A report published by The Nuffield Trust has revealed that people living in rural regions of the country are getting worse hospital services than those in urban areas.

The report, funded by the National Centre for Rural Health and Care, found that rural hospital trusts are facing funding difficulties – six of England’s smallest and most remote hospital trusts now account for nearly a quarter-of-a-billion pound deficit. Although, these trusts account for just 3% of all trusts, they actually account for a quarter (23%) of the overall deficit for trusts.

The Nuffield Trust considers that the formula for the distribution of NHS funding is “unclear, unfair and fails to fully compensate remote and rural areas for the extra costs they face.”

Rural hospital trusts face a number of challenges not faced by urban trusts: they tend to be smaller due to their remote location so can not work with others to make savings; the population they serve is older and more sick, with 24% of the rural population over 65, compared to 19% in urban areas; long journey times for staff; and difficulties in staff recruitment and retention.

As a result, rural hospitals are considerably behind the national average on meeting targets for A&E waiting times and 8-week treatment times. In small rural hospital trusts  A&Es only manage to see 84% of patients within 4 hours, compared with over 90% in most urban areas. Additionally, only 79% of patients needing treatment are seen within the 18 week target compared to 85% elsewhere.

There are also issues in delayed discharge – the number of days lost to delayed transfer of care (DTOC) are 118 per 1000 admissions in rural hospitals compared to 81 to 1000 in other trusts.

Rural hospital trusts are also faced with recruitment and staffing shortfalls which mean they often have to rely on costly agency staff, which adds to the financial pressures.

Many of these challenges were also highlighted in a 2017 report in the BMJ by David Oliver, a consultant in geriatrics and acute general medicine. He noted the issues of staff recruitment and retention in rural areas, long distances between sites and patients, particularly in community care, worse public transport, plus the higher proportion of elderly patients in the rural population. He noted that “funding formulas don’t reflect these additional costs, further disadvantaging rural areas.”


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