Inequality

Rotary Phone

What does the transition from analogue to digital landlines mean for rural communities?

Over the next few years, landline telephone services in the UK will switch to a fully digital network. This means phone calls will be carried over the internet rather than through the existing analogue telephone system. Telecom companies plan to do this by 2025. What is being done to ensure rural areas are ready for the switch? Jessica Sellick investigates. ………………………………………………………………………………………………..

It was back in 1913 when the first long distance telephone cable was laid in Europe between Leeds and Hull. This was followed by the speaking clock in 1936 and the iconic red phone boxes (Kiosk No 6) from 1936. Following a Government inquiry after the death of five women in a house fire in 1935 the 999 emergency services number was launched. From there, in 1958, the first long distance call was made without the help of an operator (by Queen Elizabeth II via Bristol telephone exchange to the Lord Provost of Edinburgh). The last exchange closed on the Isle of Skye in 1976 which made the system fully automatic. 

In 1980 the second national digital telephone exchange was installed in Baynard House, London (known as System X), with British Telecommunications (BT) formed in 1981. In 1985 an Integrated Services Digital Network (ISDN) was launched enabling people to transmit voice, video, data and other services digitally through the existing phone network. This was followed, in 1986, by System Y,  an AXE10 digital switch to provide competition for System X which was developed by a consortium of Plessey, General Electric Company, STC and BT’s state-owned predecessor, the GPO. In 1992 the first dial-up internet was provided – and in 2000 the first UK home broadband service was launched. 

Since 2008 the transition from copper to fibre has been happening – and a housing development in Ebbsfleet was the first place in the UK to receive telephony and broadband services through optical fibre cables. In 2013, the Oxfordshire village of Deddington was chosen as a pilot location for the first fibre-only exchange. 

What is the digital switchover and why can’t we continue to use the analogue network? The Public Switched Telephone Network (PSTN) uses copper cables to carry landline voice calls between users. According to Ofcom, the PSTN has been in place for many decades and over the last 10-15 years telecoms companies have built modern internet protocol (IP) based networks which can support both broadband and landline telephone services. While some providers have maintained two separate networks – the PSTN for calls services and an IP network for broadband – other providers have replaced the PSTN and now carry phone calls over broadband. According to the telecoms industry, PSTN is reaching the end of its life and is becoming increasingly difficult and costly to maintain. It was back in November 2017 that the telecoms industry first announced its intention to retire the PSTN by the end of 2025. In 2021 BT began a major rollout of a digital service to replace old analogue technology. BT has described the digital switch on and analogue switch off as ‘a once in a generation upgrade to ensure that everyone stays connected now and into the future’.  

In practice the switch over means instead of plugging a home phone into a wall mounted socket, customers will connect their handset to their broadband router. For most consumers, the switch over is expected to be straightforward, with the exact migration process dependent on their communications provider and the equipment they use. If, however, customers do not have or want broadband, the Telephony Universal Service Obligation in the 2003 Communications Act means all consumers in the UK will still have access to a landline service should they wish to do so. 

How is the switchover from analogue to digital being rolled out? Back in 2019, Ofcom published guidance on the support that should be provided when migrating customers to digital services. This includes: giving adequate notice of service changes and offering to assist with the migration process if/where necessary (e.g., making a home visit to install a router). This was supplemented, in 2020, by guidance on treating vulnerable customers fairly. If a customer has other devices connected to their landline, such as an alarm system or telecare device, they may need to take steps to ensure they continue to function correctly following migration.    

The migration programme is provider-led and underway. For some customers the switch has already happened (e.g. when they entered into a new broadband and home phone contract). New build developments are being constructed with fibre-optic cables for both internet and phone connectivity. From September 2023, no new analogue phone lines will be sold to new customers.  

Analysis by Ofcom shows in August 2022 around 27% of landline services were being delivered over broadband, up from 15% on the previous year. In the year to August 2022 approximately 1.6 million customers migrated to a Voice over Broadband (VoBB) service.  

Openreach has been trialling measures to prompt customers still using analogue phone lines to contact their provider to upgrade to digital alternatives. The trials have been taking place in Salisbury (Wiltshire) since December 2020 and Mildenhall (Suffolk) since May 2021. In both areas restrictions include the prevention of outbound telephone calls (with the exception of calls to the emergency services) and limits to broadband speeds (to around 2Mbps). Vulnerable customers are exempt from the trials. In both areas the PSTN will be switched off by October 2023 and Openreach believe that adjusting the performance of remaining analogue services will prompt customers to upgrade their lines before then. James Lilley, Director for Managed Customer Migrations at Openreach said: “Our trials in Salisbury and Mildenhall have been a great testing ground to identify and iron out issues, and we’ve already managed to upgrade the vast majority of customers in those areas successfully. Having said that, a small minority of customers are yet to upgrade despite several attempts by their service provider to contact them, so we’re planning some gentle measures which will nudge them to contact their provider and have a conversation about their future service.”  

In September 2022 Ofcom published research to understand how customers had experienced the trial. The study found, with the exception of a minority of participants, awareness of plans for PSTN closure / copper retirement were low or superficial. Many participants flagged possible issues regarding Voice over Internet Protocol (VoIP) not working during power cuts. While participants were satisfied with communications sent from providers, some participants reflected that they had made a decision to migrate to a VoIP service without being given sufficient information to make an informed choice. 

Digital Voice is BT’s home phone service powered by a broadband connection. According to Ofcom, managed migrations by BT and Virgin Media accounted for just over half of total customers who moved to digital services in the year to August 2022. 

What does it mean for customers in rural areas? Back in March 2022 BT announced that it was pausing its migration programme while it sought to address concerns raised by customers. BT described how they had underestimated the disruptive impact the upgrade would have on customers, particularly those who rely more heavily on landlines. BT also acknowledged that it wanted to do more work on getting back-up solutions in place for when things disrupt the service such as power cuts or storms. 

Storms Arwen and Eunice, for example, highlighted how some customers – particularly in rural areas – with broadband only phone connections struggled to make calls. Ofcom mapped the most prolonged and consistent power outages during Storm Arwen by postcode, revealing how the storm had a severe impact on communication services in rural areas of Northern England and Eastern Scotland. In May 2022, the Electronic Communications Resilience and Response Group (EC-RRG) published a post incident review that outlined learnings and contained an action plan to improve the sector’s response to future storms.  

BT is currently looking at the use of hybrid phones that can switch to a mobile network and have an in-built, long-lasting battery; providing in-home mobile landlines for people without broadband; continued investment in the Shared Rural Network (SRN) to address mobile ‘not spots’; and has launched a campaign so customers better understand the need to switch. 

Data analysis by Ofcom shows that while there has been an increase in gigabit-capable coverage in both urban and rural areas, there has been a greater increase in urban areas. This is because some providers tend to focus their roll-out on urban areas. Similarly, while the majority of homes and businesses have access to at least decent broadband on a fixed line connection, around half a million premises, mainly in rural areas, do not. Ofcom is seeing small improvements in 4G coverage, partly as a result of initiatives such as the Shared Rural Network. 

BT’s digital voice rollout resumed in April 2023, starting in the East Midlands. BT has said that it will not migrate anyone who falls into one of the following categories until it has worked with stakeholders to identify the support they need: customers who use a telecare device, customers who are over 70 years of age, landline only customers, customers with no mobile signal, and customers who have disclosed additional needs.

In July 2023 the Communications Consumer Panel (CCP) published ‘the struggle for fairness’, research documenting the experiences of people living in rural and remote areas across the UK using communication services. Researchers found communication services for rural dwellers were, at best, functional for the majority, and at worst very poor. The infrastructure was not in place to enable residents and businesses to manage effectively in a digital society. The research found the landline remains an important communication service for a few households, mainly those who are on broadband for calls and keep their analogue landline as an emergency backup. Amongst these, there remains some concern about the impending copper switch over in 2025.    

Where next?Communication coverage levels remain lower in rural areas compared to urban areas. While the decision to migrate from analogue to digital has been led by the telecoms industry, there is a need to ensure that critical communications infrastructure continues to work for rural residents, before, during and after migration. Ofcom is exploring areas for further research into customers’ experiences of the migration to VoIP services. What does next generation digital calling mean for all rural residents? Watch this space. 

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Jessica is a project manager at Rose Regeneration and a senior research fellow at The National Centre for Rural Health and Care (NCRHC). She is currently evaluating hospital discharge and hospital avoidance schemes, and a service that supports older people to maintain their independence. Jessica also sits on the board of a Housing Association that supports older people and a charity supporting Cambridgeshire’s rural communities. 

She can be contacted by email jessica.sellick@roseregeneration.co.uk. 

Website: http://roseregeneration.co.uk/https://www.ncrhc.org/ 

Blog: http://ruralwords.co.uk/ 

Twitter: @RoseRegen 

Mind the [rural] gender health gap?  

Mind the [rural] gender health gap?  

While women in the UK are living longer than men, many are spending a greater proportion of their lives in ill-health and disability. Women make up 51% of the population yet they are often under-represented in the health and care system which has tended to focus less on women-specific issues (e.g. miscarriage, menopause) or how other conditions impact on women in different ways. On 20 July 2022, the Government published its first ever Women’s Health Strategy for England. Will this improve the way the health system listens to women and boost health outcomes for women and girls? And what might it mean for women and girls living in rural areas? Jessica Sellick investigates. ………………………………………………………………………………………………..

According to the World Health Organization (WHO), gender norms, socialisation, roles, differentials in power relations and control over resources all contribute to differences in vulnerabilities and susceptibilities to illness, how illness is experienced, health behaviours, access to and uptake of health services, treatment responses and health outcomes. In this context, gender can determine the health risks faced and taken. Similarly, sex can affect disease risk, progression and outcomes through genetic (e.g. function of X and Y chromosomes), cellular and physiological (including hormonal) pathways. 

Health gaps are differences in the prevalence of disease, health outcomes (both physical and mental), or access to healthcare across different groups (e.g., according to gender, ethnicity, socio-economic status). 

A male health gap is when women are generally healthier across their lives than men. Studies collated by MANUAL found Eastern European countries dominate, with Georgia having one of the largest male health gaps. The WHO, for example, found the mortality rate for males in Georgia was almost twice the rate of that for females. 

MANUAL examined the health gap by gender across 156 countries around the world. They indicated how, in many countries, while men often tend to be in positions of power, have more privilege and more wealth compared to women; this advantage does not necessarily translate into better health – indeed, men often experience poorer physical and mental health outcomes compared to women. Smoking, alcohol, and substance abuse; cultures that embrace stereotypical ideas of masculinity and patriarchy tend to score highly on male health gaps. 

Unexpectedly, the United Kingdom does not follow the trend of men being unhealthier throughout their lives – we have a female health gap, wherein women’s health is generally lower than men’s health. MANUAL has ranked the United Kingdom 12th out of 156 countries for female health, revealing it has the largest female health gap in the G20.  

In the UK, women live, on average, for longer than men. In 2019, life expectancy at birth in England was 79.9 years for males and 83.6 years for females. However, the ‘mortality advantage’ that women have is offset by the fact that spend a greater share of their life in ill health. According to the Centre for Ageing Better, the proportion of women’s lives spent with disability increased from 21.2% to 26.7% between 2006-2008 and 2018-2020 (compared to 18.6% and 21.5% for men, respectively).The data also shows that, at 65 years of age, a woman living today can expect to spend less than half of her remaining years in good health (47% compared to 53% for men). 

Why is there a gender health gap in the UK? The underlying cause is often attributed to the health system being built by men for men. According to the Royal College of Obstetricians & Gynaecologists (RCOG), too often, women are struggling to get the right information they need about their health, to book routine appointments and to get their basic health needs met. Similarly, studies have found that in many areas of healthcare women experience poorer outcomes than their male counterparts. 

  • Women are less likely to be diagnosed at the early stage of Alzheimer’s because they tend to have better verbal memories than men. 
  • Women were found to be 13% less likely than men of the same age to receive life-saving drugs such as statins after a heart attack. Women are twice as likely as men to die in the 30 days after suffering a heart attack. 
  • Women are underrepresented in clinical trials. There has been five times the amount of research into male erectile dysfunction (affecting 19% of the male population) than premenstrual syndrome (affecting 90% of the female population). 
  • Women have been unable to obtain their choice of HRT medication leading some to experience migraines, severe back pain and hot flushes. In April and May 2022 this led the Government to issue Serious Shortage Protocols (SSPs) to restrict dispensing to 3-months’ supply of Oestrogel, Ovestin  and Premique Low Dose; and allow pharmacists to substitute appropriate HRT products without a new prescription.
  • The All-Party Parliamentary Group on Menopause’s Inquiry assessing the impacts of menopause highlighted instances of women experiencing difficulties in getting a diagnosis and accessing HRT – and how they were being offered antidepressants, against guidelines.    
  • It takes 8-years, on average, from onset of symptoms to receiving a diagnosis of endometriosis. Prior to receiving a diagnosis, 58% of patients had visited their GP more than 10 times; 21% had visited doctors in hospital 10 times or more; and 53% had been to A&E. 
  • The prevalence of common mental health conditions is increasing in women. Young women in particular have been identified as a high-risk group, with over a quarter (26%) experiencing a common mental disorder – such as anxiety or depression – compared to 9.1% of young men.
  • Office for National Statistics (ONS) data has shown that since 2012 suicides amongst females aged 10 to 24 years has increased. In 2019, it reached its highest level of 3.1 deaths per 100,000 females. However, in 2019, three-quarters of deaths registered as suicide were among men.  

Commentators describe how women’s health issues are likely to be misdiagnosed or dismissed by clinicians as something less critical. Similarly, many conditions are defined as medically benign and therefore not prioritised despite becoming life limiting for many women. This all leads to services which have not been designed with women or to meet their needs.  

Numerous reports have also highlighted situations where women have suffered harm as a result of poor healthcare. 

  • The Paterson Inquiry Report found a breast surgeon, Ian Paterson, had subjected more than 1,000 patients to unnecessary and damaging operations over a 14-year period. 
  • The First Do No Harm Report looked at patient reports of harm from three medical interventions. The report highlighted the suffering of patients, many of them women, and found the health system to be ‘disjointed, siloed, unresponsive and defensive’.
  • An Independent Review of maternity services at the Shrewsbury and Telford Hospital NHS Trust found failures which may have led to the deaths of more than 200 babies at the Trust. Donna Ockenden, the author of the review, is now chairing a review of maternity services in Nottingham. 
  • ‘Reading the Signals’, an independent investigation led by Dr Bill Kirkup on maternity and neonatal services in East Kent published in October 2022 found 45 of the 65 baby deaths that occurred during the review period could have had a different outcome, and how women were treated without compassion.   

What do we do about it? On 20 July 2022, the Government published its first ever Women’s Health Strategy for England. The Strategy was updated on 30 August 2022. The 10-year Strategy sets out how the Government will improve the way in which the health and care system listens to women’s voices, and boost health outcomes for women and girls. The Strategy takes a life course approach, focusing on understanding the changing health and care needs of women and girls from adolescence to later life.

A call for evidence received 110,123 public responses, and more than 400 written submissions from organisations and experts in health and care. The Government used these responses to shape the Strategy. The call for evidence also shaped the Vision for Women’s Health Strategy which was published in December 2021. This set out the findings of the consultation and identified the key themes and areas of focus. The themes were: 

  • Women’s voices. 
  • Healthcare policies and services. 
  • Information and education. 
  • Health in the workplace. 
  • Research, evidence and data. 

The following priority areas relating to specific conditions or issues were also highlighted: 

  • Menstrual health and gynaecological conditions. 
  • Fertility, pregnancy, pregnancy loss and post-natal support. 
  • The menopause. 
  • Healthy ageing and long-term conditions. 
  • Mental health. 
  • The health impact of violence against women and girls. 

Professor Dame Lesley Regan was appointed as the Government’s first ever Women’s Health Ambassador on 17 June 2022. Building on the call for evidence, vision and the appointment of Professor Regan, the Strategy is aiming to:

  • Provide £10 million for a breast screening programme, with 25 new mobile breast screening units targeted at areas with the greatest challenges in uptake and coverage. 
  • Remove the additional barriers to IVF for female same-sex couples.
  • Improve the provision and availability of IVF to tackle the postcode lottery. 
  • Introduce a pregnancy loss scheme to recognise parents who have lost a child before 24 weeks. 
  • Update the service specification for severe endometriosis. 

Further building on the Strategy, the Government has also committed to: 

  • Transforming the NHS website so that it becomes the first port of call for women’s health information. 
  • Encouraging the expansion of Women’s Health Hubs and other models of ‘one stop clinics’ that bring women’s services together. 
  • Publishing a definition of ‘trauma informed practice’ to address barriers to accessing services. 
  • Commissioning research by the National Institute for Health and Care Research (NIHR) into healthcare professionals experiences of listening to women in primary care. 
  • Introducing specific teaching and assessments on women’s health in undergraduate curricula for all medical students from 2024-2025. 

All of this work builds upon existing work undertaken by the Government, including: 

  • The establishment of a Maternity Disparities Taskforce to tackle disparities in outcomes and experiences of care for women and babies by improving access to pre-conception and maternity care for women from ethnic minority background and those living in the most deprived areas. 
  • Investing £127 million to increase and support the maternity workforce and increase neonatal care capacity. 
  • Setting up the UK Menopause Taskforce. 
  • Reducing the cost of, and improving access to, HRT.  
  • Banning virginity testing and hymenoplasty. 
  • Enhancing women’s reproductive wellbeing in the workplace through the Health and Wellbeing Fund 2022-2025. 
  • Banning the availability of Botox and cosmetic fillers to under 18s for cosmetic purposes and banning advertisements for cosmetic surgery that target under 18s. 
  • Investing £302 million in the Family Hubs and Start for Life Programme. 
  • Providing protection to people who experience domestic abuse through the Domestic Abuse Act 2021. 
  • Abolishing the Tampon Tax, thus removing VAT from women’s sanitary products and providing free sanitary products in schools, colleges and hospitals.  

While many commentators have welcomed these developments and the Strategy, some have raised concerns around the lack of initiatives focused on ensuring health professionals listen to women. Some view the Government’s approach as being too silo focused rather than changing the culture of the entire health and care system and its workforce. Similarly, some argue that the Strategy does little to address the socio-economic barriers that some women face. The Strategy also has little to say about including women in decision making (e.g. data, research, leadership roles). 

Mind the rural gender gap? The NHS Constitution is founded on the principle of equal access to health care. The Constitution states that the NHS is available to all and that it has a ‘social duty to promote equality through the services it provides and to pay particular attention to groups or section of society where improvements in health and life expectancy are not keeping pace with the rest of the population’.  The Parliamentary Inquiry into Rural Health and Care and numerous other reports have all highlighted the unmet and growing health and care needs of people living in rural areas. And yet, there are no references to rurality in the Women’s Health Strategy for England. We already know that access to health care is more problematic for people living in rural areas (e.g. access to maternity care, primary care, secondary care) and that more needs to be done to tackle the wider determinants of health in a rural context (e.g. housing, education, employment, income). Similarly, we also know, more broadly, that the provision of public services is generally poorer in rural areas compared to urban areas. 

In March 2021 the WHO published six priorities for women and health worldwide. This was part of a recognition that women and girls face new and emerging challenges, and that the COVID-19 pandemic has exacerbated existing inequalities and disrupted access to health services. 

  1. Ensuring essential health and support services for all women and girls, and prioritising women’s health needs in global research and trials. 
  2. Elevating the position of women in the health and care workforce – ensuring they occupy health leadership roles and addressing gender pay gaps. 
  3. Preventing and responding to violence against women. 
  4. Ensuring quality sexual and reproductive health for all. 
  5. Reducing noncommunicable diseases among women. 
  6. Increasing women’s participation and leadership in science and public health. 

In the United States, the National Rural Health Association (NRHA) is calling for support programme that provide continuing education opportunities to rural doctors; outreach and education to improve health literacy and increase the signs of and treatments for illness; and for the Office on Women’s Health should appoint a rural liaison to coordinate services and activities; as well as further research to identify women’s overall health status and their access to and use of health care services in rural areas (e.g. health screenings, primary care, prenatal care, family planning services, oral care, vision and eye health services and mental health). Examples of successful rural initiatives include the University of Arkansas for Medical Sciences (UAMS) Institute for Digital Health & Innovation (IDHI) High-Risk Pregnancy Program, Wisconsin Rural Women’s Initiative gathering circle, and Chuuk Women’s Council Healthy Lifestyles Program to tackle diabetes.

While gender equality and health outcomes have been measured at a country level (with country-to-country comparisons made), there are few examples of within-country comparisons or specific rural analysis. 

Where next? For me, all of this highlights the importance of ensuring rurality is considered as part of the implementation of  the 10-year Women’s Health Strategy for England [at a national level] and by local health systems in their own plans and strategies (e.g. through the work of Integrated Care Systems, Primary Care Networks). If the health system belongs to us all, and must serve us all, will this renewed focus on women-specific issues lead to the transformational change the Government wants to see? Watch this space.  

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Jessica is a researcher/project manager at Rose Regeneration and a senior research fellow at The National Centre for Rural Health and Care (NCRHC). She is currently evaluating a support programme for patients waiting to receive NHS and local government services; and a Warm Hubs scheme. Jessica also sits on the board of a Housing Association that supports older people and a charity supporting Cambridgeshire’s rural communities. 

She can be contacted by email jessica.sellick@roseregeneration.co.uk. 

Website: http://roseregeneration.co.uk/https://www.ncrhc.org/ 

Blog: http://ruralwords.co.uk/ 

Twitter: @RoseRegen 

fuel poverty

 How can we get the measure of rural fuel poverty? 

Some households need to spend a high proportion of their income to keep their home at a reasonable temperature. While there are national and local policies and initiatives which seek to support these households to alleviate their fuel poverty, some commentators have suggested that the COVID-19 pandemic and the tragedy unfolding in Ukraine is worsening fuel poverty and more now needs to be done. While here in the UK there are immediate concerns about customer’s ability to pay their energy bills, fuel poverty is a significant and long-standing issue for all too many people, and its impact is felt across many areas of life. How much of an [increasing] issue is fuel poverty in rural areas, and what more can be done about it? Jessica Sellick investigates. 

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What is fuel poverty? In general, it relates to households that have to spend a high proportion of their household income to keep their home at a reasonable temperature. 

The Warm Homes and Energy Conservation Act 2000 committed Government to publishing a strategy ‘to ensure that so far as reasonably practicable persons do not live in fuel poverty’. This adopted a measure that a household was fuel poor if, by modelling the energy efficiency of the home, more than 10% of net income would have to be spent on fuel to reach particular temperature standards and meet other needs. The 2010 Autumn Statement announced an independent review of the fuel poverty definition and measure. 

This  Review, commissioned in 2011, highlighted three key ways in which fuel poverty is a serious national problem: 

  • From a poverty perspective: households with high energy costs living in poverty or on its margins face extra costs to keep warm above those for typical households with much higher incomes. 
  • From a health perspective: living at low temperatures as a result of fuel poverty is a significant contributor to both excess winter deaths and a number of incidents of ill-health, placing additional demands on the health and social care systems. 
  • From a carbon reduction perspective: the energy inefficiency of homes affects the ability to reduce carbon emissions, with fuel poverty providing a further barrier in terms of the implementation of policies to mitigate climate change since those on low incomes are often least able to afford any increases in prices that may result from them. 

The report emphasised the overlap between low income and the energy inefficiency of the homes people live in. The authors recommended using a definition and measurement focused on ‘individuals in households living on a lower income in a home that cannot be kept warm at reasonable cost’. The review further suggested fuel poverty should be measured by looking at low income households facing high energy costs. 

In 2013 the Government published a consultation and its response, accepting many of the review’s recommendations including measurement of income after housing costs adjusted for family size; and adopting a Low Income High Costs (LIHC) framework as a new indicator of fuel poverty and a means of assessing it. Under the LIHC measure, a household was considered to be fuel poor if they had required fuel costs that were above average [the national median level]; and if they were required to spend that amount they would be left with a residual income below the official poverty line.  

In 2021 the Government introduced a new definition of fuel poverty. Called the ‘Low Income Low Energy Efficiency’ (LILEE) indicator, a household is considered to be fuel poor if: (a) they are living in a property with an energy efficiency rating in bands D, E, F or G; and (b) their disposable income – income after housing costs and energy needs – would be below the poverty line. 

Non-governmental organisations use other definitions and measures for fuel poor households. The National Energy Action (NEA), for example, define a household as being in fuel poverty if ‘it needs to spend more than 10% of its income on energy in order to maintain a satisfactory heating regime’. Fuel poverty is a devolved policy area and defined differently in the other UK nations. The Welsh Government definition aligns with the NEA in defining a household as being in fuel poverty if ‘they would have to spend more than 10% of their income on maintaining a satisfactory heating regime’. The Northern Ireland Assembly’s definition is more specific, defining a household as fuel poor if ‘in order to maintain a satisfactory level of heating (21 °C in the main living room and 18 °C in other occupied rooms), it is required to spend more than 10% of its household income on all fuel use’. The Scottish Government introduced a two-part definition in 2019 and has a broader interpretation, defining fuel poor households where (1) after housing costs have been deducted, more than 10% [20% for extreme fuel poverty] of their net income is required to pay for their reasonable fuel needs; and (2) after further adjustments are made to deduct childcare costs and any other benefits received for a disability or care need, their remaining income is insufficient to maintain an acceptable standard of living [defined as being at least 90% of the UK Minimum Income Standard].   

Regardless of which definition is applied, the causes of fuel poverty are underpinned by three key factors: (i) a household’s income, (ii) fuel prices, and (iii) energy consumption – which can be affected by the energy-efficiency of the household’s dwelling. In a rural context, fuel poverty is often driven by rising fuel prices, an ageing housing stock that is not thermally efficient, a lack of access to natural gas supplies, and/or the costs of delivering fuel to more sparsely populated areas. 

How many people are living in fuel poverty? 2020 is the latest year for which statistics are available in England – with the Department for Business, Energy & Industrial Strategy (BEIS) publishing its fuel poverty statistics report in February 2022. In 2020 it was estimated that 3.16 million households (or 13.2% of all households) in England were fuel poor under the LILEE definition. The data shows the proportion of households in fuel poverty declined by 34% between 2010 and 2019 (equating to some 1.6 million households). The depth of fuel poverty, known as the fuel poverty gap, has also declined in England. This measures the amount by which the energy costs of a fuel poor household exceed the high costs threshold (i.e., the cut in energy costs that would lift a household out of fuel poverty). The data reveals how the mean average fuel poverty gap reduced from £339 in 2010 to £223 in 2020.  

The Statistical Digest of Rural England identified 12% of households in rural areas to be in fuel poverty. While historically fuel poverty was seen to be more prevalent in rural areas, since 2017 urban areas have had the greater proportion of fuel poor households (with 13.8% of urban households and 11.6% of rural households fuel poor in 2019). However, the fuel poverty gap is larger in rural areas compared to urban areas – with the average fuel poverty gap for fuel poor households in rural villages, hamlets and isolated dwellings £585 in 2019 compared to an average fuel poverty gap of £216 for all fuel poor households. Similarly, using the LIHC measure, the average fuel poverty gap for urban households decreased between 2011 and 2019 whereas in rural areas this gap widened over the same period.  

The Government has projected fuel poverty levels in England in 2021 and 2022 under the LILEE definition. The forecasts reveal how the proportion of households defined as fuel poor are expected to fall from 13.2% in 2020 to 12.8% in 2021 and 12.5% in 2022. This fall is attributed to improvements in the energy efficiency of homes between 2020 and 2022, expected growth in low income deciles, and a support package for energy bills announced in February 2022. However, the depth of fuel poverty is projected to increase over this period, from £223 in 2020 to £233 in 2021 and £258 in 2022. This is being attributed to the default tariff price cap announced for summer 2022 resulting in higher energy prices in real terms. The energy price cap increased by 12% in October 2021 and by 54% in April 2022, an increase of some £700 for ‘typical levels of dual fuel consumption paid by direct debit’. Many observers are predicting a further increase in October 2022, possibly by a further 50%. Will the depth of fuel poverty in rural households also increase over this period? 

There is a 2-year lag in many of the statistics presented here, with some of these figures based on actual data from 2018. This makes understanding the levels and depth of fuel poor households in real time difficult. Furthermore, what would applying a rural lens through the data we already collect reveal (e.g., analysing the figures using the Rural Urban Classification and/or providing rural projections?) 

What is Government doing? In England, the Government has set a statutory fuel poverty target. This is based on Energy Performance Certificates (EPCs) for fuel poor homes and was produced as part of a fuel poverty strategy back in 2015: ‘the fuel poverty target is to ensure that as many fuel poor homes as is reasonably practicable achieve a minimum energy efficiency rating of band C by 2030’. The Government also set interim targets of EPC band E by 2020 and band D by 2025. 

The latest published fuel poverty statistics (for 2020) show an estimated 97.2% of low income households were in properties with an energy efficiency rating of band E or higher; 90.1% were in band D or higher; and 52.1% were in band C or higher. 

In July 2021, the Committee on Fuel Poverty (CFP), a Non-Departmental Public Body sponsored by BEIS, assessed progress towards delivering the 2025 and 2030 targets. Using the LILEE measure, they found the number of fuel poor households living in bands E, F or G had not materially changed, and that the number of households living in bands B and D homes considered fuel poor had increased to 1.14 million. The CFP described how the 2020 band E milestone had been missed – with only half of the 293,000 bands F and G fuel poor homes at the start of 2015 upgraded to band E or above by 2020. Although there were more than sufficient funds available to deliver the 2020 milestone, the CFP cited how only 10-30% of programme budgets were received by fuel poor households; and only a very small percentage of the funds were aimed at those in the deepest levels of fuel poverty. The CFP further highlighted how the Government is just over 50% towards achieving the 2025 band D milestone and that future progress with current programmes is forecast to be slow. 

The Government published an updated fuel poverty strategy in 2021. This set out several policies to improve fuel poverty, including: 

  • £60 million of additional investment to retrofit social housing and £150 million for the Home Upgrade Grant. 
  • An expansion of the Energy Company Obligation (ECO) requiring larger domestic energy suppliers to install heating, insulation, or energy efficiency measures into the homes of people on low incomes, vulnerable or fuel poor. 
  • An extension of the Warm Home Discount, a requirement for energy companies to provide a £140 rebate on the energy bill of low income older people and other low income households with high energy bills. 
  • Drive over £10 billion of investment in energy efficiency through regulatory obligations in the Private Rented Sector. 

These policies are intended to sit alongside other, existing measures to alleviate fuel poverty, including but not limited to: 

  • Winter Fuel Payment: a tax-free annual payment made to assist older people  in meeting the costs of their winter fuel bills. 
  • Cold Weather Payment: payments made during very cold periods of weather to some recipients of welfare benefits (e.g. income support, universal credit, pension credit). 
  • The Green Deal Finance Company (GDFC) which provides loans for home efficiency improvements. 
  • Social Housing Decarbonisation Fund (SHDF): there are currently 19 demonstrator projects in 17 Local Authorities in receipt of £62 million to learn lessons and gather innovation in retrofitting. 
  • Default Tariff Cap: a limit set on the amount that suppliers can charge certain consumers for a unit of energy. The cap is reviewed twice yearly, most recently in February 2022 where Ofgem increased the level of the cap to respond to rising wholesale prices and additional costs for suppliers during COVID-19. The current level runs from 1 April 2022 to 30 September 2022 and is due to be reviewed again by Ofgem in August.     

In February 2022, the Government announced further support to help households with higher bills. This includes a £150 Council Tax rebate in April 2022, and a £200 upfront discount off bills in October 2022 which will have to be repaid through energy bills over the following 5-years. 

As indicated in the 2011 Review, Government policy on fuel poverty impacts upon a number of policy areas. I offer three examples. 

The first example is energy efficiency which is seen as one of the key ways of alleviating fuel poverty. The Fuel Poverty Energy Efficiency Rating (FPEER) is a measure of the energy efficiency of a property. According to the Statistical Digest for Rural England; rural village, hamlet and isolated dwelling households with the poorest FPEER rating of F or G had an average fuel poverty gap of £1,213 compared with an average fuel poverty gap of £856 for urban households with the same energy rating. The Climate Change Committee (CCC) has emphasised how energy efficiency is key to decarbonisation as it reduces energy consumption and furthermore how it is important to address fuel poverty to ensure a ‘just transition’. 

The second example is health and wellbeing – with cold homes having negative impacts on a person’s physical and mental health. The Cold Weather Plan for England published by the UK Health Security Agency and NHS in October 2021, for example, describes how the health impacts of cold homes include increased risk of heart attack or stroke, respiratory illnesses, poor diet [heat or eat choices], and worsening or slow recovery from existing conditions. The Plan calls for a strategic approach to reduce excess winter deaths across local health and social care economies.  

The third example is the economy where energy efficiency can lead to job creation and provide greater energy security. Back in 2019, the House of Commons BEIS Committee estimated that energy efficiency measures could sustain between 66,000 and 86,000 jobs across the UK; prevent expensive investments in infrastructure; and increase the UK’s prominence as an exporter of insulation and retrofit goods and services.   

For the most part, these interventions and schemes take broad approaches: incorporating improved insulation, replacing old or inefficient heating systems, and/or reducing home energy bills for householders. How do these measures to alleviate fuel poverty affect rural residents? For example, how do these measures work for 4 million UK households who are ‘off grid’, meaning they do not receive mains gas and rely upon heating oil or liquid petroleum gas (LPG)? It is estimated that a typical household heated by oil will use 1,500-2,500 litres a year. According to BoilerJuice, the price per litre increased from £46.50 in September 2021 to £156.51 in March 2022. While gas and electricity prices are capped, heating oil prices are not. Moreover, data from Savills suggests that rural dwellings are often less energy efficient – with EPC ratings of E and D in hamlets compared to ratings of C and D in towns and cities. 

Taken as a collective, and in light of the CFP’s assessment, how do we know how successful these initiatives are [in rural communities and places] and what their return on investment is? How do, or can, these interventions consider the vulnerability of certain people living in cold conditions – especially when the evidence suggests rural households are more likely to suffer negative impacts as a result of their fuel poverty? And how can the approach taken join up policies and initiatives from across Government departments (e.g. with health, environment, and economy)?    

What impact has COVID-19 had? Analysis from Uswitch back in March 2020 suggested that some consumers would need to spend an extra £52 million a week on household energy bills as 16.8 million people stayed at home due to the pandemic – equating to an extra £16 for some households a month and £195 a year for those on Standard Variable Tariffs. The calculations were based on estimates that people working from home would use an additional 25% more electricity and 17% more gas each every day.  

The NEA’ fuel poverty monitor report 2019-2020 analysed how COVID-19 had impacted on vulnerable energy consumers and the organisations that support them. Five main impacts on fuel poor households were identified: (i) an increase in energy use due to more people spending time at home; (ii) a reduction in income as jobs were lost or placed on furlough; (iii) increased affordability issues and debt leading to energy rationing; (iv) reduction in smart metre/ECO installations; and (v) difficulties accessing support, especially for digitally excluded households or those with English as an additional language. 

During the pandemic the Government launched a range of measures to support vulnerable customers. These included new measures to ensure prepayment and pay-as-you-go customers remained supplied with energy; and new protections for customers struggling with their energy bills over winter.  

Citizens Advice highlighted three major risks facing consumers over the winter months in the period 2020-2021: (1) many people are struggling financially – with an estimated 2.8 million people behind on their energy bills due to COVID-19; (2) as people were forced to spend more time at home their energy usage would be higher than normal – and those unable to top up their energy or reduce their usage for fear of higher bills could face negative impacts to their physical and mental health; and (3) energy companies are also facing financial pressures and having to adapt their services. Citizens Advice called on the Government to do more to top up existing support schemes. 

What more can be done, and needs to be done, to tackle fuel poverty?In January 2022, Rural England and the Countryside and Community Research Institute (CCRI) published the results of their study on the lived experiences of customers in vulnerable situations in rural England. The researchers identified rural specific vulnerability factors associated with the age, isolation and basic service infrastructure (e.g., transport, communications).Many utility companies identify vulnerable users – and some have a ‘hierarchy of vulnerability’ with older people with disabilities or suffering chronic illness a priority. It was suggested that more needs to be done to promote the Priority Services Register (PSR) so as to both increase the number of people registering and also raise awareness of the support available to householders already on the register.  

From an international perspective, an evidence review of rural fuel poverty compiled in 2018 suggests locally delivered projects targeted at localised needs can reach significant numbers of households in fuel poverty, and that partnership working can leverage in additional funding and benefits. While some of the schemes collated by the researchers reduced household energy consumption through quick and cheap measures, the evidence also suggests that alleviating fuel poverty requires long-term measures that focus on improvements in housing stock. 

There are a plethora of examples from across rural England that seek to tackle fuel poverty. At a national level there are initiatives such as Fuel Bank, a collaboration between npower and the Trussell Trust which works from selected foodbanks and advice agencies to help customers who have problems with prepayment meters. Local Authorities have leveraged in additional funding for small schemes tailored to local needs (e.g. Warm Homes Eden). Back in 2013, Plymouth City Council recognised the role of community energy in addressing fuel poverty and carbon emissions and set up Plymouth Energy Community – making the link between communities, housing and renewables. For those off-grid, charities and voluntary and community sector organisations often run bulk oil buying schemes, although some of these schemes have been temporarily suspended because of unpredictable prices. 

A volatile energy market and poorly insulated housing stock means it is unlikely that fuel poverty will be eliminated in the near-future in rural areas. Therefore, do we need to prioritise support, perhaps focusing on those residents that are most vulnerable and/or facing the highest costs and/or geographic areas with household above average needs and costs? Or should we avoid a ‘worst first’ approach to ensure all fuel poor households are able to receive some form of support?  

What does the future hold? Will more rural residents face choosing between heating or eating or indeed be left struggling to be able to do either? What more can be done be done to tackle fuel poverty and prevent rural residents from being left out of the cold? In the short term, how can we ensure ‘rural’ features more prominently in Government support and in its annual debate on fuel poverty? And, in the longer-term, how can we invest in the housing stock in rural areas, and look at rural resident’s incomes?   

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Jessica is a researcher/project manager at Rose Regeneration and a senior research fellow at The National Centre for Rural Health and Care (NCRHC). She is currently working with young farmers to gather their views on future land use; helping public sector bodies to measure their social value; and evaluating employability schemes and a veteran programmes. Jessica also sits on the board of a Housing Association that supports older people and a charity supporting Cambridgeshire’s rural communities. 

She can be contacted by email jessica.sellick@roseregeneration.co.uk. 

Website: http://roseregeneration.co.uk/https://www.ncrhc.org/ 

Blog: http://ruralwords.co.uk/ 

Twitter: @RoseRegen 

Growing up, getting on, or leaving the countryside?

Growing up, getting on, or leaving the countryside?

Education is seen as the driving force in helping unleash Britain’s potential and rebuild after COVID-19. The Department for Education (DfE) is aiming to drive economic recovery and level up opportunity for all by improving educational standards and giving children the best start in life. Will this boost opportunities for children and young people in rural areas? Jessica Sellick investigates. 

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In the UK no one law defines the age of a child. Under health and safety rules, a child is anyone who has not reached the minimum school leaving age and a young person is anyone under 18 years of age. The Children Act 1989 and 2004 and Children and Families Act 2014 combined this to define children and young people as up to age 18 years; with ‘vulnerable young people’ entitled to support beyond 18 years. The Children and Social Work Act 2017 includes provision for extending services for care leavers up to the age of 25 years. The NHS Long Term Plan sets out actions in relation to children and young people aged 0-25 years – while the General Medical Council (GMC) guidance applies to those aged 0-18 years where ‘children’ refers to young children who do not have the maturity and understanding to make important decisions for themselves; and ‘young people’ to older or more experienced children who are more likely to be able to make decisions for themselves.  

Data from the Office for National Statistics (ONS) suggests between mid-2009 and mid-2019, the number of children [defined as those aged under 16 years of age] increased, by 8% to 12.7 million. According to mid-year population estimates, in England in 2020, 4.6% of all rural residents were aged 0-4 years, 5.5% aged 5-9 years, 5.8% aged 10-14 years, 5.2% aged 15-19 years and 4.2% aged 20-24 years. 

How have public policy and decision makers supported children and young people? 

Government focus on children and parenting encompasses pregnancy and birth; fostering, adoption and surrogacy; financial help; childcare; schools and education; separation, divorce and legal issues; and training and employment. Support for children and young people can be found across the Departments for Education; Health and Social Care; Work and Pensions; Levelling Up, Housing and Communities; Culture, Media and Sport; and The Home Office. 

Back in 2003, the Government published a Green Paper outlining proposals to reform and improve childcare, following the death of Victoria Climbie and subsequent investigations by Lord Laming and various inspectorates dealing with children matters. Entitled ‘every child matters’ the policies contained in the document were designed to focus on the universal services which every child uses from birth to 19 years of age, and on more targeted services for those with additional needs. The intention was to reduce the number of children experiencing educational failure, engaging in offending or anti-social behaviour, suffering from ill health or looking to  become teenage parents. The paper identified five outcomes that mattered most to children and young people: (1) being healthy – physically and mentally; (2) staying safe – being protected from harm and neglect; (3) enjoying and achieving – developing skills for adulthood; (4) making a positive contribution – being involved with the community and society; and (5) economic wellbeing – achieving full potential in life. The Children Act 2004 reinforced the central premise of the Green Paper, namely that all people and organisations working with children and young people have a responsibility to help safeguard them and to promote their welfare. This was followed by The Children and Young Persons Act 2008 which provided support for Local Authorities to regulate official intervention in a child’s best interest (i.e., in relation to social work services, adoption and fostering).  

In 2010 the Cabinet Office and Department for Education (DfE) published Positive for Youth, a vision setting out the ways in which young people should be supported to realise their potential through the combined efforts of their families, local communities and the State. It was a joint statement, developed by nine Government departments in consultation with Local Government and the wider youth sector. The central pillar of the vision was that young people should inform decisions, shape provision and inspect quality. Once again, emphasis was placed on those working with young people to support them to have a stake in their futures. The vision was intended to be a call for action, shifting norms and returning power to young people, their families and communities. In 2013, the Government published a snapshot of its progress to date. This recognised the number of young people volunteering their time to represent their peers through Local Youth Councils (LYCs) and the UK Youth Parliament; the National Citizens Service (NCS) programme; an increase in the support made available to young people through the Pupil Premium; the steps taken to raise the age of compulsory education or training; and investment in a Troubled Families programme and Ending Gang and Youth Violence programme. Government also funded an Outcomes Framework for Young People’s Services, a tool for providers and commissioners to measure the impact of their provision. The snapshot concluded that youth policy should be primarily a matter for Local Government, and central Government’s role is one of giving Councils the freedom and flexibilities to make decisions.  

The Children and Family Act 2014 made changes to the law to give greater protection to vulnerable children, improve support for children whose parents were separating, create a new system to help children with special educational needs, and help parents to balance work and family life. The Care Act 2014 placed a duty on Local Authorities to conduct transition assessments for children, children’s carers and young carers where there is a likely need for care and support after the child turns 18 years of age. This was intended to identify young people as early as possible in order to plan for, or prevent, the development of care and support needs. 

In 2015, the Government published its Childcare Bill. This proposed offering 15 free hours of childcare for three and four-year-olds (and disadvantaged two-year-olds) and offering 30 free hours for all working parents. Paid for from a Government pot of some £3.5 billion, these measures were introduced in 2017. Both parents have to be employed and neither earning more than £100,000; and the free hours only apply during term time (38 weeks a year).

In July 2018, the Government published statutory guidance on how inter-agency working with children and their families is fundamental to taking a child centred approach to safeguarding. The guidance sets out the key roles for individual organisations and agencies to deliver effective arrangements for safeguarding. 

More recently, the DfE’s priorities have focused on providing children’s services, education and skills training in ways that ensures opportunity is equal for all, regardless of background, family circumstances or need. This includes a cross-cutting theme on levelling up – covering both educational standards so that children and young people in every part of the country are prepared with the knowledge, skills and qualifications they need; and raising productivity by supporting people to work. As part of its levelling up approach the DfE has identified 55 ‘cold spots’, these are areas where school outcomes are the weakest. Known as ‘educational investment areas’, and covering more than one-third of Local Authorities in England, these areas will be prioritised  as the location for new specialist sixth-form free schools where existing provision is limited. The DfE also intends to run a consultation to see how schools judged less than Good in successive Ofsted inspections could be moved to multi-academy trusts and receive more support to attract the best teachers.  

Taken as a collective, these definitions reveal how there is no one understanding of children or young people shared by all agencies; nor the broader context in which a young person moves from childhood to adulthood. Much public policy has focused around realising the potential of children and young people, whilst seeking to tackle disadvantage and ensuring their protection and welfare. Similarly, there is no single piece of legislation but rather a myriad of laws and guidance that are applicable to children and young people in England. There has been less specific public policy reference to children and young people living in rural areas: for those that want to, how can we use these policy levers to help them inform provision and decisions and have a stake in the countryside? 

What impact has COVID-19 had on children and young people? 

The Department for Education (DfE) has been publishing statistics on attendance in education and early years settings throughout the pandemic. The data shows that the attendance of pupils with an education, health and care plan (EHC), and pupils with a social worker, was typically lower than that for other pupils. The number of pupils eligible for Free School Meals (FSM) has also increased – from 17.3% of all pupils in January 2020 to 20.8% of all pupils in January 2021. Other research published by the DfE estimates the mean learning loss in reading and mathematics for primary and secondary school pupils. This reveals how all year groups have experienced a learning loss in reading (ranging from 1.7-2 months in primary and secondary pupils) and a learning loss in mathematics of 3 months (primary pupils only). Ofsted’s COVID-19 series  also found some children, of all ages and backgrounds, had lost basic skills and learning as a result of school closures and restrictions on movement. The DfE has announced it will be providing additional core funding amounting to £4.7 billion in 2024-2025, including £1.6 billion in 2022-2023. This investment is in addition to planned increases included in 2019 Spending Round.  

According to the Centre for Social Justice (CSJ), 100,000 children have disappeared since schools returned in 2021. They describe the existence of “ghost children” as a national disaster – describing how children missing from formal education settings are vulnerable to gangs, county lines, and abuse within the home. CSJ research found nearly 800 schools in England with a class worth of children severely absent; with schools in disadvantaged areas 10 times more likely to have a whole class worth of children missing than schools in more affluent areas. The DfE has set up an attendance alliance group,  bringing together education, children’s, social and health services to raise school attendance. 

A report by the Carers Trust suggests throughout the pandemic child carers feel they have been completely forgotten. For many, school provides the only route away from their caring responsibilities. With teachers, social workers, nurses and therapists unable to visit in-person and checking-in on children virtually – and with many hospital appointments cancelled – some children ended up caring for a parent/carer around the clock without proper support or any break. 8% of young carers and 15% of young adult carers (those aged 18-24 years) reported spending 90 hours a week looking after relatives during the pandemic. According to the Disabled Children’s Partnership (DCP), 68% of children with disabled siblings took on more caring responsibilities during lockdown periods. 

Back in 2018 the then Prime Minister Teresa May committed to publishing a ‘State of the Nation’ report annually to integrate available evidence on children and young people’s wellbeing. The latest report, published in February 2022, suggests children and young people’s subjective wellbeing showed signs of recovery in 2021, following a small reduction in 2020. Nonetheless, there is substantial variation in wellbeing – with female respondents reporting lower levels of wellbeing compared to male respondents. Vulnerable respondents (e.g. those with special educational needs or eligible for free school meals) demonstrated more mixed patterns of wellbeing. Data also suggests rates of probable mental health disorders remained higher in 2021 than before the pandemic – analysts were unable to determine the extent to which these higher rates could be attributed to pandemic effects or reflected a continuation of general increases in mental health reported before the pandemic. The DfE has added a new module to the RSHE curriculum for primary and secondary schools specifically designed to focus on mental health. Government and the NHS have also invested in schools in mind, an initiative led by the Anna Freud National Centre for Children and Families which aims to embed good mental health across the whole school community.  

According to research from the Nuffield Trust, while children are 10 times less likely than adults to have been hospitalised with the virus, their access to health care has been badly disrupted and their mental health disproportionately affected. Around 1.7 million children in England have a long-term condition (e.g. asthma, diabetes, epilepsy) and almost one-third reported they had not been receiving enough support. Routine referrals to hospital care for children and young people fell by 89% in April 2020 compared to pre-COVID levels and by 79% for urgent referrals in the same period. There are significant backlogs for community paediatric services such as speech and language therapy.   

International evidence is beginning to suggest that the pandemic may already be influencing children’s lifestyles and increasing their risk of being overweight or obese. In the UK, researchers found children were snacking more. According to the National Child Measurement Programme (NCMP), when children start school more than one-fifth of four-year-olds are classed as overweight and one-tenth as obese. By the time they finish primary school, more than one-third of children are overweight and one-fifth obese. In 14 neighbourhoods in England in 2020-2021, more than half of the children in year 6 were found to be overweight. The poorest tenth of children in year 6 are 72% more likely to be overweight than the richest. In September 2021 the Obesity Health Alliance published ‘turning the tide’, a 10-year healthy weight strategy. Drawing on the Government’s prevention Green Paper, it calls physically active play to be incorporated into early years settings, and for support for parents and children to play in and around the home.  

The Children’s Commissioner received more than half a million responses to ‘The Big Ask’, a national survey of England’s children. The findings illuminate how the dividing line between childhood and adulthood has been blurred – offices and schools and bedrooms all collapsing into one another. Children have seen the world of adult work come closer; adults, the world of school. If adults are to learn one thing from this report, according to the Commissioner it should be: this is not a ‘snowflake generation.’ It is a heroic generation. They are a survivor generation – a sleeves-up, pragmatic generation, with civic-minded aspirations.

Over the course of the pandemic much attention has been focused on shielding and protecting older people and the clinically vulnerable – with less attention focused on how children and young people have been impacted by measures taken to control COVID-19. The population in rural areas has a higher proportion of older people and a lower proportion of children and young people compared with urban areas. How can we respond to what children and young people need now – and what they need to thrive in the future – especially in rural areas?  

How can we support children and young people to have a stake in the countryside?  

In rural areas schools are about more than their performance as measured by Ofsted inspections, league tables or exam results. They often embrace the place, community and geography where they are located. For example. The North Pennines Area of Outstanding Natural Beauty (AONB) runs a fellfoot forward next generation project which aims to excite young people about the heritage on their doorstep – this includes schools programmes on archaeology, watercourses and climate change delivered with partners. Somerset County Council and partners offer schools training and resources on the Somerset Outdoor Curriculum. Schools can also be viewed as community assets – with some open for community use in the evenings, weekends and school holidays (e.g. for adult learning, skills and training, wellbeing). And yet analysis from the Rural Services Network (RSN) reveals how schools in areas classified as Predominantly Urban received some £332 more per pupil on average than those in Predominantly Rural areas in 2019-2020. In 2021 the DfE ran a consultation seeking views on how to simplify the funding process and ensure all schools are funded on a single, fair and consistent basis.

The RSN’s revitalising rural campaign, launched in March 2021, aims to ensure rural areas are not left behind in the Government’s drive to level up. Regarding rural schools, it calls for minimum staffing levels to be included in the national funding formula, a share of capital funding to be set aside for modernisation and maintenance projects in small schools; and for funding to be offered to help clustering and collaboration between small rural schools.   

According to the RSN, just over half a million young people aged 15-19 years live in rural areas – with those aged 20-24 years showing the largest outmigration. Students living in rural areas have longer journeys to access further and higher education than their urban counterparts. On average, those working in predominantly rural areas have lower skills levels than those working in predominantly urban areas. As part of its revitalising rural campaign, the RSN is calling on Government to explore a fully funded travel scheme for young people to access further education and training, and to provide in-person and online access to skills training to rural businesses and dwellers.   

Since 2019 the Government has been establishing a network of Institutes of Technology (IoTs). These are collaborations between further education providers, universities and employers and they specialise in delivering higher technical education. The Lincolnshire Institute of Technology, for example, brings together employers, schools and providers in sub-localities to deliver agri-tech, food manufacturing, energy, digital and engineering skills; and the East Midlands Institute of Technology  will provide access to training and skills development in digital, engineering and manufacturing skills at the point of need to support local communities. Linking local employers and professionals into local schools, providing training in or near rural communities, and providing skilled and well paid employment for local young people will ensure that ‘staying’ becomes a viable reality for young people who want to learn, earn and remain.

The National Youth Agency (NYA) describes how 85% of a young person’s waking hours are spent outside of the school day. In 2021 the NYA published a report highlighting an increasing trend of gangs targeting vulnerable young people in county-towns and rural areas, as well as moving young people across county lines. The NYA underlines how youth workers are known and trusted by young people in their area and the role of youth services in identifying early and supporting young people at risk from county lines. With some 2.25 million young people living in predominantly rural areas, and as part of the COVID-19 recovery, the NYA is calling for a core youth offer regardless of locality on which wider youth provision can flourish. 

At the same time, a report from the YMCA identified a 70% funding reduction in youth services across England and Wales between 2010 and 2019-2020. According to the analysis, every region saw their funding for youth services cut by more than 60% – with further breakdowns at a local level revealing deficits of more than 90% in areas such as Gateshead, Nottingham and Norfolk. Since 2010 more than 4,500 youth work jobs have been lost and 760 youth centres have closed The figures demonstrate the weight of funding pressures facing Local Authorities and how, if youth policy should primarily be a matter for Local Government, the need for Government attention. This also involves recognising the role that Parish Councils, community groups and voluntary organisations play in rural areas – they have infrastructure, networks and are often ‘filling the gaps’ left by other agencies.  

Back in 2020, the National Federation of Young Farmers’ Clubs (NFYFC) published the results of their survey, ‘Your Post-Brexit Rural Future’. 528 young people responded, with many highlighting the impact of COVID-19 on not being able to meet face-to-face and socialise. More broadly, respondents described a lack of recreational facilities, youth clubs and schemes such as Wheels to Work available in their locality. The most important facilities they wanted to be made available included a community centre/village hall, youth club/youth service, Wheels to Work and church. Over 70% of respondents had sought advice about training, employment, farming, money and health over the past 12-months.

Similarly, research carried out by CPRE with 1,019 young people aged 16-24 years found affordable housing was their top concern (72% of respondents) – and more than three-quarters of respondents (76%) said they wanted to move away from a rural area, partly due to poor connectivity and/or because they were experiencing loneliness.  

While there are examples of employers coming together to attract talented young people into rural communities (e.g. Rock the Cotswolds, Lincolnshire Talent Academy) – for me all of this research demonstrates the need to find innovative solutions to help children and young people, live, work and thrive in the countryside.  In practice, that means providing somewhere for them to learn (school, youth club), earn (a well-paid job, help to start a business), live (affordable and safe housing), access services (transport, broadband and mobile connectivity), have fun (culture, leisure, sports and recreation) and thrive (reduce loneliness and isolation, address hidden poverty, participation in decision making). 

If levelling-up is about children and young people in every part of the country being prepared with the knowledge, skills and qualifications they need, how can we ensure this supports young people to have a stake in the countryside? All-too-often children and young people in rural areas are not visible or on the radar of numerous policies and initiatives targeted at their age category. How can we better integrate evidence on children and young people [State of the ‘Rural’ Nation?] and do we need a “Big Rural Ask” to fully see, hear, and understand the experiences of our young people and find solutions and ensure they are recognised and feel valued in our rural communities? 

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Jessica is a researcher/project manager at Rose Regeneration and a senior research fellow at The National Centre for Rural Health and Care (NCRHC). She is currently working with young farmers to gather their views on future land use; helping public sector bodies to measure their social value; and evaluating employability schemes and a veteran programmes. Jessica also sits on the board of a Housing Association that supports older people and a charity supporting Cambridgeshire’s rural communities. 

She can be contacted by email jessica.sellick@roseregeneration.co.uk. 

Website: http://roseregeneration.co.uk/https://www.ncrhc.org/ 

Blog: http://ruralwords.co.uk/ 

Twitter: @RoseRegen 

Ageing in place: how can we ensure rural residents have choice, control and support to lead healthy, independent lives?

Ageing in place: how can we ensure rural residents have choice, control and support to lead healthy, independent lives?

By 2040, over 40% of the UK population will be aged 50 years and over. Yet we are not ageing evenly – with one in three Local Authorities in rural and coastal Districts already having populations fitting this profile. On the one hand, ageing is a life-long process and older people are key contributors to our workplaces, communities and society at large. On the other hand, an ageing population has significant implications for public services; with older people (in general) more likely to access services such as health, care, and pensions than their younger counterparts. COVID-19 has seen urgent problems in social care become more acute. As part of pandemic recovery and future planning, Government is now paying increasing attention to improving services for older people. This includes the publication of the ‘People at the Heart of Care’ White Paper. What does ageing mean for rural communities – and what can be done to fix social care in rural places? Jessica Sellick investigates. 

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How old is an older person? This is not easy to define because expectations, capacities, needs, aspirations and biological ageing can take place at different rates for people of the same age. Typically, the term ‘older people’ can be used to describe people anywhere from aged over 50 years, over the age of 65 years and/or from your 60s. The poet Dante believed “old age” started at 45 years. Other descriptors include ‘elderly’, ‘aged’ and/or ‘senior’ – and there has been much debate about whether this language leads to discrimination. Rather than a specific age or age-range, sometimes older age is used to refer to people in later life, or who have reached retirement. Commentators also describe ageing as a gradual and continuous process of natural change that begins in early adulthood. Term such as the ‘grey brigade or army’ or ‘grey pound’  have also been used to describe the societal influence or purchasing power of older people. Again, there has been much discussion around whether these phrases lead to discrimination and/or whether brands and businesses overlook the spending power of older people.     

While the productivity, creativity and participation of older adults in the workplace, family life and communities is recognised, research from the Centre for Ageing Better highlights the often negative and harmful stereotypes about ageing and older age across many parts of society. The Centre for Ageing Better is working with partners to ‘reframe’ ageing and present a more positive and realistic narrative about older age. Here ageing is viewed as a life-long process where structural issues that can affect how an individual ages (e.g. policies, funding, housing) need to be tackled. The researchers found public attitudes to ageing to be more complex and nuanced – with people increasingly seeing it in a positive light.

Instead of simply looking at age (i.e., number of years), or viewing getting older as a time of decline, other measures such as frailty are now used to identify how healthy a person is and to identify whether they require care and support.  

How have public policy and decision makers seen older people? Since the 1990s Government has introduced many policy initiatives aimed at supporting older people. All of this has helped to increase the profile of older people’s issues: from the establishment of the Inter-Ministerial Group for Older People in 1998 to coordinate policy making, to the establishment of an Older People’s Advisory Group in 1999; and from a New Deal 50+ to assist older people to find employment in 2000 to the establishment of the Pension Service in 2002 and introduction of Pension Credit in 2003. 

Between 2010 and 2015 Government viewed retirement as an increasingly active phase of life where people have opportunities to continue contributing to society by working longer or volunteering in their communities; and take personal responsibility for their own wellbeing by working, saving and looking after their health. Fuller Working Lives: a framework for action, published in June 2014, explained how working longer benefits individuals, businesses, society and the economy. In March 2015 the Government published its report ‘A new vision for older workers: retain, retrain, recruit’ for improving the working lives of Britain’s over 50s.They also published guidance about employing older workers and working past 50. The Department for Work and Pensions (DWP) set out how it would provide digital services to ensure older people were not left behind and would be able to benefit from the increased independence that comes with digital competence. The Government also allocated £1 million to fund help to older people at most risk of long-term loneliness and social isolation. 

In 2017, the Government identified ‘ageing society’ as one of the Industrial Strategy’s four Grand Challenges. This included a mission to ‘ensure that people can enjoy at least five extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest’. 

Since then, Government focus has remained on helping people live more independently and healthily in older age. In January 2021 the House of Lords Science and Technology Select Committee published its report on ageing, science, technology and healthy living. The Committee assessed the feasibility of the Industrial Strategy’s mission and concluded concerted action is required in order to increase the number of years spent in good health in old age. In response, health services should be coordinated to better treat people with multiple age-related illnesses; and technology and services should be deployed more widely to support independent living in old age. Recent scientific discoveries reveal underlying processes of ageing, and the UK could play a leading role in developing treatments to address the root causes of age-related illnesses. The Government has since transitioned the Industrial Strategy into its Plan for Growth and its related strategies. 

More recently, the Government has committed to ‘levelling up’ across the UK to ensure no community is left behind in responding to, and recovering from, COVID-19. The Government has launched new investment programmes to support communities to regenerate town centres and high streets, support to get people into employment, improve local transport links and invest in local culture. In September 2021, the Government announced the Ministry of Housing, Communities and Local Government (MHCLG) was to be renamed the Department for Levelling Up, Housing and Communities (DLUHC). The Department’s current work includes growing a thriving older person’s housing sector. 

How do we care ‘about’ and ‘for’ older people? The term ‘adult social care’ can refer to all kinds of personal and practical assistance given to an individual which may take place in a range of settings. It can also cover assistance for those who care for others. Indeed, much care is delivered by informal, unpaid carers who may be family members, friends or neighbours of the recipient. In 2019-2020, for example, the Family Resources Survey (FRS) estimated that approximately 7% of the UK population were providing unpaid care. Unlike NHS health care, adult social care in England is not free at the point of use. Local Authorities play a key role in assessing the need for formal support. They are required to apply criteria to assess whether a person is eligible for formal social care. An individual may have to undergo means-testing, where depending upon their financial circumstances they may be liable for meeting a proportion or all of their social care costs. To meet the eligibility criteria in England, an individual will need to show that (i) their need for care and support arise from certain health problems, (ii) as a result they are unable to do certain things, and (iii) there is a significant impact on their wellbeing. 

On 7 September 2021, the Government published a paper setting out details of a proposed levy, based on national insurance contributions, to raise additional funding for health and social care. The Government has indicated that most of the proceeds of the levy would be directed towards the NHS first to tackle backlogs over the first three-years of the levy’s operation, with £5.4 billion of the expected £36 billion to be raised set aside for adult social care. 

The paper contains information about how people would pay for adult social care in England. Building on earlier proposals put forward by the Dilnot Commission, this includes proposals for a cap on personal care costs of £86,000 from October 2023; increasing the upper capital limit from £23,250 to £100,000 from October 2023; and increasing the lower capital limit from £14,250 to £20,000. If an individual has capital between £20,000 and £100,000 the Local Authority may fund some of their care but they may also have to contribute up to 20% of their chargeable assets per year in addition to their income. 

While many organisations and care providers have welcomed the extra funding that would be raised by the levy, they have queried how the Government will ensure the share allocated to social care will increase over time. Other bodies have questioned why the proposals only apply to the cost of care and not living expenses, that it fails to address geographical inequalities, and if the proposed £5.4 billion over three-years will be enough to achieve genuine transformation. 

More recently, on 1 December 2021, the Government published a White Paper setting out its 10-year vision for adult social care, and providing more information on funded proposals that will be implemented over the next three-years. The key proposal contained in the White Paper is the cap on how much individuals in England will contribute to their care costs from October 2023, and how care costs will be predictable and limited. Under the heading ‘People at the Heart of Care’, the Paper sets out three objectives to deliver person centred care: (i) people have choice, control and support to live independent lives; (ii) people can access outstanding quality and tailored care and support; and (iii) people find adult social care fair and accessible. The policies and proposed investment set out in the Paper include: 

  • At least £500 million so the social care workforce have the right training and qualifications – and where they also have their wellbeing prioritised. 
  • At least £300 million to integrate housing into local health and care strategies and to increase the range of new supported housing options available. 
  • At least £150 million to drive greater adoption of technology and digitisation across social care. 
  • More than £70  million to increase the support offer across adult social care – including assisting Local Authorities to better plan and develop the support and care options available. 
  • £30 million to help local areas innovate around the support and care they provide in new and different ways. 
  • Up to £25 million to work with the sector to kick-start a change in services provided to support unpaid carers.   
  • At least £5 million to pilot new ways to help people understand and access the care and support available – including a new national website to explain the upcoming changes. 
  • A new practical support service to make minor repairs and changes to people’s home to help them remain independent and safe. 

In response to the ten-year timescale, the Government notes how ‘we know that some of the challenges in social care cannot be quickly fixed. Therefore…we will continue working with a range of voices from across the care and support landscape to deliver the changes that we all want to see. This will include working closely with local authorities and supporting them so they have the right tools and capability to deliver the right care and support that puts wellbeing and personalised support front and centre. We will also engage with a diverse range of organisations and people, including those who draw on care and support or provide unpaid care’ (page 8). Overall the Government’s vision is one of offering people choice and control over the care they receive, promotes their independence and enables them to live well, and values an exemplary and committed workforce. 

According to The King’s Fund, the White Paper doesn’t take us very far forward in the right direction, and lack of money lies at the heart of the problem: ‘social care is getting just a small slice (£5.4 billion over three years) of the £30.3 billion raised by the Health and Social Care Levy, with the majority of the money going to the NHS. The cap has been reconfigured to be less generous to people with low and moderate assets. Once you have taken off the extra costs that the policy document creates for local authorities, the spending power increase in the Spending Review is only 1.8% at a time when social care costs – especially around workforce – and demand for services are surging…Though the vision includes a major focus on personalisation – choice and control – there are no measures to do that, despite an acknowledgement that current approaches are faltering. 

The Nuffield Trust has also called on the Government to back up its words with cash and taking bold and urgent action to pull social care back from the brink and deliver its vision: ‘there is a question about how thinly the funding committed to these proposals will be stretched…it also heavily banks on the actions of future governments and the assumptions that funding raised can be diverted from the NHS to social care. The sector is in the grasp of a deepening workforce crisis, losing as many as 42,000 staff in the last six months, but with no proposals to significantly address low pay…There are already long waiting lists for care and councils are already struggling to meet growing needs. Reform has been dodged for so long that we now find ourselves in a tough starting position’. The Rural Services Network (RSN) described how ‘Local Authorities in rural areas are suffering from years of historic underfunding compared to urban areas. They will be looking for financial reform to bridge the funding gap for Social Care budgets to ensure that they can meet growing demands on the service and current levels of unmet need’. 

Pre-pandemic some people were already unable to get help from their Local Authority and others found themselves in and out of the acute sector as they were discharged without proper care in place. Some people had to sell their family home and possessions to pay for their care – with the Office for National Statistics (ONS) starting to collect data on how many people fund their own care. The Government is now putting choice and investment (e.g. workforce, housing, technology) at the centre of helping those who need care, caregivers and their families. 

What impact has COVID-19 had on older people so far? The pandemic has tragically shown how poor health makes people more vulnerable to further health risks. The social care sector has borne the brunt of the pandemic in so many different ways. In 2020 care home providers notified the ONS and Care Quality Commission (CQC) of 19,248 provisional deaths involving COVID-19 occurring in care homes. In 2021 this figure was 11,229 (to 10 December). According to ONS data, in 2020 more than 800 social care workers lost their lives to COVID-19 since March 2020 – with their loss felt profoundly by their loved ones and staff. Families have been unable to visit their relatives – with data showing that around 97% of care homes closed to visitors during the first wave – with some losing touch with loved ones with dementia who will never recognise them again.  

In February 2021, Baroness Hodgson of Abinger asked the Government what assessment they had made of the impact of COVID-19 on those aged over 75 years. In his response, Lord Bethell described how “… it is a sad fact that this horrible virus targets over-75s more than any other group. We should all be proud of the country’s determination to protect the lives of the elderly and the infirm and give thanks for the vaccines that save so many lives. I assure my noble friend that the NHS has remained open to all and will catch up on the backlog for all those who need medical intervention, irrespective of age”. 

In September 2021, the House of Commons Health and Social Care, and Science and Technology Committees published their report on ‘Coronavirus: lessons learned to date’. This described how the resulting requirement to abandon testing people in the community during the early period of the pandemic cost many lives for a number of reasons, including many older people being admitted to care homes either from the community or hospitals in ignorance of their COVID status or that of staff working in care homes (page 80); and that care homes for older people regularly used bank or agency staff or employed staff regularly working elsewhere which led to a higher risk of infection (page 88). 

Age UK has published research showing how the pandemic has affected older people. It found: 

  • 27% (around 4.3 million older people) said they couldn’t walk as far. 
  • 25% (around 4 million) reported they were living in more physical pain.  
  • 17% (around 2.7 million) said they were less steady on their feet. 

Since the pandemic began many older people have relied, often for the first time, on the internet and digital devices to access services and support. ONS data pre-COVID found that 32% of those who had never or not recently used the internet were between 50 and 69 years of age (over 1 million individuals). Research commissioned by the Centre for Ageing Better sought to understand more about the effects of COVID-19 on digital skills and usage. The research highlights the importance of providing people with a small number of skills building sessions to build their confidence and use of being online; yet they found a lack of awareness amongst older adults of the digital support available. They recommended that small, local organisations be given more funding and resources to support digital inclusion; whilst recognising how non-digital channels still need to be supported. 

Throughout COVID-19 family, friends, neighbours and other informal carers have been expected to step-in or step-up the practical elements of care they were providing. Being a carer while rewarding and uplifting can also be incredibly challenging without the right support in place.  

The King’s Fund has noted how COVID-19 was magnifying the key challenges facing formal social care services, including: 

  • Means testing: adult social care is not free at the point of use like the NHS. 
  • Catastrophic costs: some people end up selling their homes to pay for their care.
  • Unmet need: many people go without the care and support they need. 
  • Quality of care: lack of choice and control. 
  • Workforce pay and conditions: many social care staff are underpaid and undervalued leading to high vacancy rates and high staff turnover. 
  • Market fragility: providers can hand back contracts or go out of business. 
  • Disjointed care: health and social care are not integrated around the individual and this causes issues such as delayed discharge from hospital.  
  • Postcode lottery: there is unwarranted variation between places in terms of access to care and the quality of care being provided.

Some of these points are echoed in a National Audit Office (NAO) report on the challenges facing the social care market in England in the context of the pandemic. This emphasised significant gaps in the Department for Health and Social Care’s (DHSC) understanding of the market. While the NAO acknowledged work underway by the DHSC to address data gaps, increase the capacity of local government and care providers, and strengthen system accountability and assurance; it also recommended that the Government develop a workforce strategy; develop a strategy for the range of accommodation/housing needed by people with care needs; assess the performance and cost data it needs to gain assurance on performance; and explore with the CQC how best to increase the visibility and transparency of provider’s financial sustainability. 

Workforce recruitment and retention were also flagged in a report from the Public Accounts Committee (PAC) on the impact of the pandemic on the care sector. The PAC called on the Government to set out a comprehensive, cross-Government reform plan for care and also emphasised the need for a workforce strategy for the care sector.  Other bodies commenting on the challenges affecting the adult social care sector during the pandemic include the Health Foundation, ADASS, and Carers UK. Similarly, Care England, which represents social care providers, has called for investment and policy support for providers and workers; with bodies such as Skills for Care, the Royal College of Nursing and trade unions all highlighting sector-wide staff shortages. 

In more recent work, the King’s Fund has suggested six things need to happen as part of a long-term wide-ranging reform programme for adult social care: (i) more money is needed to fund the current system; (ii) eligibility needs to be improved; (iii) workforce reform is essential; (iv) personalisation needs re-invigoration; (v) prevention needs to take centre stage; and (vi) carer support needs urgent attention. Will the Government’s social care levy and 10-year vision for social care address these issues? 

How can we support older people to age in rural places? Rural areas have a higher proportion of older people compared with urban areas. According to the Department for Environment, Food and Rural Affairs (Defra) Statistical Digest of Rural England (December 2021 edition): 

  • In 2020, the most prominent age groups in rural areas were 50-54 years and 55-59 years (comprising 7.7% and 8% of the rural population respectively). In urban areas the most prominent age groups are 25-29 years and 30-34 years (7.2% for both age cohorts respectively). 
  • The rural population has a higher proportion of those aged 65 years and over (at 25.4%) compared to the urban population (where 17.1% are aged 65 years and over). 
  • Rural areas in a sparse setting have the highest proportion of those aged 65 years and over – particularly settlements that are rural village and dispersed in a sparse setting (which have 30.7% of the population aged 65 years and over). 
  • Both rural and urban areas have seen an increase in overall population between 2011 and 2020. In rural areas the population increased by 6% and in urban areas by 6.6%.

In April 2021, the Centre for Ageing Better published its commentary on ageing in a rural place. This highlights how the geography of rural areas can prove problematic for the delivery of, and access to health and care services. For example, the lack of or distance from services coupled with poor transport infrastructure makes attending regular appointments difficult. Structures can also operate differently in rural areas – with Town and Parish Councils and District Councils providing housing, leisure and environmental services; County Councils delivering adult social care; Local Enterprise Partnerships supporting the business community; and NHS/ICS structures underpinning the health system. The commentary contains a number of practical solutions to help older people remain independent and be involved in their local community – from increasing levels of physical activity (e.g. promoting walking and cycling) and an increasing prevalence of remote working; through to the diverse, nimble and accessible VCS in reaching the people and places which other services cannot. Rural places are heterogeneous not homogeneous. 

In July 2021 Age UK and Public Health England published a joint report on ageing in rural and coastal communities. This identified five issues which need action: 

  • Loneliness and isolation: particularly for some groups of older men, carers, older LGBTQ+ people and older people from ethnic minorities who often struggle to identify peers in their local area. 
  • The digital divide: the rapid digitisation of services as a potential driver of inequalities. 
  • A lack of support networks among people who move to rural and coastal communities: people may need additional support to identify appropriate services and build peer networks in new communities. 
  • Gaps in public transport provision: this does not always take people to the places they want to go meaning people rely heavily on their cars. 
  • Gaps in support for carers and people with dementia. 

Echoing the Centre for Ageing Better research, the report contained a number of approaches to address these issues – from improving data collection and working with the Voluntary and Community Sector (VCS) through to supporting the development of peer-led services and making accessing services easier (e.g., reaching people through workplaces, community hubs, faith organisations).  

In 2020 Lincolnshire became the Centre for Ageing Better’s Rural Strategic Partner, complementing similar relationships with Greater Manchester and Leeds. Initial programmes of work are exploring healthy ageing (i.e., improving lifestyle choices and promoting physical activity), housing (improving accessibility and digital connectivity), and employment (developing age-friendly employment practices). Lincolnshire now joins a UK Network of Age-friendly Communities. 

In September 2021, the RSN and County Councils Network (CCN) published a joint report describing the quantifying the current state of care in rural areas. This analysed NHS England activity and financial data, and funding estimates and cost projections for adult social care in England. For example, county and rural unitary councils received 49% of all service requests in 2019-2020, up by 5.6% since 2017-2018. Nationally, those aged 65 years and over accounted for 71% of all service requests but in county and rural areas the share of requests received from this age group is disproportionately higher (at 75%). 

Between 2015-2016 and 2019-2020 county and rural unitary councils having absorbed substantially larger reductions to their core funding for adult social care than any other type of council (42.3%). Decreases in funding have been offset to a large extent since 2017-2018 by an increase in temporary grant funding. As a result of temporary grants, all council types except county and rural unitary councils have seen a rise in total grant funding in nominal terms, albeit small. By contrast county and rural unitary councils have seen an overall reduction of £128 million. The report identified the following unique issues facing rural areas when delivering social care: 

  • Resource – Government funded adult social care service costs are significantly lower in rural areas. 
  • Workforce – recruiting adult social care staff to work in rural areas is more difficult than in urban areas. 
  • Demographics – the higher average age and ageing population within rural areas places a higher burden on rural Local Authorities. 
  • Self-funders – the proportion of adults paying for their care is higher in rural areas. 
  • Care homes – the proportion of residential care homes in rural locations is higher than in metropolitan areas, encouraging service user inflow to counties. 
  • Sparsity – the time and costs involved in delivering personal care over large distances in rural and remote areas. 

Alongside demonstrating the severe strain the adult social care system is under, the report suggests that funding alone will not address these challenges: “investment needs to go hand in hand with the opportunities for service improvement and transformation which drive down long-term care costs through better demand management, integration with health and new approaches to service delivery” (page 3) and “reform must also set out a vision for social care based on a value and belief system that is focussed on promoting people’s independence” (page 37). In its rural lens review of People at the Heart of Care, the RSN drew attention to ‘fairness’ in expecting people in rural areas who draw on social care and support to be able to say: 

  • I and my carers can access good social care support regardless of where I live. 
  • I can access good social care regardless of my age. 
  • I can access good social care regardless of my financial means. 
  • I can access good digital care.
  • I can access preventative health initiatives regardless of where I live. 

Some of these unique issues were also identified in the Chief Medical Officer’s (CMO) annual report 2021. Focussing on health in coastal communities, the report highlights how “attracting NHS and social care staff to peripheral areas is harder, catchment areas for services are artificially foreshortened and transport is often limited, in turn limiting job opportunities” (page 2). 

For the past 2-years the National Centre for Rural Health and Care (NCRHC) has been providing the secretariat for a Parliamentary Inquiry into Rural Health and Care. Evidence provided to the Inquiry highlights how the costs of funding adult social care are an issue nationally, but rural Local Authorities are often spending a disproportionately high part of their budget on these services. Rural residents often face less choice and higher care costs than their urban counterparts. Recruiting and retaining social care staff in rural areas where demand for social care is high yet wages and career progression low and access to transport is poor leads to staff shortages. Ensuring parity of esteem between clinical and social care settings (e.g., hospital discharges are a key interface in linking clinical health and social care staff) is vital and social care roles should not be seen or treated as the poor relation to other health roles. The Inquiry is due to launch its findings and recommendations in 2022.

For me, what all of this research shows is that if we want older people to live independent, healthy, and fulfilling lives in rural areas we need to ensure they get the care they need, in ways that are personalised, financially sustainable, delivered in high quality settings by staff who are well trained, paid and valued, and that recognises and supports unpaid carers. We also need to recognise the role of the VCS in driving prevention and wellbeing. Successive Governments have promised but so far always struggled to deliver social care reform. There are no simple, one size fits all solutions, particularly for rural areas. While the current Government is committed to reform, it now needs to put in place the resources needed to deliver its ambitions and vision. Will investment and innovation right across the social care sector deliver for rural communities? Watch this space. 

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Jessica is a researcher/project manager at Rose Regeneration and a senior research fellow at The National Centre for Rural Health and Care (NCRHC). Her current work includes supporting health commissioners and providers to measure their response to COVID-19 and with future planning; and evaluating two employability programmes helping people furthest from the labour market. Jessica also sits on the board of a Housing Association that supports older and vulnerable people. 

She can be contacted by email jessica.sellick@roseregeneration.co.uk. 

Website: http://roseregeneration.co.uk/https://www.ncrhc.org/ 

Blog: http://ruralwords.co.uk/ 

Twitter: @RoseRegen 

Finding a place to call ‘home’: what more can be done to plug the rural housing gap?

Finding a place to call ‘home’: what more can be done to plug the rural housing gap?

Despite numerous consultations, announcements, funding packages, targets and interventions by successive Governments the housing gap remains – with the number of households [demand] outstripping the houses built [supply]. While rural places are often viewed as idyllic places to live, work and enjoy they face particular issues around affordability, accessibility and contain more second / holiday homes than their urban counterparts. How many homes do we need, and what more can be done to provide the rural homes people require? Jessica Sellick investigates.

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How many homes do we need, and are we delivering enough?  

Back in 2015 the Coalition Government set out an ambition to deliver 1 million net additions to the housing stock by the end of 2020. In 2016 a House of Lords Select Committee on Economic Affairs report recommended the development of at least 300,000 homes annually for the foreseeable future. 

In 2017 the Conservatives made a pledge to meet the 2015 commitment, and to deliver 500,000 more homes by the end of 2022. In January 2018, the Department for Housing Communities and Local Government (DCLG) was renamed the Ministry of Housing, Communities and Local Government (MHCLG); and the Homes and Communities Agency (HCA) relaunched as Homes England and tasked with implementing the Government’s white paper to supply new homes.  The white paper found ‘not enough Local Authorities planning for the homes they need; housebuilding is simply too slow; and the construction industry is too reliant on a small number of big players’. The white paper highlighted the need to: 

  • Build the right homes in the right places. 
  • Build them faster. 
  • Widen the range of builders and construction methods. 
  • Help people now – by investing in new affordable housing and preventing homelessness. 

Since the white paper numerous consultations and policy developments have taken place. The Planning White Paper published in August 2020, for example, described the planning system as central to the failure to build enough homes and made a number of proposals to reform the system. 

The current Government target is to provide 300,000 homes a year by the mid-2020s. Data shows that new supply has been increasing, reaching 244,000 completions in 2019-2020. Housebuilding starts fell in April-June 2020 as a result of COVID-19 [reaching levels similar to 2008]; though starts began to increase in July-September 2020. 

Estimates published by the Centre for Policy Studies (CPS) for 2019 show that housing completions since 2010 have averaged approximately 130,000 per year – below the current Government target. 

According to the Department for Environment, Food and Rural Affairs (Defra) Statistical Digest of Rural England (May 2021), between 2019-2019 and 2019-2020, the number of housing completions per 1,000 households increased in both predominantly rural and predominantly urban areas: with 10.5 dwelling completions in rural and 6.0 completions in urban areas. The Statistical Digest reveals how: 

  • There has been a steady increase in dwelling completions by Local Authorities and Housing Associations in predominantly rural areas: in 2019-2020 there were 2.1 completions per 100,000 households in rural areas compared to 1.1 completions in urban areas.  
  • In 2018-2019 in predominantly rural areas there were 64,700 net new dwellings, (or 12.8 per 1,000 households). This compares to 147,990 net new dwellings (9.4 per 1,000 households) in predominantly urban areas. 
  • New-build dwelling completions accounted for 90% of net additions to the housing stock in predominantly rural areas in 2018-2019, compared with 84% in predominantly urban areas. 
  • A further 8% of such net additions came from change of use of buildings in predominantly rural areas, compared with 14% of such net additions in predominantly urban areas. 
  • New-build dwelling completions per households in predominantly rural areas are higher than in predominantly urban areas: in 2018-2019 there were 11.6 new-build dwelling completions per 1,000 households in predominantly rural areas, compared with 7.9 in predominantly urban areas. 
  • In 2018-2019, the net number of dwellings arising from change of use in predominantly rural areas was 1.0 per 1,000 households and in predominantly urban areas it was 1.3 per 1,000 households.

According to a report by the National Housing Federation (NHF), nearly 8 million people have some form of housing need in England. 

Research from Heriot-Watt University in 2019, estimated a housing backlog of 4 million homes; and the total level of new social housing at around 340,000 for England per year until 2031. They proposed this comprise 90,000 homes for social rent, 30,000 for intermediate affordable rent, and 25,000 for shared ownership. 

Defra’s Statistical Digest suggests there are proportionality fewer homeless people and people living in temporary accommodation in rural areas compared to urban areas. However, research published by CPRE, the Rural Services Network and English Rural in October 2020 found homelessness in rural areas has doubled over a 2-year period: with the number of households categorised as homeless in rural Local Authorities rising to 19,975 – an increase of 115% from 2017-2018. 

Crisis distinguishes between ‘core homelessness’ and ‘wider homelessness’. Core homelessness refers to households who are considered homeless at any point in time because they are living in short-term or unsuitable accommodation. This includes rough sleeping, sleeping in tents/cars/public transport, unlicensed/insecure squatting, unsuitable non-residential accommodation such as ‘beds in sheds’, hostels, night/winter shelters, domestic violence victims in refuges, temporary accommodation such as bed and breakfast accommodation and sofa surfing. Wider homelessness refers to people at risk of homelessness or those who have already experienced it and are living in temporary accommodation. This category encompasses staying with friends/relatives, being under notice to quit, being asked to leave by parents/relatives, in other temporary accommodation (e.g. social housing, private sector leasing), and/or being discharged from prison, hospital or other state institution without permanent housing. The research team at Heriot-Watt University used the main components of core homelessness and undertook statistical modelling to predict rates. The central estimates suggest in 2018-2019 the number of core homeless households in England was approximately 201,000. 

Between April and December 2020, some 39,110 households secured accommodation through a relief duty which required Local Authorities to bring everyone living on the streets into self-contained accommodation as a response to COVID-19 [‘everyone in’] – 3,300 people were sleeping rough on approach.  

Properties must be unfurnished and unoccupied for more than 6-weeks to be classed as empty. An audit of homes that have been empty for 5-years or more by Action on Empty Homes (AEH) found 400,000 empty properties. Almost 50% of the homes liable for the empty homes premium are in council tax band A. In 2020, 300 Local Authorities in England charged owners of long-term empty properties a council tax premium. Hotspots for where those in the higher bands were charged include Cheshire East, Buckinghamshire and Surrey. AEH also suggests there are thousands of empty homes that are furnished empties, often referred to as second homes, which comprise a further 263,000 homes and do not fit the empty definition and are not therefore charged a premium. 

While the trend is for an increasing number of new homes to be supplied annually [with the Government working towards a target of 300,000 per annum], historically we have consistently been unable to meet any supply target(s) set. Such targets do not take account of the estimated 400,000 empty properties or 263,000 second homes. They also fail to take account of people with a housing need [4-8 million households], the 39,000 people housed as part of ‘everyone in’ or 201,000 households experiencing core homelessness. While some of the figures suggest the rate of new build completions is higher in predominantly rural areas when compared to predominantly urban areas, the rate of change of use is lower in rural areas. When looking at the datasets it can be difficult to understand how people in rural areas are being affected by the availability of housing in their local area – how many homes do we need in rural areas, and who for?    

Are we delivering homes in the right places, to a high standard, and at an affordable cost?  

Whatever the supply target, it is clear that providing a home for everyone who needs one is not simply about just building more houses anywhere. While there are severe housing shortages across the country, rural areas face particular difficulties. According to the Rural Services Network (RSN): 

  • Average house prices are £44,000 higher in rural areas than urban areas. Housing is less affordable in predominantly rural areas, where lower quartile (the cheapest 25%) house prices are 8.3 times greater than lower quartile annual earnings.
  • Options for those on low incomes seeking social rented housing are typically limited in small rural settlements. Only 8% of households in villages live in social housing. By contrast, 19% of households in urban settlements live in social housing. 
  • The rural stock of social rented housing has shrunk under the Right to Buy policy, with sales quadrupling between 2012 and 2015 to reach 1% of the stock each year. Although the sale income is intended for reinvestment, only 1 replacement home was built in rural areas for every 8 sold during this period, and these replacements were rarely in the same settlement.
  • Second homes and holiday lets often add to rural housing market pressures, especially in popular tourist areas. They form a particularly large share of the housing stock in some local authority areas – including, for example, Isles of Scilly (15%), North Norfolk (10%) and South Hams (9%).

Many of these difficulties were echoed in evidence given to the Parliamentary Inquiry into Rural Health and Care in 2020. Ms Jo Lavis (housing professional) described how, in 2019, just 5,558 new affordable homes were built in villages of less than 3,000 population, with 80% of those completions private sector dwellings. In 70% of rural communities it is not possible to gain affordable housing on-site from developments of less than 10 dwellings. Housing needs surveys undertaken by Rural Housing Enablers (RHEs) in 10 counties and 26 villages between January and March 2020 found: 

  • 383 households were looking for affordable housing. 
  • 71% of households were looking for a home to rent. 
  • 60% of households earned less than £30,000 per annum and half of them less than £20,000.  
  • 35% were aged 16 – 30 years and 21% 60 years and over.  
  • 42% were looking for a house and 56% looking for a bungalow/level access or adapted housing. 

Stays of longer than 28 nights on Airbnb globally rose from 14% in 2019 to 24% in the first three months of 2021 with remote working one of the contributing factors. Rural nights booked in the UK have increased from 25% to 50% of bookings. A survey by ARLA Propertymark and Capital Economics found 470,000 properties could be removed from the long-term lettings market to short-lets; and 16% of all adults have let out all or part of their property (equating to 19% of the UK’s housing stock). There are concerns that the supply in the private rented sector will drop and rent costs will increase.

What are we building?

According to Defra’s Statistical Digest, in 2011 the majority of houses in rural villages & rural hamlets and isolated dwellings were detached properties. In 2018, the majority of new-build residential transactions were detached properties in both rural village & dispersed and rural town & fringe settlements, at 58% and 52% respectively. In 2018, there were 14,000 transactions for detached properties, a level four-times greater than in 2009.  Flats made up the smallest proportion of new build transactions in rural areas, but the majority in urban conurbations (at 56%). 

Regarding existing stock, in her evidence to the Inquiry, Ursula Benion (Trent and Dove Housing/Rural Housing Alliance) highlighted how rural homes are less likely to be updated; and rural areas tend to suffer from poorer broadband, which affects the use of technology to make rural dwellings more “liveable” and the desirability of rural places as communities to live in.

A decent home? 

A report from the Centre for Ageing Better and Care & Repair England found more than 4.3 million homes in England did not meet basic standards of decency, most commonly because of the presence of a serious hazard to their occupants’ health or safety. Half of these homes are lived in by someone over 55 years of age, and a million homes contain at least one child. Households headed by someone over 75 years of age were found to be disproportionately likely to be living in a non-decent home, and the problem has worsened for this age group. Two million households headed by someone over 65 years of age find it difficult to heat their home. The largest number of non-decent homes is among owner-occupiers, with many facing financial or practical barriers to maintaining their home. Meanwhile 20% of all homes in the private rented sector were deemed ‘non-decent’.  

Research from Shelter has looked at the impact of poor quality housing on mental health. 1 in 5 English adults surveyed (21%) said a housing issue had negatively impacted upon their mental health in the last five-years. 3 in 10 of those with a housing problem said they had experienced no issue with their mental health previously. 

The Government is currently carrying out a review of the Decent Homes Standard. Part 1 will run to Autumn 2021 and seek to understand the case for change to criteria within the Standard. If the case for change is made, part 2 will run from Autumn 2021 to Summer 2022 and will consider how decency should be defined. 

What’s affordable?  

The Affordable Housing Commission has estimated that 1.6 million working age households in the bottom half of income distribution spend 33% of their net income on rent; with 1.2 million of these households paying more than 40%. Problems of affordability are heavily concentrated in the private rented sector where tenants have the least security. According to the English Housing Survey, in 2019-2020 privately-renting households spent more of their income on housing on average compared with other groups. On average, private renters spent around 32% of their income on rent, compared with 27% for social tenants and 18% on mortgage costs for mortgagors. Overall, the Commission reported that 1 in 5 households in England face some form of affordability issue. This was supported by the Church of England’s coming home report which described how: “in rural and coastal tourist destinations, even just a few homes being taken up as holiday or second homes can have a significant impact on local communities. Schools, churches and community organisations find it difficult to recruit pupils and members. Local businesses struggle out of season” (page 25). 

In ‘making housing affordable again’, the Affordable Housing Commission analysed the proportion of income that lower-income households have to spend on housing. The tables below (page 68) indicate how problems of affordability are concentrated in the private rented sector where tenants have the least security; and in London and the South East where two-thirds of private sector tenants were found to be paying one-third or more of their income in rent:

There is no all-encompassing statutory definition of affordable housing in England and there is ambiguity in the way the term ‘affordable’ is applied in relation to housing. Often used to describe housing provided with public subsidy, it can also be applied to describe housing of any tenure that is judged to be affordable to a particular household or group by looking at housing costs, income levels and other factors. 

In 2002 the Chartered Institute of Housing (CIH) submitted evidence to the Transport, Local Government and the Regions Select Committee’s Affordable Housing inquiry in which it argued for precise and appropriate definitions of affordable housing. Then, the Office of the Deputy Prime Minister (ODPM): Housing, Planning, Local Government and the Regions Select Committee conducted an inquiry into Affordability and the Supply of Housing in 2005-2006, choosing to define affordable housing as: ‘subsidised housing that meets the needs of those who cannot afford secure decent housing on the open market either to rent or buy’. Since then, within Government housing policy, affordability has been linked to below market prices and rents. Currently, ‘affordability’ as a technical term is defined in Annex 2 of the National Planning Policy Framework (NPPF) as “(i) social rented, (ii) affordable rented and (iii) intermediate housing, provided to eligible households whose needs are not met by the market.” 

While noting how the NPPF had incorporated these definitions in its 2019 update, the Affordable Housing Commission concluded in 2020 that “many of these products are clearly unaffordable to those on mid to low incomes”. 

The housing cost to income ratio (HCIR) considers the proportion of a household’s disposable income spent on housing. This measure is widely used in studies of affordability. For example, the HCIR has been used by the Resolution Foundation in its research on affordability – identifying an overall trend is one of significant increases in housing costs relative to income. While the average family spent just 6% of their income on housing costs in 1961, today this has trebled to 18%. Among private renters, the average HCIR has increased from 9% in the 1960s to 36% today. In contrast, the average HCIR among outright owners is approximately 5%. In 2020, the Affordable Housing Commission proposed a definition of housing affordability which builds on the housing cost to income ratio by taking account of personal circumstances rather than market prices: ‘our measures are based on an affordability threshold at the point when rents or purchase costs exceed a third of net equivalised household income (and take account of related affordability issues, such as housing quality, overcrowding, adequacy of housing benefit, household size and regional variations)’. 

Research by Savills, carried out on behalf of the National Housing Federation and the Joseph Rowntree Foundation, in 2015 proposed the development of rented homes which would be accessible to a household in employment with rents based on the bottom quarter of local earnings, starting at a level based on 28% of that figure. The NPPF includes a standard method for calculating housing need which incorporates a housing costs to earnings ratio. Local planning authorities are expected to use the standard method when assessing local housing need as part of the Local Plan process. The standard method takes a baseline measure of projected household growth and adjusts this upwards, based on the ratio between the median house price in the area and the median annual earnings of full-time employees working in the area. 

The NatCen takes a residual income approach to defining and measuring housing affordability, based on the Minimum Income Standard (MIS) – this details the income that different households are believed to need to reach a minimum socially acceptable standard of living in the UK. The approach states that housing is affordable to a given household ‘if they can afford to pay for their housing and have enough left over to cover what is needed to reach the minimum income standard for their household type’. However, some households have such limited incomes so that they would be below this standard even if they were to pay no housing costs. The housing affordability measure therefore takes into account whether households are below the minimum income standard because of their high housing costs rather than because they have a low income. The analysis  presented back in 2016 revealed that at least one in five households in the private rented sector had unaffordable housing costs. 

A comparison between MIS in 2008 and 2018 found that while in 2008 the MIS calculations used social housing as a starting point in calculating minimum costs for all groups, its limited availability means that private renting is now used as the MIS benchmark for working-age people without children – and is becoming the only option for many with children too. In the original MIS published in 2008, groups said that social housing would meet the needs of all household types. However in 2014, when the budgets for households without children were rebased (i.e., redeveloped from scratch with new groups), this was thought unrealistic for working-age singles and couples, while still being considered the lowest-cost socially acceptable housing for pensioners and parents. While a substantial number of working-age adults without children live in social housing, many of these are in vulnerable groups such as those with disabilities or addictions. It is perceived that, in general, there is little prospect for most people without children to get allocated social housing.

Local planning authorities may require developers to include an element of affordable housing on site as a condition of granting planning permission. Sometimes known as ‘section 106 agreements’, these are legally enforceable obligations. In 2019-2020, more than 27,000 homes were delivered through such agreements, of which 3,800 were for social rent. The NPPF states that ‘where major development involving the provision of housing is proposed, planning policies and decisions should expect at least 10% of the homes to be available for affordable home ownership, unless this would exceed the level of affordable housing required in the area, or significantly prejudice the ability to meet the identified affordable housing needs of specific groups’. 

For too many people their homes are  in a poor state and unsuitable condition. The new homes being developed in rural areas tend to be detached and do not necessarily meet the housing needs of some members of our communities looking to downsize, buy their first home, or move into an adapted property. What more can be done to ensure new builds meet the stock type needed locally? Such is the lack of consensus over what affordability means in housing terms, there are suggestions that the concept should be abandoned on the basis that it is unhelpful for describing the difficulties some households face in meeting their housing needs. Some rural places are now seen as the preserve of the rich with too few homes available for affordable rent and/or shared ownership. How might we measure what affordability looks like in different rural places?  Rather than focusing on the number of new homes built, perhaps the balance should be on the location, tenures and affordability? 

What impact has COVID-19 had – and how can we build back better and level-up communities?

In a speech on the economy in June 2020, the Prime Minister, Boris Johnson, argued that “newt-counting delays in our system are a massive drag on the productivity and the prosperity of this country”, slowing down house building; and that in recovering from the COVID-19 pandemic, we would “build back better and build greener but we will also build faster”. The Government published its white paper ‘Planning for the Future’ in August 2020. The paper contained a range of proposals – from local communities being consulted from the very beginning of the planning process, to protecting valued green spaces for future generations by allowing more building on brownfield land; and building homes more quickly by ensuring local housing plans are developed and agreed in 30 months rather than up to 7 years, through to every area requiring a plan in place to build more homes. In parallel to the white paper, the Government also launched a consultation on changes to the current planning system. The proposed changes cover four policy areas. Firstly, setting developer contributions for first homes. Secondly, raising the threshold at which developer contributions would be sought [section 106] for a limited time period to 40 or 50 homes. Thirdly, a new system to allow the Secretary of State to grant planning ‘permission in principle’. And fourthly, amendments to the standard method for calculating housing need to include percentage of housing stock levels and an affordability adjustment. 

Numerous bodies have queried whether these new approaches will make it harder to achieve the Government’s target of 300,000 new homes a year and/or lead to the loss of the countryside. In response to an opposition day debate on local involvement in planning decisions in June 2021, Graham Biggs, Chief Executive of the RSN, described how: “proposals to reform the planning system are too simplistic and will not meet the many economic, social, and environmental needs of communities in rural areas. Residents and their parish councils must continue to be given a say about planning applications. A successful land use planning system needs to have both the ability and local flexibility to plan for rural communities which are sustainable in economic, social, and environmental terms, meeting the varied needs of small as well as large settlements. Current proposals set out in the Planning White Paper will need to be revisited and considerably revised if they are to deliver that objective.”

In response to COVID-19, the Government has already been making various changes to planning rules. Some of these changes relate to permitted development rights (PDRs), under which development may take place under a general permission granted by Parliament without requiring an application to the LPA for planning permission.  Other changes – introduced through the Town and Country Planning (Use Classes) (Amendment) (England) Regulations 2020 – create new some use classes and abolish some old ones.  

In a blog for the NHF in July 2020, Lord Best described what the impact of COVID-19 might have on housing in rural areas. He identified the following trends: 

  • Young people working or living in rural areas – perhaps with parents in council housing or in accommodation linked to a farming job – may find it harder than ever to find a place of their own nearby. 
  • With our new willingness to work from home and commute less frequently, homes in the countryside seem destined to be more in demand. 
  • Older people who had been thinking about downsizing a home or garden that is becoming less accessible and more expensive may have a change of mind – a care home may be avoided at all costs in place of access to fresh air, space and sunshine. 
  • For families on lower incomes, greater insecurity around employment and/or the erosion of savings may make home ownership or shared ownership a distant dream. 

Urban flight?  

According to the Office for National Statistics (ONS), average UK house prices rose by 8.5% in 2020, despite the difficulties of physically valuing or viewing properties during periods of lockdown. In July 2020 the Chancellor announced the suspension of stamp duty on properties up to £500,000, a scheme was that due to end in March 2021 but has been extended to June 2021 when it steps down to £250,000, with the £125,000 threshold due to be reintroduced in September 2021. The Government has also announced a Loan to Value mortgage guarantee scheme intended to benefit first time buyers.  

A survey of buyers and sellers registered with Savills back in May 2020 found 51% of people in London were considering a move outside the city [compared to 42% for the same period of 2019] and 30% were more likely to consider a village or countryside location for their next move.

According to Hamptons International, in 2020 London leavers purchased 73,950 homes outside the capital, the highest number in four years. Collectively, Londoners bought £27.6 billion worth of property outside the capital this year, the highest amount since 2007 when London outmigration previously peaked.  This figure exceeds the total value of all homes sold in the North West last year (£24.8 billion). Sevenoaks recorded the biggest increase in the share of homes bought by Londoners with 62% of homes in the area bought by a Londoner, levels 39% higher than in 2019.  Other hotspots for Londoners included Windsor and Maidenhead (+27%), Oxford (+17%) and Rushmoor (+15%). 

 Rightmove reported a 126% increase in searches for village locations in 2020. Most of the top village destinations were still within a commutable distance to a city, but with the appeal of a quieter way of life. It is thought that homeowners living in cities have benefitted from strong house price growth over the years and are now able to trade up and move to the countryside. 

Research by Knight Frank and the Telegraph in June 2021 found market towns had been overlooked in the first lockdown  – where people wanted remote and rural locations – but surged during the second lockdown. The research identified 12 market towns which scored highly in terms of crime levels, healthcare, education, affordability, and having something for everyone: Spalding (Lincolnshire), Ashbourne (Derbyshire), Stratford Upon Avon (Warwickshire), Arundal (West Sussex), Shipston-on-Stour (Warwickshire), Northwich (Cheshire), Tewkesbury (Gloucestershire), Kendal (Cumbria), Tenterden (Kent), Knaresborough (North Yorkshire), Lymington (Hampshire) and Haslemere (Surrey). 

In March 2021, The Sunday Times published ‘the best places to live’ guide. The top listed rural places included Alnmouth (Northumberland), Charlbury (Oxfordshire), Denham Vale (Essex/Suffolk), Edale (Derbyshire), Isle of Eigg (Inner Hebrides), Surrey Hills, and Tisbury and the Nadder Valley (Wiltshire). The median house price varied from £299,950 to £675,000. 

Home improvements and do it yourself? 

As many of us have been spending so much time in our homes, we have become aware of how they do (and don’t) work for us. For some people, relying on our homes for everything – working, learning, relaxing, exercising, home schooling – and remaining in our property has led some of us to carry out home improvements. 

Kantar estimated that we spent some £4.94 billion on improving our homes between September and December 2020, £552 million more than during the same period in 2019. A poll by MADE found 68% of consumers shopped online for home items at least once a month during 2020 while almost 1 in 5 (19%) did so multiple times per week. 40% of respondents claimed to have bought new home accessories throughout lockdown, and the same number rearranged their furniture, in search of a fresh perspective. This resulted in MADE witnessing a notable interest from consumers for multiple products from art (+117%) to bedding (+122%) and bathroom accessories (+177%). Research by Habito found 62% of home owners intend to undertake home improvements in 2021 – with one-third planning to re-mortgage their home to fund the improvements.  

Generation(s) rent? 

As the impact of the pandemic on earnings and savings becomes clear, Paragon Bank has estimated that more than one million older people will end up renting by 2031. According to the English Housing Survey, people aged 55 years and over are the fastest growing cohort of renters – with some 609,000 renting in 2019, double the figure when compared to 2009. COVID-19 is seen to be accelerating trends amongst older people including rising divorce rates, poorer pension returns and men living longer. Some suggest there is a trend amongst older people for flexibility, simplicity and freedom that renting offers. 

Research from the Loughborough University found in the UK nearly two-thirds of people aged 20-34 years (some 3.5 million people) live in their family home, and this figure has grown during COVID-19 due to the impact of the pandemic on the mental and financial health of young adults. 

During the Spanish flu in 1918, people fled the metropolis for the countryside. COVID-19 is seeing a similar phenomena with some people wanting to move to the urban fringe and others moving to remote rural areas as they see a future of fully remote working. While some sectors of the economy have been struggling (e.g. hospitality, travel), the DIY / home interiors sectors have been booming. With many of us re-evaluating our lives and where we want to live, will current and planned housing stock meet the economic realities facing people wanting to live and work in the countryside? 

What more can be done to deliver the homes we need in the countryside? 

According to Lord Best, “in the post-coronavirus era, it looks as if the tried and tested solutions for meeting housing need remain paramount. More homes for social renting in small developments that target local people, and a few purpose-built bungalows for older people to free up family homes, can make a huge difference for the village”.

Successive Governments have focused on building new homes with the intention of the additional supply reducing prices. But we are not hitting our targets for new homes, and nor are prices falling. If the current system is broken, what can be done to fix it – and fix it in rural areas?   

The Rural Services Network is calling on the Government to produce a fully-funded, comprehensive rural strategy. Such a strategy should address: 

  • Bringing forward development sites at a price suited to affordable housing; 
  • Making sure such homes are, and remain, genuinely affordable. 
  • Planning new housing in ways which attract community support; and 
  • Ensuring the funding model for affordable house building stacks up. 

The RSN believes that for rural to be affordable places to live, the following initiatives are needed: 

  • A planning policy to fit rural circumstances – allowing affordable housing quotas where they are most needed. 
  • A realistic definition of affordable – to meet the greatest need for social rented housing. 
  • A dedicated rural affordable housing programme – to boost delivery by housing associations in small rural settlements. 
  • A bolstering of landowner and community support – to release land for rural exception sites, at prices and under the assurance that they will only over be for affordable housing. 
  • A replenishing of social housing – ensuring that right to buy sale proceeds are returned to Local Authorities so they can reinvest it and replenish the stock of affordable homes. 

In March 2021, the RSN launched ‘Revitalising Rural’ campaign. This sets out a number of key asks of Government to ensure rural areas are not left behind in the levelling-up agenda and that they are considered in post-pandemic policy making. On housing, the campaign makes specific asks around affordable housing quotas, grant funding, community-led housing, exception sites and the proceeds of the sales of affordable homes.   

The Commission on Housing, Church and Community was launched in April 2019 with a remit to re-imagine housing policy and make recommendations to Government; and to look at what actions the Church of England could take with others to tackle the housing crisis. The Commission published it report ‘Coming Home’ in February 2021. This explored some of the reasons for the mis-match between activity and outcomes. The Commission echoed the need for a long-term housing strategy: ‘What does the Government aspire to for these various tenures by 2030 and 2040? What does the Government aspire to in terms of the affordability of housing, owned and rented, defined in relation to household incomes? What does the Government aspire to in terms of the condition, and environmental sustainability of the housing stock? Without clarity on these longer terms goals, the housing policies of successive governments have been characterised by short-term interventions and announcements’ (page 75). The Commission also called for investment in existing housing stock – with a focus on safety, on ensuring private rented homes are affordable to people on low incomes and a review of social security changes. The Church of England has developed a range of theological resources to make connections between faith and housing. Much of this work is building on the Faith in Affordable Housing project, which works with all denominations in England and Wales to release surplus land or buildings for affordable housing. 

The Rural Housing Alliance (RHA) and National Housing Federation (NHF)  have developed a 5-star plan for housing associations and the wider rural housing sector. Endorsed by the RSN, the plan focuses on delivering more quality homes that meet local needs through partnerships with rural communities and landowners. Under the plan, housing associations and rural stakeholders that sign up pledge to: 

  1. Work with and for rural communities, in accordance with the Rural Housing Alliance pledge. 
  2. Increase the current level of housing supply in rural communities by 6% per year for each of the next five-years. 
  3. Bid for at least 10% of Home England investment to deliver new homes in rural areas. 
  4. Ensure that homes are delivered benefit the local economy, including the farming and food economy. 
  5. Meet the needs of rural communities and contribute towards five key tenures, as appropriate – homes for affordable rent, market rent, affordable home ownership, self-build and market sale.

The Affordable Housing Commission recommendations for rural areas chime with the RSN and RHA in asking for regulatory reforms and tax incentives to encourage land owners to assist with housing provision for local people, with housing remaining affordable in perpetuity; and permitting Local Authorities to require some affordable housing for local people in rural schemes of less than 10 homes.

What emerges from all of this work is the need for a clear plan or strategy for rural areas that not only considers housing in a post-COVID, longer-term perspective, but also seeks to support those in the greatest need and links housing explicitly to other policy areas such as work, health and education. It needs to move away from crisis intervention to prevention – for example, we tend to respond to immediate needs particularly around ill health, food banks, homelessness, rather than thinking more holistically about providing affordable housing in rural places.       

The National Planning Policy Framework encouraged larger scale developments and significant extensions to existing villages to meet supply. This led the Government to support a number of new garden villages across the country. This originally sought to support 23 places to deliver 200,000 homes by the mid-2020s. According to the prospectus, ‘this is not about creating dormitory towns, or places which just use ‘garden’ as a convenient label. This is about setting clear expectations for the quality of the development and how this can be maintained (such as by following Garden City principles). We want to see vibrant, mixed-use, communities where people can live, work, and play for generations to come – communities which view themselves as the conservation areas of the future. Each will be holistically planned, self-sustaining, and characterful’ (page 5). In June 2020, Transport for New Homes published research querying if 20 of these green communities were at risk of becoming car-dependent commuter estates, estimating they may develop up to 200,000 car-dependent households. One of the recommendations contained in the report was to build close to existing town centres or create strings of developments along public transport routes, rather than scattering developments around the countryside.

Broadway Maylan has developed the concept of the ‘reimagined village’ in seeking to reinvent the notion of village appeal and to expand it to broader target groups. This calls for the future village to be a valid economic force in its own right – connected, smart and green; and with something to offer everyone, irrespective of age, background, income, location or work/professional aspirations. They argue a number of components should be considered when designing a village, including scale and size; flexible and contemporary aesthetic housing; green space for active and healthy lifestyles; minimising environmental impact by building for a zero-carbon future; having an integrated community hub; providing places for modern working patterns; and introducing a range of sustainable transport infrastructure. 

CPRE has long advocated for a ‘brownfield first’ policy. CPRE’s State of Brownfield 2020 reveals how there is enough brownfield land for 1,061,346 housing units over nearly 21,000 sites, covering almost 25,000 hectares. There is currently planning permission for 565,564 units, or 53% of the total brownfield housing capacity. And there is currently land provision for over 1.5 million homes using brownfield land and other land with planning permission, providing enough land to meet the government’s 300,000 homes a year target. According to CPRE, an approach to development that focuses on brownfield first would help to deliver homes where people really need them; closer to services, workplaces, public transport and shops. This would help us to protect and enhance the green spaces that are crucial for tackling the climate emergency, and safeguarding health and wellbeing. 

Along similar lines, the Local Government Association and Cabinet Office have been running the One Public Estate programme since 2013 to support public bodies to get more out of their assets – including new homes and jobs.  Covering the period up to 2019-2020, the programme was set to release land for some 25,000 homes.  The programme cites the work of the London Borough of Croydon in identifying 15 publicly owned sites for regeneration which will see the development of 900 new homes and 7 new community facilities over a 5-year period. Analysis undertaken by the New Economics Found (NEF) found only 15% of homes being built on public land were classified as ‘affordable housing’; and only 2.6% of the homes being built were for social rent. 

The Climate Change Committee found residential housing is the fourth largest contributor to UK emissions, accounting for 14% of the total. Two-thirds of homes currently have an EPC rating below the Government target of C and above. 2.4 million households (10% of all households) are living in fuel poverty. Only 1% of new homes are built to the highest energy rating. The UK’s legally binding climate change targets will not be met without near-complete elimination of greenhouse gas emissions from buildings – and efforts to adapt housing stock are lagging behind.   

How can we provide more homes in the countryside without ruining it? A significant amount of land in public ownership is not needed to deliver public services and similarly, church/faith, charitable and private landowners may also have assets that could be harnessed to support the delivery of more affordable homes in rural places. While some organisations advocate for new rural settlements, others suggest we should utilise brownfield and protect the greenbelt. Rather than thinking on a settlement by settlement basis, how can we take account of the functionality and linkages between rural places? 

If many of us are going to continue to live and/or work a bit differently, what will that mean for our rural communities? Watch this space. 

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Rural Housing Week is a campaign that takes place annually to showcase the work that housing associations do in rural communities. This year it is taking place 5-9 July. More information about the campaign and how to join in can be found here. 

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Jessica is a senior research fellow at The National Centre for Rural Health and Care (NCRHC) and researcher/project manager at Rose Regeneration. Her current work includes supporting health commissioners and providers to measure their response to COVID-19 and with future planning; providing the secretariat for the Parliamentary Inquiry into Rural Health and Care; and evaluating two employability programmes helping people furthest from the labour market. Jessica also sits on the board of a Housing Association that supports older and vulnerable people – and is developing schemes in rural places. 

She can be contacted by email jessica.sellick@roseregeneration.co.uk. 

Website: http://roseregeneration.co.uk/https://www.ncrhc.org/ 

Blog: http://ruralwords.co.uk/ 

Twitter: @RoseRegen 

From community to brigade: the changing role of fire [cover] and rescue services in rural places

From community to brigade: the changing role of fire [cover] and rescue services in rural places

While the core work of fire and rescue services has always been firefighting, they also respond to a wide variety of other incidents – from flooding and road traffic accidents to people stuck in machinery. When someone dials 999 they are experiencing a crisis that could be life threatening; and they require and expect a timely emergency response. National guidelines that set response times for fire calls were first formulated by the Riverdale Committee back in 1936. They have been modified a number of times since then. If firefighting and emergency response is every bit as dangerous in rural areas as in urban areas, how can we ensure resources are deployed in ways that take account of rural communities? Jessica Sellick investigates. 

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What is fire cover – and how has it been provided in rural places? Fire cover principally involves siting fire appliances in locations which best serve local conditions and meet nationally set standards of fire cover. Determining the optimum sites for resources – and how to do this in rural places – has evolved over time.  

When the Royal Commission on Fire Brigades and Fire Prevention published its report back in 1923 it was of the view that “there are certain parts of the country which it would be uneconomic to protect, such as the hilly areas of Cumberland and Westmoreland, the Cotswold range of hills in Gloucester, or some of the mountainous districts in Wales and the Highlands of Scotland” (page 40). And yet, a civil servant called Arthur Dixon vowed to improve the provision of fire services in rural areas and two pilot schemes were set up in North Derbyshire and Norfolk. The schemes depended on Local Authorities in these areas cooperating through a joint board that could raise funds by a rate and make payments to participating brigades on a ‘fixed’ or ‘fee per fire attended’ basis. The pilot in Norfolk depended on the boy scouts identifying and preparing water supplies; and the North Derbyshire scheme resulted in a disproportionate contribution being made by authorities in towns to cross-subsidise provision in rural areas. At the end of the pilot period the Government decided the schemes would not address fire cover in other rural areas. However in North Derbyshire a ‘penny levy’ continued to fund the scheme until the Second World War. 

In 1935, Arthur Balfour was appointed Chair of the Departmental Commission on Fire Brigade Services (known as the Riverdale Committee) – and his work led to the Fire Brigades Act 1938. The Act placed, for the first time, a statutory duty on Local Authorities to provide a fire service. The Act also required areas to be categorised according to their perceived level of risk – and this specified a minimum response times to fire calls. Four main categories of risk emerged: ‘A’ risks were those located in cities or towns (e.g. large shopping, business and entertainment centres); ‘B’ risks were situated in cities and towns not falling within category A (e.g. smaller-scale shopping and business districts); ‘C’ risks were found in the suburbs of larger towns and parts of smaller towns with built-up areas of substantial size; and  finally ‘D’ risks included all other areas not falling into categories A to C, except remote rural. ‘Remote Rural’ areas were classified as ‘those areas isolated from centres of population and containing few buildings’. Attendance times were specified for risk categories A to D – from 3 pumps attending a category A and the first pump arriving within 5 minutes; through to 1 pump attending within 20 minutes for a category D. While some rural areas fitted into category D, there were no nationally recommended attendance times for Remote Rural areas. 

The Riverdale Committee resulted in a model of risk where the lowest category was deemed ‘rural areas with scattered villages and hamlets’ – with these areas requiring an appliance to arrive within 20 minutes. The focus of the risk modelling was on saving property. In practice, these attendance times were difficult to implement in rural areas. Swathes of the countryside at that time had no fire service at all – with some areas providing equipment in sheds for local people to tackle the fire until an appliance arrived but the majority establishing fire posts with hand appliances. Fire extinguishing sat within parishes and rural district councils. 

All of this led to debates about fire cover rules which had been drawn up to prioritise protecting buildings rather than lives and led to a disproportionate amount of funding being provided to urban areas – despite rates of death from fire correlated with attendance times and found to be higher in remote rural areas. 

Until the 1970s, fire safety legislation was a spread over many pieces of primary and secondary legislation. The Fire Precautions Act 1971 was intended to include all premises over time. Initially, a designating order was made for hotels, offices, retail, railway premises and factories. This led to the creation of the Fire Precaution (Workplace) Regulations in 1997. 

In June 1980, The Home Office published a Review of Fire Policy alongside a green paper for consultation. This contained proposals ‘to enable an adequate level of fire protection to be provided as economically as possible’. It recommended ‘greater selectivity in the attack on fire’, thereby targeting larger and more concentrated risks.  

In September 2002, the Government invited Professor Sir George Bain, Professor Sir Michael Lyons and Sir Tony Young, to consider the future organisation of the Fire and Rescue Service. Their report ‘the future of the fire service: reducing risk, saving lives’ described how retained services were providing fire cover for around 60% of the UK’s land area, mainly rural areas (page 39); how a typical rural brigade control room would have 4 staff on duty at all times and deal with 2 calls an hour leading to a call handling incident cost of £50 in rural areas compared to £18 for the London fire service (page 40); and the need to better recruit, support and retain rural firefighters (page 67). The report resulted in a White Paper that led to changes in the primary legislation for the operation of Fire and Rescue Services as well as changes to firefighter pay and conditions which led to industrial action at the time.    

The Fire and Rescue Services Act 2004 provides the main piece of current legislation under which fire and rescue services must operate. It sets out details of the statutory safety-orientated duties that fire authorities have. Beyond legislating for the duties and powers of fire and rescue authorities, the 2004 Act also introduced a Fire and Rescue National Framework. The Framework published in 2012 recognised the historic role of the service in putting out fires alongside increasing work on fire prevention. The Framework published in 2018 cited a significant decrease in the number of fires attended and to the testament of successful prevention and protection work. In July 2020, the Home Office published a progress report of Fire and Rescue Authorities’ compliance with the Framework. Each authority was required to provide assurance statements and, where appropriate, other documentation such as Integrated Risk Management Plans, Governance Statements and other operational and financial information. The report states: ‘having assessed this information, the Secretary of State is satisfied that every fire and rescue authority in England has acted in accordance with the requirements of the National Framework, and no formal steps have been taken by the Secretary of State since the last assurance statement in 2018 to secure compliance’. 

As policy and legislative frameworks have been updated, the environment in which fire and rescue services operate has changed – bringing different governance models, a new inspectorate and the creation of the National Fire Chiefs Council (NFCC). While these frameworks set the overall strategic direction of fire and rescue authorities; authorities themselves remain free to operate in a way that ‘enables the most efficient and effective delivery of their services’. It is intended that fire and rescue authorities be accountable to their local communities rather than Government. Because the frameworks set high level expectations, they contain no specific references to rural which is viewed as an operational matter. Importantly, the 2004 legislation led to the abolition of national standards of fire cover, allowing local areas to set attendance targets. The Act also placed a statutory duty on authorities to promote fire safety and to manage community risk.  

Collaboration has become an increasingly important feature of fire and rescue work. Under the Crime and Disorder Act 1998, Fire and Rescue authorities were designated ‘responsible authorities’. This means they are required to work alongside other responsible authorities such as Police, Councils, probation and clinical commissioning groups) on Community Safety Partnerships (CSPs). 

The Policing and Crime Act 2017 introduced a statutory requirement for fire, police and ambulance services to collaborate if it is in the interests of each of their efficiency and effectiveness to do so. The Act also established a means by which Police and Crime Commissioners (PCCs) could become directly involved in the governance of Fire and Rescue Services. This has led some PCCs to be redesignated Police, Fire and Crime Commissioners (PCPs). The Civil Contingencies Act 2004 provides a framework for organisations to plan and deal effectively with major emergencies. Here, Fire and Rescue Services are designated as ‘category 1 responders’ and are members are Local Resilience Forums (LRF). 

Following the Grenfell Tower fire on 14 June 2017 in which 72 people so tragically lost their lives, there has been intensive work across and beyond Government leading to: 

  • The introduction of a Fire Safety Bill to clarify the scope of the Fire Safety Order. 
  • The creation of a new Fire Protection Board chaired by the National Fire Chiefs Council (NFCC). 
  • Increased funding to Fire and Rescue Authorities and the NFCC to increase fire inspection and enforcement capability. 

The task of fire cover planning has changed over time – from a focus on protecting buildings in urban [A-C] and some rural areas [D]; to a prevention and protection response and integrated planning that focuses on saving lives. As fire service provision became set in statute, rural provision was sometimes viewed as needing fewer resources than their urban counterparts. With the abolition of national standards of fire cover and a preference for local target setting; calculating where to site appliances and fire fighters in rural areas needs to take account of the number and type of incidents, geography, the road network, resident needs, mobility (travel to work, visitors going to the countryside), other infrastructure and support available in rural places and the funding available. Locally set standards only apply to fire calls and fire and rescue services respond to many other incidents in rural places such as people stuck in equipment, animal rescues or floods alongside their prevention and protection work and for which there are no national targets or KPIs.   

How are Fire and Rescue Services governed, funded and delivered? And has this changed during COVID-19?  

All fire and rescue services are overseen by fire and rescue authorities (FRAs). There are 45 FRAs in England and the structure of each can slightly vary. Where a fire and rescue service shares a boundary with a single, upper tier council, the Local Authority is the fire authority and the FRS is an integral part of the authority alongside other public services. In other cases, where the FRS boundary covers more than one upper tier authority, a stand-alone Combined Fire Authority (CFA) is responsible for its governance. Other fire and rescue services cover airports, defence, royal properties, nuclear sites and ports.

FRAs must statutorily appoint a head of the paid service, a chief finance officer and a monitoring officer. FRAs are employing authorities that hire both uniformed (operational) staff and non-uniformed (support) staff. 

The funding available to FRAs is provided by Government through the local government finance settlement (revenue support grant) and council tax. FRAs may also raise funds through charging for some non-emergency services, commercial trading activities, and/or applying for grants/research funding for specific purposes. The FRAs then make the decision locally to allocate this money to the specific areas for which they are responsible: prevention, protection and emergency response.   

According to the NFCC and LGA, for the 29 standalone Fire and Rescue Authorities (FRAs) in 2009-2010 core spending power was estimated at £1.523 million, falling to £1.373 million in 2020-2021, equating to a cut of 28.55% in real terms. Home Office data on reserve levels between March 2015 and March 2019 found reserves levels at some authorities had significantly reduced over this time period – including in Derbyshire (by 60%), Buckinghamshire (by 50%), Durham & Darlington (by 38%), Cleveland (by 36%) and Humberside (by 34%); while in other authorities reserve levels remained the same (e.g. Hampshire and Nottinghamshire); and increased in other areas (e.g. Leicestershire, Hereford & Worcester, Devon & Somerset and West Yorkshire). 

Analysis of the 2021-2022 local government finance settlement by the Fire Brigades Union (FBU) found brigades will receive £1.6 million more funding in 2021-2022 compared to 2020-2021, an increase of 0.18% in cash terms (and below inflation of 0.8% CPI to December 2020), equating to £37,200 per brigade. The FBU’s analysis reveals that from 2016-2017 to 2021-2022:

  • 4 brigades have had their funding cut by more than one-third. West Sussex has lost £4.3 million (or 43.9%), Warwickshire £2.9 million (or 40.8%), Oxfordshire £3.2 million (or 38.2%), and Surrey £6.1 million (or 34.3%). 
  • A further 9 brigades have had their funding cut by more than £4 million, including Greater Manchester (£5.8 million or 10.2%), West Yorkshire (£4.8 million or 11.1%) and Devon and Somerset (£4.5 million or 16.8%).
  • 42 brigades have had their funding reduced by at least £1 million since 2016-2017 – with most brigades experiencing cuts of at least 10%.  

In March 2020, MHCLG announced emergency funding to Local Authorities in financial year 2020-2021 and additional support for 2021-2022. £28.5 million has been allocated to standalone Fire Authorities, with a further £6 million central fund made available to support services which are aiding Ambulance Services and coroners. For those sitting within county councils and unitary authorities, the additional funding is not ring fenced, with each authority setting the fire share. 

Retained firefighters are mostly based in rural areas, crewing one or two appliances at a retained fire station, with some based in urban areas on stations alongside wholetime crews. The Home Office publishes workforce statistics for England. Covering the period April 2019 to March 2020, the data reveals a headcount of 35,291 firefighters of whom 22,793 were wholetime firefighters and 12,498 on the retained duty system. Analysis by the FBU reveals that since 2010 some 3,000 retained firefighter roles have been lost (and 8,000 wholetime roles). Despite an overall increase in retained firefighter numbers in 2019, levels fell in a number of brigades including Staffordshire and Surrey.    

An Independent Review of conditions of service for fire and rescue staff back in 2015 found the retained system “offers significant opportunity to align resources to risk at a significantly lower cost that maintaining full time cover…However the difficulties in recruiting…[means] Government should bring forward legislation that extends employment protection (as enjoyed by military reservists) to firefighters engaged on retained duty systems and part-time contracts” (page 13).  Research in 2016 sought to explore the motivations and barriers that influence individuals in urban and rural areas from becoming retained firefighters. This found people in rural areas had very specific motivators compared to their urban counterparts – with people living in rural areas wanting to help their local community. The NFCC  has an employee guide setting out the skills required, time needed and terms and conditions for retained (on-call) firefighters. 

In 2019-2020, 557,299 incidents were attended by FRSs in England – a 3% decrease compared with the previous year. Of all incidents attended, fire accounts for 28% of calls, with false alarms comprising 42% and non-fire incidents 31%. The total number of fires attended by FRSs has been decreasing over the past decade – from a peak of 474,000 in 2003-2004. Sadly, there were 243 fire-related fatalities in 2019-2020, the lowest figure since 1981-1982. For every one million people, there were 4.3 fire-related fatalities in 2019-2020. Over the same time period, FRSs and their partners completed 581,917 Home Fire Safety Checks (HFSCs) – 3% fewer than the previous year and 4% fewer than in the previous five year period. However, FRSs and their partners carried out 321,437 HFSCs targeted at people aged 65 years and over – this was 8% fewer than in the previous year but 32% greater than the five years previously. 

The Home Office publishes fire statistics covering fires, false alarms, other incidents attended by fire crews, fatalities and casualties and response times. In relation to average response times, the data can be broken down by authority/geography and the Rural Urban Classification. This reveals for predominantly rural areas in 2019-2020, there were 10,671 primary fires and a response time of 10 minutes and 28 seconds; and for significantly rural areas 16,356 primary fires and a response time of 9 minutes 53 seconds. In predominantly urban areas there were 34,705 primary fires and a response time of 7 minutes 37 seconds. Primary fires are those where one or more of the following apply: i) all fires in buildings, outdoor structures and vehicles that are not derelict, ii) any fires involving casualties or rescues, iii) any fire attended by five or more appliances. The data spans a 10-year period and reveals how response times in predominantly urban areas have remained constant [around 7 minutes] while slightly increasing in predominantly rural areas (from 9 minutes 41 seconds in 2009-2010 to the current 10 minutes 28 seconds) and in significantly rural areas (from 8 minutes 44 seconds in 2009-2010 to the current 9 minutes 53 seconds).  

In January 2021, Her Majesty’s Inspectorate of Constabulary and Fire & Rescue Services (HMICFRS) published its report into the fire and rescue service’s response during the COVID-19 pandemic This found: 

  • Every service maintained its ability to respond to fires and other emergencies – with responding to emergencies prioritised over other protection and prevention activities. The overall number of incidents attended fell by 5% from 1 April to 30 June 2020 compared to the same period in 2019. 43 of 45 services had more fire engines available to respond to calls from 1 April to 30 June 2020 compared to the same period in 2019. 
  • Every service provided a range of additional support to its community that went above and beyond its statutory duties – with wholetime, retained and operational staff carrying out a wide range of support roles such as ambulance driving and food delivery.  
  • On-call [retained] firefighters were extensively deployed during the first wave of the pandemic to respond to emergencies – and their capacity to respond increased as some were furloughed from their primary employment or working from home. On-call firefighters were willing to work flexibly to fulfil a range of roles and services took steps to mitigate any financial hardship faced by individuals (e.g. offering them paid employment or short-term contracts if their primary employment was affected by the pandemic). 
  • The pandemic has been a catalyst for change and transformation – with staff redeployed and new IT and supporting infrastructure delivered [taking days rather than weeks or months to implement].   
  • Structural problems affected the way services operated during the pandemic – including the need to put in place the arrangements to carry out additional responsibilities to support partner agencies. Some chief fire officers did not have operational independence to allocate resources rapidly. But the Inspectorate highlighted how the sector came together through the NFCC to provide a coordinated response. 

Central Government has historically been the main source of funding for fire and rescue services, but in recent years fire and rescue services have increasingly turned to council tax, making savings and/or dipping into reserves to set their budgets. With Government recently allocating more funding to fire and rescue will this lead to longer-term and more sustainable funding for FRAs? Retained firefighters have other employment but respond to incidents from their homes or workplace as required. In many rural areas, they provide the only source of fire and rescue cover. What more can be done to attract, recruit and keep retained firefighters? How can the contribution retained firefighters make be better understood, recognised and valued? How can we develop a better understanding of the work of FRSs in rural areas – and the services residents want and can expect? Throughout COVID-19, fire and rescue services maintained their ability to respond to fires and other emergencies whilst stepping up to take on a range of pandemic related tasks. There is now an imperative to restore public services while remaining prepared for future waves of the virus. What should guide restoration and recovery planning in the fire and rescue sector?  

Like parts of the UK; Australia, Austria, China, France, Germany and the United States also rely upon volunteer firefighters in rural areas. In Australia, for example, they are known as ‘firies’ and they played a pivotal role in tackling unprecedented bushfires in 2019-2020.  Approximately 195,000 Australians volunteer with the country’s 6 State and 2 Territory bushfire services – or 4.5% of the total rural population. In Queensland, for example, the Rural Fire Service (RFS) is made up of 36,000 volunteers – including 2,400 fire wardens sitting within 1,500 rural brigades. In New South Wales, the RFS is running a number of initiatives with farmers to help mitigate and respond to the threat of fires (e.g. farm fire plans, farm fire units, rural liaison officers). While funding varies by area, it is generated through state and territory levies – this pays for stations, vehicles, running costs, administration and training. As a result of the bushfires, some fire services have received public donations – with some of the money being used to help volunteers who had to take leave without pay. 

The United States has a dedicated Rural Firefighting Academy (RFA). Developed by rural firefighters for rural firefighters, the RFA offers e-learning courses and publishes the ‘Rural Firefighting No Nonsense Handbook’. The RFA believes that fire departments need to communicate with the public and let them determine the level of emergency service they are willing to support.  In rural areas, access to (and getting enough) water to the scene efficiently, recruiting and retaining enough volunteers, responding to different kinds of emergency incidents and working across rural fire departments (e.g. pooling training and planning sessions) are all more apparent compared to urban brigades.  

In New Zealand, alongside responding to fires, Fire and Emergency NZ runs a Fire Smart initiative to help rural residents protect their home and property, and understand the response time of rural firefighters and first response units.  

Finally, the Brandweeracademie (Fire Service Academy) in the Netherlands recently carried out a European research project looking at the recruitment and retention of volunteer firefighters. This considered the role of task differentiation i.e., meaning that a volunteer can be trained for specific tasks reducing the amount of time they spend on volunteering; and providing employers with benefits and rewards so staff can volunteer to go out to call.  

What can we share with, and learn from, fire service organisation and delivery in other countries? How can we further develop community fire planning that identifies and address the needs of our rural communities (e.g. utilise data, consult with all members of rural communities, implement solutions – building safety, vulnerable residents – and monitor and evaluate initiatives)? And how can we ensure we have the workforce and equipment we need to respond to fire (and non-fire) calls in a timely and efficient manner in rural areas?  

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Thank you to all the RSN readers who contacted me following May’s rural words on oral health / dentistry. From requests for more data on the number of courses of treatment delivered by Urgent Care Hubs and people telling me how they had been removed from practice lists because they had not attended an appointment in the last two-years (even though you had been requesting one); through to those of you unable to restart treatment that began before the pandemic and/or being forced to pay for private treatment because you were in so much pain and the NHS waiting list so long. As a frequent user of dental services myself [though less frequent since COVID] I tried my very best to respond to all of your emails. Like many of you I too look forward to providers returning to their ‘normal contracted activity’. Thank you for all of your insights and feedback.   

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Jessica is a researcher/project manager at Rose Regeneration and a senior research fellow at The National Centre for Rural Health and Care (NCRHC). Her current work includes supporting health commissioners and providers to measure their response to COVID-19 and with future planning; and evaluating two employability programmes helping people furthest from the labour market. She has previously worked with two Fire and Rescue Services to evaluate their community safety programmes. Jessica also sits on the board of a Housing Association that supports older and vulnerable people. 

She can be contacted by email jessica.sellick@roseregeneration.co.uk. 

Website: http://roseregeneration.co.uk/https://www.ncrhc.org/ 

Blog: http://ruralwords.co.uk/ 

Twitter: @RoseRegen 

Rural Dentistry

If oral health matters, how can we prevent rural residents pulling their teeth out?

Everyone experiences oral health problems at some stage of their life; and the mouth and oral cavity is central to people’s wellbeing and identity. While oral diseases are largely preventable, they often remain untreated and persist. With the need to improve oral health impacted by COVID-19 yet recognised as a major public health issue, what is access to oral and dental care like for people living in rural places? Jessica Sellick investigates*. 

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What is oral health? 

It is a key indicator of overall health and wellbeing and is primarily concerned with teeth, gums and the mouth. It encompasses a range of diseases and conditions such as dental caries, periodontal (gum) disease, tooth loss, oral cancer, oral manifestations of the HIV infection, oro-dental trauma, noma and birth defects such as cleft lip and palate. According to the Oral Health Foundation: 

  • 66% of adults have visible plaque. 
  • 25% of adults do not brush their teeth twice a day with a fluoride toothpaste. 
  • 74% of adults have had a tooth extracted. 
  • 60 million people do not have fluoridated water. 
  • 3 million people suffer from regular oral pain. 
  • 8,722 people in the UK were diagnosed with mouth cancer in 2019. In the UK, one person every hour is diagnosed with mouth cancer. Mouth cancer accounts for just over 2% of all cancers. While mouth cancer is the 14th most common cancer in the UK, 67% of all patients are male and amongst men making it the 9th most common cancer. 

Back in August 2019, the Royal College of Surgeons of England published a Position Statement on children’s oral health. This highlighted how tooth decay remains a prominent cause of hospital admissions for young children. Amongst 5–9-year-olds, tooth decay has been a leading cause of hospital admission in each of the last three years for which data is available (2015-2016 to 2017-2018). Acute tonsillitis was the second highest reason for hospital admissions amongst 5–9-year-olds but caused less than half as many admissions as tooth decay. In total, there were 102,663 hospital admissions due to tooth decay amongst children under the age of 10 years between April 2015 and March 2018. 

How are NHS dental services commissioned and contracted? 

The Department of Health and Social Care (DHSC) is responsible for making sure legislative, financial, administrative and policy frameworks are fit for purpose and work together. NHS England and NHS Improvement then have responsibility for commissioning dental services including specialist, community and out of hours dental services. The aim of a single agency is to provide consistent standards of care delivery across the whole country. The vast majority of NHS dental care is provided through the general dental service (GDS) and personal dental service (PDS) via contracts between director of commissioning operations teams (DCO teams) and primary care contract holders. Dental care is also provided by district general hospitals and dental hospitals through hospital contracts. NHS regional commissioners plan, commission and monitor dentistry services within their region.  The Office of the Chief Dental Officer England sits within NHS England and represents the head of the dental profession, providing system-wide leadership and setting the strategic vision for oral health. 

In addition to NHS England and NHS Improvement, multiple organisations are involved in the commissioning and delivery of NHS dentistry. These include: 

  • Public Health England (PHE): provides clinical advice, data, information and resources to assist in the planning and delivery of local dental services. This includes supporting dental practitioners to improve oral health and reduce inequalities. In March 2021 the Government published a policy paper setting out its plans for public health reform. This includes proposals for current health improvement, prevention and healthcare public health functions of PHE to be transferred to new homes within the health system in 2021 (e.g. Office for Health Promotion).  
  • The Review Body on Doctors’ and Dentists’ Renumeration (DDRB): makes recommendations to Government on the pay of doctors and dentists delivering in the NHS. The DDRB’s recommendations take account of the need to recruit, retain and motivate dentists; regional/local variations in labour markets; Government funding; evidence submitted by professionals and other bodies; and legal obligations of the NHS.  
  • Local Dental Networks (LDN): groups of commissioners, clinicians, managers and patients that develop annual work plans based on the dental needs of their local population in line with national initiatives. While LDN’s vary from region to region, each network meets locally every three months, with two of their four meetings attended by representatives from PHE and Health Education England (HEE). Additionally, each LDN chair is encouraged to participate in four national assemblies hosted by NHS England the Office of the Chief Dental Officer.  
  • Health Education England (HEE): submits evidence to the DDRB. 

Defence Medical Services (DMS) is an umbrella organisation within the Ministry of Defence (MoD) which provides dentistry in the UK and overseas to service personnel (and, where appropriate, their dependents); and NHS England Health and Justice is responsible for commissioning dental services in detained settings (which includes prisons, secure facilities for children and young adults, and immigration removal centres).  

Unlike other health and care services, Local Authorities and Clinical Commissioning Groups (CCGs) are not currently involved in commissioning.

Within the NHS national dental commissioning and policy team, current priorities of work include: 

  • To reduce oral health inequalities and improve oral health in children under the age of 5 years. 
  • Flexible commissioning. 
  • To oversee national dental access and address area of weakest dental provision. 
  • To ensure a consistent and fair approach to contract performance management is applied nationally to dental contracts.
  • Dental contract reform.

The current contractual arrangements have been in place since 2006. General Dental Services contracts are usually held in perpetuity, with a set number of associated Units of Dental Activity (UDAs). Most of the primary care dentistry budget is, therefore, predetermined each year unless new services are commissioned, or current contract holders terminate their contracts. Dental practitioners can transfer their NHS contract to another practitioner by the formation and subsequent dissolution of a joint partnership. This means that contract values held in perpetuity may be provided by a new dentist who has formed such a partnership. Primary care dentists are not NHS employees and act as self-employed under contract from the NHS, in a similar way to GPs and pharmacists. Dentists in direct NHS employment (for example, secondary care) or Foundation and Core training are paid on a national scale with rates set centrally following advice from the DDRB. A dentist can have multiple contracts within an NHS England and NHS Improvement region or across a number of regions. 

The NHS Outcomes Framework (NHS OF) sets out the national goals that the Secretary of State uses to monitor the progress of NHS England and to account for the outcomes it delivers through commissioning health services. Back in 2014, dental health indicators were included for the first time – this includes an indicator measuring people who reported that they were successful in getting an NHS dental appointment when they tried in the last two years; and an indicator measuring people who reported their overall experience of NHS dental services as being ‘fairly good’ or ‘very good’. NHS Digital recently closed a consultation on changing the frequency of OF reporting, from quarterly to annually. The two dental indicators were not updated in the latest release due to the unavailability of data. 

Since 2011, there have been various pilots and ‘waves’ of dental contract reform (known as the prototypes scheme). In essence, when the dental contract was first introduced in 2006 it renumerated dentists for activity, whereas the prototypes scheme – of which 102 dental practices are currently participating – has an increased emphasis on preventing dental disease (i.e., offering “full oral health assessments and self-care plans”, in addition to traditional treatments). An evaluation of the first year of prototyping (2016-2017) found: 

  • 90% of patients had reduced or maintained levels of tooth decay. 
  • 80% of patients had reduced or maintained levels of gum disease. 
  • 97% of patients said they were satisfied with the dental care they received. 

In 2018, NHS England launched Starting Well Core, a commissioning approach that aims to reduce oral health inequalities and improve oral health for children aged 0-2 years.  The approach has been made available to all NHS dental commissioning teams for local use and is being implemented across the country in alignment with local population needs and with other local child oral health improvement work.

The DHSC intends to publish the latest results and lessons learnt from the dental contract reform prototypes in summer 2021. This includes a review of the design and implementation challenges that have prevented wider rollout. In addition, NHS England is leading the next stage of dental contract reform, working with the British Dental Association (BDA) and Government to design implementable proposals that address the key challenges facing the delivery of NHS dentistry and to leverage changes in the wider primary care system. The latest reforms are expected to meet 6 key tests: 

  1. Be designed with support from the profession. 
  2. Improve oral health outcomes [or credibly be back on track to do so]. 
  3. Increase incentives to undertake preventive dentistry – and reduce incentives to deliver care that is of low clinical value. 
  4. Improve patient access to NHS care – with a specific focus on addressing inequalities (particularly deprivation and ethnicity). 
  5. Demonstrate that patients are not having to pay privately for dental care that was previously commissioned NHS dental care. 
  6. Be affordable within NHS resources – taking account of dental charge income. 

Building on the NHS Long Term Plan and its call for greater collaboration between partners in health and care systems, Integrated Care Systems (ICSs) are expected to include primary care leadership, including dentistry, and are currently being placed on a statutory footing. 

Throughout COVID-19, NHS England has issued letters and guidance documents setting out contractual obligations. At the end of March 2021, NHS England sent a letter to primary care dental contract holders confirming dental contract reform arrangements expected to last for the first six months of 2021-2022. This includes contractual protection for practices unable to deliver normal contracted activity over this period due to COVID-19: “during this period clawback will not be applied to practices delivering at least 60% of contracted UDAs [it was 59% as of February 2021] and 80% of contracted UOAs [Units of Orthodontic Activity]. 

A new process of dental contracting is underway; one that is seeking to balance constraints in capacity due to COVID-19, with restoring patient access back to pre-pandemic levels and targeting local dental priorities. While much of this work seeks to make rapid yet modest changes at the earliest opportunity, how will these reforms and its commissioning take account of rural communities (e.g., access and take-up of dental services; promoting innovation and different delivery models in rural settings) and what data will we need to collect – and when – to measure the impact of these approaches (e.g., moving away from data on units of activity to data on access, quality, preventive outcomes)? Similarly, some of the organisations that support commissioning are themselves in a state of transition, how can we ensure rural oral health is on the agenda amid discussions on health inequalities?          

Who provides dental services? 

Dental care can be provided by a dentist, dental hygienist, dental therapist, dental nurse or dental technician. Some dental professionals specialise in different areas of the mouth or treat specific groups of patients. Key specialisms include oral surgery, orthodontics, paediatric dentistry, endodontics, periodontics, restorative dentistry, public health dentistry, oral and maxillofacial pathology, and dental and maxillofacial radiology. The training each profession undertakes to qualify and treat patients varies – for example, becoming a dentist takes at least five years’ study at dental school, followed by 1-2 years of supervised practice. 

As of 31 March 2019 there were 24,545 primary care dentists contracted to provide primary care dentistry for the NHS – this includes those dentists also contracted to provide community dental services. There were 227 NHS Trusts and NHS Foundation Trusts providing secondary care dental care in hospital under a standard NHS contract and/or providing community dental services under a primary care contract. 

Primary care dentistry is accessed by patients typically at high street practices. Urgent and emergency dentistry can be provided in primary care and secondary care settings – with patients accessing treatment via a high street practice, 111 and/or accident and emergency departments. Specialist care is usually provided in secondary care but depending upon the treatment required, can also delivered in a primary care practice. Dentists can provide NHS treatment, private treatment or both – and they can refer into primary and secondary NHS services. 

According to the National Audit Office (NAO), the UK has relatively low numbers of dentists per head of population compared with other advanced European economies, and England has the lowest number of NHS dentists per head of population in the UK. The UK reported an estimated 35,000 practising dentists in 2018, which is 5.3 practising dentists per 10,000 people. The numbers are higher in France, Germany and Italy. The data the UK submits to the OECD includes primary care dentists and dentists employed in hospitals. This data excludes those who work only in private sector dentistry. The General Dental Council (GDC) reported that in March 2019 there were 32,501 registered dentists in England. Although some might not be practising (working instead in research or overseas, for example), this equates to 5.8 dentists per 10,000 population, which is higher than the ‘practising’ number provided to OECD but still below G7 European comparators. In Germany for example the figure is 8.5, in Italy 8.3 and France 6.5. 

Health Education England (HEE) is a Non-Departmental Public Body that is sponsored by the Department of Health and Social Care (DHSC). HEE leads education, training and workforce development in the health sector. Back in 2017, HEE commissioned an Advancing Dental Care Review (ADC) to identify a future dental workforce model and the training required to deliver it. The ADC is divided into two phases. Phase 1 (2017-2018) scoped the training and model, producing 21 recommendations. Phase 2 (2019-2021) is now concentrating on modelling flexible education and training programmes for the dental workforce, informed by the evidence HEE has been able to gather and more focused engagement with stakeholders. SQW has been commissioned to carry out an independent review to test and evaluate the training initiatives that are being piloted. HEE is due to publish the findings of the ADC in 2021. 

On 25 March 2020 NHS England and NHS Improvement announced that all routine, non-urgent dental care including orthodontics should be stopped and deferred until advised otherwise and that urgent dental care (UDC) hubs would be set up around the country. Dental practices began to reopen for some care from 8 June 2020. In August 2020, the General Dental Council (GDC) commissioned Ecorys UK to undertake a study to explore the impact and future implications of COVID-19 on dental professionals. 78% of dental business owners reported a decrease in current income compared to the same period in the previous year – at some practices income had decreased by 45% and projected to fall by a further 41%. In focus groups dentists and dental hygienists highlighted how the requirement to practice enhanced PPE had impacted on their visibility, dexterity and confidence when carrying out intricate procedures. They also expressed concerns about the marked increase in the provision of interim solutions for patients (non-AGP treatments) and increased lone working due to staff absence. Analysis undertaken in September-October 2020 on those who expected to be economically inactive, working outside of dentistry, or not registered as a dental professional, found that one-third of dentists (32%) and DCPs (38%) did not expect to be practicing in 12-months’ time.  

What changes are needed to support oral health and dental practitioners recover from COVID-19? How will the ARC help attract, train, recruit and retain a dental workforce in rural areas as we recover from the pandemic and seek to restore dental services?  

How much do we spend on dental services? And how much dental activity is taking place?  

NHS dental charges were first introduced in 1951. Charges vary, with some people entitled to free NHS dental treatment if they meet certain criteria. 

In March 2019, the Government announced that dental charges in England would increase by 5% from 1 April 2019. Charges are divided into bands, with fees determined by the course of treatment. They are as follows: 

  • Band 1 (£23.80): This covers examinations, diagnosis, and preventative care. 
  • Urgent dental treatment (£23.80): This covers emergency care. 
  • Band 2 (£65.20): This covers everything listed in band 1, plus any further treatment such as fillings and root canal work. 
  • Band 3 (£282.80): This covers everything listed in bands 1 and 2, plus crowns, dentures, bridges, and other laboratory work.

Some people are entitled to free NHS dental treatment. This includes if an individual is: 

  • Under 18 (or under 19 and in qualifying full-time education). 
  • Pregnant or if they have had a baby in the previous 12 months. 
  • Being treated in an NHS hospital, with treatment carried out by a hospital dentist (although patients may still have to pay for any dentures or bridges). 
  • Receiving low-income benefits, or if they are under 20 and a dependant of someone. 

Some dentists and professional bodies have reported patients fail to show up for an appointment or do not complete a course of treatment because they cannot afford to pay for it. While help is available, dentists believe some patients were not aware they might qualify for free treatment, or how to access it; and some lower income households and older people may be struggling to pay for treatment across the different bands. A recent study of adult dental fee exemptions found fee-exempt patients in 2018-2019 accounted for 23.7% of all adult claims in NHS primary dental care. This percentage has decreased year-on-year since 2011-2012 (when it was 31.5%). In 2018-2019 there were significantly fewer band 1 claims (36%) but a higher number of treatment claims for bands 2 and 3 (49% and 30.8% respectively). Why has there been a decline in total numbers of fee-exempt adults and what accounts for these band fee differences? In a YouGov poll with a sample size of 1,878 adults (aged 18+ years) based in England, carried out for Healthwatch England just before lockdown in March 2020, more than 7 in 10 people (73%) felt that NHS dental treatment charges were expensive and more than 2 in 5 (42%) said they either struggled to pay or avoided any dental treatment because they could not afford the costs.

NHS Digital publishes a biannual report containing dental activity for England. Covering the period April to September 2020, and patients seen data for a 24-month period (adults) and a 12-month period (children) up to 31 December 2020; the report reveals: 

  • 19.7 million adults were seen by an NHS dentist in the 24-months up to 31 December 2020, equating to some 44.5% of the adult population. 
  • 3.6 million children were seen by an NHS dentist in the 12 months up to 31 December 2020, equating to some 29.8% of the child population. 
  • 2.8 million courses of treatment were delivered in quarter 2 of 2020-2021; a decrease of 7.04 million compared to the same quarter in 2019-2020. 

NHS Digital notes how to limit COVID-19 transmissions, dental practices were instructed to close and cease all routine dental care from the 25 March 2020. The data recorded in the report, including activity and patient numbers, is therefore lower than expected due to a period of COVID-19 restrictions. NHS Digital published a supplementary report outlining the estimated impact of COVID-19 using data at a national level for NHS practices. This found, to the 30 June 2020, 876,000 (4%) fewer adult patients were seen in the previous 24 months to receive NHS dental treatment compared to the 24 months before February 2020. 758,000 (10.7%) fewer child patients were seen in the previous12 months to receive NHS dental treatment compared to 12 months to February 2020. 

In September 2020, Healtwatch published a report on accessing NHS dental care. Covering the period July-September 2020 and based on feedback from 1,313 people in 142 Local Authority areas in England, more than 7 in 10 people (73%) had found it difficult to access help and support compared to just over 1 in 10 (11%) who could access care easily. More than half of the respondents (51%) expressed negative sentiments about dentistry compared to in in 25 people (4%) who said something positive. 

With people finding themselves and members of their household out-of-work or with reduced hours and pay, and patients having increased treatment needs as a result of the deferral of routine and non-urgent treatment; how can we reduce the gap between fee-exempt and fee-paying patients? COVID-19 has clearly made it difficult for most people to access services and some are still struggling to access NHS dentistry because practices are either not taking on new NHS patients or have no available appointments – how can we end the despair of getting dental care?     

How is dentistry regulated and quality monitored?  

A range of regulations cover accreditation, the registration of dental and oral health practitioners, and practice oversight to ensure standards and quality care provision. This includes the NHS (General Dental Service) Regulations 2005, NHS (Personal Dental Service) Agreement Regulations 2005, and NHS (Primary Dental Services) Regulations 2016.

All dentistry providers must register with the General Dental Council (GDC). The Dentists Act 1984 gives the GDC powers to grant registration to dental professionals to practice dentistry anywhere in the UK, to set standards for providers of dental education and training and the conduct of dental teams, investigate complaints against dental professionals (fitness to practice process), and require dental professionals to keep their skills up-to-date through continuing professional development. In 2017, the GDC published ‘shifting the balance’, a document considering how the system of dental regulation could be more collaborative so that issues are dealt with in the right place and deliver the right outcomes for patients and the public. It contained four main proposals: (i) move upstream – putting a stronger emphasis on patient protection, learning, engaging with professionals and developing alternative approaches to CPD. (ii) First tier complaints – improving the handling of patient feedback, concerns and complaints. (iii) Working with partners and other regulators. (iv) Refocusing fitness to practice – being clearer on ‘impaired fitness to practice’. More recently, in 2020, the GDC published ‘moving upstream’ setting out progress made to deliver the proposals in shifting the balance.  

The Care Quality Commission (CQC): holds a register of primary dental providers; and inspects and monitors dental services according to the requirements set out by Government regulations. The inspection approach is based on ratings and level of risk: if a provider is rated ‘outstanding’ or ‘good’ their services are monitored through the CQC’s transitional monitoring approach. If a provider is rated as ‘requires improvement’, ‘inadequate’ or has never been inspected, from April 2021 a new approach is being implemented.  

The Dental Assurance Framework was developed for area teams at NHS England to engage with providers to secure and improve service quality. It is designed to be used with GDS and PDS contracts and agreements – and contracts with NHS trusts. The framework has four domains: (i) delivery – centred around UDAs and UOAs; (ii) patient safety; (iii) patient experience – based on data and complaints; and (iv) quality/clinical effectiveness. 

While regulatory approaches are needed to set the standards, professional values, knowledge, skills and behaviours required of oral health and dental professionals, are the existing frameworks, with their national pattern of decision making and activity, flexible enough for rural practices where some issues are atypical?   

What are oral and dental health services like in rural areas? 

Existing research has sought to understand and map areas where children and adults experience dental decay and/or hospitalisation. In March 2021, PHE published a report providing a current picture of oral health inequalities and oral health services inequalities in England and ways to reduce them. This describes how poor oral health affects the most vulnerable and socially disadvantaged individuals and groups in society, with other dimensions related to socio-economic position, protected characteristics and geography [by region, Local Authority]. The document contains two references to rural: the first in a summary of the academic literature and the second in the reference list. PHE intends to publish a companion piece to the report, setting out in more detail what action is needed to address research gaps.  

The report’s findings around geography and deprivation are echoed in previous work. This includes research from the Nuffield Trust and Health Foundation back in 2017 on dental health outcomes and activity. This found dental health to be generally better in the south and East of England, and poorer in the North of England. Children in the Blackburn with Darwen Local Authority area, for example, were four times more likely to have missing, decayed or filled teeth compared to children in South Gloucestershire in 2015: just 44% of children in Blackburn were free from decay compared with 86% in South Gloucestershire. In Yorkshire, hospitalisation for tooth extractions in children under 10 years of age was five times higher than in the East of England in 2015-2016 (845 per 100,000 population in Yorkshire compared with 160 per 100,000 in the East of England). More recently, in 2019 PHE’s National Dental Epidemiology Programme (NEDP) found 23.4% of 5-year-old children in England whose parents gave consent for participation in the survey had experience of dental decay. The severity of experience of dental decay in children who have experienced dental decay was 5 times higher in Norwich, Norfolk (5.4 teeth) than in Rushcliffe, Nottinghamshire (1.6 teeth). The overall prevalence of dental decay was higher in children from more deprived areas (34.3%) than in children from less deprived areas (13.7%).

Existing data is only available at a certain level of geography (e.g., the English Indices of Deprivation are available at Lower Super Output Area). Not all deprivation indicators are relevant for rural places: health outcomes in rural areas are normally, on average, better in rural areas; and housing, access to transport, distance to services (GP, dentistry) can be more important in rural areas. It is the aggregation of statistics that masks rural deprivation. Multiple witnesses giving evidence to the Parliamentary Inquiry into Rural Health and Care cited the joint PHE and Local Government Association (LGA) ‘Health and Wellbeing in Rural Areas case study report. Evidence collected throughout the Inquiry has sought to illuminate how and why to address the statistical gap in information collected about rural places. This includes the development of a Rural Deprivation Index – with further research underway by the University of East Anglia (Norfolk) and the University of London (Lincolnshire) facilitated by the National Centre for Rural Health and Care (NCRHC). 

According to the British Dental Association (BDA) a growing number of dental practices are reporting problems filling core clinical vacancies. In March 2019, a survey of 358 BDA members found 75% of them had struggled to fill vacancies, with this figure rising to 84% amongst those with the highest NHS commitments. The survey also highlighted a practice in Barrow having permanent vacancies unfilled for 5 years, resulting in the practice operating at 25% capacity; and a recruitment agency that had been unable to fill any posts advertised in Cumbria over the past 12 months (as of March 2019). The following tables produced by the BDA, using NHS website and google maps data, shows journey lengths and times across England for new adult NHS dental patients as of March 2019: 

NAO analysis of dentists per head of population within England highlighted the top 5 areas with dentists: Bradford City (12.6), Horsham and Mid Sussex (9.7), Crawley (9.2), Hammersmith and Fulham (8.8) and South Tyneside (8.6); and the bottom 5 areas: West Norfolk (3.4), North Lincolnshire (3.4), East Riding of Yorkshire (3.6), North Staffordshire (3.7) and South Lincolnshire (3.8). 

Current data and information reveal a mixed rural picture. The number of dentists in rural areas appears to be varied – with some rural places having a high number of practitioners and others having a much lower number. In some rural and coastal places residents are having to travel between 20 and 90 miles to access an NHS dental appointment. 

While research from other countries has found rural communities often lack access to oral health providers due to their geographic isolation and/or workforce shortages – and studies are underway in Scotland, Wales and Northern Ireland – more work is needed to properly understand and measure oral health and dental care in rural England (e.g., access to services – distance/transport, quality of interventions, and the outcomes achieved). We need to continue to unpick a widespread belief that people living in rural places are better off (both in monetary terms and in terms of health and wellbeing) compared to people living in towns and cities, for it masks pockets of significant rural deprivation and people experiencing poorer oral health outcomes. 

Where next? 

NHS England published a revised Standard Operating Procedure (SOP) for dentistry during COVID-19. While the SOP sets out a phased transition for dental practices to work towards resuming a full range of dental provision, services are not operating a pre-pandemic levels and dentists are still only able to see a significantly smaller number of patients (e.g., social distancing, infection protection control procedures, fallow time). A report published by Healthwatch in December 2020 signalled greater dental problems in the future and the pressure being placed on hospitals and GPs  as a result of limited access to dental care. Similarly, the Health and Social Care Select Committee Inquiry on ‘delivering core NHS and care services during the pandemic and beyond’ described the substantial burden of untreated dental diseases and an overall worsening of the nation’s oral health as the UK emerges from the pandemic. Put simply, too many people patients are falling through the cracks and not seeking, or not able to access, appropriate dental care. 

At the same time, there is a real opportunity for oral health and dental care practitioners to now come together to provide the access to those who need it and to tackle what are wholly preventable diseases. Tobacco use, alcohol consumption, sugary food, not practicing good oral hygiene daily exacerbate not only oral conditions but also impact upon general health and wellbeing. This requires oral health to have a stronger position within, and integrated with primary, secondary and community health services as well as other, wider, public services. 

For too many people dentistry is currently unavailable, too distant, unaffordable, or inappropriate. What more can be done to better understand the oral health needs and dental diseases of rural residents and how can we make rural oral health more visible? 

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National Smile Month is a charity campaign to champion the benefits of good oral health. In 2021 the campaign is taking place between 17 May and 17 June. More information Is available from the Oral Health Foundation here. 

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Jessica is a senior research fellow at The National Centre for Rural Health and Care (NCRHC) and researcher/project manager at Rose Regeneration. Her current work includes supporting health commissioners and providers to measure their response to COVID-19 and with future planning; providing the secretariat for the Parliamentary Inquiry into Rural Health and Care; and evaluating two employability programmes helping people furthest from the labour market. Jessica also sits on the board of a Housing Association that supports older and vulnerable people. 

She can be contacted by email jessica.sellick@roseregeneration.co.uk. 

Website: http://roseregeneration.co.uk/https://www.ncrhc.org/ 

Blog: http://ruralwords.co.uk/ 

Twitter: @RoseRegen 

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* This briefing seeks to provide an overview of NHS oral and dental health services from the perspective of a non-expert/specialist. It is not exhaustive and nor does it contain information pertaining to adults and children accessing private dental care. 

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Taking a longer-term view: do we need a new intergenerational contract?

Taking a longer-term view: do we need a new intergenerational contract?

Back in May 2018 the House of Lords appointed a Select Committee on Intergenerational Fairness and Provision. The Committee, which published its report in April 2019, found that while the relationship between older and younger generations was defined by mutual support and affection; an ageing population, the global financial crisis and successive Government policies had failed to fully consider generational issues. More recently, a number of debates and discussions on intergenerational fairness have taken place to try to better understand what impact COVID-19 is having on and between generations. If the pandemic is leading us to think much more about our obligations to each other, how can we keep society together and not favour one generation at the expense of another? Jessica Sellick investigates. 

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What is intergenerational (un)fairness? In May 2018, the House of Lords launched a Select Committee to consider the long-term implications of Government policy on intergenerational fairness and provision. It was established in response to a concern that intergenerational unfairness was growing as a result of the millennial generation appearing worse off than the baby boomer generation. The Committee’s work was intended to build upon earlier Lords reports on demographic change and social mobility and a debate on intergenerational fairness; as well as a House of Commons report on intergenerational fairness.   

The House of Commons Work and Pensions Committee report published prior to the Committee’s work in November 2016 described how intergenerational fairness is ‘not simply a matter of comparing the circumstances of different age groups at a given point of time, but instead the economic experiences of generations over the course of their lifetimes – but it should not be confused with valid concerns about inequality within generations.  The report centred on an implicit social contract between generations and how this underpins the welfare state – with the older population funded by the taxes of the working population who, in return, expect to receive similar benefits when they are ready to retire. 

In 2019, the House of Lords Select Committee on Intergenerational Fairness and Provision took a broad definition of generations; grouping together people by their current stage of life and their common lived experience rather than by their year of birth. The Committee defined intergenerational fairness as ‘the idea that each cohort should retain a fair expectation of social improvement and can have a fulfilling life without being unduly harmed by the actions of a previous or subsequent cohort’. The Committee suggested this sense of fairness extend to generations just born, or about to be born, that have no voice to advocate for them. The Committee’s view was that ‘unfairness results from not providing appropriate support to people at different stages of the life course’. 

Similarly, according to the Intergenerational Foundation (IF), intergenerational fairness is ‘the idea of fairness between different generations alive today as well as those generations yet to be born….younger generations should have the same standard of living as generations who have gone before’. 

What unites these definitions is their focus on the need to provide support to people at different stages of the ‘life course’ – highlighting the bond between younger and older generations. The ‘fairness’ dimension becomes apparent when they compare the situations of different generations (their economic and lived experiences). 

How much of a problem is it?The House of Commons Work and Pensions Committee report back in 2016 highlighted how the State Pension triple lock [which was introduced in 2012 and annually uprates the state pension by whichever of price inflation, average earnings growth or 2.5% is highest] is leading to the state pension expenditure to account for a greater share of national income at a time when public finances are fragile. Combined with increases in the state pension age, this was seen as disproportionately affecting young people and those socio-economic groups with lower life expectancies in retirement. The report therefore recommended benchmarking the new state pension and basic state pension at levels relative to average full-time earnings they reach in 2020 – with the triple lock replaced by a smoothed earnings link ‘that is more fiscally sustainable and more intergenerationally fair’. In response to COVID-19, the Office for Budget Responsibility’s (OBR) fiscal outlook forecasts how the triple lock will deliver a cumulative increase of 19.3% over the six-year forecast period between 2020-2021 and 2025-2026, compared with 15.2% cumulative growth in average earnings and 9.6% cumulative increase in CPI inflation over the same period.

The Select Committee on Intergenerational Fairness and Provision’s report in 2019 highlighted particular problems and perceptions of younger people. Examples included the student loans system and cost of a university education to students, which were cited as a “fiscal illusion” with many student loans not paid off in full within a 30-year period leaving the taxpayer to foot the bill. Expecting future taxpayers to bear the brunt for funding today’s students was regarded as unfair. According to the Committee, the system also risks perpetuating unfairness within a generation – between those who can access Higher Education and those who cannot. Other examples concerning young people cited in the report included difficulties in finding employment that is secure and well paid, and access to affordable housing. The Committee also collected evidence which highlighted how some Local Authorities charge a lower rate of Council Tax on second properties. This was also viewed as an unfairness that should be redesigned so the rate is related to the size and capital value of the property alongside additional protections for people who are asset-rich but income poor through a system of delayed payments. The Committee reached six main conclusions that had led to unfairness: 

  1. Accounting for the future: policy data is not published on generational differences in income and wealth, nor on the potential effects of policy on different generations at the time the policy is being considered.  
  2. The housing challenge: an insufficient supply of affordable homes to buy and rent by younger people. 
  3. Educating generations: the education and training system is ill equipped for the needs of a rapidly changing labour market. Post-16 vocational education is underfunded and poorly managed. Options to retain and reskill in later life are incoherent and underfunded.  
  4. Working: younger generations are more likely to experience slower pay progression and find themselves in insecure employment. They are also unlikely to enjoy the same generation-on-generation income gain that their predecessors received. 
  5. All-age communities: communities and a strong sense of place strengthen intergenerational bonds by bringing generations together and sustaining shared loyalties. Communities may also help to tackle skills, care and housing shortages through innovative local initiatives. 
  6. Intergenerational taxation: the failure to make proper provision for the costs of social care in the older age category, particularly for people now entering a lengthy retirement who will rely on smaller, younger generations to pay for them. Retired people were found to have higher incomes, on average, than younger working age groups. 

These examples often focus on the barriers and obstacles people in the younger age groups face – although many of the issues highlighted also affect older age groups. They also place an emphasis on central Government to update and revise policies to meet the challenges not only faced by young people but also by people across the life course (e.g. pensions, social care). 

Generations apart – how much of an issue is it in rural areas? There is little work exploring intergenerational fairness in the countryside. Papers and studies that do reference rural focus on ‘age segregation’; that is, the outmigration of young people and older people moving to (and wanting to remain in rural places) – and the increasing divide this leads to (i.e., how some rural places have no children or young people living in them). Research carried out by the IF, for example, found rural areas have aged nearly twice as rapidly as urban ones over the past 25 years and for the typical child in the 25 largest cities, only 5% of their neighbours are now over 65 years of age. The pattern that emerges is one where urban areas are seen as more youthful than rural areas.  

The Select Committee took evidence from Professor Elspeth Graham (University of St Andrews), who suggested, at the extreme, that segregation could threaten social cohesion, because people might vote for different self-interests, or age-related interests. David Kingman (IF), added that a political system based on age-segregated geographical representation would be likely to contribute towards political polarisation, given that age is now the most accurate demographic predictor of which way someone will vote. The Committee also referenced the work of the Pub is the Hub campaign. 

Outside of the Committee’s work, literature on age segregation often cites a lack of affordable and appropriate housing options; the role of connectivity and technology; and access to public transport – and while these issues may resonate with younger people they can affect rural residents of all ages and abilities.  

What has been done to tackle unfairness? The House of Commons Work and Pensions Committee report back in 2016 recommended Government collate and make available reliable and comprehensive information about the intergenerational distribution of public and private resources to estimate the balance of fiscal contributions and withdrawals by different generations over their entire lifetimes. The House of Lords select committee in 2019 extended this view in calling for: 

  • A new fiscal rule focused on the Government’s generational balance of debt and assets and a more transparent spending review process. This should draw out a sense of equivalence and fairness about what is contributed over a lifetime and what is received by successive generations. 
  • Giving Local Authorities stronger powers to develop housing on publicly owned land and borrow to fund house building. 
  • More investment in vocational education and lifelong learning to prepare younger generations for a 100-year life. 
  • Further consideration of employment rights by ensuring worker status is the default position; and consider initiatives such as flexible working, mid-life career reviews and tackling ageism in the workplace. 
  • Changes are needed to age-related benefits and the taxation system to make proper provision for the costs of social care.  

The Government responded to these recommendations in July 2019: 

  • Accounting for the future: The Government agreed that “fully considering the long-term implications of policies is important”. It argued this was evidenced by its fiscal rules, which aimed to ensure “sustainable public finances which lessen the debt interest burden on future generations”. The Government added that it had already “committed to requiring departments to show how their bids deliver long-term” following a National Audit Office report that made recommendations in this area. It also said HM Treasury’s guidance on appraisal and evaluation for programmes, policies and projects (contained in the Green Book) already recommended steps be taken in the preparation of business cases to “ensure that the impacts of an intervention on future generations are fully captured and appraised”.
  • Housing: The Government said it was committed to increasing the supply of affordable housing and outlined policy responses designed to increase the supply of homes, including allowing Local Authorities to borrow more to build council homes; releasing Government-held land for home building; and making changes to the planning framework.
  • Education: The Government said it was aiming to improve the quality of education provision, particularly in relation to apprenticeships and further and technical education. It added that it was also engaged in testing various retraining and life-long learning programmes for effectiveness.
  • Work: The Government said it had committed to a “wide range of policy and legislative changes to ensure that all workers can access fair and decent work, that both employers and workers have the clarity they need to understand their employment relationships, and that the enforcement system is “fair and fit for purpose”. It said it supported flexible working and highlighted that it was now standard practice for all civil service roles to be advertised as available for flexible working unless there was a strong business case otherwise.
  • Communities: The Government said it was “committed to bringing people together and enabling communities to influence and act” and outlined different funding streams available to support community organisations and wider civil society in local areas.
  • Taxation: The Government disagreed with the committee’s recommendation that the triple lock for the state pension should be removed. The Government said it was “committed to ensuring economic security for people at every stage of their life, including when they reach retirement”. 

The Office for National Statistics (ONS) also responded to the Select Committee, confirming that the body was “already in the process” of taking forward specific aspects of the Committee’s recommendation, including a generational breakdown of the effects of tax and benefits on household income data set and backdating this to the extent that the data allowed.

What has been the impact of COVID-19? Public Health England (PHE) carried out a review of data into disparities in the risk and outcomes from COVID-19. The largest disparity found was by age. Among people already diagnosed with COVID-19; people who were 80 years or older were seventy times more likely to die than those under 40 years of age. Risk of dying among those diagnosed with COVID-19 was also higher in males than females; higher in those living in the more deprived areas than those living in the least deprived; and higher in those in Black, Asian and Minority Ethnic (BAME) groups than in White ethnic groups. These inequalities largely replicate existing inequalities in mortality rates in previous years, except for BAME groups, as mortality was previously higher in White ethnic groups. Several studies, although measuring the different outcomes from COVID-19, report an increased risk of adverse outcomes in obese or morbidly obese people. 

A publication from the Institute for Fiscal Studies (IFS), supported by the Joseph Rowntree Foundation (JRF), examined how living standards – most commonly measured by household incomes – were changing in the UK up to the eve of COVID-19. The report found the COVID-19 crisis had hit at a time when income growth had already been extremely disappointing for some years. Median (middle) household income was revealed to be the same in 2018−2019 (the latest data) as in 2015−2016. For people aged 60 years or over, median income was 12% higher in 2018−2019 than before the previous recession in 2007−2008, and amongst the rest of the population it was only 3% higher. Trends among lower-income households had been worse still – they had experienced five years of real income stagnation between 2013−2014 and 2018−2019. Workers whose livelihoods look most at risk during COVID-19 already tended to have relatively low incomes, and were relatively likely to be in poverty, prior to the onset of the crisis. Employees working in ‘shut-down sectors’, such as hospitality, for example, were already almost twice as likely to be in poverty as other employees, and poverty rates were higher still for self-employed people working in these sectors. Cleaners and hairdressers were highlighted as groups with higher poverty rates than other workers who are unlikely to be able to work from home. Despite temporary increases in benefits announced in response to the pandemic, the benefits system in 2020 was found to provide less support to out-of-work households compared to 2011. Average benefit entitlement among workless households is 10% lower in 2020 than it would have been without any policy changes since 2011, and among workless households with children it is 12% lower.

The IF’s index of young adults’ wellbeing 2020 found average wellbeing declined by 8% in people aged 18-26 years between 1991 and 2017-2018. While overall wellbeing began improving between 1991 and 1999, it worsened (by 19%) at the height of the financial crisis and economic downturn and has not recovered since. Another variable which measures the closeness of relationships between family members has also declined significantly: the proportion of young adults who say that one of their three closest friends is also a relative has fallen from 34% in 1991 to 16% in the most recent year for which data was available. Physical and Mental Wellbeing measures subjective changes in young adults’ physical and mental health. The indicator which measures mental wellbeing suggests that one in five young adults reports suffering from symptoms of moderate mental distress. Economic Wellbeing has improved by a small amount since 1991, but the average working member of this age group is earning only 1% more in real terms than their counterpart in 1991 was, despite being much more likely to have a university degree. The average income of a worker in this age group remains 11% below the pre-2008 level in real terms. Overall, the results of the IF Index suggest that today’s young adults were already falling behind the level of wellbeing which previous generations enjoyed when they were at the same stage in life, and this was before the COVID-19 which may reduce their standard of living yet further.

The Resolution Foundation and Nuffield Foundation published an intergenerational audit in October 2020 to examine the impact of the initial phase of COVID-19 for different generations in Britain. There were four key findings. Firstly, COVID-19 has had profound physical health risks for older adults, and there is a clear distinction between the experiences of older people and working-age families during lockdown. Secondly, the labour market has hit a U shape, affecting the youngest and oldest workers most – although actual incomes fell most during lockdown for those in their late 40s. Thirdly, consumer debt usage accelerated for 35-44 year olds and falling equity prices have dented the wealth of people in their 50s. Fourthly, post-lockdown impacts may be more clearly tilted towards the bottom of the age range. By July 2020, younger adults had become the most likely to fall behind with housing payments; young people risk long-term employment and pay ‘scarring’ effects from starting careers in a downturn; the prospects for a post-coronavirus home ownership increase among aspirant buyers appear limited; and any removal of temporary welfare boosts look set to provide a major drag on the incomes of younger generations.  

Debates have also taken place in the Lords and Commons since the start of the pandemic that have picked up the issues covered in the Select Committee’s 2019 report. This includes a debate in March 2020 which highlighted the importance of intergenerational thinking: “the best old people are those who remember that they were once young, because it is that idealism, vision and hope young people have which carry us to do our best things at all ages. Of course, younger people are only older people in waiting. We all have a common intergenerational interest” (Lord True, chair of the Select Committee). In a debate on COVID-19 recovery strategies in June 2020, Baroness Hayman indicated that “we need fairness between generations, between regions and between industries’; with Lord Tunnicliffee noting that “doing this will require new policies rooted in a new consensus. We need to change, from how we engage with businesses and citizens to how we restructure central Government…the scale of the challenge we face is significant. Very little will come out of COVID-19, but acceptance of the need to reshape our economy could be one glimmer of hope”. Lord Robathan highlighted how “young people in this crisis have seen their education trashed, schools and universities closed, and exams missed. When lockdown is lifted, unemployment will shoot up; it will not be a good time to look for a job. We are facing a deep recession, possibly a global depression…Our prosperity and quality of life will be severely lessened and healthcare will suffer. If we older people are “all right, Jack”, and while our futures are largely behind us, we have mortgaged our country’s future and our children’s future”. Lord Hastings of Scarisbrick concurred in highlighting the number of companies cancelling graduate placements and internship opportunities. Lord Ravensdale called for an evidence-based plan for recovery that fits regions and provide a key reference point linked to the Government’s levelling up agenda. In an economy debate in November 2020 Lord Agnew of Oulton posited that “intergenerational solidarity is vital as we come through this crisis. I worry about the cliff edge of debt that we are generating”. A written statement made by Lord Greenhalgh (Minister of State for Building Safety and Communities) in December 2020 described how the Government ‘want to build more homes as a matter of social justice, of inter-generational fairness and as one of the best proven ways of creating jobs and economic growth’. 

While still at an early stage, all of this work highlights the impact of COVID-19 on different generations – illuminating the disproportionate effects so far on younger and older generations. ‘Unfairness’ has been laid bare during the pandemic in its disproportionate (health, economic, societal) impacts on some people more than others. This is leading to debates about whether fairness should be a core principle in our evidence base, policy making and delivery interventions post COVID-19.  

What more can be done to address unfairness? In March 2020, the Wellbeing of Future Generations Bill was introduced into the House of Commons for its first reading. If it becomes law – and it is not currently supported by the Government – the Bill will require public bodies to act in a way that accords with the ‘future generations principle’ i.e., balancing short-term needs with safeguarding long-term needs, deploying resources to prevent problems occurring or getting worse, forecasting and managing emerging risks. Public bodies would be required to publish future generations impact assessments and a new Commissioner for Future Generations would be appointed to oversee the implementation of the Act. It would also lead to the establishment of a Joint Parliamentary Committee on Future Generations. The bill would build upon the Well-being of Future Generations (Wales) Act 2015 in making provisions for the principle to apply across the UK.  

A briefing paper from the Social Market Foundation (SMF) in April 2020 discussed the need for the economic costs of responding to the pandemic to be shared fairly across the generations. The paper suggests the economic costs of tackling COVID-19 will fall heavily on those of working age, especially in terms of redundancies and lost income – and how the lockdown has been aimed at saving the lives of those at greatest risk (a group that is largely, though not exclusively, made up of older people). While the economic sacrifice is the right things to do, the report argues as we emerge from the crisis ‘older generations must uphold their part of the [social] contract by bearing a fair proportion of future tax rises and welfare reforms’. Echoing other research, the SMF has also called for the replacement of the triple lock with a double lock, whereby the basic state pension is tied to increases to earnings or inflation (whichever is higher). This could contribute £20 billion to deficit reduction over the next five-years. Pensions would still rise, but more slowly, reducing the fiscal burden of the working-age population.  

In January 2021, the House of Lords held a debate on tackling intergenerational unfairness. Contributors raised issues around loneliness, wage levels, debt, the unaffordability of house prices, a low-wage poor-health equilibrium, the state of the welfare safety net, the importance of having a good state pension, the gig economy and the role of churches and faith communities. According to Viscount Chandos “although COVID-19 has posed a far greater direct threat to the health of older people, the broader social and economic impact of the measures taken to control the spread of the virus has affected every generation, and in many respects, particularly the younger ones…that the greatest poverty and unfairness now lies with younger working-age people, is likely to be emphasised by the effects of the pandemic-combating policies of the past year and the months still to come”. As a state and a society the Lords were clear that we need to do more in real-time to get to grips with some of the extraordinary policy challenges that have arisen as a result of the pandemic. 

COVID-19 has brought the Select Committee’s report into renewed sharpness. For the pandemic has highlighted and exacerbated existing intergenerational economic and social inequalities and tensions. On the one hand, research has explored the differential impacts of COVID-19 on different generations. On the other hand, illuminating what different generations have in common and the mutual self-support and aid provided have also been highlighted. Where the ‘intergenerational contract’ fits in a policy context and how plays out in practice [perhaps through the Wellbeing of Future Generations Bill] as we recover from the pandemic is now in focus. 

Whatever we do, and whatever the future holds, this implicit contract between generations lies at the heart of our society. While we are all in this, clearly we have not all been in it together. Whether it’s housing, wages, social care, the environment, or the welfare system, all require some reform so we can create a fairer and better society for all. Importantly, this requires thinking about generational relationships through a rural lens – where the generation gap between young and older is more pronounced. What are the lived and economic experiences of different rural residents? How can we improve data collection to better understand generational similarities and differences in rural areas? And what more can we do to ensure all generations can enjoy healthy and fulfilling lives in rural areas?  

Finally, the All-Party Parliamentary Group (APPG) for Future Generations is carrying out an inquiry into long-termism into policymaking. The inquiry is covering four main questions: (i) to what extent is a lack of long-term thinking a challenge in policymaking – and why is long-term thinking important? (ii) What are the root causes of failures in long-term thinking? (iii) What are some of the success stories – and what are some examples of poor long-term planning? (iv) How can we better incorporate long-term thinking in the policy making process? If the situation we face cannot be solved with short term election cycles or economic production and growth measures such as GDP; will the current inquiry help shift our thinking to address intergenerational challenges? In May 2018, the Wales Audit Office published its assessment of how public bodies in Wales have responded to the 2015 welsh Act. This found public bodies supported the principles of the Act and were taking steps to change how they work (e.g. undertaking wellbeing impact assessments); but inserting change into planning and decision-making processes is a gradual process. Will the Bill and the work of the inquiry help to embed longer-term thinking? And what could it mean for rural places? Watch this space.  

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Jessica is a researcher/project manager at Rose Regeneration and a senior research fellow at The National Centre for Rural Health and Care (NCRHC). Her current work includes supporting health commissioners and providers to measure their response to COVID-19 and with future planning; and evaluating two employability programmes helping people furthest from the labour market. Jessica also sits on the board of a Housing Association that supports older and vulnerable people. 

She can be contacted by email jessica.sellick@roseregeneration.co.uk. 

Website: http://roseregeneration.co.uk/https://www.ncrhc.org/ 

Blog: http://ruralwords.co.uk/ 

Twitter: @RoseRegen 

Cable

Are rural areas falling through the net?

The digital divide is the gap between people who have full access to digital technologies and those who do not. COVID-19 has underlined the importance of access to and comfort with technology.  Throughout the pandemic the internet and digital devices have played a vital role in enabling people to access services, attend medical appointments, use contact tracing apps, learn or work from home and keep in touch with friends and family. Just imagine how much worse your life would be if you didn’t have proper functioning broadband. This is the reality for many rural residents who are either not connected at all or reliant on 20th century infrastructure. What impact has the digital divide had on rural residents during the pandemic, and what more needs to be done to get everyone connected? Jessica Sellick investigates. 

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What is superfast broadband and full-fibre broadband? Back in December 2010, the Government published its superfast broadband strategy. Since then, Government policy has focused on the roll-out of superfast broadband, which it defines as ‘download speeds of at least 24 megabits per second (Mbps)’. According to Ofcom, and based on this definition, superfast broadband availability reached 95% of UK premises in February 2018. While Government focused on promoting a competitive market for the rollout of infrastructure, it also initiated a superfast broadband programme to support delivery in those areas not reached by the private sector. Under the programme, Government has been providing some £719 million in funding to Local Authorities and/or Local Enterprise Partnerships (LEPs) to subsidise roll-out in areas not reached by commercial investment. The programme is ongoing, accounting for approximately 17% of the county’s total superfast coverage, with contracts expected to run until 2024. In October 2020, the National Audit Office (NAO) published a report on the programme. While the NAO found the programme had helped to extend coverage, many people were found to be still experiencing poor broadband – particularly in rural areas.  It is worth noting that only 57% of properties were found to have signed up to superfast broadband packages (owing to lack of awareness that faster services were available and/or cost) and that premises do not necessarily experience the advertised speeds (attributed to distance from the cabinet or multiple users in the home or workplace). 

Superfast broadband has been mostly delivered by Fibre-to-the-Cabinet (FTTC) technology. This is where a fibre optic cable runs to a street cabinet, and then existing copper telephone wires are used to connect the cabinet to individual premises. The copper telephone network is owned and operated by Openreach, which allows other broadband retail providers to deliver broadband services using this network. 

While superfast broadband has been fast enough for most individual/household needs; the availability of, and demand for, data intensive services (e.g. video calling, virtual meetings) is increasing. To support this, high capacity internet connections that can support fast download speeds, large amounts of data, and multiple users at one time, will be required. Fibre-to-the-premises (FTTP) or fibre-to-the-home (FTTH) can deliver 1 gigabit per second (Gbps) download and upload speed. This is where fibre optic cables run from the cabinet to premises – these can carry more and faster data when compared to copper wiring. Investment in fibre networks requires access to every premise to install equipment – negotiating this (and variances across different Local Authority areas) and build costs may be expensive for commercial providers leading to an inconsistent approach. Similarly, 5G is the next iteration of high capacity broadband networks. 5G is expected to support very fast download speeds and near instant response times. However, with some rural areas lacking 4G coverage there is a risk that rural areas will be left behind in the mobile roll-out, compounding the lack of broadband connectivity. 

Why are some rural areas ‘hard to reach’? Rural areas are typically more expensive to deliver broadband to. This is because the geographies of some rural areas increase installation costs, and low population densities [fewer chimney pots!] reduce the commercial return for providers. 

In December 2020, the Government announced £5 billion of funding to support the roll-out of gigabit capable broadband in ‘the hardest to reach 20% of the country’. In the Spending Review 2020, the Chancellor confirmed £1.2 billion of this sum would be made available during the period 2020-2025. In March 2021, the Government published a ‘Build Back Better: our plan for growth’. This seeks to achieve economic recovery from COVID-19 through building three pillars of investment: infrastructure, skills and innovation.  This confirmed £5 billion to accelerate UK-wide gigabit broadband roll-out, a Shared Rural Network extending 4G mobile coverage to 95% of the UK and £250 million to ensure resilient and secure 5G networks and £50 million for the continuation of the 5G Testbeds and Trials Programme in 2021-22. Rural areas and parts of Scotland, Wales and Northern Ireland are cited as the beneficiaries of this investment. 

It is likely the investment will be managed by Building Digital UK (BDUK), part of the Department for Culture, Media & Sport (DCMS). In the meantime, existing Government funded programmes to support gigabit capable broadband include: the Rural Gigabit Connectivity Programme (RGC) – which includes a voucher scheme for rural residents and small and medium-sized businesses (SMEs) without broadband speeds of 100 Mbps to put towards the cost of a gigabit capable connection. SMEs can claim up to £3,500 and residents up to £1,500 although they can only be used to support group schemes where residents come together and combine their vouchers. Providers have to request vouchers on behalf of businesses and residents. A map shows where vouchers are available and how they have been allocated – as of October 2020 the scheme had issued vouchers worth £33.5 million. Some full fibre operators including B4RN, Gigaclear and TrueSpeed specifically target rural areas.

In September 2020 seventeen Local Authorities were provided with £22.2 million of additional funding to top-up Government vouchers in their area.  These include Buckinghamshire, Cambridgeshire & Peterborough, County Durham, Derbyshire, Dorset, East Riding of Yorkshire, East Sussex, Warwickshire, West Sussex and Worcestershire. This complements the RGC programme which has been connecting rural public sector buildings such as schools and hospitals to a gigabit connection, with these buildings acting as ‘hubs’ in improving access to services and making the surrounding area more viable for commercial providers. In England, this has initially prioritised sites in Cornwall, Cumbria and Northumberland.   

In all of this investment, the Government seeks to adopt an “outside in” approach, which means targeting the hardest to reach premises first. This follows the publication of the Future Telecoms Infrastructure Review (FTIR) back in 2018 which suggested deployment of gigabit capable connectivity across all areas of the UK should be achieved at the same time so no areas are systematically left behind. This approach also means that while competition serves the commercially feasible areas, the Government will support investment in the most difficult to reach areas at the same time- this was estimated to be 10% of the total target (some 3 million premises). A staged process of investment was suggested, starting with areas that do not have superfast broadband [5% of the total target]. In November 2020, the Government confirmed in oral evidence to the Public Accounts Committee that outside-in is “still baked into our planning for the future programme. In a sense, we are trying to ensure that the commercial market goes as far as possible, and alongside that we can target our subsidised parts of the programme on the areas of greatest need…when you look at a cost curve for the most difficult premises, they are not all neatly grouped together”. However, the timeline, process and costs for doing this remain unclear therefore leading to a risk that some rural premises will be left behind.       

An increasing rural digital divide? According to the NAO, the superfast programme in the UK has enabled suppliers to prioritise easier-to-reach premises, leaving a rural divide in place because they are the hardest and most expensive to reach. There are also concerns that if rural areas have only one provider they may get locked in to higher prices. The NAO estimates that rural coverage in the UK is 80% – this compares to 97% in urban areas. Overall, England has higher coverage than the devolved administrations. While urban coverage is broadly the same across the four nations, rural coverage varies and, at 66%, is lowest in Northern Ireland. The NAO’s data is drawn from Ofcom and based on actual and predicted data from network operators. The speeds achieved in practice may be higher or lower than those predicted.

In January 2021, the Public Accounts Committee published its report on improving broadband. This describes how ‘1.6 million UK premises, mainly in rural areas, cannot yet access superfast speeds, and as the Department [DCMS] turns its attention to upgrading the UK’s broadband connectivity again, there is a risk that rural areas will be left even further behind’. The Committee also highlighted a concern that those living in rural areas may have to pay more and may reach gigabit broadband speeds late. The report recommends that the Department [DCMS] set out how it will establish which premises do not yet have superfast broadband, how reliable the data it will use to identify them is, and when they can expect to receive gigabit capable broadband. Without a clear plan the report suggests those living in rural and remote areas may not get superfast speeds until 2024-2025.   

What impact has the digital divide had on rural communities during COVID-19? The term ‘digital divide’ is being used by practitioners and academics to describe ‘the gap that exists between individuals who have access to modern information and communication technology and those who lack access’. There are multiple dimensions to the digital divide, including: access: to hardware and software data; use: the skills and knowledge to use technology and handle updates to it; confidence: that it is safe and secure to use; money: to pay for the connection and technology; time: to fully utilise it; and family and peer support: which enables it to form part of our everyday lives.  

Between December 2019 and February 2020 Capgemini surveyed 1,300 people with no internet access in the UK, France, Germany, Italy, Sweden and the US. More than 40% of those surveyed were aged 18-36 years and many described being unable to get information about the virus, talk to relatives, interview for jobs, or access welfare programmes and banking services. For those living in rural areas, cost was the key reason for being offline: nearly half (47%) said they had never used the internet because an internet subscription was too expensive and 44% said the device was too expensive. The share of households living in rural areas accessing the internet daily stood at only 62% (versus 88% in cities), driven by higher costs and long implementation times of broadband in rural areas. 

According to the NAO’s report the existing infrastructure has coped well with increased demand for the internet during the pandemic – but it acknowledges that rural populations with poor broadband had felt the impact more sharply.  Ofcom estimates that a small but significant number of premises have been struggling to get connected – some 43,000 premises that cannot access either a decent fixed broadband service or good 4G coverage indoors. In 2020, consumer use of fixed broadband increased by an average of 2.5 hours a day, and on mobile by 1 hour a day.  

The Good Things Foundation has found since lockdowns began libraries and internet cafes that many use to get online have closed. Others who have a smartphone but struggle to pay for data have not been able to access free hotspots. The Foundation is working with the Prince’s Countryside Fund to tackle the inequity that means 11% of rural premises in England still cannot get access to a good broadband connection, compared to 1% of urban premises. The project is looking at how to scale lack of digital skills and/or digital connectivity across rural communities. This includes the creation of Digital Enterprise Hubs and Digital Enterprise Champions. The two current Digital Hubs are A1 Community Works (North Yorkshire) and Airedale Enterprise Services (West Yorkshire). The Foundation has also recommended the establishment of a ‘data poverty lab’, which recognises broadband as an essential utility like water and electricity. It has suggested the lab could facilitate initiatives like data donating whereby people can donate unused mobile data to others who cannot afford it; Wi-Fi sharing between neighbourhood households; subsidised broadband schemes; and extending public Wi-Fi in towns and cities. 

While initiatives are underway to understand the digital divide in relation to home-schooling and online distance learning or workplace skills; the focus often remains on the main factors that shape the digital divide (i.e., age, region, socio-economic status and whether a person has a disability) rather than applying any kind of rural lens.   

What more can be done to ensure no-one is left behind? In its National Infrastructure Assessment, the National Infrastructure Commission (NIC) recommended that the Government develop a plan to allow a copper switch off by 2025. This means all customers/premises would move from a copper to non-copper based network. While running a copper network alongside a fibre network is costly, there are customers without any broadband connection and vulnerable customers relying on the copper network for telephone calls. The Government is referring to a switchover instead, with customers/premises moving over to new non-copper based networks. This is important because as yet there is no date for 100% coverage and no date for when those without superfast access can expect better broadband. 

HM Treasury published a National Infrastructure Strategy in November 2020. This explicitly references rural areas as part of the Government’s levelling up agenda. Under a section titled ‘leaving no community or business behind’, the Strategy references the existing UK-wide gigabit broadband roll-out and a Shared Rural Network to extend 4G mobile coverage to 95% of the UK.  

In the Budget presented on 3 March 2021, the Chancellor described how the UK has a relatively low adoption of digital technologies and software compared to international competitors, and how this directly affects productivity. The budget made provision to support SMEs to boost their digital and management capabilities [help to grow digital programme to upskill 100,000 SMEs with advice and software worth up to £5,000 each]; saw the establishment of a UK Infrastructure Bank with £12 billion of equity and debt capital to finance local authority and private sector infrastructure projects across the UK; and £375 million allocated to help scale up the most innovative, R&D intensive businesses.

We need a better understanding of what is connectivity really like in rural areas. Should having a broadband internet ‘service’ be treated as a basic ‘utility’ and critical infrastructure, or as a ‘nice to have’? Mobile phone coverage remains as much of an issue as broadband in many rural areas. 

We need quicker, smarter, affordable and future-proofed [fibre] solutions to connect rural communities. In addition to the delivery infrastructure put together by the Government, how can residents and businesses deliver broadband in their area? There are a plethora of examples of where communities have decided to get on and ‘do it yourself’ (e.g. Cybermoor) and some rural communities will not have access to high speed broadband unless they take more action. How can we encourage rural communities to come together and solve the connectivity conundrum that they are facing? For example, where and how can communities be supported to obtain access to finance, technical skills and infrastructure? Should digital access form part of planning considerations for new developments in rural areas? Regardless of how it is delivered, for those living in rural areas lucky enough to get full fibre during the pandemic, it has had transformative effects in how they live, work and socialise. 

Finally, it is worth noting that broadband is not a catch-all solution to the issues facing rural communities – it needs to be joined up. It is important that we do not impose ‘online solutions’ to ‘offline issues’.  Yet if the Government views digital infrastructure as central to the future of the economy – and vital to its levelling up agenda as we recover from the pandemic – them every part of the country, including rural areas, needs to benefit. While policy and decision makers have been providing a plethora of initiatives and funding pots since 2010, and want to follow an outside in approach, to what extent we will finally reach the final 11% remains to be seen. Will it be by 2024-2025 or from 2026, watch this space…  

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Jessica is a researcher/project manager at Rose Regeneration and a senior research fellow at The National Centre for Rural Health and Care (NCRHC). Her current work includes supporting health commissioners and providers to measure their response to COVID-19 and with future planning; and evaluating two employability programmes helping people furthest from the labour market. Jessica also sits on the board of a Housing Association that supports older and vulnerable people. 

She can be contacted by email jessica.sellick@roseregeneration.co.uk. 

Website: http://roseregeneration.co.uk/ https://www.ncrhc.org/ 

Blog: http://ruralwords.co.uk/ 

Twitter: @RoseRegen 

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