PEOPLE in England who dream of “retreating to the rural idyll” do not always understand that those who live in the countryside face many social and economic challenges, the Bishop of St Albans, Dr Alan Smith, has said.
He was speaking in a debate in the Grand Committee of the House of Lords, last week, on the delivery of healthcare in rural areas.
Poor access to banks and cash; patchy broadband; sporadic mobile signal; virtually non-existent public transport; and minimal childcare were among the problems facing rural communities, he said. Healthcare provision was especially stressful, as it was “primarily and unsurprisingly” designed for an urban setting.
Urging the Government to devise a strategy to improve conditions in the countryside, Dr Smith pointed out that rural populations were significantly older than urban ones: one quarter of England’s rural population are aged over 65. “An older population exacerbates the difficulties of delivering healthcare in rural areas, because those people are much more likely to require higher levels of intervention and support,” he said.
Isolation was a significant problem: more than one million older people in England suffered persistent, chronic loneliness, he said. “As a consequence, rural areas face a significantly higher rate of hospital admissions for alcohol-related harm and self-harm. Put simply, mental-health issues are exacerbated in rural areas.”
Dr Smith referred to statics compiled by the Rural Services Network, which suggest that residents in rural areas receive 14 per cent per head less in social care support than those in urban areas, and the NHS also receives less funding per resident. “With an older population, higher levels of mental-health problems, issues with connectivity, and poor access to services, it is clear that those areas need more support, not less,” Dr Smith said.
The Bishop of Exeter, the Rt Revd Robert Atwell, also spoke in the debate. He said that Devon had the country’s second-oldest population. “We should not underestimate the challenge, both logistical and financial, of delivering health care to an ageing population, particularly in coastal communities and remote rural areas,” he said.
Difficulties in accessing services were exacerbated, he said, by poor or non-existent public transport, and an ageing population was increasing demand for social care when capacity was shrinking. “There is an urgent need to transform what is a low-paid, low-status workforce in the care sector into a viable and noble career,” he said.
Experienced NHS staff were leaving “in droves”, he continued. “The loss of their expertise is a national tragedy. Many are exhausted by the obligation to navigate a health system that has become Byzantine in its complexity. We need to address these challenges, and, above all, give energy to raising the morale of our hard-pressed NHS and social care staff.”
Lord Evans of Rainow, replying for the Government, said that it intended to publish its adult social-care plan in the spring, and was putting £2.8 billion extra into the sector next year.
He recognised that the NHS in the countryside faced different challenges to urban areas. The Health and Care Act 2022 allowed local areas the flexibility to design services that were right for them, he said, and a record £4.5 billion was being provided for primary and community care by 2023-24.
He said that NHS funding was based on a formula devised by the independent Advisory Committee on Resource Allocation, which considered factors such as population, age, and deprivation. It had recently revised its formula to reflect needs in rural, coastal, and remote areas.
“However, we recognise that some systems are significantly above or below the target of where their allocations should be,” he said. “So, NHS England has a programme in place to manage convergence over several years.”