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March Edition of Casebook from the Rural Health and Care Alliance
March 2025 Edition
Welcome to this month's edition of Casebook, where we announce that we have joined the Health Equals Coalition and highlight government debate on service provision in rural communities. We also feature articles on research into patient trust and job satisfaction, as well as West Norfolk’s pioneering health initiative. Service delivery is also at the fore with news on expansion of services and the delivery of additional appointments as well as the plight of unpaid carers. Read more...
The Rural Services Network Joins The Health Equals Coalition
The Rural Services Network (RSN) has officially joined the Health Equals coalition, a collaborative effort dedicated to reducing health disparities and fostering a society where every individual, regardless of background or location, has the best chance of achieving good health.
Health Equals is a coalition of organisations united by a commitment to improve the foundational aspects of health through collective expertise and knowledge-sharing. This partnership includes renowned organisations such as Trussell, National Energy Action, and Barnardo’s, which have been instrumental in amplifying the coalition's mission.
As a supporter of the Health Equals coalition, RSN will participate actively in the discussion on the building blocks of health, contributing our unique insights into the rural health landscape. We will also gain access to a network of Parliamentary Champions consisting of over 72 cross-party MPs, dedicated to advancing health equality across the UK.
This collaboration aligns perfectly with our long-standing commitment to highlight the unique challenges faced by rural communities in accessing comprehensive health and care services. Rural residents encounter significant barriers due to geographic isolation, an aging demographic, and a scarcity of local healthcare resources.
Through this partnership, we aim to elevate the rural health issues on national platforms, ensuring that rural communities are not left behind in the health discourse. RSN will also benefit from the latest research, briefings, and communication tools provided by the Health Equals coalition, enhancing our capacity to advocate effectively for our communities.
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RSN Chief Executive, Kerry Booth, expressed enthusiasm about this new venture:
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We invite all members to engage with this initiative and support our shared vision for a healthier, more equitable society. For more information on the coalition and to learn how you can contribute, please visit the Health Equals website at Health Equals.
Together, we can make a difference in the lives of millions, ensuring that every resident in our rural communities can live a healthier, fuller life.
Debating Government Support for Rural Communities in Parliament
In a recent spirited debate at Westminster, MPs discussed the pressing issues faced by rural communities across the UK, shedding light on the unique challenges rural areas endure. Caroline Voaden, MP for South Devon, highlighted the profound rural-urban ‘divide’, emphasising the distinct operations of rural economies compared to urban settings.
Caroline Voaden passionately stated:
"It is vital that at the top, making decisions, there are people who understand rural communities."
The debate extensively covered the difficulties rural residents face, from healthcare access and transportation difficulties, to economic disparities and infrastructural deficiencies. Jim Shannon, MP for Strangford, supported Caroline Voaden's points, particularly highlighting the transportation challenges that often leave rural residents stranded.
Jim Shannon shared a vivid comparison:
"If I miss a tube in London, another one is along in two minutes; if I miss a bus in Portavogie, I may have to wait half a day to get another one."
Vikki Slade, MP for Mid Dorset and North Poole, brought attention to the additional costs imposed on families for school transport due to government policy changes.
Vikki Slade explained the financial burden on rural families:
"Many children in rural areas rely on the school bus. When the previous Government increased the age of participation from 16 to 18, they failed to also increase the age up to which children who live in rural communities get free transport to school, creating costs of up to £1,000 per family per child."
Jamie Stone, MP for Caithness, Sutherland and Easter Ross, furthered the discussion on the high costs of delivery charges in remote areas, suggesting that the government should strive for equitable pricing across regions.
Jamie Stone highlighted the disparity:
"One of the big problems that we have in my very remote constituency is the cost of delivery charges and surcharges. They are a lot higher than one would pay in cities such as Glasgow or Edinburgh."
In response, the Minister for Food Security and Rural Affairs, Daniel Zeichner, addressed the Parliament, affirming the government's commitment to improving the livelihoods of rural communities. He outlined several initiatives and funding opportunities designed to bolster rural economies and infrastructure.
Daniel Zeichner articulated the government's approach:
"We are committed to the rural brief and are actively delivering improvements through the Rural England Prosperity Fund and the Community-Owned Assets Fund. These initiatives aim to enhance local infrastructure, create jobs, and support essential community hubs."
Daniel Zeichner also emphasised the need for cross-departmental cooperation to ensure that rural concerns are integrated into broader governmental policies. He reassured MPs that the challenges of delivering services in rural areas, such as higher transportation and healthcare costs, are being addressed through strategic investments and policy adjustments.
The debate and the government's response emphasise a critical crossroads for rural communities. As MPs call for comprehensive, cross-departmental strategies and fair funding, the overarching message is clear: rural communities must not be left behind in national discussions and policy formulations that shape the future of the UK. The ongoing challenge will be ensuring that rural communities receive the sustained attention and investment they need to thrive alongside their urban counterparts.
Read the debate transcript in full HERE.
Urgent Need for Support Among UK's Unpaid Carers
A recent State of Caring Survey conducted by Carers UK has exposed significant challenges faced by unpaid carers across the UK, revealing a distressing trend of overwhelm and inadequate support. The survey provides a crucial insight into the lives of those caring for disabled, older, or ill relatives.
Findings from the survey indicate a severe impact on the mental health of carers, with more than half (57%) of respondents feeling overwhelmed "often" or "always." Additionally, over a third (35%) reported their mental health as "bad" or "very bad," marking an increase from 27% the previous year.
A major contributing factor to these feelings of overwhelm is the lack of opportunities for carers to take breaks from their responsibilities. Two-thirds (66%) of carers stated a need for more support with their health and wellbeing, with 65% attributing their stress to an inability to take time away from their caring roles.
Despite legal entitlements under the Care Act 2014, which mandates local councils to conduct a Carer’s Assessment to determine support needs, the uptake and subsequent support are lacking. Only 23% of substantial care providers have received an assessment in the past year, and 42% of these individuals report no follow-up support from their local authority.
The survey also highlighted issues with social care services, including long wait times for support, reported by 57% of carers, and a lack of available services when needed, as indicated by 51% of respondents. Among those experiencing these service shortfalls, 79% reported a negative impact on their mental health.
The invaluable contributions of unpaid carers, who provide care worth an estimated £184 billion to the UK economy annually, are often overlooked. The survey notes that 50% of overwhelmed carers are also struggling with their own health issues, and over a quarter (27%) report poor physical health.
These findings emphasise the urgent need for improved support and resources for unpaid carers, to better safeguard their mental and physical health and to ensure the continued provision of care for the UK's most vulnerable individuals.
Helen Walker, Chief Executive of Carers UK:
"Unpaid carers are under immense pressure. Many tell us that their world has shrunk, that they feel isolated and alone in their caring role. Breaks are essential for carers, enabling them to focus on their own health, needs and interests. An increasing demand for social care services, together with a lack of funding for social care means that, all too often, replacement care and respite services are not available when carers need them.
Far too many carers are not receiving adequate support, resulting in poor mental health and burnout. We need to see a clear plan for long-term, sustainable funding ensuring that all local authorities can fulfil their duties to carers under the Care Act 2014 and all carers can access high-quality social care when they need it".
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Kerry Booth, Chief Executive, Rural Services Network:
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Read the full State of Caring Report HERE
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Critical Alert: Potential Financial Crisis in Councils over SEND Funding
A concerning report from the Local Government Association (LGA) has highlighted a looming financial crisis that could affect over half of the councils responsible for supporting children with special educational needs and disabilities (SEND). This crisis stems from the upcoming expiration of the "statutory override," a temporary accounting measure that currently allows councils to manage SEND-related spending deficits separately from their main financial statements.
Without this measure, which is set to expire in March 2026, many councils anticipate severe financial distress. According to the LGA's findings, 53% of councils project they will not be able to balance their budgets in 2026/27. This figure is expected to increase to 63% in 2027/28 and 65% in 2028/29, highlighting a growing trend of financial instability.
The increase in financial pressure is primarily due to the rising demand for SEND support services. Since the introduction of the Children and Families Act in 2014, the number of children and young people requiring Education, Health and Care Plans (EHCPs) has surged by 140%, from 240,183 in 2014/15 to 575,973 in 2023/24. This rise has significantly escalated the costs associated with providing necessary support, with councils anticipated to face a combined high needs deficit of approximately £5 billion next year.
In response, the LGA is urgently calling for government intervention in the upcoming Spending Review. Their primary request is for the government to erase the high needs deficits that are crippling council budgets. The LGA emphasizes that without such measures, many councils will struggle to maintain the essential services required by children with SEND.
Cllr Arooj Shah, Chair of the LGA’s Children and Young People Board, stresses that the discontinuation of the statutory override not only risks the financial health of councils but also threatens the integrity of support systems crucial for SEND children. Cllr Shah argues for a bold approach in the Spending Review, advocating for not only the clearance of existing deficits but also for a comprehensive plan to enhance inclusion within mainstream education settings. Such reforms would ensure that schools, early years settings, and colleges are better equipped to meet the diverse needs of SEND students.
Expansion of Urgent Dental Care: 700,000 New Appointments to Address NHS Accessibility
The Department of Health and Social Care, along with NHS England, has announced the rollout of 700,000 additional urgent dental appointments in England, following directions issued to integrated care boards (ICBs) nationwide. This initiative is part of a broader plan to address accessibility issues in NHS dental services.
Health Minister Stephen Kinnock stated that the additional appointments are part of efforts to fulfil the government's manifesto commitment, with the extra appointments being available from April 2025. This rollout targets areas known as 'dental deserts'- regions where patients have faced significant challenges in accessing necessary dental care.
Recent statistics from the GP Patient Survey 2024 highlight a critical gap in service provision, noting that about one in four patients who attempted to access an NHS dentist over the past two years were unable to secure an appointment. This backdrop sets the stage for the government's latest action to improve access to dental care.
The announcement also comes in response to the broader issues affecting NHS dentistry, including past interventions like the new patient premium, which was intended to enhance patient access to dental services but has been noted for its high costs and limited impact on improving patient outcomes. In light of these challenges, the government has confirmed plans to scrap the premium and focus on more direct measures to increase appointment availability.
In addition to tackling adult dental care shortages, the government is addressing children's oral health, which remains a concern. With tooth decay as the leading cause of hospital admissions among children aged 5 to 9, the new initiative includes a supervised toothbrushing scheme aimed at improving dental health among children, especially in more deprived areas.
The rollout of these appointments is a part of ongoing efforts to reform NHS dentistry, with a focus on increasing the number of available appointments and enhancing service delivery. This includes offering incentives for dentists to work in underserved areas and reforming dental contracts to attract and retain dental professionals within the NHS.
For a detailed list of the distribution of these additional appointments across various regions and integrated care boards, further information can be accessed here.
This announcement marks a significant step in addressing the urgent need for dental appointments across England, aiming to provide relief for patients in need and improve the overall structure of NHS dental care services.
Making GP visits easier for rural communities
If you live in a rural area, you might have faced some challenges when trying to see your GP—long wait times, confusing booking systems, or even not being sure what help is available. That’s why Healthwatch North Yorkshire, who work to listen and make care better, has put together a guide to help people navigate their local GP practice more easily.
This guide is full of straightforward advice on things like:
- Booking an appointment – Whether it’s online, over the phone, or in person, we break down your options so you can find what works best for you.
- Knowing when to see your GP – Not sure if you need a doctor, a nurse, or another service? This guide helps you figure that out.
- Understanding your rights – Find out what you’re entitled to as a patient and how to get the best care.
- Giving feedback – Got a great experience to share? Or something that didn’t go so well? The guide explains how to pass on your thoughts.
- Getting extra support – If you have additional needs, there’s information on what help is available to make sure you’re supported.
The goal is to make accessing healthcare easier and more transparent for everyone.
If you’ve ever felt frustrated or confused about how to get an appointment or what services are available to you, this guide is a great resource. You can check it out on the Healthwatch North Yorkshire website at www.HealthwatchNorthYorkshire.co.uk for all the details.
In just three minutes, you can make a difference.
Share your views on health or social care services, wherever you are in England. Tell Healthwatch what works and what needs improvement. It's confidential, quick and won't affect your care. But your experience will help us tell NHS and social care services how to make your care better. https://www.healthwatch.co.uk/have-your-say
Over Two Million Extra NHS Appointments Delivered Early
In a major healthcare milestone, the government has announced that over two million additional NHS appointments have been delivered early, including crucial treatments such as chemotherapy, radiotherapy, endoscopy, and diagnostic tests. This achievement, part of the government's broader Plan for Change, was reached seven months ahead of the schedule, indicating significant progress in addressing the longstanding issues within the NHS.
According to the Prime Minister's Office, these results are due to a concerted effort by NHS England, which managed to provide almost 2.2 million more elective care appointments from July to November last year compared to the same period the previous year. This surge in appointments has contributed to a notable reduction in waiting lists, with a decrease of almost 160,000 since the current government took office.
The Prime Minister, Rt Hon Sir Keir Starmer KCB KC MP, emphasised the importance of this achievement not only as a fulfilment of a government promise but as a crucial lifeline to patients across the country who have been waiting for essential treatments. "This milestone is a shot in the arm for our plan to get the NHS back on its feet and cut waiting times," he remarked.
In addition to the increase in appointment availability, the government has pledged an extra £40 million to trusts that demonstrate significant improvements in reducing waiting times. This funding is expected to support capital projects that can expedite patient access to treatments and enhance the conditions within NHS facilities.
The NHS's elective care capacity has been bolstered by extending the operational hours at Community Diagnostic Centres to 12 hours a day, seven days a week, and by integrating new technologies such as AI scanners and surgical robots. These measures are part of a wider Elective Reform Plan aimed at reducing waiting times and improving patient experience by ensuring more prompt and localized care.
Health and Social Care Secretary Wes Streeting stated, "We are finally putting the NHS on the road to recovery," highlighting the government's proactive approach in resolving the crisis that had plagued the health service.
NHS England's chief executive, Amanda Pritchard, also acknowledged the hard work of the NHS staff and the role of innovative care solutions in achieving these results. She noted that there remains much to be done to further reduce waiting times but expressed optimism about the ongoing reforms.
Rural Services Network Perspective
While the Rural Services Network recognises and applauds the government's early delivery of over two million additional NHS appointments as a monumental achievement, we urge the government to remain mindful of the persistent challenges faced by rural communities in accessing these improved services.
Residents in rural areas often encounter barriers such as longer travel distances to healthcare facilities, reduced availability of services, and limited public transport options, which can prevent them from benefiting equally from national health service enhancements. As such, while we celebrate this progress, we also advocate for the need to address these discrepancies to ensure equitable healthcare access across all postcodes.
Ensuring that every UK resident has access to essential healthcare services, irrespective of their geographic location, must be a central consideration in all NHS reforms and improvements. The RSN is committed to working alongside the government and other stakeholders to promote and develop policies that support this vision, truly embodying the NHS principle of comprehensive and accessible care for all.
Survey Reveals Concerns About Trust in NHS Primary Care Among Ethnic Minority Patients
A recent survey conducted by the NHS Race and Health Observatory has unveiled troubling levels of distrust and reported discrimination among ethnic minority patients towards NHS primary care providers. Over 2,680 individuals participated in the survey, which aimed to gauge trust and satisfaction across several aspects of primary care.
Key findings from the survey reveal significant disparities in the experiences of ethnic minority patients compared to White British patients. Notably, one-third of South Asian participants reported they rarely or never trust primary care to meet their health needs. This sentiment is further exacerbated by reports of discrimination, with 51% of participants experiencing some form of discrimination and substantial percentages of Asian (38%) and Black (49%) participants feeling treated differently due to their ethnicity.
The survey also highlighted concerns about the medical competence of primary care providers, particularly in treating conditions that disproportionately affect ethnic minority communities, such as sickle cell disorder, lupus, and diabetes. Additionally, many patients reported a lack of cultural awareness and appropriate resources in primary care settings.
The NHS Race and Health Observatory, along with stakeholders, is urgently calling for reforms to address these inequities. Professor Habib Naqvi, Chief Executive of the NHS Race and Health Observatory, emphasised the need for a two-tier system to be eradicated and for primary care services to be co-designed to meet the diverse needs of the UK's population.
The publication of these findings coincides with a roundtable discussion led by Dr. Chaand Nagpaul, aiming to address the report's findings and improve trust and care delivery in primary care for ethnic minority patients.
For more detailed insights and recommendations from the report, you can access the full document here.
West Norfolk Embarks on Pioneering Health Improvement Initiative
The RSN is excited to share an innovative health initiative unfolding in West Norfolk, spotlighting the launch of the region's new Marmot Place Programme. This pioneering effort, the first of its kind in the county, aims to tackle the pronounced health inequalities within the community by adopting a set of evidence-based principles developed by Professor Sir Michael Marmot and the Institute of Health Equity at University College London.
West Norfolk’s initiative is steered by a collaboration involving the Borough Council of King’s Lynn and West Norfolk, Norfolk County Council Public Health, and Norfolk & Waveney Integrated Care Board. Their strategy focuses on the "social determinants of health" - the environmental and socio-economic factors that influence individual and community health outcomes.
This programme is not only about health care but extends to vital sectors such as housing, education, and employment, emphasising a holistic approach to health equity. Over the next two years, the programme will identify key priorities and systemic changes aimed at enhancing life expectancy and quality of life across diverse socio-economic backgrounds.
The disparities in West Norfolk are stark: approximately 23,300 residents live in areas that are amongst the 20% most deprived in England. Starkly, the gap in life expectancy between the most deprived areas and least deprived communities is 11.5 years – the largest of any Norfolk district. The Marmot Place Programme seeks to bridge this gap by creating environments that bolster health opportunities for all.
Councillor Jo Rust from the Borough Council emphasised the critical nature of this initiative, stating:
"We are committed to improving the healthy life expectancy and life chances of people across our neighbourhoods. This includes narrowing the health gap between the most and least affluent areas."
Professor Sir Michael Marmot expressed his enthusiasm about the partnership, highlighting the unique challenges of promoting health equity in rural settings. The insights gained from West Norfolk will contribute to a broader understanding and implementation of effective strategies across the UK’s Marmot Places.
West Norfolk’s adoption of the Marmot Principles marks a significant move towards systemic health improvements, driven by community-wide cooperation and informed by a deep understanding of the complex interplay between living conditions and health outcomes. The Rural Services Network applauds this landmark initiative and looks forward to the positive changes it will bring to the communities of West Norfolk.
Job Satisfaction Falling for NHS’s Youngest Workers, Study Shows
A recent study by the Nuffield Trust has found that the youngest clinical staff in the NHS are increasingly stressed and unhappy at work. The study, which looked at data from the NHS England Staff Survey over the last 20 years, shows a growing gap in job satisfaction between younger and older NHS workers.
Key findings from the study reveal worrying trends among young clinical staff:
- Over half (52%) of workers aged 21-30 felt ill due to work-related stress in 2023, up from 38% in 2013.
- Dissatisfaction with pay has grown significantly among the younger workers. In 2023, 22% were unhappy with their pay, more than double the percentage in 2013 (10%).
- Young workers are enjoying their jobs less. In 2023, 15% said they did not look forward to going to work, up from 12% in 2013. Also, 7% reported not feeling enthusiastic about their jobs, up from 4%.
The study also looked at overtime work:
- Younger staff are doing more paid overtime than before, with nearly a third (30%) working at least six hours of paid overtime a week in 2023, up from 20% in 2013.
The Nuffield Trust's report calls for urgent action from NHS leaders to address the growing levels of stress and dissatisfaction among younger staff. The trust emphasises the need for tailored approaches to staff well-being, support, and retention that consider the varied experiences of different age groups.
This study serves as a critical reminder of the challenges facing the next generation of NHS workers and stresses the importance of proactive measures to ensure a supportive work environment for all age groups. The health service's future depends on the well-being and retention of these young professionals, making it important for policymakers and employers to act swiftly on these insights.
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RURAL SERVICES NETWORK
Up to date news on Health and Care
The Rural Services Network provides a useful source of themed news content and data. Check out the latest news on Health & Wellbeing and Vulnerability, where you’ll find articles on a diverse range of rural issues affecting rural communities. You might also find this research on Over 65 Population Projections useful too.
Latest from RSN Member Insights
RSN Member Insights is the place to discover the statistics that define communities within our membership. It is regularly updated with new analyses, and these will be highlighted in the 'What's New' section of the RSN's Weekly Rural Bulletin. The Rural Bulletin also provides a selection of the most rurally topical news items, so do subscribe and encourage your colleagues to subscribe to what is an invaluable weekly periodical.
| The Rural Health & Care Alliance is a membership organisation administered by the Rural Services Network on behalf of the National Centre for Rural Health & Care. Explore the RHCA service below: |
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