Agenda item

An update on the Rural Health and Care Summit findings and next steps.

Dena Dalton and Ashley Green provided the Board with a presentation, the key points of which are summarised below.

·        The summit was prompted by awareness of several reports, including the 2021 North Yorkshire Rural Commission report and the 2023 Healthwatch report on rurality and access to healthcare, and knowledge that over 50% of North Yorkshire’s population lives in rurally defined locations.

·        It helped attendees understand how reports and data are being used to drive change and how organisations can work together to mitigate the impact of rurality as a health inequality.

·        The following key findings arose from the summit.

-        Rural health issues are not just about access to health services but also linked to wider determinants like transport, digital connectivity and housing.

-        Integration across care sectors (primary care, local authority, voluntary, community) is crucial. Concerns were raised regarding the transfer of patients between hospitals.

-        Workforce shortages are a pressing issue, especially for community transport.

-        People may be reluctant to seek help because of limited access to healthcare. There is a lack of local provision, a predominantly older population, a high cost of transport and fuel, a reliance on others for transport (but a difficulty in getting taxis), and extreme weather can prevent people from attending appointments. Concerns about ambulance services in remote areas were also raised.

-        The withdrawal of local services, not just health but also shops, is contributing to loneliness and isolation. Unreliable digital access can cause issues as health services move online.

-        Concerns about confidentiality in small communities may make people less likely to share mental health concerns with local contacts. Safeguarding and domestic violence may go unnoticed in rural communities.

-        Poor road infrastructure (lack of lighting, potholes, and narrow lanes) may act as a barrier physical activity.

-        Old housing with poor conditions and heating can contribute to worse health.

·        The following improvements were suggested at the summit.

-        The development of appointment clusters and the improvement of transport. The potential of holding appointments in village halls and community centres. Reviewing models of care like district nursing and health visiting to better meet rural needs.

-        Utilisation of technology to offer virtual wards and digitised health records.

-        Enhancing the appeal and viability of rural areas through the development of affordable and key worker housing to help address workforce shortages.

-        Utilising Integrated Neighbourhood Teams and involving communities in the design and delivery of care.

-        Making better use of local premises through colocation of services (i.e. NYC and the NHS).

The discussion also covered Healthwatch’s report on understanding the challenges and promoting help-seeking in farming communities. This report highlighted that 79% of North Yorkshire's land is used for farming and it sought to understand why farmers often present late with health issues. Key findings included high rates of muscular pain (nearly 75%), stress, anxiety, depression (just under half), and sleep problems (about a third).

·        The following barriers faced by farmers were highlighted.

-        The 24/7 nature of farming makes it hard to arrange and attend appointments.

-        Access difficulties are significant.

-        Concerns about losing gun licenses if diagnosed with a mental health issue.

-        There is a tendency to not think their problems are severe enough.

-        Farmers are often more likely to talk to their vets about their health than GPs, highlighting the importance of trusted relationships and professionals who visit them.

·        The following solutions were suggested.

-        Delivering services directly to rural communities through mobile health units offering drop-in clinics at locations like auction markets and farm sites. This approach is being piloted.

-        Utilising local venues such as community hubs, pubs, and village halls to share information about available services.

-        Ensuring confidentiality to build trust and encourage engagement.

-        Communicating in clear, accessible, and culturally appropriate language.

-        Equipping rural professionals with training and resources to guide and refer farmers to relevant services.

-        Offering flexible appointment options to accommodate varying schedules and needs.

Regarding next steps from the summit and the report, there was a consensus on the need to build on this work. The idea of reviewing the 2021 Rural Commission recommendations was discussed, noting that whilst they didn't focus specifically on health, they had relevant insights on housing, environment, and schooling, and perhaps should have covered health. There was a discussion about how these topics could be integrated into existing work (e.g. through organisations such as the local care partnerships, community anchor organisations and Neighbourhood Health Joint Committee). The consensus moved towards anchoring the above points to the recommendations within the Health and Wellbeing Strategy, ensuring explicit actions are delivered and monitored. Board Members were asked to take the findings of the summit and report to their respective organisations.

It was proposed that a task force – led by Dina and Ashley, and including Naomi Smith, Louise Wallace, and Mark Bradley – be convened to review the outcomes of the summit and the report. The group will assess the existing commitments and identify new areas to be addressed, with the aim of reporting back within 6 to 12 months.

It was also suggested that, similar to the inclusion of an Equality Impact Assessment (EIA) appendix in reports, a Health Impact Assessment (HIA) should be incorporated into reports of the Council.

Resolved

a)     That the update is noted.

b)     That the above task force is established.