The Context
There are different challenges and barriers when delivering care in rural areas compared to cities. Delivering adult social care in rural areas is challenging due to barriers such as physically accessing services; staff recruitment and retention; limited choice and higher costs. Despite the evidence suggesting the existence of a strong sense of community in rural settings, loneliness is a common problem that needs to be addressed.
This network began with an evidence review by Dr Victoria, IMPACT Project Officer for Wales, identifying why social care is different and challenging in rural areas. The evidence review first identified the differences across the UK:
- 17% of people in Scotland live in rural areas (6% in remote rural areas), The Scottish Government introduced the National Care Service Bill. This has to include thinking about creative social care for people living in Island communities.
- In Wales, 32.8% of people live in rural areas (Office for National Statics 2013). Community resource teams (CRTs) in Pembrokeshire include integrated and coordinated teams of health and social care oriented to work with people living at home. This approach was effective in providing co-ordinated and seamless care, focusing on both vertical and horizontal integration (Thiel et al. 2013b)
- 36% of people in Northern Ireland live in rural areas (Scott 2020). In Northern Ireland, they have a law called the Rural Needs Act.This says that all policies and public services must consider the needs of people who live in rural areas
- 9.7 million people live in rural areas in England (Department for Environment, Food & Rural (2022) and 25.4% of people living in rural areas were aged 65 and over, in comparison with 17.1% of those living in urban areas.
Our Networks
- Eden Country Care – Cumbria, North-West England
- Carers NI – Northern Ireland
- Mencap NI – Northern Ireland
- Hywel Dda University Health Board – West Wales
- Self Directed Futures – South England
Discussion Materials
The initial discussion material included case studies where organisations have tried to tackle these challenges. Rurality is complex. There are debates about how to define ‘rural’. Size and density of population and accessibility to urban areas are generally used for statistical analysis (Department for Environment, Food & Rural Affairs 2021; Department for Environment, Food & Rural Affairs 2022; Scottish Government 2022) but in reality, rurality is more complicated and an approach should be used based on the specific characteristics and needs of the area.
There are three key challenges related to delivering adult social care in rural areas:
- Characteristics of population in rural areas – In addition to demographics, this also includes culture and family configurations. Assuming people only come from one background and have similar needs leads to different levels of care and inequalities. A case study from the South Eastern Health and Social Care Trust in Northern ireland Recovery College highlighted how collaboration can help with the design of services in rural areas to better meet the needs of the local population.
- Loneliness and isolation – When it is hard to access services, support, or friends and family due to people’s conditions or illnesses, this can feel much worse. A lack of transport and infrastructure can stop people from being able to physically travel to access services and support. A case study from the Highlands team in Scotland highlighted an example of integrated care online to support care delivery in rural areas.
- Workforce issues. – There are a number of workforce challenges associated with delivering care in rural area including recruitment in remote areas and the higher costs of delivering care services and less funding per patient compared to urban areas. Two case studies were provided to showcase effective partnership working in rural areas. The Midhurst Macmillan service in Southern England and Community Resource Teams in Pembrokeshire, Wales.
First meeting discussions
After reading the evidence review, the networks discussed the content and shared their own experiences of rurality in their local area. Although National and local policy contexts are different across the Networks, people shared some similar problems about social care in rural areas, these included:
Poor transport links
Transport was identified as a specific issue of rural areas.
The remoteness of certain houses and poor infrastructure
“some roads are not even paved” – makes it complicated to find carers and social workers who want to provide support in the area.
Fewer services and care workers
Recruitment is harder in rural areas.
Fewer social workers and care workers want to work in rural areas
This is due to the long distance that needs to be done in order to provide support which can be very expensive and time consuming for the care supporter.
Poorer quality care
Participants reported a series of negative experiences in accessing the support they needed- not being able to choose meant some people had to choose between poor quality care or no care.
Difference in children’s and adult’s social care services
One network highlighted the drastic difference in children’s and adult’s social care services and the lack of future care options for young people living in rural areas.
Reliance on unpaid carers
Due to lack of services in rural areas, carers are under pressure as they try to fill the various holes in the social care and health systems.
Digital exclusion
Technologies can improve the communication with people living in remote areas and provide support to reduce isolation. However, not all rural areas have good quality internet and some are not reached at all. Additionally, the use of the internet is a problem also in relation to the population age of some rural areas.
Getting information and advocacy
Another common theme was the difficulty in getting information – “How do you know what you don’t know?” Networks discussed the complexity of accessing information about services and where to seek help. This adds further stress over the struggle of unpaid carers.
Discussion Summary
- Rural areas need social care services designed and created for the place and the community
- Importance of knowing the geography of the place. “We need to identify the real needs of the people and the existing strengths in the community.”
- Volunteers are important. They helped out a lot in the COVID-19 pandemic in local communities.
- Innovation or new ideas are the key. Networks agreed that the delivery of social care services and support to rural communities requires a more innovative, personalised and outcome-based approach.
- There are different good practices in the UK and internationally. Networks are interested to know more about them.
- Participants thought that Multidisciplinary teams (teams with different professionals from social and healthcare) – a good solution to avoid multiple appointments in an already dispersed territory.
- The creation of a network of support in the community – called Community Development- was proposed as a good way to solve rural community lack of care services.
Third meeting discussions
As networks developed their local action plans, common themes were identified when looking at solutions to issues in rural communities.
- Equity of access to services across the 4 UK countries: the main issue of rural areas is the unequal access to services due to scarcity of services and the remoteness of some people/communities. In Northern Ireland in particular carers felt it was very frustrating going online in search of services and finding that they were only available in parts of England or they were only available in parts of Northern Ireland.
- Establishment of partnerships across multiple service providers: for example, one network is looking at partnership between public transport and third sector; or the strategies for Age-Friendly Community Development in Cambridge which is based on a systems-wide collaboration between different services.
- New and innovative ways to face the lack of services and shortage of staff: such as multi agency ambulatory, self employed care for people who cannot access services and intro-agencies were just few of the potential solutions discussed.
In each local network, the groups came up with potential action plans, and identified through a theory of change approach, what they can do as a local group, and with IMPACT to create change.
Northern Ireland
The Mencap group focused on:
- Better coordination of local transport between agencies (e.g., day centre buses).
- Higher priority on healthy living for people with learning disabilities.
- Increased involvement of people with learning disabilities in decision-making around transport.
- Learning from other networks’ experiences to address staffing, funding, and transport issues.
South England
The network run by Self Directed Futures aims to make Cambridgeshire a happier and healthier place for older people to live, by:
- Empowering older people to feel valued members of society.
- Systems-wide collaboration across housing, voluntary sector, and others.
- Exploring and implementing innovative solutions.
Social Care in Rural Areas