New dimensions for rural healthcare

THE latest Rural Health Network conference was hosted at the House of Lords on 29 January.

Around 60 delegates gathered for the event, titled "Challenging Times - A New Dimension".

Presentaters included leading academics and health professionals such as Public Health England chief executive Duncan Selbie, Alison Marshall of the University of Cumbria and Ray Jones of Plymouth University.

They also included Lora Fleming from University of Exeter and Linda Wilson from Airedale NHS Foundation Trust.

To view the programme and presentations for the event click here

Nick Payne, who organised the event on behalf of the Rural Services Network said "The conference provided a unique insight in to some of the excellent best practice being delivered by service providers working in rural health and social care despite these very challenging times.

"From our analysis of delegate evaluations everyone enjoyed the day immensely with at least one commenting that it was the best event they had attended."

Baroness Byford began proceedings by asserting that this Parliamentary business session reflects the national interest and concern with health as both Houses are actively considering three Private Members Bills relating to health and palliative care. Lady Byford also outlined her personal experiences in this regard and her considerable breadth of understanding of the current challenges in the sector.

Duncan Selbie, Public Health England Chief Executive, gave the keynote presentation addressing the particular challenges of promoting excellence in rural public health. Whilst length of life has improved, the number of years people spend in ill health has increased, he affirmed.

It is well understood that health and health inequalities are linked to deprivation. With 1 in 5 private rented dwellings not meeting statutory housing standards, the specific rural challenges of loneliness and isolation, increasing obesity in the population as a whole and the need to address other key social determinants of health, professionals are facing major challenges. Local government has a vital role to play in addressing these issues.

The duty to promote public health is directly linked to other local authority strategic priorities and must have equal status with them. PHE is looking at improving data collection techniques to support local organisations and working with the University of East Anglia, which is piloting new systems of data gathering with Norfolk County Council to specifically look at assessing health needs in small populations of 1,500 or less.

Mr Selbie highlighted recent publications such as the national outdoor recreation strategy as sources of information, as well as highlighting best practice in a number of areas of the country including the Villages in Action project in Devon. Mr Selbie was pleased to confirm that the Department of Health now accepts that a sparsity factor will be included in the way public health funding is allocated to local councils.

Dr Linda Wilson, a consultant at Airedale NHS Foundation Trust provided a most informative session on the Trust's highly regarded End of Life care services and its application to local rural populations.

Their widely acclaimed groundbreaking Gold Line project is a very effective, patient-centred service that supports many patients' and their carers' desire to be able to die at home in a supported and dignified manner.

The service is advantageous to both the patient, their family as well as the Trust, with tangible evidence of a more efficient use of the Trust's resources. A video clip on the Gold Line service can be viewed at

Professor Ray Jones of Plymouth University took the opportunity to look creatively about how telehealth and e-health might be used more effectively in future and the potential positive role for students in helping to modernise the understanding of these capabilities.

He believed wider medical training needed review to ensure these capabilities and the opportunities they might provide were reflected in the development of the professions. His research had highlighted that for a whole variety of reasons not every patient or carer wants a face to face interaction with a clinician.

The event continued with a panel discussion lead by Professor Lora Fleming, University of Exeter, with other colleagues looking at the positive contribution that e-wellbeing can make in rural areas.

A quick fire panel session included best practice being highlighted in the management of a portfolio of rural social housing assets and how an enlightened approach to data capture can assist the occupiers to lead comfortable and healthy lifestyles.

Another panellist asserted that housing is the biggest determinant of health but is still too often marginalised in terms of policy and thinking. Many people are not less caring but are becoming increasingly less directly engaged in their communities.

Technology can enhance social engagement of communities if it's used effectively. Rural populations typically have a higher proportion of elderly people. We need to be conscious of new demands that an increasingly ageing population, especially pertinent in rural localities, will generate over the next 10 years and how current projections of those demands need to change.

Professor Alison Marshall outlined the extensive collaborative strategy development work undertaken by the Cumbria Rural Health Forum and how this work is starting to help improve the response to challenges of delivering integrated health care across one of England's most rural and remote counties. The Forum, led by the University of Cumbria, brings together around 50 public, private and third sector organisations and is a platform to influence the digital agenda within sustainable transformation plans, procurement and skills development.

Ursula Bennion, CEO, Trent Dove Housing Association described her successful integrated Housing, Health and Social Care project at Pencric in Staffordshire and how this widely acclaimed case study is an exemplar for effective collaborative working between agencies.

The project is now complete and successfully occupied by a range of people who are either choosing to rent, to "part rent/part buy" (shared-ownership) and full ownership. The project delivers care and support tailored to individuals' needs. The high quality facilities, including restaurant, gym and beauty salon, are aimed at both residents and the local community.

The presentations concluded with Tracey Roose, Age UK and NHS Kernow, explaining about the Living Well project in Cornwall and the advantages it has afforded to both service users as well the greater efficiencies generated for providers. The success of the project is now being rolled out to other parts of the Duchy. This is a link to a video that Ursula used in her presentation:

The conference presentations and other event details can be viewed at

The Rural Health Network was created and launched in 2012. Its objectives are:-

• Representing the case for a better deal for rural provision in health services and rural proofing in policy making.

• Exchanging useful, relevant and thought provoking information in order to enable improved public health and health services delivery

• Developing and sharing best practice in public health and health delivery.

NHS funding continues to sit at the very top of the political agenda with many becoming concerned that the existing system of resourcing the best health service in the world is becoming unsustainable. Rural communities contain a higher proportion of elderly residents, who by definition are often high demand users of health and social care services.

RSN analysis has recently highlighted that:-

Estimated allocations per head for over 65 allocations for Adult Social Care (ASC) were significantly lower for rural authorities than other local authority types. Shire authorities received some 44% less cash funding per head compared to the national average, 61% less than London Boroughs and 53% less than Metropolitan Boroughs.

Between 2013/14 and 2015/16, on average Shire authorities have witnessed the largest reductions in estimated ASC funding (-22.9%) compared to other local authority types, and higher reductions in estimated cash funding (20.1%) than the national average.

Over the next five years, the number of older residents in rural authorities is projected to rise at an average annual rate of 2.0%, compared to the England average of 1.8%. This is also faster than the London boroughs (1.9%), other unitary authorities (1.9%) and metropolitan boroughs (1.5%).

Rural councils will see increased costs of £247m of additional demographic cost pressures by the end of the decade. This is 52% of all demographic costs for English local authorities.

There are also major inequities regarding Public Health. For England as a whole, the allocations for public health equate to approximately £51 per head. For rural authorities, the allocation is equivalent to £37 per head. London boroughs (£67), unitary authorities (£57) and metropolitan boroughs (£66) all receive a higher per capita allocation than rural authorities. Rural councils therefore receive approximately £0.4bn less in public health funding.

Looking ahead reductions in social care already in the pipeline and those yet to come through are now forecast to have major implications for the NHS. This will be compounded by a shrinkage in the private social care sector due to significant funding reductions from local authorities wrestling with diminishing budgets.

More recently Norman Lamb MP, supported by two former Secretaries of State and other MPs, has argued strongly in the Commons for a new Commission to investigate the funding of Health and Social Care. A 10 Minute Rule debate on 6 January 2016 approved the introduction of a Bill for the appointment of such a Commission to be debated by Parliament. The Bill will be debated in the House of Commons in March.


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