Healthcare in Rural Areas

Baroness McIntosh of Pickering Excerpts

Thursday 23rd February 2023 Grand Committee

Asked by

[Baroness McIntosh of Pickering]

To ask His Majesty’s Government what plans they have for the delivery of health care in rural areas.

[Baroness McIntosh of Pickering (Con)]

My Lords, I am delighted and grateful to have secured this debate this afternoon and I look forward to contributions from other noble Lords across the Committee, especially my noble friend Lord Evans in summing up. I draw attention to my entry in the register, my work with the Dispensing Doctors’ Association based at Kirkbymoorside in North Yorkshire, and to the fact that I am a proud daughter and sister of dispensing doctors. I also sit on the Rural Affairs Group of the Church of England General Synod.

I pay tribute to all those who deliver health and social care in rural areas: doctors, nurses, carers, pharmacies, paramedics, and community hospitals—where they still exist, such as St Monica’s in Easingwold and Malton Community Hospital. I thank all those in the NHS for their help with my recent injury, from the accident and emergency department through to orthopaedics. I am hugely grateful for the care provided.

One-fifth of the population live in remote, rural and coastal communities. This amounts to 9 million people, more than the population of Greater London, yet at present there is a stark disparity in the care and services available. Undoubtedly, the cost and challenges of delivering healthcare in a rural area are markedly greater than those in urban areas, and I question the extent to which this is reflected in current policy decision-making. For example, is the policy tool of rural-proofing used by the department and NHS England? There was a very useful report on this by a committee of this House chaired by the noble Lord, Lord Cameron of Dillington, in 2016. I have not yet seen any evidence that those recommendations have been acted on.

Similarly, last year the All-Party Group on Rural Health and Social Care published a report that has a wealth of recommendations on how to improve the provision of services to patients. It has to be asked: why have the Government failed to act on any of its recommendations?

In the past, rurality and sparsity of population used to be reflected as criteria in health spending, but that is no longer the case. Many remote, rural and coastal GP practices are permitted to dispense medicines to their patients for the simple reason that there is no community pharmacy within a reasonable distance. The department’s cost of service inquiry from 2010 demonstrates that the income from dispensing cross-subsidises the general practitioner service.

Dispensing practices are under the same cost pressures as their community pharmacy colleagues, buying their medicines in the same marketplace. Despite this, the recent changes to the system of drug reimbursement in pharmacies have not been reflected in the dispensing doctor contract. A recent example was the spike in chickenpox cases, where penicillin was to be issued to all children, but my understanding is that rural practices were not properly reimbursed for the cost. I hope that my noble friend Lord Evans will take this opportunity to revisit that.

In addition, there are barriers such as poor connectivity for both broadband and mobile signals. How widely is it known that electronic prescription services cannot be delivered in rural areas by dispensing doctors for this very reason? Similarly, remote consultations to patients and other telehealth innovations are unable to be delivered. I was disappointed that in the exchange at Oral Questions earlier today my noble friend Lord Markham seemed unaware of this problem in remote rural areas. The problem is seen not just in health. When we have the influx of population in all the beauty spots represented by the Members of the Committee today, tourists often rely on mobile signals if their car breaks down or if they are involved in an accident. This needs to be addressed as a matter of urgency. I applaud the investment that the Government have made and the work of local authorities such as North Yorkshire County Council and others, but it is the last 3%, 4% or 5% of deeply rural, remote and isolated areas where we have not yet got full connectivity either for mobile phones or broadband.

I am grateful to Alzheimer’s UK for alerting me to the clear irregularities of dementia diagnosis in rural areas, with the consequential effect on the care and support that families can access. I therefore urge my noble friend to level the rates of dementia diagnosis across rural areas, allowing those living there faster and more equal access to the essential care and support that they and their families desperately need.

I want to raise the role of NHS England in this regard, which is clearly undermining the role of GPs and demoralising practitioners and therefore patients. The level of micromanagement is breathtaking. It has removed all the regular interface that GPs would normally have with patients in rural areas—and, I accept, in other areas as well. You can no longer access minor injuries treatment; you can no longer have your ears dewaxed; you can no longer have a routine check-up in the way a GP used to give before, giving the GP the opportunity to question patients about their general health and mental welfare.

NHS England has been asked to focus on a one-size-fits-all solution, oblivious to the fact that what may work in an urban area is totally inappropriate and cannot necessarily be delivered in a rural one, across a highly isolated, sparsely populated, deeply rural area with, in addition, many elderly patients with a number of comorbidities. This level of micromanaging is inappropriate and must cease, and clinicians must be allowed to decide on treatment.

At its inception in 1948, the NHS was set up to be universally available to everyone, free at the point of delivery and based on clinical need and not the ability to pay. My father was one of the very first practitioners, commencing his practice in 1948.

Equality of access was reflected in the more recent NHS constitution. As I referred to earlier, the APPG report on rural health called for levelling up between rural and urban areas and removing impediments in rural areas such as lack of workforce capacity and poorer access through inadequate transport, leading to the inequalities of outcomes for patients which it identified.

I regret that, at the moment, the Government seem blind to the challenges of delivering healthcare in rural as opposed to urban areas. I hope that the contract about to be negotiated will provide an opportunity to revisit this issue and ensure both that there is a better balance between primary and secondary care spending and that rural areas are identified as a priority. I urge my noble friend the Minister to use his good offices, through today’s debate, to address the issues before us; to ensure delivery of universal healthcare across the country, delivering in rural as well as urban areas; and to reduce the health inequalities for those of us who live in rural areas. I beg to move.