Findings from a research partnership exploring palliative care access and experiences in rural, coastal and low income communities in southwest England.
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This study highlights inequities in access to palliative care for people living in rural, coastal and low income communities. Fragmented services and limited local capacity make it difficult for families to secure care that meets the needs of the person they support, particularly when home-based care is required.
A lack of clear information about who provides care and what support is available at different stages contributes to confusion and stress for families. From a care equity perspective, this uncertainty creates unequal experiences, with those in resource-limited areas facing greater challenges in navigating services.
The findings also draw attention to the impact on family carers. Emotional and physical strain is intensified by limited respite and low awareness of mental health support, increasing the risk of burnout and unmet need.
The paper points to the potential role of voluntary and community sector organisations in addressing gaps, particularly around emotional support. However, without stronger coordination between NHS and community provision, inequities in access and experience are likely to persist for families in these communities.
A quantitative study analysing hospital data to examine the health and social care needs of people experiencing homelessness attending emergency care services in rural and coastal areas of North-East England.
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This study examines the health and care needs of people experiencing homelessness who attend emergency care services in rural and coastal areas of North-East England. It uses routinely collected hospital data from Northumberland and North Tyneside to explore patterns of emergency department use and underlying health conditions.
The findings show that people experiencing homelessness frequently present to emergency care services with complex and overlapping needs. Substance use, mental health conditions and social problems were among the most common reasons for attendance. Around one third of visits involved multiple diagnoses, highlighting the high levels of comorbidity within this population.
Emergency departments often become a key point of access to care for people experiencing homelessness. Barriers to primary care, difficulties registering with a GP and limited availability of community services can all contribute to reliance on emergency services.
Geography also plays an important role. Rural and coastal areas tend to have fewer specialised services, limited public transport and greater distances between service providers. These factors can make it more difficult for people experiencing homelessness to access continuous support, increasing the likelihood of emergency care use.
From a social care equity perspective, the study highlights how homelessness intersects with geographic disadvantage. People experiencing homelessness in rural and coastal areas may face additional barriers compared with those in urban areas, including limited service availability and hidden forms of homelessness.
The findings suggest that improving coordination between health services, housing support and community organisations could help address these challenges. Integrated approaches that address housing, health and social needs together may reduce emergency department reliance and improve outcomes for this population.
A commentary examining how the Covid-19 pandemic exposed links between housing conditions, domestic care responsibilities and existing social inequities.
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This commentary explores how the Covid-19 pandemic brought new attention to the role of the home in everyday care. During lockdowns, many people spent far more time at home than usual. This shift made housing conditions more visible as an important factor affecting wellbeing and the ability to provide care.
Homes are often the main place where people care for themselves and others. Everyday activities such as cooking, resting, maintaining hygiene and supporting family members all take place within the home environment. When housing conditions are inadequate, these basic forms of care become more difficult.
The pandemic highlighted how housing conditions vary widely across society. Some people had access to larger homes, gardens or nearby green space, which helped them cope with restrictions. Others lived in small or overcrowded homes, sometimes without outdoor space or with limited privacy. These differences shaped people’s experiences of lockdown.
Housing conditions also interact with wider social factors such as income, gender and employment. For example, many households experienced increased unpaid care responsibilities during the pandemic, particularly childcare and support for relatives. People with fewer financial resources or insecure housing were often less able to manage these pressures.
Neighbourhood environments also played a role. Access to local services, shops, parks and supportive communities influenced how easily people could maintain social connections and support networks during lockdown.
From a health and social care equity perspective, the article highlights the importance of recognising housing as part of the wider infrastructure that supports care. Policies that improve housing quality, affordability and neighbourhood conditions may help strengthen people’s ability to care for themselves and others.
Overall, the pandemic revealed how housing and care are deeply connected. Improving housing conditions and addressing structural housing inequities could play an important role in supporting wellbeing and strengthening care systems in the future.
A report examining how housing quality affects the health, wellbeing and care needs of older people, particularly during the COVID-19 pandemic.
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This report examines how housing conditions affect the health, wellbeing and care needs of older people in England, particularly in the context of the COVID-19 pandemic. It highlights the central role that the home plays in supporting health and independence later in life.
A key finding is that a large number of older people live in homes that do not meet acceptable housing standards. Around two million non-decent homes are occupied by older people, often containing hazards such as excess cold, poor repair or risks of falls. These housing conditions can contribute to a range of health problems including respiratory illness, heart disease and injury from accidents.
The pandemic reinforced the importance of housing quality. During lockdowns, many older people spent almost all of their time at home, which intensified the effects of living in unsuitable or unhealthy housing. Poor housing conditions were associated with worsening physical health, mental health challenges and greater social isolation.
Housing conditions also affect how health and social care systems function. For example, unsafe or inaccessible homes can delay hospital discharge, increase the risk of hospital readmission and make it more difficult for people to receive care at home. The report highlights the importance of home adaptations, such as grab rails, stair lifts and accessible bathrooms, which can help older people remain independent and reduce demand on health and social care services.
Unpaid carers are another important part of this picture. Many carers experienced increased responsibilities during the pandemic as formal services were disrupted. Providing care in homes that are cold, unsafe or unsuitable can create additional strain for carers and increase risks for both carers and those receiving care.
From a care equity perspective, housing conditions are unevenly distributed across society. Poor housing is more common among people with lower incomes and in disadvantaged areas. These housing inequities contribute to wider health inequities by increasing the risk of illness and reducing the ability of people to remain independent in later life.
Overall, the report argues that improving housing conditions should be considered a core component of health and social care policy. Targeted investment in housing improvements and adaptations could support healthy ageing, reduce pressure on health and social care services and address wider inequities in health outcomes.
Investigating how policy changes affect end-of-life care in certain areas
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This realist evaluation explores how national end of life care policy in England shapes the experiences of older people nearing death. The study highlights the complexity of translating national policy into consistent local practice.
Patient experience at the end of life is shaped by a combination of formal services and informal care. Interviews with patients and families emphasised the importance of compassion, dignity and social connection during the final stages of life. Many patients expressed a preference to remain in familiar environments such as their home or care home rather than being admitted to hospital.
However, the study found that achieving these preferences often depends on the availability of community-based services. Shortages of community nursing, limited overnight palliative care support and inconsistent access to home visits from clinicians were identified as barriers to delivering care outside hospital settings.
Variation in service provision between local areas was a recurring theme. Differences in commissioning decisions, local budgets and organisational structures meant that some areas offered more comprehensive services than others. For example, variation in spending on end of life care between clinical commissioning groups suggests that resource allocation may influence the quality and availability of services.
The research also highlights the fragmented relationship between health and social care systems. Medical care, such as pain management, is typically funded through the NHS, while practical and relational support such as personal care is often provided through social care services. Because these services operate under different budgets and governance structures, patients may experience gaps in support.
The study emphasises that policy alone cannot guarantee equitable care. Successful implementation requires alignment between national policy goals, local commissioning decisions and the priorities of professionals, patients and families.
From a health and social care equity perspective, the findings illustrate how geographical variation in services contributes to unequal care experiences at the end of life. Addressing these disparities will require stronger integration between health and social care systems, better support for the social care workforce and clearer mechanisms to reduce local variation in service provision.
A study examining how geographical location and economic disadvantage shape access to community palliative care in rural, coastal and low-income communities in southwest England.
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This study explores how geographical location and socioeconomic disadvantage shape access to palliative and end-of-life care in rural, coastal and low-income communities in southwest England. The South West Peninsula has one of the oldest populations in England, with more than a quarter of residents aged 65 or older. This ageing population increases the need for palliative care and community support services.
People living in rural and coastal areas often face practical barriers to accessing care. Services may be located far from where people live, and public transport options can be limited. For people with serious illness or reduced mobility, travelling long distances for care can be particularly difficult. These barriers can delay access to support or make it harder for people to receive care in their preferred setting.
Economic disadvantage can further increase these challenges. Some rural and coastal communities experience higher levels of deprivation alongside limited service availability. This combination can make it harder for individuals and families to access consistent and high-quality end-of-life care.
The study highlights the value of working directly with local communities when planning services. Through partnerships between researchers, healthcare providers and community organisations, the project gathered insights into the specific needs and priorities of different communities. This approach helped identify gaps in services and possible ways to improve care delivery.
From a care equity perspective, the findings show how location can shape access to health and social care services. People living in rural and coastal communities may experience structural barriers that are less common in urban areas. Without targeted policies and investment, these barriers can lead to inequities in access to palliative care and support at the end of life.
Overall, the report suggests that improving palliative care access requires locally tailored solutions. Strengthening community services, improving transport and addressing workforce shortages could help ensure that people living in rural and coastal areas receive equitable support at the end of life.
A Welsh policy report examining how collaboration between housing providers, health services and social care organisations can improve outcomes, prevent hospital admissions and support people to remain living at home.
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This report examines how stronger partnerships between housing, health and social care organisations can improve people’s wellbeing and reduce pressure on public services. It is based on interviews with fifteen collaborative projects across Wales that are already working across these sectors.
The report highlights the strong link between housing conditions and health. Poor housing, including cold, damp or unsafe homes, contributes to illness and increases demand for health services. The report estimates that poor housing costs the NHS in Wales more than £95 million each year in treatment costs, with wider social costs exceeding £1 billion annually.
One of the central ideas in the report is that housing should be considered part of the health and social care system. For example, some projects included housing staff working directly in hospitals to help patients resolve housing issues before discharge. Others used social prescribing approaches or integrated community hubs where multiple services work together to support people.
These partnership models aim to help people stay in their homes safely and independently. This can prevent avoidable hospital admissions, reduce delayed discharges and improve quality of life. The report also highlights how joint funding and shared leadership can support these approaches.
From an equity perspective, housing conditions play an important role in shaping health and social care outcomes. People living in poor-quality or unstable housing are more likely to experience health problems and require additional support. These challenges are often concentrated in lower-income communities, meaning housing can act as a driver of wider health and social care inequities.
The report argues that stronger partnerships between housing, health and social care organisations can help address these issues. By coordinating services and focusing on prevention, integrated approaches may help reduce avoidable pressures on the health and social care system while improving outcomes for individuals and communities.
A longitudinal population study examining how overall and health-related deprivation changed across England between 2004 and 2015, showing persistent regional patterns and the continuing North–South health divide.
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This study examines how deprivation across England changed between 2004 and 2015. It shows that deprivation tends to remain concentrated in the same places over long periods. Areas that experienced high deprivation at the start of the study were very likely to remain deprived more than a decade later.
One of the clearest findings is the continued North–South divide in health-related deprivation. Northern regions such as the North East and North West consistently experienced worse outcomes than southern regions. In some northern areas, improvements seen earlier in the study period had reversed by 2015.
These patterns reflect broader social and economic conditions. Regions with higher unemployment, lower incomes and poorer housing conditions often also experience worse health outcomes. These wider determinants of health can contribute to long-term demand for health and social care services.
The study also shows that deprivation often occurs in geographical clusters, meaning neighbouring communities may share similar levels of disadvantage. For service planners, this is important because clusters of deprivation may lead to concentrated demand for health and social care support.
From a care equity perspective, the findings highlight how place shapes health outcomes. People living in areas with long-term deprivation may experience poorer health, greater need for services and fewer local resources to support wellbeing.
Overall, the research suggests that reducing health inequities requires sustained and targeted policy action. Interventions that address the wider determinants of health, alongside investment in health and social care services, are likely to be important for improving outcomes in persistently deprived communities.
A parliamentary inquiry examining the health and social care challenges faced by rural communities in England, including access barriers, workforce shortages and funding pressures.
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This parliamentary inquiry highlights the challenges faced by people living in rural communities when accessing health and social care services. Around 9.7 million people live in rural areas in England, many in small villages and isolated communities where services are more spread out.
Distance is one of the main barriers. People in rural areas often have to travel further to reach hospitals, GP services or social care support. Public transport options are often limited, meaning access to care may depend on having a car or support from family members. These barriers can be particularly difficult for older people, people with disabilities and unpaid carers.
Workforce shortages also contribute to care inequities in rural areas. Health and social care providers often find it harder to recruit and retain staff in rural locations. Staff may need to travel long distances between patients, and smaller local services may struggle to maintain stable teams.
Funding arrangements can reinforce these inequities. Delivering services across large rural areas is often more expensive, but existing funding systems do not always account for these additional costs. As a result, services in rural areas may receive fewer resources relative to the challenges they face.
Another issue highlighted in the report is that rural disadvantage is often less visible in national statistics. Because poverty and health needs are more dispersed across rural communities, they may not appear clearly in standard deprivation measures. This can make it harder for policymakers to identify where support is needed.
Overall, the inquiry argues that addressing rural care inequities requires policies that recognise the specific challenges of rural areas. Improvements in funding, workforce support, transport and community-based services are needed to ensure that people living in rural communities can access health and social care on fair terms.
A study examining how the location of residential and nursing care homes in Wales compares with where older people live, showing clear regional differences in access to care.
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This study looks at how access to care homes varies across Wales depending on where people live. The researchers mapped the location of care homes and compared this with the distribution of older people who may need residential care. This helps show whether some areas have better access to care home places than others.
The results show that care homes are not evenly distributed. More homes tend to be located in urban areas and the post-industrial valleys of south-east Wales. However, these areas also have larger older populations, which means demand for care home places is higher. As a result, the actual availability of places may not be as high as the number of homes suggests.
Some rural areas appear to have a better balance between the number of places and the number of older residents. However, people in these areas may still face challenges because care homes are further apart and travel distances can be longer. This can make it harder for families to visit relatives and for people to remain close to their communities when they move into residential care.
The study also highlights how the organisation of the care sector affects access. In Wales, most care homes are run by independent providers rather than local authorities. This means the location of homes is partly shaped by market conditions and business decisions, not just local need. Areas that are less profitable or harder to operate in may therefore have fewer services.
These patterns matter for care equity. If some communities have fewer nearby care homes, people living there may have fewer choices or may need to move further away from their families and support networks. This can affect wellbeing and continuity of care.
Overall, the study shows that looking at where services are located, and where people live, can help policymakers understand where gaps in care provision exist. This kind of analysis can support better planning of care home services and help ensure that access to residential care is more evenly distributed across regions.
