A new report from Policy Exchange, The Rural Penalty, highlights a problem that will be familiar to many people living in the countryside. Too often, public services are designed around the needs of urban communities, leaving rural people to make do with a system that does not reflect the realities of where they live.
The report raises important questions about the government’s plans to shift more care into neighbourhood services. Bringing healthcare closer to home is a worthwhile ambition, but it will mean little if the model fails to account for rural geography. A service that works well in a densely populated town may not be practical across a large rural area. Centralisation should not be presented as local care simply because it is delivered outside a hospital.
The Countryside Alliance welcomes the report and its recognition that geography matters. Access to a GP, a local pharmacy or other essential health services should not depend on whether you live in a city or a village. Yet in rural areas, distances are greater, public transport is often limited and smaller practices face higher costs with fewer opportunities to spread them. Seasonal populations can place additional pressure on services, while recruiting and retaining healthcare staff can be more difficult.
These are not marginal issues. They affect whether people can get an appointment, how far they have to travel for care and whether a local service can remain viable at all.
The answer is not necessarily to spend more everywhere. It is to recognise that delivering the same service can cost more in some places than others, and that funding and workforce policies must reflect this. The report’s recommendations, including strengthening rural weighting in primary care funding, recognising the pressures on smaller practices and improving recruitment and training in rural areas, offer a constructive starting point.
There is also a wider lesson here. The rural penalty is not confined to healthcare. Across public policy, rural communities can be overlooked when decisions are made without proper consideration of distance, transport, population density or the economic realities facing local businesses and services. The result is a cumulative pressure on the people who live and work in the countryside.
That is why the Countryside Alliance’s Campaign for the Countryside is calling for a rural reset. The countryside contributes more than £300 billion to the UK economy each year and supports millions of jobs, yet too often its needs are treated as an afterthought in national decision-making. The government must recognise that policies which work in one part of the country can have very different consequences in another.
A rural reset does not mean asking for special treatment. It means asking for fair treatment, with policies shaped around the realities of rural life, proper consideration of their impact before decisions are made and a willingness to listen to the people who understand their communities best.
The Rural Penalty makes a valuable contribution to that debate. Its findings should prompt the government to look again at how healthcare is funded, organised and delivered outside our towns and cities. More broadly, they underline why rural communities must have a stronger voice in the decisions that affect their future.
The countryside is not an exception to the national interest. It is an essential part of it. It is time for a rural reset.
Join the Campaign for the Countryside and write to the Prime Minister today to help make the countryside heard: www.ruralreset.org