Farming and Rural Communities

Lord Kakkar Excerpts

Thursday 3rd April 2025 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join other noble Lords in congratulating the noble Lord, Lord Roborough, on securing this important debate and on the very informative way in which he introduced it. I do not come from a farming or rural background, but the territorial designation that attends my peerage is a small hamlet in Mid Devon, Loxbeare, where my father-in-law is a sheep farmer. Over the past 35 years, I have come to understand in some way the powerful communities that exist in these small farming areas, and I have come to greatly respect them.

His Majesty’s Government have a range of economic policies, and they will inevitably impact all parts of the country, including rural areas. But the impact of policy on health outcomes, and population health outcomes in particular, is frequently neglected. We know that in rural communities, health outcomes differ. There is an assumption that because the countryside is beautiful and people can get out and about, they will in general be healthier and live longer. But there are substantial disparities in outcomes. We have heard of the higher suicide rate experienced in farming communities in comparison with many urban communities, but there are also disparities in other health outcomes and, importantly, there are inequalities in access to healthcare facilities.

For instance, 51% of rural populations live over an hour’s travel distance from their closest hospital, compared with only 8% of urban populations. Some 43% of rural populations are within half an hour’s walk of a general practice or primary care facility, compared with some 95% of urban populations. So there is inequality of access. Ambulance waiting times can be longer; pharmacies are more sparsely distributed; and, most importantly, dispensing pharmacies in rural locations frequently have less stock of medicinal products, so individuals have to travel much longer distances to get their medicines. These are all important problems with regard to access.

There are also concerns about accessing clinical services in acute situations. The time from onset of symptoms to intervention for patients with acute myocardial infraction and acute stroke is critical in terms of achieving the best clinical outcomes—yet frequently patients in rural locations experiencing those conditions have to wait longer to achieve those interventions. This problem extends to management of chronic conditions, particularly troublesome when there are long distances to travel for those who, for instance, receive daily fractions of radiotherapy to manage their cancers.

All this suggests that there must be a very clear focus in terms of planning considerations, when taking forward economic and other policies, to ensure that we can achieve equitable outcomes for those living in rural locations, as we do for those living in urban locations, with regard to the provision of healthcare. We are about to experience a major reorganisation of the NHS in England. The Government have set three clear priorities: a move from hospital to community care; a move from analogue to digital care; and a move from treatment to prevention. But for all those transformations to apply equitably in rural as well as urban locations, there needs to be very careful consideration of the specific needs in rural locations to achieve those policy objectives.

Can the Minister confirm that, in taking forward and understanding an assessment of the impact of various policies—economic, planning and other—with regard to impacts in rural communities, or for rural communities, there will be proper consideration of the impact on achieving health outcomes? Most important, in terms of economic policy, is the impact on the social determinants of health—housing, education, jobs and so on—which are the most important determinants of the health outcomes for those communities.