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.
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.
A study examining how austerity policies affected English city governments and how reductions in local authority funding were passed on to poorer communities through changes to services and public spending.
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This study examines how austerity policies affected local government services in English cities and how these financial pressures ultimately affected poorer communities. The research combines national financial data with detailed case studies of several English local authorities to understand how funding reductions translated into changes in services.
Between 2010 and 2015, English local authorities experienced significant reductions in their spending power. The study shows that these reductions were not evenly distributed. Councils serving more deprived populations tended to lose a greater share of their funding because they relied more heavily on central government grants. When these grants were reduced, the financial impact was larger for poorer areas.
One important finding is the erosion of the historic principle of equalisation in local government finance. This principle aimed to compensate poorer councils for the higher levels of social need they faced. As austerity policies reduced this funding premium, poorer councils became less able to provide services at levels comparable with more affluent areas.
The research also highlights how the structure of local government spending affects how cuts are experienced. Many services provided by local authorities are used more frequently by lower-income households. Because these services make up a large share of council spending, it becomes difficult for councils to protect them completely when budgets are reduced.
Even services used by all residents can affect disadvantaged communities more strongly when they are reduced. For example, cuts to libraries, parks or neighbourhood maintenance may have greater consequences for households with fewer private resources or alternatives.
From a health and social care equity perspective, the study demonstrates how funding decisions made at national level can influence the distribution of services at local level. When deprived cities lose more resources, their ability to support vulnerable populations may decline.
Overall, the study shows that austerity policies can produce uneven impacts across places and populations. Without mechanisms that account for differences in local need, reductions in local government funding risk reinforcing existing social and geographical inequities.
A study examining why social care reform has progressed unevenly across England, Scotland, Wales and Northern Ireland, highlighting the political and institutional factors that shape policy change.
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This study explores why social care reform has progressed unevenly across the four nations of the UK. Despite widespread recognition that the current system needs reform, many proposed changes have been delayed or only partially implemented.
The authors use the concept of policy drift to explain this pattern. Policy drift occurs when existing policies remain in place even though social needs and pressures have changed. In the context of social care, demographic ageing and rising care needs have increased pressure on systems that were not originally designed to cope with these demands.
The research compares England, Scotland, Wales and Northern Ireland, each of which has responsibility for its own social care system following devolution. Although these systems share common origins, they have developed in different ways over the past two decades.
Scotland has taken the most significant steps towards reform. In 2002 it introduced free personal care for older adults, a policy that later expanded to include working-age disabled people. This approach represents a form of “risk pooling”, where the costs of care are shared across society rather than falling mainly on individuals.
England has experienced greater delays in reform. Although legislation introduced in 2014 proposed a cap on the amount individuals would have to pay for care, the policy was repeatedly postponed due to financial and political concerns. Wales and Northern Ireland have made some changes to funding arrangements but have also faced institutional and political barriers.
The study identifies several factors that can lead to policy drift. These include the high cost of reform, political disagreements between parties, the complexity of the social care system and competing policy priorities. In England, these factors have combined to slow progress more than in the other UK nations.
From a health and social care equity perspective, the findings show how differences in political systems and policy decisions can lead to uneven social care arrangements across the UK. People living in different nations may face different rules around care funding and access to services.
Overall, the study highlights how institutional and political factors shape the pace of social care reform. Without sustained political commitment and agreement on funding solutions, policy drift may continue to delay reforms designed to protect people from the high costs of care.
A study examining mental health-related ambulance callouts in rural England during the COVID-19 pandemic, highlighting differences in presentations and service pressures compared with urban areas.
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This study examines mental health emergencies attended by ambulance services in rural England during the COVID-19 pandemic. Ambulance services often act as the first point of contact for people experiencing acute mental health crises, particularly when other services are difficult to access.
The findings show that people attended by ambulances in rural areas were more likely to present with behavioural disturbance, suicidal thoughts or actions, and anxiety-related crises. These types of emergencies often require specialist mental health support, yet access to such services can be more limited in rural areas.
Rural ambulance services also face practical challenges that differ from urban settings. Longer travel distances, fewer nearby healthcare facilities and limited availability of specialist services can affect response times and the type of support that can be provided during an emergency.
During the COVID-19 pandemic, many community and mental health services experienced disruption. As a result, ambulance services often became an important entry point into care for people experiencing acute distress.
From a health and social care equity perspective, the study highlights how geographical location can shape access to crisis support. People living in rural areas may have fewer options for urgent mental health care and may rely more heavily on emergency services. This can place additional pressure on ambulance services and may delay access to specialist support.
Overall, the findings suggest that improving access to community mental health services and crisis support in rural areas could reduce reliance on emergency responses and help ensure more equitable access to mental health care.
