Healthcare in Rural Areas

Lord Bishop of Exeter Excerpts

Thursday 23rd February 2023 Grand Committee

[The Lord Bishop of Exeter]

My Lords, I begin by thanking the noble Baroness, Lady McIntosh, for securing this important debate. We all acknowledge that the NHS is operating under enormous pressure at the present time. Perhaps inevitably, publicity focuses on our inner cities but, as we have been hearing this afternoon, rural communities are also pinch points. My own county of Devon has the second-oldest population in the country. We should not underestimate the challenge, both logistical and financial, of delivering healthcare to an ageing population, particularly in coastal communities and remote rural areas.

In his 2021 report on coastal communities and their patchy provision of medical services, the Chief Medical Officer for England observed that some

“of the most beautiful … and historically important places”,

including in the south-west region,

“have some of the worst health outcomes in England, with low life expectancy and high rates of many major diseases”.

As we heard in the Chamber this morning, patients experience difficulty in accessing physiotherapy following strokes and operations. This is exacerbated in rural areas by poor and non-existent public transport. In parts of the south-west, we are finding it difficult to recruit GPs and I encourage His Majesty’s Government to think outside the box and consider adopting a salaried approach to recruitment, rather than a partner approach.

Age UK estimates that each day a medically fit patient occupies an NHS bed costs three times as much as if they were to be cared for in a nursing home. Given the age demographic of shire counties, you do not have to be a brilliant mathematician to realise that the NHS and care services are under huge pressure in rural areas. Our ageing population, with increasing levels of frailty and multimorbidity, is generating increased demand for social care at a time when capacity in the sector is shrinking, not expanding. We need to face the fact that successive Governments of all complexions have failed to grapple with the social care problem. Social care is the responsibility of local authorities but over the last 10 years it has been subject to severe cuts, so what is to be done?

One reason is that it is hard to recruit carers following a patient’s discharge from hospital because of zero-hour contracts that do not allow for transport time between sites. Devon is a massive county and it may take an hour, without pay, for a carer to travel between visits. As a result, admissions to care homes may be the only viable option, although it is the least attractive. This leads me to say two things: first, there has got to be a better deal for unpaid carers. Secondly, there is an urgent need to transform what is a low-paid, low-status workforce in the care sector into a viable and noble career.

Last month saw the publication of the report by the commission of my most reverend friends the Archbishops of Canterbury and York on social care. Entitled Care and Support Reimagined, the report identifies a pressing need for a new national care covenant that would set out the respective rights and responsibilities of national and local government, communities, families and citizens. “Covenant” has strong biblical overtones, and the commission chose it in preference to “contract” because the health of a nation is dependent on the underlying principles and values that shape a society.

The report also points to a malaise at the heart of the NHS that needs to be addressed. The greatest resource the NHS has is its staff: people matter. The unpalatable fact is that good, capable and experienced staff are leaving the NHS in droves. It takes years to train doctors and nurses, and even longer for a qualified medic to accumulate the experience that is the prerequisite of good healthcare. Older and experienced staff are burnt out and retiring early. The loss of their expertise is a national tragedy that could have been avoided. Many are exhausted by the obligation to record unnecessary data and navigate a health system that has become byzantine in its complexity. They find themselves servicing the system rather than the patient. If we are to secure a more effective delivery of healthcare in our rural areas, we need to address these challenges and, above all, give energy to raising the morale of our hard-pressed NHS and social care staff.