Calls for end to ‘underfunding’ that damages rural hospitals

PATIENTS who live in the countryside get a raw deal because rural hospitals are underfunded, research suggests.

A study by The Nuffield Trust think tank said the way the NHS distributed funding was “unclear, unfair and fails to fully compensate remote and rural areas for the extra costs they face”.

As a result, patients in isolated areas faced longer waits for treatment, and were far more likely to fall victim to bedblocking, it found.

The research, commissioned by the National Centre for Rural Health and Care, found that the funding situation was so precarious that six of England’s smallest and most remote hospital trusts now account for nearly a quarter of the £1billion NHS trust deficit. It warned that funding formulas failed to take proper account of the fact those living in rural areas were likely to be older and sicker than average.

On average, at small remote hospitals just 84per cent of patients were treated in A&E within four hours, compared with 90per cent of those in other trusts. Just 79per cent of those needing treatment began it within 18 weeks, compared with 85per cent elsewhere.

The number of days lost to bedblocking was far higher in small remote hospitals, the research showed, with 118 per 1,000 admissions, compared with 81 per 1,000 admissions in other trusts. The average trust deficit was four times that of others, it found.

Researchers said NHS trusts in rural areas faced cost pressures that were not properly compensated, including difficulties recruiting staff, meaning higher reliance on costly agency staff. It also said previous research found those in rural areas tended to be sicker by the time they used health services.

Rural populations are older, with 24per cent aged over 65, compared with 16per cent in urban areas, data from the Department for Environment, Food and Rural Affairs shows. However, the factors used to determine funding take at least £1.3billion a year away from rural areas, the study found.

Prof John Appleby, the Nuffield Trust’s chief economist and director of research, said: “The evidence is mounting that small and remote hospitals face higher costs that they cannot avoid, with comparatively poor performance against key NHS measures and dire financial positions. It is certainly worrying that the methods used to allocate funding to these hospitals are inconsistent, obscure and depend so heavily on judgment. We recommend that the true scale of costs is examined again.”

Jan Sobieraj, the National Centre for Rural Health and Care chief executive, said: “This report is showing us that there is growing evidence that rural healthcare is not properly funded.”

“The choice that trusts in these areas have is to either have a deficit, or find themselves in danger of not having enough resources to cover the service.”

An NHS England spokesman said: “People in every part of the country will benefit from NHS funding rising by at least 17per cent over the next five years, as part of investment worth £570billion to support the long term plan for the health service. The NHS funding formula is overseen by an independent panel, and already accounts for unavoidable costs related to providing services in rural areas.”