Casebook November 2023

This month we focus on the cabinet reshuffle and implications for health and social care, the CMO’s annual report, a Q&A with the new Chair of the National Centre for Rural Health – Nigel Edwards, and other news including our Health and Care Seminar focusing on workforce issues on 29 November. Read on to find out more…

Cabinet reshuffle and health changes

It has been a month of big announcements in the world of politics.  This week saw a major reshuffle in the cabinet with Victoria Atkins MP being named as the Secretary of State for Health & Social Care.

Ms Atkins has a background in law and order, practising as a criminal barrister specialising in serious organised crime.  She was elected to the constituency of Louth & Horncastle in 2015 and in 2017 joined the Home Office.  In 2021, she moved to the Ministry of Justice and then, in 2022, was appointed as the Financial Secretary to the Treasury.  As a MP with a predominantly rural constituency, she says she fights for issues “including the provision of rural broadband, defence, wind turbines, coastal issues, roads, schools, the health service and the importance of the rural way of life.”  On health issues, Ms Atkins has voted for reforming the NHS so GPs buy services on behalf of their patients.

Taking to Twitter following the announcement of her appointment she said: “Our NHS matters to us all, and I look forward to working with NHS and social care colleagues to bolster services during what promises to be a very challenging winter period, cut waiting lists and improve patient care.”

On her first day as Health & Social Care Secretary she met Professor Chris Whitty amongst others to discuss bolstering services for winter, cutting NHS waiting lists, improving patient care and ending industrial action.  This is significant following Professor Whitty’s latest annual report Health in an Aging Society and the NCRHC hopes that Ms Atkins will work closely with him to address the issues he raised.

Other appointments as part of the reshuffle included Andrew Stephens MP as Minister of State in the Department of Health & Social Care.  Also appointed to the department as Parliamentary Under Secretary of State, is Andrea Leadsom MP.

This month has also seen the King’s Speech in Parliament.  Written by the government, this year it focused on growing the economy and law and order.  The health-specific announcement included raising the age of sale for tobacco products, effectively eliminating smoking for the next generation.

It also mentioned the NHS Long Term Workforce Plan.  King Charles said: “Working with NHS England my government will deliver its plans to cut waiting lists and transform the long-term workforce of the NHS.

“This will include delivering on the NHS Workforce Plan, the first long-term plan to train doctors and nurses the country needs and minimum service levels to prevent strikes undermining patient safety.”

However, there was a missed opportunity in this speech which has frustrated many health leaders.  There was no mention of the mental health reform which is long overdue and means many people are living in a state of crisis with little or no access to services.  However, with a General Election looming, one would expect this to feature as part of future electioneering.

Q&A with the new Chair of the National Centre for Rural Health & Care

This month, Nigel Edwards has taken over the Chair of the National Centre for Rural Health & Care.  Nigel currently works as an associate with PPL Ltd, RAND Europe and the National Association of Primary care, as well as with the WHO on primary and hospital care in Europe.

He has been telling Casebook more about his work and what he hopes to achieve in his new role.

What is your professional experience of Rural Health & Care?

I have a long standing interest in hospital provision in rural and coast areas and have researched solutions and worked with people developing ideas to solve these problems.  I have also done work on the challenges of rural primary care in the Republic of Georgia, Azerbaijan and Lithuania.  Recently I have also been involved in helping to develop strategies for acute care in rural areas in Northern Ireland and Wales.  As CEO of the Nuffield Trust I also encouraged my researchers to think about the rural dimensions of areas they were studying.  The Trust has previously done work with the Centre.

What impact will the government’s Long-term NHS Workforce plan have on rural communities in its current format?

It is good that a workforce plan has been developed after a long wait and the general proposals to expand and strengthen the workforce are welcome and will benefit rural communities.  However, the issues of rurality receive relatively little mention in the plan and there is more to do to develop specific responses to the particular problems of rural areas.   The programme announced by HEE last year for rural and coastal areas is a good start but may need to be much more imaginative.  New medical schools and local recruitment are a good start but perhaps we should also be thinking about whether we need professionals with a more generalist training and who are recruited to a different, more community oriented set of values than are often currently applied.

What one simple change can government make to improve the health and care for rural communities?

The easy answer to this is getting resource allocation right but, I have learned that in policy areas like this there are no single simple changes.  This is a complex area and a range of complementary interventions designed to facilitate bottom-up change and based on a deep understanding of the issues is what is required.  The coalition of interests around rural issues provides a great way of working out what needs to be done and how it can be achieved.  That’s a good thing because unfortunately some of the policy machinery in central government has been weakened and will need all the help it can get.

Is there anything else you would like our Members to know?

I am very interested to hear from members about their ideas on how the Centre can help and their views on where there is an opportunity to make the most significant difference. You can contact Nigel here.

Rural Health and Care Seminar 29 November 2023

We’ve had over 120 bookings so far for the Rural Health & Care Seminar on Wednesday 29 November 2023.  The free online event aims to discuss the topic of Rural Health and Care in England focusing on “Tackling the rural health and care workforce problem”. It will also consider in depth the points made in the National Centre for Rural Health and Care's paper in response to the NHS Workforce Plan.

Speakers include:

• Nigel Edwards, Chair of the National Centre for Rural Health and Care
• Professor Jim Rourke, Professor Emeritus & Former Dean of Medicine, Memorial University of Newfoundland, Canada
• Adrian Clements, Executive Medical Director, North Cumbria Integrated Care NHS Foundation
• Lisa Hughes, Associate Head of Workforce Transformation, Workforce Training and Education, NHS England
• Claire Flavell, Strategic Lead, Lincolnshire Talent Academy

If you haven’t already booked, please register here.

Chief Medical Officer’s Annual Report paints bleak picture for rural

Last week the government’s Chief Medical Officer, Professor Chris Whitty, published his annual report, this year focussing on Health in an Ageing Society.  In it, he says: “For policymakers, the biggest concern I have is that government and professional bodies have not recognised the degree to which the population living in older age is concentrating geographically in the United Kingdom in general, and England specifically. The great majority of people move out of cities and large towns before older age, concentrating geographically in coastal, semi-rural or peripheral areas, often with relatively sparse services and transport links.”

The report goes on to set out the challenges facing the aging rural population including the difficulty in recruiting staff in the social work and domiciliary care sector to look after these communities.  It attributes these problems to high property prices in rural areas, poor public transport, high fuel costs and higher demands from the quantity of patients.  The report warns that “if we do not tackle the health problems of these communities vigorously and systematically there will be a long tail of preventable ill health in peripheral areas which will get worse as current populations age.”  This is supported by ONS figures which show a stark picture:

The government hopes its NHS Long-term Workforce Plan will address these challenges.  However, as the NCRHC’s response to the plan explains, rural areas have specific needs and require tailored solutions.  You can read the full response here.

In the following media interviews Professor Whitty talked about ‘old fashioned answers’ like proper exercise and diet, alongside access to social and mental stimulation.  However, what the Professor and his report failed to mention is the access to the facilities which provide this, namely modern leisure centres, accessible museums, libraries and cultural venues and reliable public transport to get people there.  This year urban councils have budgeted to spend twice that of rural councils on discretionary services, receiving 38% (£135) more in Government Funded Spending Power per head compared to rural authorities.  Furthermore, people living in urban areas have public transport options to get them there.  Local authorities in rural areas have said they do not have budget to spend on these discretionary services and rural public transport remains an issue for many.

These are issues for the new Secretary of State for Health & Social Care.  As a rural MP, Victoria Atkins (Con, Louth & Horncastle) has spoken out about rural health in the past and many health professionals will be hoping that she brings her own experience to bear on implementing the government’s plan.

APPG Report shows lack of services is impacting on dementia diagnosis for rural patients

A new joint report by the All-Party Parliamentary Group (APPG) on Dementia and the Alzheimer's Society has revealed that poor access to, or a lack of services in rural areas, means many people suffering from Alzheimer's aren’t receiving the care and treatment they need.

The report follows an inquiry which “focuses on understanding the scale of impact of regional health inequalities on access to a dementia diagnosis and developing solutions to reduce their influence.”

Raising the Barriers is an “action plan to tackle regional variation in dementia diagnosis in England”.  It also considers that impact rurality can have on accessing services.  The report says that “Ageing is the biggest risk factor for dementia, and older people comprise a significant segment of the approximately 10 million people in England who live in rural areas. Rural populations are generally older – 24% of those living in rural areas are over 65, compared to 16% in urban areas. The percentage of the population aged over 85 – the group most likely to need care – is significantly higher in rural areas than in urban areas. Public Health England reported in 2019 that the population aged over 65 years old will grow by around 50% in rural areas by 2039. There are particular challenges to accessing healthcare services in rural areas, including infrastructure limitations such as sparse or unreliable transport links and internet access. In addition, living in rural areas increases the risk of social isolation and loneliness which are known to contribute to the risk of dementia. Future Health’s recent analysis of dementia diagnosis rates data for England found an association between above average levels of rural living and rates of dementia under-diagnosis.”

Mr Ian Sherriff BEM, Academic Partnership Lead for Dementia at the University of Plymouth, was amongst a group of experts who gave evidence to the APPG.  He told the inquiry that his conversations with GPs in rural regions indicated that the link between GPs and the community teams responsible for dementia diagnosis (memory clinics and community mental health teams) can be poor, with referrals often declined unexpectedly or lost in the system. 

Mr Sherriff said: “The divide between urban and rural health and care access in England is currently significant and needs to be addressed. Rural populations are generally older and the farming community in particular experiences high levels of reluctance to seek a dementia diagnosis.

“Our research and other activities is making a difference here in the South West to this, supporting and empowering those living with dementia. But, if we are to deliver real and lasting change, that needs to be driven at a national level, and this report will hopefully go some way to achieving that.”

The report makes a series of recommendations and calls on the government to put an end to the differences in dementia diagnosis rates facing people depending on where they live in the country.

To find out more about the report and its recommendations, visit: 
https://www.alzheimers.org.uk/about-us/policy-and-influencing/all-party-parliamentary-group-dementia.

Government complacent over rural mental health

The Government has published its response to the EFRA (Environment, Farming and Rural Affairs) Committee report which was published in May. 

Despite the EFRA Report finding worrying conclusions as a result of its research, the Government has found that the specific mental health needs of rural communities ‘do not require targeted action and consider that existing provisions are sufficient to safeguard rural mental health.’

This is a disappointing blow to rural communities whose needs are yet again being ignored by the Government.

Key findings of the EFRA Inquiry and recommendations are:

• Rural Communities’ needs are not fully reflected in mental health policy and services and national NHS planning.
• NHS mental health services are often not fairly accessible for rural communities, with services largely centred in towns and cities creating barriers to access, compounded by the limitations and weaknesses of rural public transport and digital connectivity.
• Far too much avoidable demand ends up at the door of Child and Adolescent Mental Health Services (CAMHS) in rural areas because of a fundamental lack of social infrastructure and youth services.

The EFRA Committee made a range of recommendations relating to mental health and crisis events, such as flooding, something many rural communities have experienced first hand during the storms in recent weeks.  Sadly the Government has no plans for upgrading local preparedness for rural populations mental health following crises events, and says that the local mental health care provision currently in place is sufficient.

The recommendations were supported by a recent BBC report on how farmers say the floods have taken a huge toll on their mental health and they have received little support. You can read the story here of Lincolnshire grower Henry Moreton who had 155 acres of land underwater, losing around £65,000 worth of oil seed rape, winter wheat and barley to flooding after Storm Babet hit.

Commenting on the report, Chair of the Environment, Food and Rural Affairs Committee, Sir Robert Goodwill, said: “Our committee was hopeful that the Government would recognise the distinct needs and circumstances of the rural population and would follow our carefully considered recommendations to support and protect them. While we recognise that the Government has taken measures to support the mental health of the general population, we are disappointed by its rejection of measures to support the specific and identifiable mental health needs of those who live in rural areas.  

“This was an opportunity to make significant changes which could greatly impact our rural communities. With this response the Government demonstrates a worrying degree of complacency on the issue and so will fail to confront the significant problem of improving rural mental health.”

The British Association for Counselling and Psychotherapy (BACP) has stated they are deeply disappointed at the government’s response to the Environment, Food and Rural Affairs (EFRA) Committee rural mental health report which called for more targeted mental health provisions for rural workers and communities.  

Martin Bell, Head of Policy and Public Affairs at BACP, said: “The government’s response to the EFRA Committee report feels like a slap in the face to rural workers and communities, and we believe they are seriously failing our farmers. Faced with a unique set of challenges, every week three people in the UK farming and agricultural industry die by suicide. Male farm workers are also three times more likely to take their own lives than the male national average. The government’s current support package for rural communities is simply not enough – so much more is needed, particularly with regards to making psychological therapies more accessible.

“We know that counselling and therapy can provide an essential lifeline to those in need in rural communities. But often people in these communities face barriers to access mental health support – such as a lack of public transport, poor internet connection, and knowing where to access the support. However, when these barriers are removed, we know that people will access help and can thrive from it.” 

ONS building a holistic picture of health in the UK

The Office of National Statistics has been reviewing its data collection and how it can create a coherent picture of health across the four nations.

Deputy Director of ONS Local and Coherence of the ONS, Becky Tinsley, has been leading the project which aims to examines how the devolved administrations and health bodies are ‘working together to improve the comparability of UK health data.’

Ms Tinsley says it is crucial to have an overview of data: “A joined-up, UK-wide, statistical picture allows for deeper and wider insight, which in turn helps users and policy makers in their decision making. Coherence is a key aspect of high-quality official statistics as the inability to compare statistics creates challenges to service planning, as well as to evaluation and development of new policies across the UK.”

She goes on to explain that the key to better outcomes is understanding the root causes: “This work will continue to better describe health across the four nations and will continue through 2024 with a greater focus on health outcomes. We will focus on providing the UK wide picture of health, improving the user experience, and understanding, and discouraging misuse of data. We will also aim to complement the existing work on health statistics by health bodies across the UK and the devolved administrations.”

You can read the full article here.