The Levelling Up White Paper follows hot on the heels of the Inquiry into Rural Health and Care, launched on 1st February.  This highlighted the various significant problems experienced by many rural citizens in accessing health and social care services.  The Inquiry Report also emphasised the many factors that contribute to these access problems, ranging from poor digital connectivity to lack lustre public transport services. The funding of health and care in rural areas, in addition to poor community infrastructure, is at the heart of healthcare disadvantage. The National Centre for Health and Social Care (NCRHC) welcomes the commitment to levelling-up, but it must go beyond political rhetoric and result in meaningful action appropriate to local areas.  The underpinning determinants of poorer access to health and social care are clear and the solutions obvious, including the use of a funding formula that recognises the true costs of service delivery in dispersed communities and coastal towns.

At the launch event Professor Sir Chris Whitty, The Chief Medical Officer for England commented

“The health challenges of rural areas are distinct from those of urban areas, and they've received much less attention than they should have. So, I'm extremely grateful to the authors of this report, and those who've promoted it after doing so”.

We only have to look at the recently released statistics on delayed transfer of care (when a patient is medically fit for discharge from acute or non-acute care and is still occupying a bed) to see the impacts of the levels of service availability in rural settings..

Patients from predominantly rural areas experienced longer delays for both acute and non-acute care. Predominantly rural residents experience 3.19 delayed days per 1,000 resident population compared to 2.51 for predominantly urban and 2.75 for England overall. There was no difference in the providing organisation as delays were greater for Predominantly Rural areas whether the responsible organisation was the NHS or Social Care.

Levelling up is not just about socio economic, inequalities, or the north south divide - important though these are - they must also address rural disadvantage as well. And we need a place-based approach when it comes to looking at these dispersed and different communities in rural, remote and coastal areas

Commenting on the Levelling Up agenda, NCRHC Chair Professor Richard Parish said:

"Healthcare is often viewed somewhat inappropriately as a cost.  In truth, health and wealth are indivisible.  Poor health is undoubtedly a cost to society.  However, good health is an economic asset, contributing to improved productivity and a more efficient economy.   What is more, economic improvement is fundamental to better health.  It is a virtuous circle.  Better health contributes to economic improvement and in turn a more vibrant economy leads to improved health outcomes.’  It is a classic ‘win-win’ scenario. This point is recognised in the Levelling-Up White Paper which says “The UK Government’s goal is to tackle the stark disparities in health outcomes across the UK, ensuring people have the opportunity to live long, healthy lives wherever they live. Better health improves productivity and well-being".

"There is widespread agreement that poor access to health and social care in rural areas is inequitable and fails to deliver on the commitments made in the NHS Constitution.  It goes without saying that it must be at the forefront of the levelling-up agenda.  By definition, this means that if levelling up is properly designed and implemented many economically disadvantaged rural and coastal towns will get a better deal and their wider rural catchment populations will benefit as well.  But design must reflect the different challenges in rural areas and avoid a one-size fits all approach. We need different models of delivery, not just a tweaked urban approach, and we need better measures of impact and health outcomes. However, levelling-up for rural and coastal communities should not mean levelling down for our urban cousins.

We look forward to seeing the promised ‘White Paper designed to tackle the core drivers of disparities in health outcomes’ which must be fully rural proofed reflecting the evidence in our Inquiry report”

Reaction to the Report

Described by international observers as the most comprehensive review of its kind, the three-year Inquiry into Rural Health and Care, published by the National Centre and the All-Party Parliamentary Group (APPG) at the beginning of February, has been received to widespread acclaim. 

Matthew Taylor, Chief Executive of the NHS Confederation said:

“This report identifies what many health leaders continue to tell us about the additional pressures experienced by health and care services in rural parts of the country.

“Filling workforce shortages is a particularly significant challenge facing rural healthcare services, which at its worst can add to waiting times, limit the breadth of services available locally, and lead to some people having to travel further to seek treatment.

“While the introduction of statutory integrated care systems and the development of primary care networks will hopefully lead to improvements and allow healthcare planning to take place across bigger regions, there are still around 93,000 vacancies, which will take time and resource to fill. A detailed and fully costed workforce strategy is urgently needed.

“NHS leaders are committed to working together to tackle these challenges but if the Government is serious about levelling up the country, it cannot overlook the deep-rooted disparities between rural and urban healthcare provision and patient experience.”

Commenting on the Inquiry Overview, the director of policy and strategy at NHS Providers, Miriam Deakin said:  

“We welcome this report, which highlights the importance of understanding the distinct needs of rural areas, and ensuring structural, operational and financial challenges are taken into account in regulatory frameworks.  

“This report reflects the complexity and diversity of the communities the trust sector serves, with rural areas facing unique challenges and opportunities, and requiring unique solutions.  

“Delivering care across geographically dispersed communities is challenging for trusts across all sectors: whether large acute hospitals with isolated sites serving rural communities, ambulance trusts with large distances to cover or community and mental health trusts with a number of smaller settings based in rural areas.   

“Workforce challenges are often significant, with recruitment and retention issues and a more mobile workforce. However, trusts also tell us that staff can be drawn to the supportive culture of working within smaller teams – and to the benefits of living in more rural locations themselves.  

“Health inequalities are a priority focus for trusts, and a ‘one-size fits all’ approach is not appropriate. This report highlights the unique factors impacting health outcomes in rural, remote and coastal communities, and the health inequalities challenge facing these communities differs from the challenge faced by more urban populations. Efforts to address health inequalities must take into account these differences in context.  

“Trusts in rural and coastal areas will continue to work hard to understand the inequalities facing their communities, and address them with their system partners. They play a crucial role in contributing to care pathways which meet the needs of their populations.”