Meeting the needs of people with long-term neurological conditions in rural communities. By Dr Michael Toze.

There are many different long-term neurological conditions. Some of the most common ones include migraines, epilepsy, Parkinson’s disease, multiple sclerosis and muscular dystrophy. In the UK and around the world, these conditions are a common reason why people have appointments with medical services. However, previous research also suggests that health services are not always well-designed to meet the needs of people with long-term neurological conditions.

The HARG team previously undertook a project in partnership with Lincolnshire County Council to carry out a health needs assessment health needs assessment  looking at long-term neurological conditions in Lincolnshire. This included a survey of patients, carers, voluntary sector organisations and healthcare providers.

We then looked in more depth at what is known about supporting people with long-term neurological conditions in rural areas. In our survey, people highlighted both that it was difficult to access specialised services, and that some local health and social care services did not have good knowledge of neurological conditions. This issue was made worse by long travel times in rural areas. This also caused difficulties for staff: for example, it was hard for them to access training or support. Support from charities and voluntary sector organisations was often also reduced in rural areas, though there were some good examples of local community groups. As a result people living with neurological conditions and their carers did not always find it easy to access support and social activities.

When looking at wider research on this topic, one issue is that there is a lot of variation in what is meant by “rural”. For example, rural health research from Canada or Australia often involves much larger distances and sparser settlement patterns than exist in the UK, may focus on the needs of Indigenous communities, and may also involve meeting challenges of extreme weather. It is therefore not necessarily always appropriate to apply rural health research from one context to another.

Some commonly suggested solutions to challenging in rural health are improving use of technology, and building expertise in local health and social care services. While there are benefits to these approaches, they also require careful tailoring to the local context. For example, video consultations are not a solution in rural areas with poor quality internet connections. Rural professionals such as local nurses can only build expertise and specialised skills if they have the time and support to do this well – but rural areas often struggle with staff recruitment, meaning they may not have capacity to take on new responsibilities.

NHS England’s long-term strategy emphasises the importance of locality in health, and that wherever possible people should be treated close to their homes, using community based services (which might include voluntary sector organisations, peer support, or self-management of long term conditions, as well as health services). We think there needs to be more research into how to address the specific challenges faced in providing community services in rural areas, in order to ensure people living in these areas can also access services in their local community.

We set out these arguments in much more detail in a paper for the British Journal of Community Nursing