A report commissioned by the University of Central Lancashire’s (UCLan) National Centre for Remote and Rural Medicine has revealed the health inequalities experienced by people in the UK’s rural areas.
The research, published in A tale of two countrysides: Remote and rural health and medicine today, analyses ‘the unique health problems prominent in remote parts of the UK’. It pulls results from all corners of the UK, including Jaywick in Essex, Blackpool in Lancashire, and up to Copeland in Cumbria, and outlines the measures needed ‘to tackle the problem head-on’. In collaboration with local government, educators, industry and politicians, the paper advocates r a focus on improving health in remote and rural areas. By contrasting coastal towns with market towns and their hinterlands, it gives a measure of how far we have to go to ‘level up’ local communities.
The researchers, who analysed a number of available indicators – including life expectancy, cancer survival, admissions, and readmissions – ‘to understand more about health inequalities and the healthcare system in rural areas’, found rural areas are disproportionately affected by ‘diseases of despair’. In County Durham in the North East, the rate for alcohol-related-harm hospital admissions was 758 per 100,000 population – significantly worse than the average of 664 per 100,000 for England as a whole. This represents 3,972 admissions to hospital per year. The rate for self-harm hospital admissions is 197 per 100,000 population, representing 1005 admissions per year.
The report also concludes that rural health technology is ‘developing at a slower pace than that in towns and cities, leaving its inhabitants geographically isolated and lonely’. While it concedes that ‘much has been done to improve UK-wide connectivity’, rural communities still face problems. According to Ofcom, 234,000 people in rural England are unable to receive decent broadband from a fixed line.
A focus on the demographic make-up of rural and coastal populations, meanwhile, found that these were ageing twice as fast as the UK average. The proportion of residents over 65 in Richmondshire District Council in North Yorkshire, for example, rose from 15% in 2001 to 21% in 2018, according to research from the Resolution Foundation. The average age in North Norfolk is 53.8 years, the oldest average of any local authority.
The worst health outcomes were found in the UK’s seaside towns in terms of mental health problems, more homeless people, and more alcohol and drugs problems. Dr Vincent Argent, Consultant in Rural Emergency Medicine at Dorset Rural County Hospital, says access to health services intensifies the problem: “Our health services often have poor access because, of course, they’ve got the sea on one side of them. They don’t have 360 degree catchment, and quite often the roads to seaside towns are not very good – there aren’t any seaside towns with a motorway coming into the centre of town. Places like Hastings and Rhyl are quite difficult to get out of. People often don’t have jobs, so they don’t have cars, and the public transport is inadequate.”
Added to this, the report says, is ‘the challenge of recruitment’. Rural hospitals were found to be struggling to find consultants to fill their vacancies, with some hospitals not able to fill a single vacancy in a year. A recruitment crisis amongst senior clinicians was revealed in research by
the Royal College of Physicians published in October 2019, showing that just 13% of consultants appointed in England in the previous year went to hospitals serving mainly rural or coastal areas, with the other 87% hired by those with mainly urban populations.
While rural Clinical Commissioning Groups (CCGs) have better or similar outcomes to urban ones, likely due to being generally more affluent, ‘huge health inequalities remain in many areas’. In Cumbria, a region ‘with striking inequalities and diverse geographies’, to the east and south of the county, including the Eden Valley and Appleby-in-Westmorland, communities are generally affluent, and life expectancy long. However, to the west, there are small coastal towns with ‘significant deprivation’. In the borough of Copeland, for example, the rate of alcohol-related admissions is 774 per 100,000 population – worse than the average for England.
Similar differences can be seen across child health and life expectancy. not just between those two boroughs. but also between Eden and Barrow-in-Furness. The rate of child obesity among children aged 10-11 in Eden is 16.2%, compared with 25.5% in Barrow-in-Furness. Life expectancy in Eden is 82.0 years, but in Barrow-in-Furness only 77.1 years. The report’s authors say this ‘highlights the existence of pockets that often get overlooked when it comes to rural medicine, indicating that a more unique approach to rural healthcare is needed’.
The report identified five ‘solutions’ for achieving an equitable health service for all:
- Better training for rural clinicians;
- More training for pharmacists and professions allied to medicine.
- Connectivity in rural areas to reduce isolation and accelerate the uptake of digital health solutions.
- Accelerating digital uptake and training on digital health skills for the clinical workforce
- Addressing ‘the recruitment crisis in rural areas ‘by incentivising clinicians to take rural jobs.
Professor Catherine Jackson, Executive Dean, Faculty of Clinical & Biomedical Sciences,
and head of the School of Medicine at UCLan, said: “Because doctors now specialise at a much earlier stage than they used to, both primary and secondary care doctors feel uncomfortable in a remote and rural setting. Primary care doctors of my generation who went to work in remote and rural locations had usually all done something else beforehand – they’d been a surgeon or an anaesthetist or, as in my case, a physician – so brought additional experience. Because of the training routes for doctors, that increasingly doesn’t happen anymore.
“At UCLan, we’ve created a number of courses specifically designed to train remote and rural practitioners, basically wherever help isn’t coming very quickly. They could be working here in the UK, on oil platforms, in the middle of the desert, or in an aeroplane. It’s to provide people with the skills, competencies, and confidence to practice, so they feel able to go and work in these places – to be able to practice safely and to provide a very good standard of care.”
The full report can be read at: https://www.uclan.ac.uk/assets/pdf/rural-medicine-and-health-report.pdf
