That this House has considered healthcare in rural areas.
It is a pleasure to serve under your chairship, Dr Huq. I hope that this debate can be a constructive discussion of the particular challenges that rural communities face in accessing healthcare. In that spirit, I will open the debate by saying some things that I hope no one will find controversial.
Rural communities are bigger and further apart than urban ones and have fewer people in a wider area, which makes the delivery of basic services much harder than in major conurbations. The time and money lost to travel is higher because the distance between places is larger, and it is more challenging to recruit and retain staff in public services such as healthcare. Accessing online support—often seen as a silver bullet for the future of healthcare—can be challenging in rural areas where high-quality broadband and mobile signal have not yet arrived. All that means that securing equal access to healthcare in rural areas as in urban areas is more challenging and expensive, which has practical implications. In the Health Secretary’s constituency of Ilford North, there are 20 main GP surgeries. In my constituency of Mid Bedfordshire, there are just nine. The age of the village doctor is gone.
When my constituents heard of the plans for a neighbourhood health service, with a neighbourhood health centre, within the Government’s 10-year health plan, there was some optimism that that age might return, even if not necessarily in the same way as before. In principle, neighbourhood health centres are absolutely the right step. They are a way to empower people to get the healthcare that they need on their doorstep and to keep them out hospitals, which could then focus on those who need the most specialised care.
Does the hon. Member agree that rural communities, such as mine and his, and villages such as Lyneham, which is famous for its serious airbase and is full of veterans, now find themselves with poor GP surgeries and no future for that? People in those villages are waiting longer and longer to get that care and feel completely left behind, as they have no access to any form of health service.
I know Lyneham quite well; it is a beautiful part of the world—although of course, Mid Bedfordshire is far more beautiful. I have to agree with the hon. Lady. The situation is deeply concerning for those in rural communities who are struggling to access GPs, and, given the growth and development in our communities, access is becoming much more difficult as the years roll on.
The hon. Gentleman is making a valid point about development. In the rural village of Bosham in my constituency, a resident was recently told that they would have to wait four months for a GP appointment. Meanwhile, they have seen plans come online for the development of 300 homes behind the GP surgery, and the surgery is now expecting 600 new patients. Does the hon. Gentleman agree that we need to have an infrastructure-first principle, because the reason that residents get so frustrated with development is that they cannot see those extra GP appointments coming online once those homes have been built?
The hon. Lady front-runs entirely a point I will make later, and I thank her for doing so.
Unfortunately, that early optimism about neighbourhood healthcare was somewhat tempered by a response I received to a written question, indicating that the Government expect neighbourhoods to have a geography of around 50,000 people. I am afraid that that will do nothing for people in Mid Bedfordshire. It will mean either that rural communities on the edge of urban catchments will be split up and served by “neighbourhood” health hubs in nearby major settlements, which will likely be Hitchin, Bedford, Luton or Milton Keynes, or that one rural “neighbourhood” will cover the vast majority of rural communities, meaning that constituents will have to travel to a central location to access the services that they need. In either case, that is what already happens now.
People in rural communities can only get to healthcare services in big towns that are often a distance away. They deserve better than to be viewed as the hinterland of larger urban areas. They deserve a neighbourhood health service designed not as a one-size-fits-all solution, but as genuinely local to their needs. I appreciate that funding is not unlimited and that tough choices need to be made, but those tough choices always seem to result in rural communities losing out when it comes to access to healthcare.
My hon. Friend is making an excellent speech. Does he agree that allocating NHS resources on a strictly per head basis disadvantages rural communities, particularly when nearly a quarter of rural residents are over the age of 65 and the rural population is ageing faster than in urban areas? Will he join me in encouraging the Minister to commit to reviewing the funding formula to reflect age profile, travel times and sparsity?
Absolutely. I do join my hon Friend in asking the Minister to respond to that specific point in summing up. I know many MPs who represent rural communities have concerns about the fairer funding formula. In fact, it is not fair, particularly for rural communities. It would be helpful if the Minister were to reflect on that in his speech.
I would like the Minister to give serious consideration to amending the Government’s plans on neighbourhoods. Neighbourhoods in urban communities can likely afford to be larger. The relative impact of that in many urban communities will be minimal. However, in rural areas, we need neighbourhoods in the region of 10,000 not 50,000, so that people living in small rural towns such as Flitwick and Ampthill in my constituency do not have to leave their towns to access “neighbourhood health services” and so that people living in villages large and small only have to travel to the next village over and not to a big town many miles away.
My concern over the Government’s plans for healthcare in rural areas does not end there. In Bedfordshire, we have recently seen our integrated care board—initially serving Milton Keynes, Luton, Bedford and central Bedfordshire—absorbed into a huge conglomerate ICB covering Hertfordshire, Bedfordshire, Cambridgeshire, Peterborough and Milton Keynes. That is an area of around 3.5 million people. It is hard to see that the new ICB will be able to give the level of attention to people in our rural communities that they need and deserve.
In Wixams, a new town being built in my constituency, a GP surgery has long been promised. It was promised when shovels first went into the ground in 2007, and it has been promised ever since, but the empty field remains, waiting for a building and some doctors. Wixams now has roughly 5,000 residents, and it made up about 0.4% of the population of the previous ICB area. It needs its promised GP surgery, but residents have found it incredibly difficult to get action from the ICB. Under the Government’s new ICB arrangements, Wixams’ residents represent just 0.1% of the ICB’s population. It seems obvious to me that an already small but growing community that needs healthcare services will find that this centralisation of leadership structures will make it even harder for them to get the healthcare they need.
This is a popular debate, so there will be a time limit of three minutes to begin with, but it might drop down. The first exemplar of perfect timing will be Samantha Niblett.
Thank you, Dr Huq—it is a pleasure to serve under your chairship. I am really grateful to the hon. Member for Mid Bedfordshire (Blake Stephenson)—I will call him my hon. Friend; we were in the armed forces parliamentary scheme together—for the opportunity to speak in this important debate on healthcare in rural areas.
In my constituency, we are proud of our strong sense of community, but too many of my constituents face growing barriers when it comes to accessing healthcare. For many residents, the first challenge is distance: GP surgeries are fewer and farther between, community hospitals have been hollowed out, and public transport is limited or unreliable. When appointments are moved online or centralised miles away, what is described as efficiency can feel more like exclusion, and older residents, carers and those without access to a car are too often left struggling.
Rural practices find it harder to attract and retain GPs, nurses and allied health professionals. Smaller patient lists and higher operating costs make practices less financially viable, placing additional strain on already overstretched staff. The result is longer waiting times, fewer appointments and growing frustration for patients who simply want timely care close to home.
Those pressures are compounded by wider inequalities. Rural communities tend to have older populations and higher levels of chronic illness, yet funding formulas do not always reflect the true cost of delivering care across a large, sparsely populated area. It is also worth mentioning that South Derbyshire has a high number of falls, which accounts for a large proportion of emergency hospital admissions for people over 65, and has other negative consequences such as impacting people’s confidence and their sense of independence. Mental health services are also particularly patchy, leaving many people waiting far too long for support, if they can access it at all.
It is a pleasure to serve under your chairship, Dr Huq. I congratulate the hon. Member for Mid Bedfordshire (Blake Stephenson) on securing this important debate.
The delivery of quality rural healthcare has been neglected for too long. After years of chronic underfunding, and a pandemic from which many areas have not fully recovered, health outcomes in rural areas are on a dangerous downturn. In my own constituency, local populations are growing fast, while GPs and hospitals struggle under the strain. Dental provision in Cambridgeshire is particularly poor, with more than 2,300 people for every single dentist providing NHS services.
The picture is particularly bad among children; recent data showed that at least 45% of children have not seen a dentist in the past two years. That is simply not good enough. We know how important it is for children in particular to see a dentist: good oral hygiene has a strong link to heart health, as infections and inflammation can increase the risk of cardiovascular diseases. It is vital that all children have ready access to a dentist to prevent such debilitating conditions and to introduce important hygiene practices.
Delivering rural healthcare is not simply about hiring GPs, dentists and other healthcare professionals; it is about delivering access, with reliable transport and connectivity infrastructure that is integrated with local healthcare. In rural areas like mine, many rely on cars for travel, but many older and vulnerable residents are left to manage with public transport, which is too often unreliable and does not always take them where they need to go. A constituent might be referred to a GP in a neighbouring village that is only a short distance away, but entirely inaccessible by foot and served by perhaps only a few buses a day, or in some cases no buses at all. The Government and local ICBs must start using such real-terms information when assessing access to healthcare, to avoid rural communities being left even further behind.
It is a pleasure to serve under your chairship, Dr Huq. I thank the hon. Member for Mid Bedfordshire (Blake Stephenson) for securing this important debate.
I represent a semi-urban, semi-coastal, semi-rural constituency, and I know that delivering healthcare across a wide and dispersed population brings very real and practical challenges. I want to speak briefly about three things: hospital trust funding, staff recruitment and transport.
Unfortunately, our funding formulas do not fully recognise the additional costs of providing services over a larger geographical area. Major cities can rely on one large hospital with everything in one place, covering a range of specialities. My local trust serves a similar population size, but it goes from the south of Lancaster all the way to Barrow, around the beautiful Morecambe bay. It is not safe or practical for one hospital to try to do the whole job, yet the funding arrangements do not fully recognise those costs and tend to treat them as inefficiency, rather than as an inherent part of delivering over that geography.
Although funding rightly takes into account deprivation, deprivation can look different in different areas of the country. In my constituency, we have a mix of wealthy and low-income households in the same larger geographical area, and that often determines the funding. Pockets of deprivation get diluted and sometimes miss out on vital funding pots or targeted interventions that would really help. At the same time, my population is older, with higher rates of dementia, which is caused not only by ageing, but by poor cardiovascular health and inequalities.
Hospitals in coastal and rural areas often have persistent issues with staff retention. Professional development opportunities are often focused on the big cities, so services such as major trauma, where people need to go to do their training, are more likely to be there.
It is a pleasure to serve with you in the Chair, Dr Huq. I thank my hon. Friend the Member for Mid Bedfordshire (Blake Stephenson) for securing this debate on such an important topic.
Any Member who represents a rural constituency can attest to the practical challenges that our healthcare system faces in the countryside. It can often be difficult to sustain genuinely local GP services, and that forces people to travel long distances to access care. Where services do exist, they are often unable to provide the full suite of care owing to resource shortages or manpower deficiencies. Hospitals, of course, are even further away.
The current make-up of the workforce and workload cannot meet those challenges, so I was heartened by this Government’s plans, introduced earlier this year, to prioritise British medical graduates over foreign-trained doctors, though there is still much work to be done on ensuring that our medical training system rewards our most talented graduates.
I have also been heartened by some of the Health Secretary’s rhetoric on Pharmacy First, and the need to reduce the workload on doctors, so that the public can access basic services without contributing to the NHS waiting list. It is a superb initiative, and was launched by my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins) under the previous Conservative Government. Clearly we need to move the healthcare service towards a model that reduces the workload on doctors, trains more of our workforce here and rewards our best-performing practitioners. That would be better for doctors and patients alike, and would be particularly welcomed in rural areas, where it is often much more practical to have a pharmacy in a village than a full GP surgery.
In principle, the Health Secretary’s public statements on this issue represent a step in the right direction, but since coming to power, this Government have conceded to medical unions such as the British Medical Association, which takes an altogether different line. For example, on Pharmacy First, a scheme that allows people to be treated for simple conditions at their local pharmacy, the BMA said that patients are
Several hon. Members rose—
20 of 45 shown
To give credit where credit is due, the new ICB leadership have been very responsive to my representations on Wixams. After nearly two decades of delay, it feels like we are finally making some progress, together with the Mayor of Bedford and the hard work and commitment of local councillors Graeme Coombes, Marc Frost and Andrea Spice—all of whom I thank for their hard work. However, the point remains the same: when the area covered by ICBs is made bigger, the influence of our smaller rural communities and their healthcare needs becomes smaller.
What the Government are doing in Bedfordshire is in no way an isolated incident. I understand that the 42 ICBs that existed before will be reduced to just 26 super-ICBs once the Government’s process finishes. That means thousands of rural communities across England will have less control over their local healthcare overnight, and it was confirmed almost in the same breath as the Government’s plans to bring healthcare closer to communities. That is particularly short-sighted when put against the Government’s plans for mayors. The Government have previously spoken of their desire to line up the boundaries of mayoral areas and integrated boards. Even as part of the 10-year health plan, they stated that their aim is that:
“integrated care boards should be coterminous with strategic authorities wherever feasibly possible.”
What a fantastic idea. Doing so would give proper political accountability to integrated care boards. It would mean that the rural village has a proper elected voice at the table when decisions about the future of healthcare are being made, and a representative that they could hold accountable at the ballot box if their local healthcare needs were left wanting. That is exactly what rural communities need to ensure they get the healthcare they deserve.
The proposals, like so many others, seem to have been put back on the shelf and watered down. Now ICBs will be coterminous with lots of strategic authorities. In Bedfordshire, we are to be forced to have a mayor covering Bedford, Luton, Milton Keynes and central Bedfordshire. Our new ICB would therefore be covered by three mayors, including a mayor for Hertfordshire and a mayor for Cambridgeshire and Peterborough. That dilutes the political pressure our mayor can bring and the impact that rural Bedfordshire communities covered by that mayor can reasonably have.
If the Government change course back to the sensible idea of having an ICB and a strategic authority be coterminous, that will have been a whole lot of money wasted in two needless restructurings that could have gone into more doctors and nurses. It makes absolutely no sense—we need more doctors and nurses. In Bedfordshire, in the decade since 2016, we now have 18% more patients per fully qualified GP. That reflects the reality that in that same decade, our rural communities have been targeted for more and more development—a point made by the hon. Member for Chichester (Jess Brown-Fuller).
In central Bedfordshire alone, more than 20,000 houses have been built in that period, with many more in Luton, Milton Keynes and Bedford, including significant build-out in Wixams, as I mentioned earlier. There is barely a village in Mid Bedfordshire that has not been expanded significantly over the past decade. We expect to see many thousands more built in the coming years, including potential new towns at Tempsford and expansions east of Milton Keynes.
The old argument for healthcare with development no longer works. The argument would go, “Build a large development or new settlement. Give up a bit of what makes your rural community special, and in return you’ll get the new GP surgery or healthcare hub. You’ll get the infrastructure your community needs”. That just does not happen anymore. Now we get the houses, but the field where the GP surgery was promised remains empty, just as it has for two decades in Wixams.
The same argument has been made for the Government’s flagship new towns: build a big new town from scratch and it will come with the right infrastructure. However, the Department of Health and Social Care has not been able to confirm to me that additional funding will be provided for GP surgeries, and there does not appear to be future funding provided from the Treasury. That leaves open the prospect that GP surgeries in new towns will be funded at the expense of new GP surgeries in areas such as Wixams and other rural communities across the country, which have been waiting far too long. I would be grateful if the Minister could assure me on that point specifically.
The overall point is clear: where rural communities see development, they need infrastructure to cope with it. That is common sense; it is simple, and it is what our constituents want to see. They need to see that infrastructure arrive before the houses are occupied, and not for the burden on overstretched existing infrastructure to be relieved at some indeterminate point in the future.
It has been proposed a few times in this Session, but I fundamentally believe something must be done to allow councils and ICBs to benefit from developer contributions from the day that planning permission is granted, not as development is happening. That could be achieved by something as simple as the Government providing funding up front and reclaiming it from the developer via section 106.
This is one of the biggest issues facing my residents. When the wait to see a GP soars because of a new housing estate next door, nobody wins. I know this is not confined solely to rural areas, but it is in rural areas where existing infrastructure is strained to capacity, and where a good proportion of the Government’s 1.5 million homes are expected to be built.
I will bring my remarks to a close, and I look forward to hearing the views of others in this debate. There are particular challenges for rural communities in accessing healthcare. For too long the approach has been to centralise care in larger and larger towns, and in doing so take it away from villages and small towns. The Government’s move to centralise local healthcare decision making over much bigger areas risks leaving rural residents further behind.
The planned shift to a neighbourhood health service is welcome, but it must be a truly neighbourhood-based service. While a neighbourhood of 50,000 people might make sense in our big towns and cities, it risks leaving our rural small towns and villages out in the cold, served only as a bit on the edge of a larger urban area. Equally, as services move more and more online, consideration must be given to the challenges in rural communities that cannot get good broadband or wi-fi, for reasons beyond their control. Finally, we must ensure that development in rural areas comes with the local healthcare infrastructure that we know communities need. For too long, that has not happened, and communities such as mine in Mid Bedfordshire have paid the price.
Tracey Thorneloe, one of my constituents in South Derbyshire, experiences debilitating pelvic girdle pain as part of a chronic health condition. While pelvic girdle pain is normally experienced during pregnancy or childbirth, she began experiencing this pain six years ago and has had great difficulty accessing physio. There are no specialist physios for her condition in South Derbyshire, and access to hydrotherapy is very limited.
Wheelchair provision is also an ongoing issue in my constituency. My constituent Amanda Storer has told me of her year-long battle to get a wheelchair for her son Derrick, who has Down’s syndrome. A wheelchair allows him to be more independent and allows Amanda to get out and about more as he grows. We have helped her as much as we can, but we have been struggling too.
All that does not have to be the case; with the right investment and planning, rural healthcare can thrive. We need fairer funding that properly reflects rural need, stronger incentives to recruit and retain healthcare professionals in rural areas, and a renewed commitment to community-based services. Digital healthcare has a role to play, but it must complement, rather than replace, face-to-face provision.
I am encouraged that new technologies allow at-home testing and monitoring, which can prevent the need for regular access to GPs and hospitals, but many of my constituents face connectivity barriers as a result of poor broadband and poor mobile reception. Does the Minister agree that the Government must bring forward a strategy to end the neglect of rural healthcare, with new services for left-behind areas and a comprehensive approach to rural connectivity?
For patients living in rural areas, the cost of and lack of access to transport place huge burdens on their time and finances. I do a lot of work with Lancaster Bus Users’ Group and Sedbergh and District Public Transport Users. We all know the challenges facing rural bus services. One of my constituents was waiting in A&E with her sick child, but they had to leave the hospital before they were seen, because they simply could not afford a nighttime taxi journey.
Progress has been made; I really welcome the 10-year health plan, particularly the shift from hospital community care, which will ensure people are seen closer to home. However, I urge the Minister to consider the points I have made today about recognising the true scale of the real and unavoidable costs of serving dispersed rural communities.
“being seen by less-skilled people to further enable the steady downgrade of patient expectations”.
It has since retracted those comments, but that the sentiment exists within the BMA at all is deeply troubling. On physician associates—a group of healthcare professionals who can carry out certain assessments and tests to reduce the workload of doctors—the BMA has launched legal action over whether they can even be called “medical professionals”. Fortunately, it lost the case, but again, its overwhelming hostility towards the reforms that our healthcare system needs in rural areas is concerning.
Enabling local health services such as pharmacies to provide care is particularly important in the countryside, where it will never be possible to sustain a large hospital in a rural area. I very much welcome the Government’s rhetorical direction on Pharmacy First and on reforming the NHS workforce, but will the Minister tell us what this Government intend to do to face down groups such as the BMA, which stand in the way of the reforms that we need to provide high-quality care to the British public?