Kerry Booth - Rural Services Network Assistant Chief Executive

Who could have foreseen when I wrote the last Health and Social Care Spotlight the situation we would now find ourselves in?  At times it feels so unreal and rather than search for rural health news as I usually do, it seems that every article I read is health and virus related.  The RSN is the national champion for rural services, but how are health and care services impacted by Covid-19 and the lockdown differently in rural areas?

Older people make up a significant part of rural communities, meaning that whilst to date, on average mortality figures are higher in urban areas in the UK, if the virus were to take hold in rural areas, a greater % of the community are considered vulnerable and would be at risk.  This article highlights the potential risk to rural communities. 

Rural communities can experience difficulty accessing services during ‘normal’ life, supermarkets, pharmacies, and shops for other necessities are often located in rural ‘hub’ towns that serve a wide hinterland. The reduction of already minimal transport services can make accessing these for large numbers of older residents that are in lockdown difficult.

Many rural communities were still recovering from the aftermath of devastating flooding which had destroyed homes and businesses when the country went into lockdown.

Rural isolation has long been a concern for the RSN as the culmination of factors such as poor access to transport, lower than average wages and lack of facilities can create a particular form of rural vulnerability.  Isolated in their homes, often far from neighbours, friends and family, rural residents are at greater risk of vulnerability.  Despite progress in technology, many remote rural communities do not have the broadband or mobile connectivity that the rest of the country are now relying on for accessing medical advice, education, grants and support for businesses and even social contact with loved ones.
However, the resilience of rural communities has been shining through in recent weeks, we have been collecting stories of parish councils and community groups who are providing voluntary support to their communities with everything from shopping to collection of medicines to regular phone calls for isolated residents. 

Mental health is so important during this time when we are isolated from our families and friends and usual support networks, organisations have put together plans in record time to support those in need, as featured here with one of our Rural Services Partnership members, Young Somerset.

The Rural Services Network will continue to urge Government to consider rural communities in the way they deal with the crisis, and when developing eventual plans for easing of restrictions, to ensure that the particular nature of rural communities and the services that they deliver are supported and policies are rural proofed and appropriate.

Stay at home – Government Advice

• Only go outside for food, health reasons or work (but only if you cannot work from home)
• If you go out, stay 2 metres (6ft) away from other people at all times
• Wash your hands as soon as you get home
• Do not meet others, even friends or family.  You can spread the virus even if you don’t have symptoms

News stories that have been featured on our rsnonline.org.uk website include:

COVID-19 death rates 'could be 80% higher in rural communities'
The Evening Standard published a study which has predicted significantly higher levels of COVID-19 fatalities in rural locations due to larger ageing populations
The analysis found that death rates could be up to 80 per cent higher if the outbreak reaches people in these more remote areas.
It is feared this could have long-term socio-cultural impacts on certain communities, particularly on rural areas with higher ageing demographics and areas which are strongholds for minority languages.
If the pandemic continues to prevail and the virus spreads to all areas of the UK, remote small towns and rural communities are projected to have 50 per cent to 80 per cent higher death rates than the main cities because of their old population composition, which in some small communities could be devastating.

Water companies step up action to help customers in need
Water companies in England and Wales have stepped up efforts to help customers who have lost their jobs or had their incomes cut during the coronavirus crisis
The companies are encouraging households suffering from immediate or short-term issues with paying their bills to get in contact so that they can receive help.
All water companies have measures in place for people who struggle to pay for their water and wastewater services. During the current crisis, companies are reaching out to their household customers to encourage them or people they know to take advantage of the assistance available.

RSN make contact with Government regarding the covid-19 exit strategy and the implications for rural communities 
The Rural Services Network has written to The Rt Hon. Matthew Hancock (Secretary of State for Health and Social Care) along with other key rural organisations to open discussions regarding the Covid-19 exit strategy and the implications for rural communities.
Along with the Chair of the Rural Coalition, Action with Communities in Rural England (ACRE), the National Centre for Rural Health and Care and the Rural Health and Care Alliance, the Chair of the RSN set out their concerns for rural communities post 'lockdown'.

Families in parts of rural England say they are totally dependent on volunteers delivering food during the coronavirus crisis
In rural England many households face long journeys to buy food and this is more difficult if families are self-isolating. Under lockdown restrictions, shopping for food is one of only four reasons why people are allowed to leave their home.

Chancellor sets out extra 750 million coronavirus funding for frontline charities

• £750 million pot for frontline charities across the UK – including hospices and those supporting domestic abuse victims
• £360 million direct from Government departments and £370m for smaller charities, including through a grant to the National Lottery Community Fund
• Government will match donations to the National Emergencies Trust as part of the BBC’s Big Night In fundraiser later this month – pledging a minimum of £20 million

Charities across the UK will receive a £750 million package of support to ensure they can continue their vital work during the coronavirus outbreak, Chancellor Rishi Sunak announced today (Wednesday 8 April).

Government pledges extra £1.6 Billion for Councils
Councils across England will receive another £1.6 billion in additional funding as they continue to respond to the coronavirus pandemic, the Local Government Secretary has announced (18 April).
This extra £1.6 billion takes the total given to councils to help their communities through this crisis to over £3.2 billion, an unprecedented level of additional financial?support in recent times.  The funding will mean councils can continue to provide essential services and support to those who need it most.
This includes getting rough sleepers off the street, supporting new shielding programmes for clinically extremely vulnerable people and assistance for our heroic public health workforce and fire and rescue services.  The funding will also mean councils can provide vital services including adult social care and children’s services.

RSN provide a range of opportunities for colleagues to come together to discuss issues affecting rural health.

Given the current lockdown situation, we have postponed all face to face meetings and events. 

We did however host a virtual Health Seminar on 9th April which focused on Rural Mental Health and the presentations and meetings notes are available on our website

We are planning for ways in which we can host virtual meetings in the upcoming months to bring together our member organisations.
The Rural Services Network host a regional seminar programme includes 7 different events in different regions around the country.  These are designed to enable local networking and sharing of best practice. 

The next seminar focuses on Rural Transport and Connectivity and will be hosted online on 19th May for those members based in the North East of England.  It is open to all members of the Rural Services Network free of charge.  For more information contact [email protected]

Rural Public Health Funding
Local authorities (upper tier and unitary) are responsible for improving the health of their local population and reducing health inequalities
In 2020/21 the total public health grant to local authorities will be £3.279bn, increasing from £3.134bn in 2019/20. The grant is ring fenced for use on public health functions exclusively for all ages.
NB : This article was written pre-lockdown and any allocations since however is still relevant in discussions about public health.

Outliers or Trendsetters - Are ‘anchor ‘organisations sticking to rural communities?
Schools, GP practices, libraries, churches, village halls, shops and post offices are seen as playing a key role in securing the viability of rural communities. In fulfilling social and economic functions they could be described as ‘community anchors’, ‘anchor organisations’ or ‘anchor institutions’ – they have strong ties to the geographic [rural] area where they are based and have a significant impact (individually or collectively) on the local community and economy. Who and where are the anchors in rural places – and are they meeting the socioeconomic needs of local communities or at risk of becoming unstuck? Jessica Sellick investigates.

Whitehall updates the Index of Multiple Deprivation
The 2019 version of this Index does not solve rural concerns, but it is likely to be widely used and should not be ignored, says Brian Wilson.

The RSN's Observatory is the place to discover the statistics behind key issues facing rural communities in England, issues that the RSN is striving to highlight and tackle through its work. The Observatory is additionally a great place to understand the numbers that define the communities within our membership through an expanding group of analyses, with this body of work soon to be given its own area on the RSN website called Member Insights & Analysis.
It also includes statistics on Housing, Health & Wellbeing, the Economy, the Environment and Travel and Transport.

Plea for restraint as rural areas inundated with visitors escaping Covid-19
(22 March 2020, Sky News)
Britons are increasingly ignoring advice to stay home and are using the countryside as an escape from coronavirus, with Snowdonia National Park experiencing its "busiest visitor day in living memory".
The Scottish government says people with second homes and campervans have been travelling to the Highlands in search of isolation in recent days.
They issued a travel warning, describing the actions of travellers as "irresponsible behaviour", reiterating the warning of Prime Minister Boris Johnson that people should instead stay home.

Staffordshire coronavirus care home deaths almost as high as hospital toll
(28 April 2020, Express & Star) 
More than 150 people died in care homes in the Black Country and Staffordshire after contracting Covid-19 in the space of two weeks, new figures show.
Care providers said it is clear the "epicentre of this crisis is in care homes" and that the sector is "sadly the most affected area of society in terms of deaths from Covid-19".

Drone to door medicines trial takes place in Ireland
(30 April 2020, BBC News)
A drone company that had to abandon its fast-food delivery tests has partnered with Ireland's health authority to deliver prescriptions instead.  Manna Aero is working with the Health Service Executive to deliver medicines and other essential supplies to vulnerable people in the small rural town of Moneygall.
The company's trial uses autonomous drones made in Wales.
And it is looking at the possibility of testing in the UK within weeks.

The Chair of the Rural Services Network, Councillor Cecilia Motley, has written an article for the Local Government First Magazine published this month highlighting key issues for rural communities during lockdown.  It highlights the issues the lack of broadband and connectivity can bring for rural communities during lockdown and considers the ways in which the rural economy may be adversely affected by lockdown.
For more information and to read the article click here

The Rural Services Network is receiving almost daily stories of the ways in which rural communities are supporting each other and their vulnerable communities during lockdown, we have been publishing 10 of these each week and you can view them here

The Case Study below is just one example of hundreds of communities across England where support for residents is not just about the practicalities of life in lockdown but also emotional support with telephone calls to check in with people:

From the front line of a parish in North Oxfordshire
As early as mid-March, Deddington and Parish Covid-19 Response Team swung into action. The initiative came from residents and had the active support of both Parish Council and the Parish Church. The parish, comprising one large village and two hamlets, was divided into 12 zones, each with a captain and a team of volunteers. An instant service was set up to help anyone self-isolating by having supplies and medications delivered, dogs walked – or hearing a friendly voice on the end of a phone. They rapidly identified the most vulnerable in the parish and took special care that no one was left without support.

The main means of communication is a weekly newsletter, printed and delivered to our 2000 or so residents, and also posted online on our various community group social media sites.  We are fortunate to have superfast broadband in our parish so online connectivity is part and parcel of many people’s lives. But inevitably there were those without access to smartphone, tablet or computer and extra care was taken to reach these people.

The regular monthly 36pp Deddington News could no longer be printed as that was a community effort involving many residents in printing, collating and distributing. Instead it appeared online on our parish website, Deddington OnLine so we could continue informing and entertaining our corner of paradise.

Most people had gardens, however small, so were able to get outside in the gorgeous April weather to set them up for the summer. There is plenty of space to walk in the countryside and our heritage Castle Grounds without infringing the 2m social distancing rule.

We set up a Covid-19 archive in Deddington OnLine to inform future generations of how Deddington stayed safe and looked after its own in the time of coronavirus – answer brilliantly! And it was the younger generation who stepped up so promptly. We’ve always had a strong community spirit and it came to the fore here – in spades.  

By the fifth week of the lockdown we have made 375 shopping trips for 82 parishioners.

Collected 71 scripts for 33 people. Telephoned 20 residents for a chat on 102 occasions. Delivered 5000 newsletters plus various other errands. What became apparent was that we were successfully meeting the demand for practical support but we noticed a need for more mental health and wellbeing action.

We have created a second version of the news sheet which focuses more on information about the services provided by professional support services and will keep this up-to-date.

We have also asked the community an open question about what is needed. We are aiming to contact all age groups and are ensuring that those who are not online can get in touch.

We plan to encourage those who provided group activities in the parish to move to virtual platforms that also support those who want to telephone in to listen or participate.

We want to evolve the services we provide and to listen to the community to ensure we can share information about what is available as it is required and support our parishioners.

Focus on Young Somerset – 24/7 Mental Health Helpline
Young Somerset, one of our Rural Services Partnership members, is proud to be part of this initiative to support Somerset Communities.

Mental Health Helpline now available 24/7 to support Somerset communities: 01823 276892

At this time of uncertainty and ongoing challenges to our daily lives, we recognise the importance of keeping ourselves emotionally well and getting the right support for our Mental Health. The opportunity to talk to someone who can listen, advise and support on how to take care of ourselves and ones we care for, is of vital importance.

Expanding on the existing successful Somerset Mindline service, the round-the-clock helpline will make it quicker and easier for people in Somerset to get the right advice they need for their mental health and wellbeing. Open 24 hours a day, seven-days a week, it is open to people of all ages who need urgent mental health support. The helpline is the first port of call for mental health help – it is operated by people in your local area who will know how best to support you.

Somerset NHS Foundation Trust’s CAMHS and Young Somerset are delighted to continue expanding their partnership, joining the Mental Health Alliance to deliver this service. For the first time in Somerset, young people, parents and carers will be able to access support and advice for mental health 24/7. This is a new and exciting challenge for us, truly embracing the ideals of accessibility and user defined pathways for young people.

We are providing second-stage support to Mindline call handlers where the needs of children & young people may need further, on-going support. Both CAMHS and Young Somerset have access to their own provision and can guide, support and broker a range of partner services for callers.

CAMHS and Young Somerset are already committed to securing high-quality, sustainable positive outcomes for children and young people and are delighted to be able to provide further support during this time of crisis, an unprecedented situation which has seen the sudden and immediate removal of young people’s normal routines, socialisation and access to usual support routes.

Professional routes of support remain unchanged, your School/GP/Social Worker can still refer you directly to services if a more intense/specialist level of support is needed. Mindline is in addition to the existing lines provided by Somerset County Council. Ie Somerset Direct 0300 123 2224, COVID19 Helpline 0300 790 6275 and Educational Psychology Service Helpline 01823 357000 all of whom are here to support children and families at this time.

More and more organisations are finding alternative ways to reach out to people struggling with their mental health during lockdown and help people become more active at home. 

ACTIVE DEVON
Working with Sport England, Active Devon, an Active Partnership have been exploring new ways of communicating with the people of Devon and have launched ACTIVE AGENTS.  Active Devon work collaboratively with local partners to create the conditions for an active nation using the power of sport and physical activity to transform lives.

Active Agents is a pioneering and innovative approach, which we are really excited to be launching and trialling.

This live-chat function, enables you to digitally connect directly with us, so that we can help you.

The Active Agents are all members of our very own friendly and supportive Active Devon team. Our Agents are not athletes or world-record holders, but local, helpful and informative people with real lived experience.

Having a Positive Conversation Can Really Help
Good conversation is about the ability to really listen as well as talk.

Through our new live-chat function, we are providing you with the opportunity to have a personalised conversation with us, from the comfort of your home.

The power of positive conversation is an incredible tool. It can help ease the nerves of starting a new activity, address any burning questions or just allow you to discover the best types of activity to do as a family.

What Are the Benefits for Me?
Now more than ever, it is crucial that we all remain active to support our physical and mental wellbeing.

Whilst staying at home, you may be wondering what to do and how to get started? And, when you do try something new it can be quite daunting. Or, you may have questions around how can you best support those around you to keep moving too. 

Chatting to someone who can listen, understand and provide useful information can really help to encourage and inspire you, or point you into the right direction.

For more information visit:
https://www.activedevon.org/try-our-new-live-chat-function-active-agents/

What is the Rural Services Network?

What is the Rural Health and Care Alliance?