Healthcare in Rural Areas

Lord Evans of Rainow Excerpts

Thursday 23rd February 2023 Grand Committee

[Lord Evans of Rainow (Con)]

I thank the Committee, noble Lords and noble Baronesses for their contributions to this debate. I know that this topic raises great interest across your Lordships’ House. I also congratulate my noble friend Lady McIntosh of Pickering on bringing forward this debate and on her work not just in this House but over many years as the Member of Parliament for the wonderful constituency of Thirsk and Malton.

I recognise many of the challenges of delivering healthcare in rural areas, including the distinct health and care needs of rural populations and the challenges of access, distance and ensuring a sufficient workforce to enable safe and sustainable services. As a resident of a rural area myself—Rainow—I am no stranger to the challenge of people having to travel further to access healthcare, or their difficulties in relying on rural transport networks to reach the care that they need. However, I assure my noble friend that this Government are, and will remain, committed to improving the health service in rural areas, as we are committed to improving it across England.

First, I can give my noble friend an assurance that we are in full agreement that the NHS needs to be flexible enough to respond to the particular needs of the various rural areas in England. That is why we passed the Health and Care Act 2022, which embeds the principle of joint working right at the heart of the system, promoting integration and allowing local areas the flexibility to design services that are right for them.

Integrated care boards and integrated care partnerships give local areas forums through which to design innovative care models, bring together health and social care and prioritise their resources to ensure they best align with the needs of their area. We are also enabling the NHS to establish place-based structures covering smaller areas than the ICS—for example, covering a local authority footprint or, in some cases, even smaller subdivisions for those larger county areas.

By establishing these models for the NHS to follow we have set the framework, but we have left it to individual areas to tailor the specific details. That is the right approach because, as established in this debate, local areas know better than Ministers in Whitehall how best to organise themselves to design and deliver the best possible care for patients. While we can guide and hold accountable, it is right that we also protect that local flexibility.

I share noble Lords’ passion on internet connectivity. We recognise that some rural areas may have greater challenges accessing the internet than others. I assure the Committee that the Government are taking action to improve broadband and mobile phone connectivity in rural and hard-to-reach parts of the UK. More than 73% of premises in the UK can now access gigabit-capable broadband, which is a huge leap forward from January 2019, when coverage was just 6%. This will only get better.

To help drive this rollout further, we are awarding a series of contracts to suppliers to deliver gigabit-capable connectivity in areas to which the market will not go without subsidy. We have already awarded six contracts and, in total, have made almost £1 billion of funding available through our live contracts and procurements, covering up to 681,000 premises—two-thirds of a million homes. This can be a solution for those hard-to-reach communities on a case-by-case basis. However, we recognise that connectivity remains limited in some areas at this time. As such, digital approaches to health and care should always be only one part of a multipronged offering reinforced with the right support, including face-to-face meetings and visits for those who struggle to access digital services.

The Government recognise the important work done by dispensing practices. This is reflected in the five-year GP contract framework we agreed with the British Medical Association in 2019, underpinned by a record-level addition of £4.5 billion for primary and community care by 2023-24, as part of the NHS long-term plan. This money will help ensure that dispensing practices can continue to provide patients and communities with the prescriptions that they need and to which they are entitled.

I would like to address the important topic of dementia, which my noble friend specifically raised. I assure your Lordships that the Government and the NHS are committed to tackling dementia head-on. On 24 January this year, the Government announced that they will publish a major conditions strategy covering six conditions including dementia. An interim report on the major conditions strategy will be published in the summer. Only in December, the recovery of the dementia diagnosis rate to the national ambition of 66% was included in the NHS priorities and operational planning guidance. This reinforces the importance of dementia as a key priority for the NHS and provides a clear direction to those with responsibility for planning healthcare to make sure that they deliver timely diagnosis.

What is more, work is under way to investigate underlying variation in dementia diagnosis rates. This includes the assessment of underlying population characteristics such as rurality, ethnicity and age. The aim of this work is to provide the context for variation and, in doing so, enable targeted support at local levels to improve diagnosis. This is important work and that discovery must be undertaken to learn how we can make things better for patients in rural areas.

I turn briefly to resources, which many Members have mentioned today. As noble Lords will know, it is vital that we allocate resources in a fair way. NHS England is responsible for funding allocations to integrated care boards. This process is independent of government, and NHS England takes advice on the underlying formula from the independent Advisory Committee on Resource Allocation. That formula takes into account various factors including population, age and deprivation.

In 2019-20, the Advisory Committee on Resource Allocation introduced a new element to the formula to better reflect needs in some rural, coastal and remote areas that, on average, tend to have older populations. NHS England is now using this formula and making allocations accordingly. However, we recognise that some systems are significantly above or below the target of where their allocations should be, so NHS England has a programme in place to manage convergence over several years.

I will now answer some of the specific questions that noble Lords asked. The right reverend Prelate the Bishop of Exeter mentioned social care. The Government have read the archbishops’ report with great interest. We have already committed to publishing a plan for adult social care by spring 2023, which will build on progress so far. 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.

The noble Baroness, Lady Bennett, also mentioned dental care in Shropshire. I am sorry that I am not quite familiar with dental care there—in Cheshire, perhaps, but not Shropshire. The Government put £50 million into funding for NHS dentistry in 2021-22. We acknowledge that some areas are experiencing recruitment issues, and we are actively considering what measures can incentivise dentists to work in more rural areas. We know that we can go further, however, and our priority is to improve access to rural dentistry.

In response to the noble Lord, Lord Mann, I have not been to Iceland, but I hope to one day. He made a very powerful point. We have increased significantly—by 50%—the money going into virtual ward beds. By the end of this year, 100,000 people will be able to have consultations through the virtual ward system. It is a way forward but, as he said, we need digital connectivity for that to be effective.

In response to the noble Lord, Lord Allan, electronic patient records are close to my heart. Our digital health and social care plan sets out a commitment to ensure that all trusts have electronic patient records. NHSE will produce a digital work plan by the autumn. I will take a keen interest in that, as I am sure he will too. The noble Lord also mentioned the correct apprenticeships for key priority areas. The Government are working on that so that it mirrors the local population apprenticeships as a good way for young people to get into the health service.

In response to the noble Baroness, Lady Merron, iPhones are popular with all ages, but I take the point that this is not for everyone. I went to a 102 year-old’s birthday lunch; he took a photograph on an iPhone and texted it to me. There is hope for us all but she made a good point: digital technology is not for everybody.

Before I close, I pay tribute to the NHS and social care services across England for their work. They deliver excellent care now and did so throughout the pandemic. The country is rightly proud of them. We absolutely recognise the importance of ensuring that the challenges faced by rural areas are given due diligence and consideration. These areas face a different range of challenges from those of the NHS in more urban or suburban areas and it is right that we give the systems the flexibility to respond to them.

I hope that I have given my noble friend some reassurance that the current system works. I also hope that she has a speedy recovery from her damaged leg.