Casebook March 2022

Casebook March 2022

Posted: March 25th 2022


In Casebook this month, some interesting stories about a resilient coronavirus, the impact of rising prices and a shortage of dedicated facilities on mental health in rural setting and an emerging agenda for our work next year.

Would-be paramedics hit with £27,500 bill to retrain for vital service

I suspect this unfortunate situation will impact the pipeline of paramedics available in rural settings.  This story tells:

Professionals who want to retrain as paramedics are facing tough financial decisions after discovering they are barred from government funding.

Many who were inspired by the pandemic to join the NHS say they are being treated as second-class applicants because an outdated policy has excluded them from loans and grants available to almost all other mature healthcare students.

Since September, trainees must complete a university (BSc) degree to qualify as a paramedic. However, paramedic science, unlike other NHS professions, is ineligible for a student loan if studied as a pre-registration (second) degree course in England. Those wanting to join ambulance crews face £27,500 tuition fees.

They are also barred from receiving a £5,000-a-year NHS maintenance bursary launched in 2020 to encourage healthcare recruitment. Most pre-registered students studying related subjects are eligible for the money, which is not means tested. Mature students in Scotland, Wales and Northern Ireland qualify for varying degrees of government support.

The English funding anomaly means that a paramedic seeking to retrain as a nurse or a dentist can apply for a student loan and an NHS learning support grant, whereas a nurse or dentist who wants to retrain as a paramedic will have to fund fees and training expenses, as well as living costs, themselves.

‘Pandemic is not over’: ministers criticised for scrapping UK Covid surveillance

Have we taken our foot off the gas too soon??

Ministers have been accused of “turning off the headlights at the first sign of dawn” after scrapping nationwide Covid surveillance programmes, with scientists saying it will almost certainly end up costing more money in the long run.

Last week, scientists announced that the React study – which randomly tests about 150,000 people across England each month to see how many are infected with coronavirus – will be scrapped at the end of March, and no further data will be collected beyond that point.

Funding is also being withdrawn from the Zoe covid symptom study, the Siren and Vivaldi studies (which monitor infections in health workers and care homes) and the CoMix social contacts survey, while mass free testing is due to end on 1 April.

The Office for National Statistics’ Covid infection survey, which regularly samples the same 180,000 people to estimate what percentage of the UK populations is infected, will continue.

It comes as growing numbers of new infections in multiple countries led one expert to prompt speculation that Europe could be at the start of a sixth wave of Covid infections, partly driven by the “stealth” BA.2 Omicron variant.

What is Deltacron? Everything you need to know about the new Covid-19 variant

This virus just refuses to be shaken off and with mutations like this I worry that another bleak winter for rural dwellers could be in store. This story tells us:

A fresh reminder that the pandemic is not yet over comes as new Covid-19 variant Deltacron is officially identified with cases confirmed in France and the US.

Deltacron is a Covid variant that is made up of elements from both Delta and Omicron.

It contains genes from both of these previous variants, which makes it a recombinant virus.

This is when the genetic material from more than one origin is combined- in other words, when someone is infected with two variants at the same time and their cells then replicate together.

‘Inadequate’ children’s mental health hospital ‘put safety of patients at risk’ CQC report finds

Services for children with mental health challenges are rarely discussed. For rural dwellers they are few and far between and we often end up with major dislocation for people wanting to access services and their families. This story reminds us that where these services do exist they are sometimes contested in terms of their effectiveness. It tells us:

Serious safety concerns have been raised about a children’s mental health hospital where staff lacked respect for patients, as the provider faces a police investigation into another one of its units.

The concerns about this hospital come as The Independent revealed police have launched an investigation into another mental health unit run by the provider.

Tenants face having to find extra £1,000 for 2022 rent and bills

This story, filtered through the lens that it is more expensive to live in rural setting in terms of both rent and utilities is worrying. There is strong evidence that the quality of housing impacts on the mental health and well-being of residents. It tells us:

Tenants already struggling with the cost of living crisis typically face having to find an extra £1,000 this year to cover higher rent and essential bills, research shows.

The estate agent Hamptons said tenants’ finances faced a record squeeze as higher rents and energy bill increases combined to pile more pressure on households in Great Britain.

Recent research from other property firms such as Rightmove has already shown that rents have been rising at their fastest rate on record as tenants making plans for a post-pandemic life jostle for properties. In its latest monthly lettings index, Hamptons said this strong growth led to the average household in Great Britain spending 42% of their post-tax income on rent in 2021 – the highest proportion since its records began in 2010.

When other costs such as gas, electricity, council tax, broadband and a TV licence were included, it meant a typical household spent 52% of their post-tax income on rent and bills in 2021.

Other stuff

In this month’s “Other Stuff” we reference some thinking on our priorities for 2022. Here are four things we would like to achieve, all inspired by our Parliamentary Inquiry. If you are interested in joining in please let us know:

1) Piloting of the National Centre for Rural Health and Care Toolkit (PI recommendation 4)  – We have 4 early adoption areas on standby to implement the rural health and care toolkit, develop with Rural England. They are: Devon, Lincolnshire, Suffolk and Shropshire. Output 4 detailed case studies and the directly positive health outcomes arising in these settings. 

2) Develop a curated network for innovative primary care centres which are community focused (PI recommendation 12) – identifying and sharing best practice about multi-agency working, self-care and increased health literacy in relation to rural health inequalities. We intend to have an initial focus on coastal settlements associated with the key health workforce challenges identified in the PMOs 2021 report. Output a gazeteer of best practice and a fully functioning and self supporting ongoing network. 

3) Create a knowledge exchange of good practice and problem solving focused on the rural challenges associated with the interface between health and care (PI recommendation 10 and 11) – we will undertake detailed research across England and follow the international good practice leads arising from the Parliamentary Inquiry to look at writing up and sharing examples of where dislocation at the interface of health and social care, in the context of local delivery blight desired outcomes. This will focus on more effective resourcing of early discharge from acute settings, the most effective examples of staffing of domiciliary care and the effective use of technology to support innovation. We will not only create a repository of good practice but we will create a self supporting network of rural ICS interested in this theme, beginning with our own membership, but open to all.  Outputs detailed report covering best practice and a dedicated ongoing community of practice. 

4. Create a rural mental health network (PI cross cutting) – there is significant recognition of the need for a good practice and network facility to address the particular nature of rural mental health. The Scottish national rural mental health strategy has delivered a real impetus in terms of the recognition of this issue and has driven preventive improvements and a recognition of the importance of this issue from a workforce perspective, both in terms of the skills needed to address mental health challenges in rural settings and the mental health challenges facing rural health practitioners. Output, Rural Mental Health Strategy and good practice dissemination materials and plan.