Geographical Inequities
What are 'geographical inequities'?
This theme explores inequities in accessing social care services across different regions. While distribution of services is a key focus, it also considers other factors that influence inequities and how they impact individuals and communities. These include variability in the presence of services, particularly between rural and urban areas, and the distances people need to travel to access care. Differences in the standard and reliability of care provided across regions, as well as regional variations in the costs of care and the financial burden on individuals and families, also play a role.
This theme aims to understand the complex factors driving geographical inequities in social care, shedding light on barriers to access and opportunities to address them.
Key Statistics
NHSA (2024)
CQC (2024)
RSN (2022)
References
ONS (2023). Unpaid care, England and Wales: Census 2023
Scottish Government (2024). Scotland's Carers Update Release March 2024
NI Assembly (2024). Support for Unpaid Carers in Northern Ireland
CarersUK (2024). Valuing Carers 2021/22: the value of unpaid care in the UK
The data shows notable regional variation in the proportion of people providing 50 or more hours of unpaid care per week, with Northern Ireland (3.7%) having the highest percentage across the UK. The North East of England (3.4%) and the North West (3.1%) also have high proportions, while London has the lowest (2.3%).
Key Observations:
- Northern Ireland (3.7%) – the highest proportion: This may reflect higher rates of long-term illness, an ageing population, and potentially lower availability of formal care services.
- Scotland (2.9%) and Wales (3.1%) – similar to northern England: The proportion of the Scottish population providing 50 or more hours of unpaid care per week is estimated at 2.9%, meaning that nearly one in four unpaid carers (24.3%) in Scotland provide this level of care. Overall, 12% of the Scottish population are unpaid carers, with 13.5% of females and 10.1% of males providing care. This reflects a significant gender disparity, reinforcing previous evidence that women are more likely to take on unpaid care responsibilities.
- Higher levels in northern England: The North East and North West have some of the highest proportions in England, which aligns with higher levels of deprivation and health inequalities in these areas.
- Lower levels in London (2.3%): The capital’s lower percentage may be influenced by a younger population, higher incomes allowing for private care, or better access to paid social care services.
Commentary
The geographical disparities in unpaid care suggest that access to formal social care is uneven across the UK, with rural and deprived areas more reliant on unpaid carers. Higher levels of unpaid care provision correlate with areas of socio-economic disadvantage,
indicating that those with the greatest need for support may be the least likely to receive it.
The higher proportion of women providing unpaid care (13.5%) compared to men (10.1%) is a clear gender equity issue.
This unpaid care burden can limit women’s participation in the workforce, contribute to financial insecurity, and
impact their health and wellbeing. Current social care policies do not sufficiently address this gendered impact,
leaving many women unsupported.
Regions with higher unpaid care burdens often have weaker or less accessible formal social care services, exacerbating inequalities.
The reliance on unpaid carers masks the gaps in public provision, leading to inconsistent support depending on location and economic background.
The data highlights the ongoing reliance on unpaid carers across the UK, with Northern Ireland, Scotland, Wales, and northern England having the highest burdens.
However, this reliance is not distributed equitably, with disparities based on geography, socio-economic status, and gender. Without targeted policy action, these inequities will continue to exacerbate health and financial inequalities for both unpaid carers and those receiving care.
For more insights, read CarersUK's full report into the value of unpaid care in the UK
Reference
Higgs et al. (2022).Towards an understanding of inequalities in accessing residential and nursing home provision: The role of geographical approaches
Key Messages
- Geographical modelling is essential for identifying and understanding local variations in social care service provision.
- Rural areas face significant barriers in accessing care, with lower service availability compared to urban centres.
- The demand for residential care is rising sharply, requiring urgent policy interventions to address capacity and accessibility.
- The covid-19 pandemic has affected the sector, making it critical to monitor how service provision and occupancy rates evolve over time.
- Equitable access to care requires targeted policies that reflect regional demographic and socio-economic differences.
Commentary
This study highlights stark geographical disparities in access to residential and nursing home care, reinforcing the well-documented link between social care equity and location. Urban areas, particularly in south-east Wales, have a higher density of care homes, while rural and more economically deprived areas face significant gaps in provision. These so-called ‘social care deserts’ exacerbate existing inequalities, making it harder for older adults in these regions to access the care they need. The findings suggest that demand for care home places will rise sharply over the next decade, yet the current distribution of services is already uneven. Without targeted interventions, rural communities and lower-income areas will be disproportionately affected, further deepening inequities in access to social care. The covid-19 pandemic has added another layer of complexity, affecting occupancy rates and the financial sustainability of care homes. Ensuring long-term resilience in the sector will require policymakers to use spatial analysis to direct funding and resources where they are most needed. Addressing these challenges is essential for creating a fairer, more equitable social care system across all regions.
Reference
APPG Rural Health and Care Inquiry (2022). National centre for rural health and care
Key Messages
- Geographical barriers to care mean that rural residents face longer travel times, limited public transport options, and fewer nearby services.
- Staffing shortages in rural areas create gaps in service provision, with recruitment and retention of professionals posing a significant challenge.
- Lower funding allocations fail to reflect the additional costs of delivering health and social care in rural communities, leading to under-resourced services.
- Policy solutions must be tailored to rural settings, including revised funding models, workforce incentives, and improved transport infrastructure.
Commentary
The APPG’s findings highlight how rural location is a major determinant of social care equity. Limited service availability, long travel distances, and workforce shortages make it harder for rural residents to access timely and appropriate care. These issues particularly affect older adults, individuals with disabilities, and unpaid carers who rely on local services.
The funding gap between rural and urban areas exacerbates these disparities, as existing financial models do not account for the higher costs of delivering services in sparsely populated regions. As a result, social care provision is often fragmented, leaving many without adequate support.
Addressing these inequalities requires a strategic policy response, including fairer funding allocations, incentives for health and social care professionals to work in rural areas, and investment in community-based services that reduce the need for long-distance travel. Without such interventions, rural communities will continue to fall behind in accessing essential care.
Reference
Good health brought home (2019). What makes a good partnership between housing, health and social care? UK Collaborative Centre for Housing Evidence (CaCHE)
Key Stats
- Financial impact of poor housing: In Wales, substandard housing conditions cost the NHS over £95 million annually in treatment expenses. Addressing these issues could yield a return on investment within six years.
- Broader societal costs: Poor housing is estimated to cost Welsh society more than £1 billion each year.
Key Messages
- Partnerships improve efficiency: Collaboration between housing, health, and social care leads to cost savings, better service quality, and improved outcomes.
- Person-centred services: Integrated approaches ensure services are tailored to individual needs rather than restricted by organisational boundaries.
- Cultural change is essential: Strong partnerships create positive shifts in organisational culture, increasing innovation and responsiveness.
- Six guiding principles: Successful collaboration relies on shared problem analysis, strong leadership, sustainable funding, a focus on prevention, localised service delivery, and joint budgeting.
Commentary
This report highlights the importance of integrated working in reducing social care disparities. Poor housing is a major determinant of health inequalities, disproportionately affecting lower-income and rural communities. These areas often experience fragmented services and funding gaps, making cross-sector partnerships even more crucial.
By embedding collaboration within policy and funding models, local areas can develop more equitable health and social care systems. This is particularly important in rural and deprived regions, where access to suitable housing, health services, and social care is often limited. Implementing the report’s principles can help bridge these gaps and create a more sustainable, person-centred system.
Reference
Derby City's Healthy Housing Hub (2018). Preventing hospital admissions and more
Key Stats
- Reduction in emergency care usage: A 2013–14 study reported a 39.5% decrease in A&E visits and a 53.8% reduction in acute hospital stays among clients with a history of falls who received services from the Hub.
- Sustained independent living: In 2015–16, 91% of clients remained in their own homes one year post-intervention, reducing reliance on residential care.
- Decreased hospital admissions: There was a 20% reduction in hospital admissions for emergency inpatient care among Hub clients compared to those who did not receive support.
- Improved well-being: Approximately 86.3% of clients reported enhanced health and well-being, reduced anxiety, and increased confidence at home following interventions.
Key Messages
- Preventive interventions: Addressing housing-related health hazards proactively can significantly reduce emergency healthcare utilisation and improve quality of life.
- Collaborative approach: Partnerships between housing services and health and social care professionals are essential for identifying at-risk individuals and delivering effective support.
- Cost-effectiveness: Investing in housing improvements for vulnerable populations can lead to substantial savings in healthcare and social care expenditures.
- Sustainable outcomes: Holistic interventions not only address immediate health concerns but also contribute to long-term independent living and reduced demand for institutional care.
Commentary
The Derby City Healthy Housing Hub demonstrates how targeted, place-based interventions can reduce health inequalities linked to poor housing conditions. By focusing on older adults, people with chronic illnesses, and low-income households, the Hub tackles social care inequities worsened by inadequate housing. Its success highlights the value of integrating housing initiatives with health and social care services to create more equitable support systems. Such models are particularly important in urban areas, where housing quality varies widely, and disadvantaged communities often face barriers to accessing essential care.
Reference
Making Homes Fit for Ageing and Caring (2021). Care and Repair England
Key Stats
- Non-decent homes: Approximately 2 million older households in England live in non-decent homes, with issues such as inadequate heating, poor repair, or hazards.
- Impact on health: Living in non-decent housing increases the risk of health issues, including respiratory problems, falls, and mental health conditions.
- Unpaid carers: Over 4.5 million people aged 50 and over provide unpaid care in England, a number that has risen during the pandemic.
Key Messages
- Housing quality and health are interconnected: Improving housing conditions is essential for enhancing the health and well-being of older adults.
- COVID-19 has intensified existing challenges: The pandemic has highlighted and worsened the vulnerabilities associated with poor housing and the reliance on unpaid carers.
- Policy interventions are necessary: There is a need for targeted policies to upgrade housing stock, support carers, and integrate housing with health and social care services.
Commentary
The report underscores significant geographical disparities in housing quality, with older adults in certain regions more likely to reside in substandard homes. These disparities contribute to unequal health outcomes and place additional pressure on informal care networks.
Addressing these inequities requires region-specific strategies that consider local housing conditions and resource availability. Integrating housing improvements with health and social care planning is crucial to promote equity and support healthy ageing across all communities.
Key Stats
- Demographic challenges: The South West Peninsula has the highest proportion of residents over 65 in England, at 24.2%, and is the only English rural area with greater economic deprivation than urban regions.
- Service accessibility issues: Rural, coastal, and low-income communities face significant barriers to end-of-life care, including transportation difficulties, isolation, and inconsistent palliative care services.
Key Messages
- Community engagement is vital: Involving local communities in palliative care planning ensures that services are tailored to specific regional needs, enhancing effectiveness and accessibility.
- Multisectoral partnerships enhance research and service delivery: Collaborations between academic institutions, healthcare providers, and community organisations foster comprehensive understanding and innovative solutions to palliative care challenges.
- Addressing geographical and economic disparities is essential: Targeted strategies are needed to overcome the unique obstacles faced by rural, coastal, and low-income populations in accessing quality end-of-life care.
Commentary
This study highlights the impact of geographical and economic factors on palliative care access and quality. Residents in rural and coastal areas often encounter significant challenges, such as limited transportation and health and social care infrastructure, leading to disparities in end-of-life care.
Economic deprivation further exacerbates these issues, as low-income communities may lack the resources to seek or provide adequate care. The partnership's approach demonstrates that sustainable, community-driven solutions are crucial for addressing these inequities and ensuring that all individuals, regardless of location or economic status, receive compassionate and competent palliative care.
Key Stats
- Persistence of deprivation: Between 2004 and 2015, overall deprivation exhibited a strong persistence with a correlation coefficient (r) of 0.94, while health-related deprivation had an r of 0.92.
- Regional disparities: In 2015, the North East, North West, and Yorkshire regions experienced an increase in health-related deprivation, reversing previous declining trends.
- Spatial clustering: The South East consistently demonstrated the highest spatial clustering of deprivation, whereas the North East showed the lowest, with minimal changes over time.
Key Messages
- Enduring deprivation patterns: Deprivation levels in England remained largely consistent over the study period, with minimal regional shifts, indicating entrenched inequalities.
- North-South health divide: The study highlights a persistent disparity in health-related deprivation between northern and southern regions, with the North experiencing higher levels of deprivation.
- Policy implications: Addressing these persistent and geographically clustered inequalities requires targeted, region-specific interventions to effectively reduce deprivation and its associated health impacts.
Commentary
This study underscores the deep-rooted nature of geographical health inequalities in England. The persistent deprivation, especially in northern regions, correlates with adverse health outcomes and increased demand for social care services. The pronounced North-South divide necessitates tailored policy responses that consider the unique socioeconomic contexts of these regions. By focusing on the spatial dimensions of deprivation, policymakers can better allocate resources and design interventions that promote social care equity across England.
Key Stats
- Increased domestic responsibilities: The pandemic has led to a significant rise in unpaid care work within homes, disproportionately affecting women and low-income households.
- Housing inadequacies exposed: Lockdown measures have underscored the challenges faced by individuals in substandard or overcrowded housing, exacerbating health and well-being disparities.
Key Messages
- Interconnectedness of home and care: The pandemic has revealed how housing and caregiving are deeply intertwined, with inadequate housing amplifying the burdens of care.
- Amplification of existing inequalities: Social and economic disparities have been magnified during the pandemic, particularly affecting those with limited access to quality housing and support systems.
- Need for integrated policy approaches: Addressing these challenges requires policies that simultaneously consider housing quality and caregiving support, recognizing their combined impact on well-being.
Commentary
This article sheds light on the spatial dimensions of inequality, illustrating how geographic location influences access to quality housing and care services. Urban areas with high population densities often experience overcrowded living conditions, while rural regions may face limited access to care services.
These geographical disparities necessitate tailored policy responses that address the unique challenges of different communities, promoting social care equity across diverse settings.
Key Stats
- Place of death preferences: A significant proportion of older adults express a preference to die at home or in familiar surroundings, yet many continue to die in hospital settings.
- Resource allocation disparities: Variations in local funding and resource distribution contribute to unequal access to quality end-of-life care services across different regions.
- Policy-practice gap: Despite national policies advocating for patient-centred end-of-life care, implementation at the local level often falls short, leading to inconsistencies in care experiences.
Key Messages
- Alignment of policy and practice: There is a critical need to bridge the gap between national end-of-life care policies and their practical implementation to ensure consistent and equitable care for older adults.
- Holistic care approach: Effective end-of-life care should integrate medical treatment with social and emotional support, honouring the preferences of older adults to receive care in familiar environments.
- Addressing systemic disparities: Policymakers must recognize and address the systemic factors contributing to regional inequalities in end-of-life care provision, ensuring that all individuals have access to high-quality care regardless of location.
Commentary
This study highlights significant geographical disparities in the provision of end-of-life care for older adults in England. Variations in local resources and funding result in unequal access to quality care, with some regions unable to fully implement national policies due to systemic constraints. These inequities underscore the necessity for targeted policy interventions that consider regional differences, aiming to provide equitable end-of-life care services across all areas. Addressing these disparities is essential to honour the preferences of older adults and to ensure that high-quality care is accessible to all, irrespective of geographical location.
Reference
Skills for Care (2024) The state of the adult social care sector and workforce in England
Commentary
The social care workforce vacancy rates highlight ongoing challenges in recruitment and retention,
with regional disparities creating inequities in access to care. According to Skills for Care, vacancy
rates remain higher than pre-pandemic levels, though international recruitment has helped reduce vacancies
since 2021/22. Despite this, the vacancy rate in adult social care (6.9%) remains significantly above the
wider UK economy (2.8%) and is on par with the NHS in England (6.9%), indicating persistent workforce pressures.
London (9.1%) has the highest vacancy rate, whilst the North East (4.6%) has the lowest rate, but this does not
necessarily indicate sufficient care provision, as workforce stability does not always align with demand.
Rural regions, such as the South West (6.2%), also face recruitment challenges due to long travel times for carers
and fewer local workers, leading to longer waiting times for care. Higher vacancy rates correlate with staff
shortages that reduce service availability, leaving more people without the support they need.
Skills for Care's analysis suggests that while vacancies have
fallen, pay and working conditions continue to drive workforce challenges, and without action,
these staffing shortfalls will exacerbate inequalities in access to care. Addressing these issues
through improved pay, career progression, and localised recruitment strategies is essential to achieving
a fairer, more sustainable social care system.
Additional references
- Wales
Reference
Lucas et al. (2016) Transport poverty and its adverse social consequences.
Key Messages
- Transport poverty is poorly defined and inconsistently measured, making it difficult to address effectively.
- A significant proportion of households experience transport poverty, ranging from 10% to 90% depending on the definition used.
- The transport engineering and policy professions have largely overlooked transport poverty, resulting in fragmented and inadequate responses.
- Both rural and urban populations face transport-related inequalities, with challenges exacerbated by urbanisation, migration, and economic disparities.
- Current policy approaches fail to capture the lived experiences of those affected by transport poverty, leading to limited and tokenistic interventions.
Commentary
Transport poverty is a significant but often overlooked barrier to equitable access to social care services. Individuals in deprived or rural areas often face substantial difficulties in reaching health and social care facilities due to high travel costs, inadequate public transport, or long journey times. This disproportionately affects older adults, disabled individuals, and those in lower-income households, reinforcing existing health and social inequalities. The fragmented approach to transport policy mirrors similar inconsistencies in social care provision, where access is often dictated by geography rather than need. Care workers also face challenges in reaching service users, particularly in rural areas, reducing the availability and quality of care. Addressing transport poverty requires coordinated policy responses that integrate social care needs with transport planning. Without such measures, inequalities in mobility will continue to limit access to essential services, further entrenching disparities in social care provision.
Reference
Thirkle et al. (2023) Understanding the needs of people experiencing homelessness presenting at emergency departments in rural and coastal North-East England: a quantitative study using hospital data.
Key Messages
- Individuals experiencing homelessness in rural and coastal North-East England frequently present to emergency departments with complex health issues.
- There is a significant need for integrated health and social care services tailored to the unique challenges of these populations.
- Geographical isolation and limited service availability exacerbate health disparities among homeless individuals in these regions.
- Enhanced data collection and analysis are essential for informing effective interventions and policy decisions.
- Collaborative approaches involving multiple sectors are crucial to address the multifaceted needs of homeless populations in rural and coastal areas.
Commentary
This study sheds light on the pressing health and social care challenges faced by people experiencing homelessness in rural and coastal areas of North-East England. The frequent reliance on emergency departments underscores a gap in accessible, continuous care. Geographical isolation and limited resources in these regions further compound the difficulties in providing comprehensive support. Addressing these issues necessitates integrated, multi-agency strategies that consider the unique socio-economic and environmental factors at play. By enhancing service coordination and tailoring interventions to local contexts, we can work towards reducing health disparities and improving outcomes for this vulnerable population.
Reference
Buckner et al. (2020) Ageing well in rural communities: the contribution of neighbourhood planning in England.
Key Messages
- Neighbourhood Planning (NP) has the potential to engage rural communities in shaping environments that support healthy ageing.
- Integrating ageing-well objectives into NP can influence local development to better meet the needs of older adults.
- Community-led planning initiatives may enhance social care accessibility and service provision in rural areas.
- There is a need for more empirical research to evaluate the effectiveness of NP in promoting ageing well.
- Collaborative approaches between planners, policymakers, and communities are essential to address the challenges of rural ageing.
Commentary
This study underscores the potential of Neighbourhood Planning (NP) as a tool for rural communities to create age-friendly environments. By involving residents in decision-making, NP can lead to developments that align with the needs of an ageing population, such as accessible housing, health and social care facilities, and social spaces. However, the research highlights a gap in empirical evidence assessing the direct impact of NP on ageing well outcomes. To fully harness NP's potential, it is crucial to integrate ageing considerations into planning processes and conduct further studies to evaluate their effectiveness. Collaborative efforts among local authorities, planners, and community members are vital to ensure that rural development supports healthy and active ageing.
Reference
Moriarty et al. (2018) Recruitment and retention in adult social care services.
Key Messages
- Recruitment and retention in adult social care are longstanding challenges, exacerbated by factors such as low pay and competition with the NHS.
- Rural areas face unique difficulties, notably the reliance on personal transport, which many potential employees lack, limiting their ability to take up care roles.
- The sector has developed various approaches to improve recruitment and retention but has limited control over service pricing, affecting investment in workforce conditions.
- There is a need for greater clarity on local councils' responsibilities in sustaining the adult social care workforce, particularly in market shaping and commissioning.
- Diversifying the workforce, including targeted efforts to attract underrepresented groups such as men, could strengthen the sector.
Commentary
This study highlights critical challenges in recruiting and retaining adult social care staff, with a particular focus on rural areas. The dependence on personal transport in these regions poses a significant barrier, as many potential care workers do not own vehicles, limiting their employment opportunities. This transportation issue exacerbates existing recruitment difficulties, leading to staff shortages and impacting the quality of care provided. Addressing these challenges requires a multifaceted approach, including improving public transport options, offering travel subsidies, and re-evaluating service commissioning practices to ensure they support workforce sustainability. Additionally, enhancing the sector's appeal through better pay, career progression opportunities, and efforts to diversify the workforce could mitigate some of the recruitment and retention issues identified.
Reference
Local Government Association (2017) Health and Wellbeing in Rural Areas.
Key Messages
- Approximately 19% of England's population resides in rural areas, which constitute 85% of the land.
- While rural areas generally exhibit better health outcomes than urban areas, significant pockets of deprivation and poor health exist within these communities.
- Sparsity and rurality influence poverty levels, impacting health outcomes in rural populations.
- Local authorities must gain a detailed understanding of their rural populations to effectively address health inequalities.
- There is a need for more granular statistical information to reveal health disparities within small rural areas.
Commentary
This report sheds light on the nuanced health and wellbeing landscape of rural England. Despite overall favourable health indicators, rural communities face unique challenges, including hidden deprivation and health inequalities. The influence of sparsity and rurality on poverty levels underscores the importance of tailored public health strategies. Local authorities are encouraged to delve deeper into the specific needs of their rural populations, moving beyond broad-brush indicators to uncover and address pockets of poor health outcomes. Enhancing data collection at more granular levels will be crucial in formulating effective interventions and policies aimed at reducing health disparities in these areas.
Reference
Curry and Oung (2021) Fractured and forgotten? The social care provider market in England.
Key Messages
- Adult social care in England is delivered by over 14,000 diverse provider organisations, leading to a fragmented market.
- The COVID-19 pandemic has exacerbated existing systemic issues within the social care provider market.
- Funding reforms alone are insufficient; comprehensive changes addressing market structure and provider sustainability are necessary.
- Regional disparities in provider availability and quality highlight the need for tailored local solutions.
- A coordinated approach involving policymakers, providers, and communities is essential to reform the social care market effectively.
Commentary
This report sheds light on the complex and fragmented nature of England's adult social care provider market. The diversity of over 14,000 providers contributes to inconsistencies in service quality and accessibility. The COVID-19 pandemic has further exposed vulnerabilities, underscoring the urgency for systemic reforms beyond mere funding adjustments. Addressing these challenges requires a holistic strategy that considers regional variations and promotes collaboration among stakeholders to create a more resilient and equitable social care system.
Reference
Gray, M., & Barford, A. (2018) The depths of the cuts: the uneven geography of local government austerity. Cambridge Journal of Regions, Economy and Society, 11(3), 541-563.
Key Messages
- Austerity measures have led to significant disparities in local government funding and resources across Britain.
- Central-local government relations have been reshaped, reducing the capacity and autonomy of local authorities.
- Regional disparities have been exacerbated, with deprived areas facing more severe service reductions.
Commentary
This study highlights the pressing need to reevaluate funding strategies for local governments, particularly concerning social care services. The disproportionate impact of austerity on already disadvantaged regions has intensified social care inequities, leaving vulnerable populations with reduced access to essential support. To promote social care equity, it is imperative that policymakers address these geographical disparities and allocate resources in a manner that reflects the specific needs of each community.
Reference
McCann, P. (2016) The UK Regional–National Economic Problem: Geography, Globalisation and Governance. Routledge.
Key Messages
- The UK's centralised governance model has hindered effective regional development.
- Economic disparities between London/the South East and other regions are significant and growing.
- Globalisation has exacerbated these regional inequalities, favouring already prosperous areas.
Commentary
McCann's work sheds light on how centralised governance contributes to regional economic disparities, which in turn affect social care access and quality. The book highlights that while London and the South East have thrived, regions such as the Midlands, North of England, Northern Ireland, and Wales lag in productivity, income, employment, and wealth. Regions facing economic challenges often experience underfunded social care services, leading to inequities. Decentralising decision-making could enable more tailored and effective social care solutions, addressing the unique needs of each region and promoting equity.
Reference
Hastings, A et al. (2017) Austerity Urbanism in England: The 'Regressive Redistribution' of Local Government Services and the Impact on the Poor and Marginalised. Environment and Planning A, 49(9), 2007-2024.
Key Messages
- Austerity measures have disproportionately reduced services for low-income and marginalised urban populations.
- Mechanisms include service cuts, increased personal costs, and resource shifts favoring wealthier areas.
- These actions deepen social and economic inequalities, further marginalising vulnerable groups.
Commentary
This study underscores the urgent need for policies that address the specific challenges of disadvantaged urban communities. The identified mechanisms by which austerity impacts the poor highlight areas where targeted interventions are necessary to preserve essential services, prevent undue financial burdens, and ensure equitable resource allocation. Such measures are crucial for fostering social equity and cohesion in urban environments.
Reference
Needham, C., & Hall, P. (2023) Dealing with Drift: Comparing Social Care Reform in the Four Nations of the UK. Social Policy & Administration, 57(3), 287–303.
Key Messages
- Policy drift in social care reform is influenced by factors such as high costs, political veto players, and policy complexity.
- Scotland has advanced furthest in implementing reforms, while England faces significant delays due to political and economic barriers.
- Inter-nation comparisons affect reform dynamics, with nations referencing each other's policies to justify their own positions.
Commentary
This study provides a comprehensive examination of the uneven progress in social care reform across the UK's four nations. By identifying the factors contributing to policy drift, the authors offer critical insights into the challenges of implementing equitable social care policies. Policymakers can leverage these findings to address nation-specific barriers, fostering more effective and just social care systems throughout the UK.
Reference
Hoeft, T. J et al. (2018) Task-Sharing Approaches to Improve Mental Health Care in Rural and Other Low-Resource Settings: A Systematic Review. The Journal of Rural Health, 34(1), 48-62.
Key Messages
- Engaging community health workers and primary care providers can extend mental health services in rural areas.
- Technology, such as telehealth, enables remote support from mental health specialists.
- Ongoing education and supervision are essential for non-specialist providers delivering mental health care.
- Collaborations with local communities enhance the effectiveness of task-sharing initiatives.
- Confidentiality concerns in rural settings need to be addressed to maintain patient trust.
Commentary
This study highlights the potential of task-sharing models to improve mental health care access in rural and low-resource settings. By reallocating specific tasks to trained non-specialists and integrating technology, these approaches can enhance service delivery. Successful implementation requires comprehensive training, robust supervision, and strong community partnerships. Additionally, addressing confidentiality issues is crucial to maintain patient trust in close-knit rural communities. Policymakers and practitioners should consider these factors when developing mental health interventions for underserved regions.
Reference
Moore, H. E et al. (2024) Exploring Mental Health Emergencies Attended by Ambulances in Rural England During the COVID-19 Pandemic. Journal of Rural Mental Health, 48(3), 205.
Key Messages
- The COVID-19 pandemic has led to a rise in mental health-related ambulance calls in rural areas, indicating heightened distress among these populations.
- Patients attended in rural regions were more likely to present with behavioral disturbances, suicidality, and anxiety compared to those in urban areas.
- Ambulance services in rural settings face unique obstacles, including longer response times and limited access to specialized mental health resources.
Commentary
This study underscores the critical need for tailored mental health interventions in rural communities, especially during global crises like the COVID-19 pandemic. The reliance on ambulance services as a primary response highlights gaps in accessible mental health care. Policymakers should consider enhancing community-based support and integrating mental health services within rural health and social care infrastructures to address these disparities effectively.
