Healthcare in Rural Areas

Baroness Bennett of Manor Castle Excerpts

Thursday 23rd February 2023 Grand Committee

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank the noble Baroness, Lady McIntosh of Pickering, for securing this debate and for overcoming her injury to make it in today. I put this issue of rural healthcare out to Green councillors around England. What I got back could be described only as a flood of concern.

We have heard an overview from the first two speakers. I will narrow down largely to one county, Shropshire, which is one of the most rural counties in England, with a population of 323,000, around a quarter of whom live in Shrewsbury. The rest are widely dispersed across small market towns and rural areas. As the right reverend Prelate noted, 23% of the population are over the age of 65, compared with the English average of 18.5%.

Public transport is often simply non-existent. The NHS’s own figures state that 45,000 people live 30 minutes or more away from a GP practice by public transport. It is clear that access has got dramatically worse in recent years.

Rural healthcare is often seen as inefficient. In Shropshire, it is centralised at either the Royal Shrewsbury Hospital or Telford’s Princess Royal Hospital. This is undoubtedly cheaper for the NHS, but the cost is transferred to individuals, who might simply not be able to bear that cost or might encounter barriers they simply cannot overcome. Cost, age, disability and a lack of transport lead to people either seeking healthcare later, which greatly increases costs to the NHS in the long run, or simply deciding to go without, with significant social, personal and economic impacts.

In many cases, services have simply disappeared. Cardiology outpatient appointments, including diagnostic tests, used to be available in Shrewsbury, but recently there were centralised to Telford. That is an hour’s drive from Ludlow or Bishop’s Castle. By public transport, you need two trains, a bus and a hearty wish of good luck.

Another issue is midwife-led maternity units. There used to be a network of five of those. Closure was first mooted in spring 2016, with cost explicitly cited as the issue. There was then a period of short-term closures, often at extremely short notice—as little as two hours—so women would find out on the day they were giving birth that their expected plan for birth simply could not be followed through. It is not that there has been no reaction to this; there were very strong protests against these closures in Ludlow, Bridgnorth and Oswestry. Although the MLUs remain open as a base for antenatal and postnatal care, there is no out-of-hours service, so if a patient finds themselves with unexpected bleeding or reduced foetal movement at night, they very often have no chance to get care. You might say, “Take a taxi”, but in many rural areas there simply is no taxi available to take. So that is the reality in Shropshire.

I have just one more point to make in that area about community hospitals. We see repeated attacks on the whole concept of community hospitals, and we have seen cutbacks and further cutbacks, but there needs to be a vision for such hospitals—that is, a strategy of how they can best be used for local people and the local healthcare system, taking medium acuity patients to relieve some of the enormous pressures that the acute hospitals are experiencing and, of course, making sure that people can visit patients and that patients can remain in and be part of their communities. It is suggested that Shropshire could become a centre for training and education for rural healthcare, perhaps teaming up with Keele University to offer better services to meet local needs.

I just want to branch out briefly into a couple of other areas. We are focused on healthcare but, of course, health and social care are closely interrelated elements. I heard from a councillor in north Somerset about the huge issue in very rural areas of simply finding a carer who is available to provide care in a small village. If someone needs that care and there is one person available, it means that the patient has absolutely no choice at all in terms of the carer they receive; if it is not working out very well, there is simply no other option available.

Finally, another terribly important issue is that of the shortage of dental care. I should declare my position as a vice-president of the Local Government Association because I will refer to recent LGA analysis that shows that rural and deprived communities particular suffer from a lack of dental provision. In comparing data from January 2022 for the bottom 20 areas, a year on, we can see that only one of them had seen improvements; all the others are going backwards. Meanwhile, the areas with the best access to dental care are seeing more and more dentists opening up and offering NHS services. So we are seeing a huge displacement of services to areas where there is relatively little need, but we are not seeing services coming into the areas where they are needed. Of course, what that means is that people either forgo dental treatment or resort to DIY dentistry. That is hideous in terms of pain but also in terms of the final cost of treatment that will need to be provided by the NHS. Indeed, if the Government will not listen to any other arguments, we can again come back to the issue of economic costs. We are looking for workers but those workers are all too often too ill to be available for work.