges collaborate on cross specialist training? Should more medical schools be established in rural areas?

Are there structural challenges fitting current delivery models into a rural setting with different needs? Can/should the Northumbria model and/or Torbay coastal models be replicated? Will “stretching” existing models be enough? How should regulatory reporting be adjusted? How can budget and reporting line barriers be overcome?

What are the technology opportunities and challenges? What role should technology play in medical service delivery, diagnosis and treatment? What role could it play in social care and urgent and emergency care? Could its communication attributes be more innovatively used in public health?

What are the Integration opportunities and threats? How can service delivery be integrated to maximise care and treatment over distance, and across multiple co-morbidities? What part should families and communities play? How can the voluntary sector be better integrated into primary and secondary care?

The secretariat for the Inquiry is being provided by  the National Centre for Rural Health and Care, which was established early in 2018. This organisation is Chaired by Professor Richard Parish and the  Secretariat will also comprise Ivan Annibal, Director of Operations, and Dr. Jessica Sellick, Senior Research Fellow. More information about the Inquiry can be found on their website:

RSN Observatory

The RSN Observatory provides a statistical overview of rural life.  It provides analyses and comment on key service provision and issues affecting rural communities.
It includes information on housing, health, the economy and local services.

Analysis and commentary from the RSN

That it costs more to deliver health and care in rural areas is well-rehearsed among RSN members. But how much more does it actually cost to deliver in rural areas and are these costs recognised in current funding formulae?

Jessica Sellick investigates (Read more...)

Rural Health and Care Alliance

The Rural Health & Care Alliance is a membership organisation dedicated to providing news, information, innovation and best practice to those delivering and interested in rural health and care

The Rural Health & Care Alliance (RHCA) has been established through a partnership between the National Centre for Rural Health and Care and the Rural Services Network (RSN) and is affiliated to both the National Centre and the RSN.

  1. Seeking equity of health and care for rural communities
  2. Creating a strong, collective voice for those involved in rural health and care
  3. Raising awareness of the challenges faced in rural health and care

We want to create a strong collective voice to draw attention to issues relating to health and care in rural communities. This voice is currently lacking – no such forum or alliance presently exists - we aim to change that.

Issues such as vulnerability, isolation and loneliness sit at the heart of our rural communities across the UK. With these challenges come the additional cost and workforce requirements of delivering effective services to improve healthcare outcomes for those living and working in these communities.

We will develop the Alliance through the sharing of information, case studies and best practice from the local to the global level. We will exercise influence right at the heart of policy making in the UK by engaging with decision makers and opinion formers through the partnership between The National Centre for Rural Health and Care and the Rural Services Network.


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