Health Policy

Rural hospitals left in the lurk says Nuffield Trust

By - Integrated Care Journal

Rural hospitals left in the lurk says Nuffield Trust

Hospitals in remote and rural areas face a steep climb to recover waiting lists if national pandemic measures continue to overlook long-stated workforce and capacity challenges.

A briefing from the Nuffield Trust has warned that national measures put in place at the beginning of the pandemic to boost NHS capacity, including the creation of seven ‘urban-centric’ Nightingale hospitals in England, the £10 billion deal to block-book independent sector hospital beds and additional support to reconfigure services, will likely disproportionately benefit trusts in urban areas.

These national measures have been accused of ‘eating up’ much of the additional funding to support the NHS through the pandemic, so a lack of tailored support could leave many rural trusts, GPs and social care services struggling to catch-up.

Nuffield Trust Senior Research Fellow, Dr Billy Palmer, said: “Our research has found that many of these national policies inadequately considered the needs of rural areas and reflect the long-standing workforce, financial and capacity issues of rural and remote services. Rural services are far less likely to benefit from ambitions to use either the urban-centric Nightingale hospitals or the independent sector to clear waiting lists.


Analysis of the challenges that Covid-19 presents for rural health services found that, while rural areas have seen fewer Covid-19 cases overall, they have seen a more dramatic impact on patient access to services than in some urban areas. This is apparent when comparing data from March to June, during the first wave, with the same data for the previous year. It identifies:

  • Larger falls in the number of patients that were seen for their first consultant appointment for cancer in rural trusts (-66 per cent) compared to a decline of 58 per cent in urban areas.
  • Over 10,000 fewer patients in rural areas saw cancer specialist in April.
  • The number of patients admitted for emergency care fell by 57 per cent for rural trusts compared with 45 per cent elsewhere.

Long-standing challenges and the starting position of trusts in rural and remote areas have put them under increased strain. These challenges include:

  • Rural sites typically have less unoccupied floor space and, arguably, flexibility. Eight per cent of floor space in non-rural sites is unoccupied compared with a lower level – just 5 per cent – in rural areas, making it more challenging to reconfigure services to cope with increasing Covid admissions.
  • Ahead of the pandemic, rural services had a higher level of occupied beds across their services (93 per cent) compared with other urban areas (89 per cent).
  • Remote and rural services have pre-existing workforce issues. They have a greater spend on agency staffing (8 per cent of budget) compared to other areas (6 per cent) meaning staff absences have a greater impact on the delivery of care.
  • While the number of hospital and community health staff increased by 7 per cent nationally in the year to June 2020, the workforce of remote trusts grew by only 5 per cent over the same period.
  • The underlying financial position of remote services was worse than the position of more urban trusts before the pandemic started and has historically been less likely to get a fair share of additional NHS national funding.

National Centre for Rural Health and Care Chair, Richard Parish, said “We continue to be concerned that Covid has made a number of rural inequalities worse. There doesn’t appear to be much short-term prospect of respite. When there is we still have to make progress towards a level playing field. This would involve, for a start, reducing the reliance on agency staff in rural health settings, speeding up rates of hospital discharge and reducing waiting times for elective surgery. ”

The briefing urges that the learning from the first wave of the pandemic should inform support for rural and remote services going into a busy winter period as the service continues to battle a second spike in infection rates.


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