The NHS is facing sustained pressure as it grapples with an unprecedented backlog of procedures put on hold due to the pandemic.

More than five million people are waiting for NHS hospital treatment in England, with hundreds of thousands waiting more than a year.

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The BBC - Budget 2021: NHS in England to receive £5.9bn to cut waiting lists

Although the RSN welcomes the initial announcement of extra funding we hope to see that the funding allocation is fairly distributed across both urban and rural areas and that the additional costs of delivering health services in rural areas is taken into account.

The campaign features on a number of topics which are pertinent across rural communities and one of these areas is 'Access to Rural Health and Care Services'.

The health and wellbeing of the nation’s population is as relevant to and important for rural communities as it is to those who live elsewhere. This universality is embedded within the vision that led to the creation of our National Health Service.

Surveys of rural residents and of those who represent them consistently find that health and care services are one of their top priorities. This may, in part, reflect the older demographic residing in mostly rural areas (which is not a reason to overlook health and care issues affecting younger age groups). It is likely to be even more true following the Covid-19 pandemic.

Health services that serve rural populations need to be safe and of high quality. They also need to be geographically accessible. This can lead to a dilemma, often not well resolved, where services become more specialised and centralised, but are then more distant from rural communities.

The asks in the Access to Rural Health and Care Services chapter of the Revitalising Rural campaign can be shown below:

Access and travel to hospitals: local health partnerships (STPs and ICSs) and trusts should take better account of accessibility and transport availability when drawing up plans to reconfigure acute and emergency services at their main hospital sites. This should address access for patients, visitors, and staff from rural locations, including those without a car or those unable to drive. It is especially important for patients whose treatments require a regular visit. Hospital transport schemes should also be made more widely available. This and other issues would be easier to address if funding allocations to local NHS areas were better aligned with the costs rural areas typically face from serving an older aged population. The hospital building programme should be used to improve access to hospitals in rural areas which are not well served.

Primary and community care services: local health partnerships should seize opportunities to create locally based multi-disciplinary teams and to develop health hubs in rural town locations. Hubs should aim to make a wide range of treatments and services more accessible to nearby rural populations, thereby avoiding the need for many patients to travel to main hospitals. They should provide services such as minor procedures, diagnostic tests, baby clinics, rehabilitation, and re-enablement. Local pharmaceutical services need to be retained in rural areas, which in some cases means supporting dispensing GP surgeries.

Public and mental health services: in the light of recent experience, Government should give more prominence to public health and mental health services. Both need better resourcing to become more accessible in rural areas. Historic funding allocations for public health cannot be justified and need urgent overhaul to even out provision. Good practice in rural provision of mental health services needs active promotion and encouragement. Large disparities in numbers of mental health professionals working in rural and urban areas need resolving.

Social care provision: Government should implement the findings of its Fair Funding Review to help level-up the provision of social care services in rural areas, taking full account of their delivery cost in more sparsely populated areas. This would also enable improved or more consistent engagement with and commissioning of ‘low level’ support services for vulnerable rural residents, which are typically delivered locally by voluntary and community sector organisations.

Workforce and recruitment: Government and the NHS should ensure that delivery of the NHS Workforce Plan includes an explicit rural dimension. Pay bonuses should be considered to attract recruits into those rural places with the highest vacancy and turnover rates. Medical training should include a rural placement, wherever possible, to give trainees exposure to work in rural settings. Similar initiatives are needed to cope with serious rural shortages in the social care workforce.