The hidden cost of being rural: an examination of geographical variations in Local Government funding with a focus on healthcare services

This research examines the multiple and divergent definitions of rurality employed by public bodies in England. It sets out how evolving definitions have influenced what counts as rural England, and describes the resulting implications for rural land areas and populations. Evolving approaches to defining rural areas reflect changing social and political priorities. Prior to the increased political presence of rural areas, service provision and urban development concerns shaped geographical classifications with rural areas treated as a residual category. However, the rising emphasis on rural affairs policy since the-late 1990s, marked by the creation of the Countryside Agency in 1998, ,has prompted the development of classification systems based on the defining characteristics of rural areas themselves. The classifications and definitions of rural areas are relevant to the funding of government services as it is these classifications, alongside definitions of deprivation and need, which determine the type of services provided in an area and the amount of funding allocated for their provision. It is impossible to understand the funding services in England without an attempt to provide a summary of the datasets and methods. This thesis provides a guide to the funding methodology of health and social care in England with reference to the role of rural classifications. Although throughout the focus will be on the provision of health and social care services, most, if not all, of the issues raised are, in addition, relevant to the provision of other services. The cost of delivering health care services to rural areas is higher per capita than their urban counterparts. The current English NHS funding formulae inadequately reflect this additional cost, leaving rural PCTs in debt (Badrinath et al., 2006). The same problems face local authorities in their provisions of health and social care. Currently, in contrast with urban areas, the needs of rural areas are poorly characterised by both generic indices and by inappropriate classification systems. Change to the current formulae is therefore needed and this thesis provides a range of possible solutions.