Community palliative care needs in rural and low-income communities

Findings from a research partnership exploring palliative care access and experiences in rural, coastal and low income communities in southwest England.

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.

Emergency care use among people experiencing homelessness in rural and coastal North-East England

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.

Key statistics 

  • 260 individuals experiencing homelessness made 567 emergency care visits between February 2019 and March 2022 in Northumberland and North Tyneside. 
  • 55% of visits were repeat attendances within 12 months, indicating frequent reliance on emergency services. 
  • 83% of attendees were male, with a mean age of 39 years. 
  • 32% of emergency visits involved multiple diagnoses, showing high levels of comorbidity. 
  • The most common diagnoses included poisoning related to drugs or alcohol, psychiatric conditions and social problems. 

Key messages 

  • People experiencing homelessness in rural and coastal areas often present to emergency services with complex combinations of health, mental health and social care needs. 
  • Substance use, mental health issues and social problems are common drivers of emergency care attendance. 
  • Repeat emergency department use suggests gaps in accessible community-based support. 
  • Rural and coastal contexts create additional barriers to care, including limited services and geographic isolation. 
  • Integrated health and social care responses are needed to address the complex needs of people experiencing homelessness outside emergency settings. 

Policy implications 

  • strengthen integrated health and social care support for people experiencing homelessness 
  • develop community-based interventions that reduce reliance on emergency departments 
  • improve coordination between hospitals, housing services and community organisations 
  • address rural service gaps and barriers to accessing support 
  • improve recording of homelessness status in healthcare data to support better planning 

Gaps 

  • homelessness status was identified using the hospital code “no fixed abode”, which may underestimate the true number of homeless patients. 
  • hidden homelessness (for example sofa surfing or temporary accommodation) may not be captured in routine hospital data. 
  • the study covers two areas in North-East England, which may limit generalisability to other regions. 

Commentary 

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. 

Palliative care access in rural and coastal communities

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.

Key statistics 

  • people aged 65 and over make up 24.2% of the population in the South West Peninsula, the highest proportion in England 
  • the South West Peninsula is the only predominantly rural region in England with higher levels of economic deprivation than urban areas 
  • rural and coastal communities in the region often experience longer travel distances and limited transport options for accessing services 
  • ageing populations in these areas are expected to increase demand for community-based and end-of-life care services 

Key messages 

  • geographical location strongly influences access to palliative and end-of-life care services 
  • rural and coastal communities often face barriers including travel distance, limited service availability and workforce shortages 
  • community engagement is essential for designing services that meet local needs and cultural expectations 
  • partnerships between universities, health services and community organisations can help identify gaps in care provision 
  • addressing both geographical and economic disadvantage is necessary to improve equitable access to end-of-life care 

Policy implications 

  • expand community-based palliative care services in rural and coastal areas 
  • improve transport and outreach services to support access to health and social care 
  • strengthen partnerships between local communities, health services and researchers to design locally appropriate services 
  • increase workforce recruitment and retention strategies in underserved areas 
  • integrate palliative care planning into broader strategies addressing rural health and social care inequities 

Gaps 

  • the study focuses on one region of England, which may limit the generalisability of findings to other areas 
  • limited quantitative analysis is presented on the scale of service gaps across different rural or coastal regions 
  • further research is needed to examine how workforce shortages affect palliative care access in remote communities 
  • more evidence is required on the effectiveness of community-led solutions for reducing inequities in end-of-life care 

Commentary 
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.

Rural health and social care inequities in England

A parliamentary inquiry examining the health and social care challenges faced by rural communities in England, including access barriers, workforce shortages and funding pressures.

Key messages 

  • around 9.7 million people live in rural areas in England, many in small and isolated communities 
  • people living in rural areas often experience poorer access to health and social care services than those in towns and cities 
  • longer travel distances and limited public transport create barriers to accessing services 
  • rural areas often have older populations, which increases demand for health and social care 
  • recruitment and retention of health and social care staff is more difficult in rural areas 
  • funding allocations often fail to reflect the additional costs of delivering services in sparsely populated areas 
  • existing data systems do not always capture the specific health and care needs of rural communities 

Policy implications 

  • develop funding models that recognise the higher costs of delivering health and social care in rural areas 
  • strengthen recruitment and retention strategies for rural health and social care workforces 
  • improve transport and digital infrastructure to reduce barriers to accessing services 
  • support community-based services that allow people to receive care closer to home 
  • incorporate rural considerations into wider policy areas including housing, transport and digital connectivity 

Gaps 

  • national datasets often mask rural disadvantage because deprivation measures are designed primarily for urban settings 
  • limited research examines how current funding formulas affect rural health and social care provision 
  • more evidence is needed on how travel and transport barriers influence access to care 
  • there is limited evaluation of interventions designed to improve rural workforce recruitment and retention 
  • rural communities are diverse, yet policy discussions often treat rural areas as a single category 

Commentary 
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.