NIRWN’s 2018 research uncovered that many rural women felt that they were “becoming more isolated, with many of our support agencies being located in urban settings.” Health appointments were consistently raised as an issue, both GP and hospital appointments. These are an extra burden to rural women as they are very often caring for both elderly relatives and young children and as such are tasked with organising the transportation to appointments. Transport was also raised as an issue. Those in rural areas said they found it was necessary to have access to their own transport to attend hospital due to lack of public transport and not knowing how long they may be at the hospital making it impossible to plan their return journey.
Research indicates that costs ‘saved’ by the NHS in centralising services are, in reality simply transferred to patients. Rural dwellers, particularly those without private transport, are likely to be most disadvantaged by these changes. A recent study of a remote rural community in Northern Ireland found that district nurses had been withdrawn, GP surgeries had become larger and less personalised and GP out of hours services were located at substantial distances.
Experience of GP services varied greatly depending on location and examining this in the regional context the NIRWN’s observations22 on this issue are that there is no equity across the region in how GP services are delivered. Appointment availability, booking systems, available clinics, etc very much depend wholly on the General Practice and their own systems and guidelines.
There was a consensus amongst NIRWN research participants that, centralisation of support services was impacting on their communities locally, not just in terms of access poverty but also on exacerbating social isolation.
Whilst the nature of rural isolation and its associated impacts would seem to vary, it is clear that there will be individuals who experience negative impacts such as mental health issues, the risk of suicide and potentially reduced life expectancy.23 Given these potentially negative impacts, the existence and even apparent growing impact of many of the potential causal factors identified such as the increases in people living alone24 may raise concerns going forward.
Social networks and local community support play a critical role in helping people either to avoid or to overcome their experience of disadvantage, by providing emotional or practical support such as help with shopping, transport and money. Research has highlighted the increasing importance of lack of community support and social isolation leading to disadvantage, as rural social networks are breaking down. UK research indicates that the additional costs of providing social care for older people may be exacerbating this problem.
Scottish research indicated that stigma related to mental health issues is also particularly problematic. Rural areas are known to have strong communities and whilst this can act as a protective factor for people with mental health issues it can also be a barrier to them seeking and accessing services due to the perceived stigma of their circumstances.
This is an excerpt from the WRC response to Call for Evidence – Debt Respite Policy Proposals for Northern Ireland