National coronavirus measures hitting rural trusts worse

A new briefing from the Nuffield Trust has warned that national measures put in place at the outset of the pandemic to boost NHS capacity will likely disproportionately benefit trusts in urban areas.

The measures, which includes the creation of seven ‘urban-centric’ Nightingale hospitals in England, the £10 million deal to block-book independent sector hospital beds and additional support to reconfigure services, are all likely to disproportionately benefit trusts in urban areas. The Nuffield Trust believes that a lack of tailored support could leave many rural trusts, GPs and social care services struggling to catch up.

Analysis finds that although rural areas have seen fewer coronavirus cases overall, they have seen a more dramatic impact on patient access to services than in some urban areas. By comparing data from around March to June, during the first wave, with the same data for the year previous, it identifies: that there was a larger fall 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; and that there was a fall in the number of patients admitted for emergency care of 57 per cent for rural trusts compared with 45 per cent elsewhere.

Furthermore, the long-standing challenges and the starting position of trusts in rural and remote areas have put them under increased strain. For example, rural sites typically have less unoccupied floor space and arguably flexibility, and, 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 also have pre-existing workforce issues. They have a greater spend on agency staffing (eight per cent of budget) compared to other areas (six per cent) meaning staff absences have a greater impact on the delivery of care. In fact, while the number of hospital and community health staff increased by seven per cent nationally in the year to June 2020, the workforce of remote trusts grew by only five per cent over the same period.

Billy Palmer, Nuffield Trust Senior Research Fellow, said: “There is no denying that the Covid-19 pandemic was a game-changer across the whole health and care system. Health and care services face a tough battle ahead to recover growing waiting lists and support their staff who are working heroically against this ongoing crisis. In the early stages of the pandemic, we saw the NHS put in national measures to help the service to brace itself for a surge in Covid-19 patients. These responses should have been tailored in a way which supports local teams to meet the care needs of the communities they serve.

“Yet 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. Because of this starting position, rural areas face an ever-growing steep climb to recover from the pandemic without the growing resources, support or capacity available in more urban areas.”