City-REDI Presents Evidence at Parliamentary Inquiry on Rural Health and Social Care – 30th October 2018

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In our last blog, “Professor Anne Green Presents City-REDI Research at the Parliamentary Launch of the National Centre for Rural Health and Care” we described the research City-REDI and Rose Generation completed this summer on issues around recruitment and retention of NHS and care workers in rural areas and described the aims of the new National Centre for Rural Health and Care.

This time we are reporting on the launch of a Parliamentary Inquiry on Rural Health and Social Care which has been established to look at the key issues in providing good quality and effective health and social care in rural settings. The enquiry is jointly chaired by Sarah Mullally, Bishop of London and Anne Marie Morris MP.

There are eight key issues being considered by the Inquiry:

  • What are the needs of rural communities, how are they different from their urban counterparts?
  • How are rural health and social care needs currently met?
  • What is not working in rural communities and why?
  • Workforce challenges and opportunities
  • Education and training challenges and opportunities
  • Structural challenges of fitting current delivery models into a rural setting with different needs and challenges
  • Technology opportunities and challenges
  • Integration opportunities and threats

We were asked to give evidence at the first session of the Enquiry took on Tuesday 30th October 2018 in Committee Room 17, House of Commons on the following three questions:

  • Rural areas suffer problems with recruitment across the spectrum of health and adult social care – how do these manifest themselves?
  • What are the threats arising from them and how do we address them?
  • Does this cover some occupations more than others and if so how?
Rural areas like Lincolnshire suffer recruitment problems for the NHS

City-REDI provided an oral presentation on our research. This included setting out the nine challenges we identified:

  1. Rural areas are characterised by disproportionate out-migration of young adults and in-migration 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 the 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 the best health and care outcomes.
  9. Examples of innovation/ good practice are not routinely mapped and analysed, so hindering sharing and learning across areas

As well as challenges we also identified nine opportunities for employers in the NHS and social care sector to transform and make more sustainable health and social care provision in rural areas:

  1. Realising the status and attraction 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 the many different 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 that 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.

In addition to ourselves evidence was also provided by Stephen Hall from the Department of Environment, Food and Rural Affairs; Dr Rashmi Shukla;, Public Health England; Dr Robert Lambourn, Royal College of General Practitioners Rural Forum; Professor Clive Ballard, Pro-Vice Chancellor, University of Exeter Medical School; Martin Collett, English Rural Housing Association; Phil Confue, Cornwall Partnership NHS Foundation Trust; and William Palmer, Nuffield Trust.

The Inquiry is being managed by the National Centre for Rural Health and Care and is still accepting written evidence from the public. This can be sent to the Operations Director for the Centre Ivan Annibal via

This blog was written by Anne Green, Professor of Regional Economic Development and George Bramley, Senior Analyst, City-REDI, University of Birmingham.

The views expressed in this analysis post are those of the authors and not necessarily those of City-REDI or the University of Birmingham.

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