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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. 

Unequal access to care homes across Wales 

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.

Key messages 

  • care home provision in Wales included 25,607 residential and nursing beds across 1,069 sites in March 2020 
  • the average care home had around 24 places, although many homes were small and over a quarter had six or fewer places 
  • only around 9% of care home places were provided by local authorities, with most delivered by independent providers 
  • there were on average 53.3 care home places for every 1,000 people aged 70 or over, but this varied widely between areas 
  • cities and densely populated areas had more care homes, but they also had higher demand for places 
  • where people live strongly affects access to care homes, with some communities having far fewer nearby options 
  • simple measures of care home supply can hide local inequalities, especially in rural areas 

Policy implications 

  • use detailed mapping of care homes and population need to identify areas with limited access to residential care 
  • improve coordination between neighbouring local authorities when planning care home provision 
  • target investment in areas where demand for care is increasing but local provision is limited 
  • include population ageing, deprivation and health needs in long-term care planning 
  • monitor how financial pressures and changes following COVID-19 affect the stability of care home services 

Gaps 

  • demand was estimated using the number of people aged 70 or over, which does not fully reflect health needs or disability 
  • the study did not include data on how many beds were already occupied, meaning real availability may differ from total capacity 
  • financial barriers to accessing care homes were not included in the analysis 
  • the study did not consider differences in care home quality, fees or specialist services such as dementia care 
  • travel assumptions were based on driving distances and may not reflect access for people without a car 

Commentary 
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.

Transport poverty and access to essential services

A review examining how transport poverty affects access to employment, services and social participation, highlighting the challenges faced by both rural and urban communities.

Key statistics 

  • estimates of households experiencing transport poverty range from around 10% to as high as 90%, depending on how transport poverty is defined and measured 
  • transport poverty can occur when households cannot afford transport costs, lack access to transport services, or experience excessive travel time to reach essential services 
  • people living in low-income households, rural areas or peripheral urban neighbourhoods are more likely to experience transport-related disadvantage 

Key messages 

  • transport poverty remains poorly defined and inconsistently measured across research and policy 
  • limited attention from transport policy and engineering has contributed to fragmented responses 
  • transport disadvantage can restrict access to employment, education, healthcare and social participation 
  • both rural and urban populations can experience transport poverty, though the causes may differ 
  • current policy approaches often fail to capture the lived experiences of people affected by transport barriers 

Policy implications 

  • develop clearer definitions and indicators of transport poverty to support consistent policy responses 
  • integrate transport planning with wider social policy areas including health and social care access 
  • improve public transport connectivity in areas with limited service provision 
  • consider affordability alongside physical accessibility when designing transport systems 
  • involve communities affected by transport poverty in policy development and planning 

Gaps 

  • there is no widely accepted definition or measurement framework for transport poverty 
  • evidence is limited on the scale of transport poverty across different regions and demographic groups 
  • more research is needed on how transport barriers affect access to health and social care services 
  • limited evaluation exists on the effectiveness of policy interventions designed to reduce transport poverty 

Commentary 

This paper explores the concept of transport poverty and how limited mobility can create wider forms of social disadvantage. Transport poverty occurs when people are unable to reach essential services, employment opportunities or social networks because transport is unavailable, unaffordable or unreliable. 

The authors argue that transport poverty has received relatively little attention from transport policy and engineering compared with other areas of infrastructure planning. As a result, responses to transport disadvantage have often been fragmented and inconsistent. 

Transport barriers can affect many aspects of daily life. People may struggle to reach workplaces, educational opportunities, shops or healthcare services. These challenges can contribute to social isolation and economic disadvantage, particularly for people living on low incomes. 

Transport poverty affects both urban and rural populations. In rural areas, people may face long distances between services and limited public transport. In urban areas, the problem may relate more to the cost of transport or poor connectivity between neighbourhoods and employment centres. 

From a health and social care equity perspective, transport plays an important role in determining whether people can access services. Difficulties travelling to health and social care appointments may delay treatment or prevent people from receiving support. Transport barriers can also affect care workers, who may need to travel long distances to visit people receiving care at home. 

The study highlights the importance of recognising mobility as part of the wider system that supports access to services. Policies that improve public transport availability, affordability and connectivity could help reduce transport-related inequities and improve access to health and social care services. 

Mental health emergencies attended by ambulance services in rural England

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.

Key statistics 

  • the study analysed ambulance attendances for mental health emergencies in rural England during the COVID-19 pandemic using routinely collected ambulance service data 
  • people living in rural areas were more likely to present with behavioural disturbance, suicidality and anxiety-related crises compared with people living in urban areas 
  • rural ambulance services experienced longer response times and greater travel distances when responding to mental health emergencies 

Key messages 

  • mental health emergencies attended by ambulance services increased during the COVID-19 pandemic 
  • people living in rural areas were more likely to present with behavioural disturbance, suicidality and anxiety-related crises 
  • rural ambulance services face operational challenges including longer travel distances and response times 
  • limited access to specialist mental health services in rural areas increases reliance on ambulance responses for crisis situations 

Policy implications 

  • strengthen community-based mental health support in rural areas to reduce crisis presentations 
  • improve integration between ambulance services, mental health teams and community services 
  • invest in rural mental health services to reduce reliance on emergency responses 
  • develop targeted crisis response pathways for rural populations 

Gaps  

  • the study focuses on ambulance attendances and does not capture individuals who experienced mental health crises but did not contact emergency services 
  • the analysis is limited to the COVID-19 pandemic period and may not reflect longer-term trends in rural mental health emergencies 
  • the research focuses on ambulance service data and does not include patient outcomes following emergency response 
  • further research is needed to understand how service availability affects crisis presentations in rural communities 

Commentary 
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.

Health and wellbeing challenges in rural England

A report examining health outcomes, deprivation and service access in rural England, highlighting hidden health inequities and the need for locally tailored public health strategies.

Key statistics 

  • 19% of England’s population lives in rural areas, yet these areas cover around 85% of the country’s land area 
  • people living in rural areas generally have better overall health outcomes than those in urban areas, including longer life expectancy 
  • however, rural areas contain small pockets of significant deprivation and poor health outcomes that may be hidden within overall averages 
  • rural populations tend to be older on average, with higher proportions of residents aged 65 and over compared with urban areas 
  • the sparsity of rural populations and greater travel distances can affect access to services, employment and support networks 

Key messages 

  • overall health indicators in rural England often appear favourable, but they can mask significant local variations in deprivation and health outcomes 
  • rural populations are typically older, increasing demand for health and social care services 
  • geographic sparsity and distance between communities can influence access to services and support 
  • local authorities need detailed knowledge of rural populations to identify hidden health challenges 
  • better local data and more granular statistics are needed to reveal health disparities within small rural communities 

Policy implications 

  • improve local data collection to identify hidden deprivation and health needs in rural areas 
  • develop rural-specific public health strategies rather than relying on national averages 
  • strengthen collaboration between health services, social care providers and local authorities in rural communities 
  • consider transport, service accessibility and population ageing when planning rural services 
  • support community-based approaches that address local health needs in dispersed populations 

Gaps 

  • national and regional statistics often mask variation within rural communities 
  • limited granular data exists on health outcomes in smaller rural settlements 
  • further research is needed to understand how service accessibility affects health outcomes in rural areas 
  • more evidence is needed on the effectiveness of rural-focused public health interventions 

Commentary 

This report examines the health and wellbeing of people living in rural England and highlights the complexity of rural health outcomes. Rural areas cover most of England’s land area but contain a relatively small proportion of the population. Despite this, rural communities play an important role in the national health and social care landscape. 

On average, people living in rural areas experience better overall health outcomes than those living in urban areas. For example, life expectancy tends to be higher and some health indicators appear more favourable. However, these averages can hide important differences within rural communities. 

The report emphasises the presence of “hidden deprivation” in rural areas. Small pockets of poverty and poor health may exist within otherwise affluent rural districts. Because rural populations are smaller and more dispersed, these issues may be less visible in national or regional statistics. 

Rural populations also tend to be older than urban populations. Higher proportions of residents aged 65 and over increase demand for health and social care services, including community support and long-term care. 

Geography plays an important role in shaping access to services. Rural communities often experience longer travel distances to healthcare facilities, fewer public transport options and limited availability of specialised services. These factors can make it more difficult for people to access timely support. 

From a health and social care equity perspective, the report highlights the importance of recognising rural diversity. While some rural areas experience strong health outcomes, others face significant challenges linked to deprivation, ageing populations and limited service access. 

The report argues that local authorities need detailed understanding of their rural populations in order to identify and address these challenges. More granular data and locally tailored policies may help ensure that rural communities receive appropriate support and that hidden inequities in health and wellbeing are addressed. 

Recruitment and retention challenges in adult social care

A study examining recruitment and retention challenges in adult social care services in England, including workforce mobility, rural employment barriers and the role of commissioning and labour market conditions.

Key statistics 

  • the adult social care workforce in England includes around 1.47 million jobs (at the time of publication), making it one of the largest employment sectors in the country 
  • the sector experiences high staff turnover and vacancy rates, reflecting ongoing recruitment and retention challenges 
  • competition with other sectors, including the NHS and retail, contributes to recruitment difficulties because these sectors may offer higher pay or more predictable working conditions 
  • some rural areas report additional recruitment barriers linked to travel requirements and limited public transport, meaning staff often need access to personal vehicles to undertake care roles 

Key messages 

  • recruitment and retention difficulties in adult social care are longstanding and influenced by pay, working conditions and labour market competition 
  • local labour market conditions and geography influence the ability of providers to recruit and retain staff 
  • rural areas may face additional workforce barriers due to travel distances and limited public transport 
  • care providers have limited control over service prices, which affects their ability to improve pay and working conditions 
  • diversifying the workforce, including attracting groups currently underrepresented in social care employment, may help strengthen workforce sustainability 

Policy implications 

  • improve pay, working conditions and career development opportunities within adult social care 
  • strengthen workforce planning across health and social care sectors 
  • consider transport and travel barriers when planning workforce strategies in rural areas 
  • clarify the role of local authorities in market shaping and supporting workforce sustainability 
  • develop initiatives to attract a wider range of people into the social care workforce 

Gaps 

  • much of the evidence is based on interviews and stakeholder perspectives rather than large-scale workforce data 
  • the study focuses primarily on England and may not fully reflect workforce conditions in other UK nations 
  • limited evidence is presented on the long-term effectiveness of specific recruitment or retention interventions 
  • further research is needed on how workforce policies affect regional workforce stability 

Commentary 

This study explores the challenges involved in recruiting and retaining staff in adult social care services in England. The social care workforce is large and diverse, yet the sector continues to experience difficulties attracting and retaining staff. 

Low pay and demanding working conditions are commonly cited reasons why people leave social care roles. Care providers must also compete with other sectors such as the NHS, hospitality and retail, which may offer higher wages or more stable working hours. These labour market pressures can make it difficult for social care employers to recruit and retain staff. 

Geography also influences workforce recruitment. In rural areas, care workers often need to travel between people’s homes to provide support. Where public transport is limited, workers may need access to a personal vehicle to take up these roles. This requirement can limit the pool of potential staff and make recruitment more difficult for rural providers. 

The report also highlights the influence of commissioning and funding arrangements. Social care providers often have limited control over service pricing because fees are set through local authority commissioning processes. When funding levels are constrained, providers may struggle to improve pay, invest in training or create more stable working conditions. 

From a health and social care equity perspective, workforce shortages can affect the availability and quality of care services. Areas that face greater recruitment challenges may experience reduced service capacity or higher staff turnover, which can affect continuity of care for people receiving support. 

Overall, the report suggests that improving recruitment and retention will require coordinated action across workforce policy, funding arrangements and labour market conditions. Addressing these issues is important for building a sustainable social care workforce and ensuring equitable access to care services across different regions.