Bishop of St Albans speaks in debate on healthcare in rural areas

The Bishop of St Albans took part in a debate on healthcare in rural areas on 23rd February 2023, highlighting issues of age, access and infrastructure:

The Lord Bishop of St Albans: My Lords, I thank the noble Baroness, Lady McIntosh, for obtaining this debate. She is a powerful champion for these issues; we are grateful that she continues to raise them. I also add my thanks to and appreciation of all those who work on the front line in our rural areas. They often have to drive huge distances, sometimes along quite difficult roads; it is not always easy and is certainly not always as wonderful as our memories of remote rural areas from our holidays. I declare my interest as president of the Rural Coalition.

Although many people in this country dream of retreating to the rural idyll that is deeply embedded in the English psyche, they do not always realise that, if their dream comes true, they may face many challenges in living in rural areas: poor access to banks and cash; patchy broadband; sporadic mobile signal; virtually non-existent public transport; and little childcare. Then, of course, there is the topic we are exploring today: the stresses on the healthcare system, which is primarily and unsurprisingly designed for an urban context. Rurality faces a unique challenge in the delivery of healthcare, demanding that the Government adopt a clear strategy for improvement. I welcome His Majesty’s Government’s promise to rural-proof our healthcare system; my hope is that that promise will be able to deliver what is needed.

Rural areas are home to significantly older populations than those in towns and cities, with a quarter of England’s rural population aged over 65—and that figure is due to rise. An older population exacerbates the difficulties of delivering healthcare in rural areas because those people are much more likely to require higher levels of intervention and support. Although many rural areas have a strong sense of community—it is often much stronger than in urban areas—there is nevertheless the challenge of isolation. More than 1 million older people in England suffer from persistent, chronic loneliness as they are cut off from wider society. As a consequence, rural areas face a significantly higher rate of hospital admissions for alcohol-related harm and self-harm. Put simply, mental health issues are exacerbated in rural areas.

Fortunately, in many rural areas, such as some of the villages and communities in Bedfordshire and Hertfordshire that I serve in my diocese, there are all sorts of active churches and charities working on the ground. They visit the lonely and offer support and practical help. However, they are not in a position to offer the professional care that is required. We therefore need the Government to develop and fund a comprehensive, universal rural healthcare strategy that is fit for the future. The Rural Services Network has found that rural residents receive 14% per head less in social care support overall. I therefore ask the Minister what assessment he has made of the gap in social care funding between our urban and our rural areas. Will His Majesty’s Government take any steps to close it?

It is not just social care that suffers from lower levels of funding. The Rural Services Network also noted that the NHS receives less funding per resident in rural areas despite the unique challenges that they face. With an older population, higher levels of mental health problems, issues with connectivity and poor access to services, it is clear that those areas need more support, not less. As His Majesty’s Government rightly noted in their report on rural-proofing England, we need to pursue innovative solutions to those challenges. Just throwing money at them is not enough to tackle the structural issues that we face; we need to bring all the parties together to work out how we can address them.

Improving rural infrastructure will help people to get the help they need. Going to the doctor or the pharmacy should not be a difficult task, but currently many people rely on expensive transport or on taxis, and it is not easy.

Finally, it is important that we work to recruit and retain a workforce of healthcare professionals in those areas. Those who work on the front line know that this is not easy. Life in the city has its benefits: higher wages, greater access to services and a faster pace of life. It would be helpful if programmes to help people return to work were as flexible as possible and part-time jobs were available. What are the Government doing to attract carers to work in rural areas and, indeed, ensure that they want to stay there?

I look forward to hearing from the Minister the plans His Majesty’s Government have to support this vital part of our healthcare system.


Extracts from the speeches that followed:

Lord Alan of Hallam (LD): The third area is transport, mentioned by the right reverend Prelate the Bishop of St Albans and the noble Baroness, Lady Bennett, who said that taxis are not always there for patients. Certainly, if you have a medical emergency at the time of the school run, in most rural communities you will find that the taxi or the two taxis in your town or village are already fully booked. There are real issues for patients, but I will focus on the issues for staff and the calculation of travel times for them. As I understand it, health and care staff in the most sparsely populated areas can spend 10 times as many hours on travel as those in the most urban areas. That means that you cannot look after the same number of people with the same number of staff, because the ratio of travel hours versus treatment hours is very different.

Baroness Merron (Lab): I want to refer to the matter of dispensing doctors. I am grateful to the Dispensing Doctors’ Association for its briefing, because it threw up a lot of whys for me. I want to put those whys to the Minister. Dispensing doctors are NHS GPs who can dispense medicines in designated rural areas where a community pharmacy is not economically viable. This seems a good thing to me. They account for some 15% of all prescriptions dispensed. We know that pharmacies now provide more clinical services to their patients, such as hospital discharge planning and medicine use reviews. Again, that is a good thing, but such services are not available for rural patients who use dispensing practices. Why not? Can this be addressed?

Similarly, the electronic prescription service is not available for dispensing patients. This builds on the point made by the noble Lord, Lord Allan, about the whole system, to which the right reverend Prelate the Bishop of St Albans also referred. The EPS is not designed with dispensing practices in scope. Can the Minister confirm that, as the NHS moves towards ever more integrated IT solutions, it will be possible for a hospital consultant to send a prescription to a patient who receives their medication from a dispensing practice, which is not currently the case?

It has been said that rural residents are paying more, receiving fewer services and earning less on average than those in urban areas, and that this is inequitable. That is indeed the case. I hope that the Minister can help us today.

Lord Evans of Rainow (Con): We will consider the report as part of that work. The noble Baroness, Lady Bennett, and the right reverend Prelate the Bishop of St Albans also mentioned social care. The Government are putting £2.8 billion next year into additional funding. In spring 2023, the Government will publish a plan for adult social care system reform.

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