Key statistics

• the average life expectancy gap between the most and least deprived wards in Plymouth is 7.5 years.

Key messages

• families experience difficulties securing care packages that meet needs, particularly in rural and low income areas
• limited support to arrange GP, district nurse and palliative care home visits restricts access to timely care
• lack of clarity about who provides care and what support is available at different stages makes services hard to navigate
• family carers face significant emotional and physical strain, with limited respite and low awareness of mental health support.

Policy implications

• access to coordinated community palliative care may need to be strengthened in rural and low income areas
• clearer communication about roles, responsibilities and care pathways could support families to navigate services
• greater involvement of voluntary and community sector provision may help address unmet emotional support needs
• improved coordination between NHS and voluntary sector services may reduce fragmentation.

Gaps

• limited evidence on the availability and impact of respite and mental health support for family carers
• lack of evaluation of models that improve coordination across statutory and voluntary services
• limited understanding of how access barriers differ across rural, coastal and low income settings.

Commentary
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.