Delivering and receiving services in rural areas

People who live in rural areas often face poor access to welfare services, education, employment, income and life chances, according to Shucksmith’s 2003 review into social exclusion in the country. Other research has reinforced this message and found that social care services in rural areas generally fail to provide the same level of service as those in larger towns and cities.

In recent years, there has been more recognition by UK governments that rural people and their concerns have been marginalised. In England, all new government policies are “rural proofed” to ensure that they are applicable to people who do not live in towns and cities.

Some obstacles to using and providing health and social care services in rural areas are easily recognised, such as the increased costs in time and transport taken to provide and access services, or the lack of alternative provision from the independent and voluntary sector. Others are less obvious and result from general features of rural life such as lack of anonymity, poverty and homelessness, which can impair people’s capacity to find out about services and to use them.

Evidence

The tendency to idealise country life and make inaccurate assumptions about what it is like can lead to a lack of recognition of social problems and the development of effective responses. It may be wrongly assumed that poverty, drug use, racism, and domestic violence are essentially urban rather than rural problems. Scie’s overview of research on this topic – Obstacles to Using and Providing Rural Social Care – found that overall the evidence base on rural social care is uneven. Most studies are based on what services are provided rather than what are needed.

Evidence shows considerable variability in the provision and availability of services between different rural areas. But the overall picture is of under-provision compared with urban areas. For example, older people in rural areas are likely to receive lower levels of supportive services such as domiciliary care and meals on wheels than those living in urban areas, and the general take-up rates for welfare benefits seem lower.

A possible barrier to delivering rural social care is cost. A comprehensive review of the evidence on the additional costs of service provision in rural areas concluded that there was a clear cost premium in order to achieve a similar standard of service to that in urban areas. It also found that, even where there were uplifts in rural funding, these were often insufficient to cover the service costs. For example, in one case where the uplift for rural domiciliary care was £51 a case, the modelled costs were estimated at about £460. Despite the sound evidence of the higher costs of rural provision, several reports have shown that funding mechanisms for resource allocation to public services have disadvantaged rural populations.

Stigmatisation is also widely reported in rural areas. Daily life in many small communities is often more socially exposed, as the anonymity that urban dwellers have, is not always possible in a place where movements and relationships may be more easily observed and noted. While this informal surveillance may prompt helpful interventions from friends and neighbours, it can be problematic for those whose problems do not elicit a sympathetic response or who feel ashamed, or at risk, in some way. For example, a woman wishing to escape domestic violence may be deterred from seeking help at a family centre or Women’s Aid office if she fears that her visit might come to the attention of her abuser, or she may be reluctant to enter a refuge if it means a move far from other people who might support her.

Further information
● Shucksmith M (2003), Social Exclusion in Rural Areas: A Review of Recent Research, Aberdeen: Arkleton Centre
● Rural health good practice
● Institute for Rural Health 
● Commission for Rural Communities 
● Department of Environment, Food and Rural Affairs 

Related article
Research abstracts: social exclusion in rural areas

This article appeared in the 1 November issue under the headline “Delivering and receiving services in rural areas”