Debate: Rural Health Care

Rural health challenges are well documented. People living in rural communities have issues relating to accessing health and social care, general practice, domiciliary care, medicines, shopping and transport. The response times of health care staff are longer and domiciliary care may be limited. Access to physical activities and leisure services can also be limited, which makes it much harder for health professionals to support people to take preventative measures in regard to their health. In addition, the effects of loneliness and poverty have significant impacts on health. Nursing staff working in rural settings have also reported challenges around access to technology and broadband, and the implications of this on patient care.

Devolved governments have taken different approaches to addressing these challenges. Scotland and Wales have a greater policy focus on care in remote communities, while in Northern Ireland, rural health outcomes are generally higher than in urban areas. However, across the UK there is a deepening nursing workforce crisis with too few being trained and too many leaving the profession.
Across the UK there must be adequate and equitable provision of health and care services which meet the health needs of the local population. Ensuring that there is adequate provision of community and social care services is especially important, as is a focus on strengthening technology and access. This requires a robust understanding of the needs of rural communities and sufficient funding to meet demand. Nursing staff working in rural areas must be supported to provide the best possible patient care.

In Northern Ireland, the 2018 Health Inequalities Annual Report (Health Inequalities Section, Department of Health, 2018) published by the Department of Health demonstrated that most health outcomes in rural areas are higher than in urban areas. The only outcome that is lower is ambulance response time. The debate about rural health care provision is linked to the transformation of health and social care, along with the associated discussion about the size and configuration of acute hospital services across Northern Ireland.

In 2015 RCN Scotland published Going the Extra Mile, which recommends improving access to community health care for older people in remote and rural Scotland. (RCN Scotland, 2015) In 2017, it published a joint statement with other professional bodies on the Scottish Government’s digital strategy, setting out the importance of appropriate digital infrastructure in remote and rural areas. (RCN, 2017). The Islands (Scotland) Act 2018 places new duties on certain organisations and the Scottish Government to assess the impact of policies and legislation on Scotland’s many island communities, and to consult with residents.

The National Assembly for Wales has a rural health care research centre to inform the development of policy. In addition, it established the Mid Wales Health Committee to particularly focus on health care needs in this rural area. NHS service provision and delivery in Wales is through seven Health Boards which all cover urban and rural areas. Access to specialist care, the need for improved digital health care and investment in community services are frequently raised as concerns by people living in rural communities in Wales.

In England, planning and funding of health and social care provision is not based on a robust assessment of population need. Nursing shortages, particularly in the community, mean that people living in rural communities may find it harder to access the support they need, when they need it. A key aim of the Sustainability and Transformation Plan (STP) programme is to shift care away from hospitals, but concerns have been raised about STPs being overly biased towards urban settings. There could be a risk to community nurse funding in rural areas with less to spend per capita, meaning that commissioners of services might be unable to afford the required nurses and nursing staff to transform services and deliver safe and effective care.