Healthcare in Rural Areas

Wednesday 4th March 2026 Westminster Hall

16:29

[Blake Stephenson (Mid Bedfordshire) (Con)]

I beg to move,

That this House has considered healthcare in rural areas.

It is a pleasure to serve under your chairship, Dr Huq. I hope that this debate can be a constructive discussion of the particular challenges that rural communities face in accessing healthcare. In that spirit, I will open the debate by saying some things that I hope no one will find controversial.

Rural communities are bigger and further apart than urban ones and have fewer people in a wider area, which makes the delivery of basic services much harder than in major conurbations. The time and money lost to travel is higher because the distance between places is larger, and it is more challenging to recruit and retain staff in public services such as healthcare. Accessing online support—often seen as a silver bullet for the future of healthcare—can be challenging in rural areas where high-quality broadband and mobile signal have not yet arrived. All that means that securing equal access to healthcare in rural areas as in urban areas is more challenging and expensive, which has practical implications. In the Health Secretary’s constituency of Ilford North, there are 20 main GP surgeries. In my constituency of Mid Bedfordshire, there are just nine. The age of the village doctor is gone.

When my constituents heard of the plans for a neighbourhood health service, with a neighbourhood health centre, within the Government’s 10-year health plan, there was some optimism that that age might return, even if not necessarily in the same way as before. In principle, neighbourhood health centres are absolutely the right step. They are a way to empower people to get the healthcare that they need on their doorstep and to keep them out hospitals, which could then focus on those who need the most specialised care.

[Sarah Gibson (Chippenham) (LD)]

Does the hon. Member agree that rural communities, such as mine and his, and villages such as Lyneham, which is famous for its serious airbase and is full of veterans, now find themselves with poor GP surgeries and no future for that? People in those villages are waiting longer and longer to get that care and feel completely left behind, as they have no access to any form of health service.

[Blake Stephenson]

I know Lyneham quite well; it is a beautiful part of the world—although of course, Mid Bedfordshire is far more beautiful. I have to agree with the hon. Lady. The situation is deeply concerning for those in rural communities who are struggling to access GPs, and, given the growth and development in our communities, access is becoming much more difficult as the years roll on.

[Jess Brown-Fuller (Chichester) (LD)]

The hon. Gentleman is making a valid point about development. In the rural village of Bosham in my constituency, a resident was recently told that they would have to wait four months for a GP appointment. Meanwhile, they have seen plans come online for the development of 300 homes behind the GP surgery, and the surgery is now expecting 600 new patients. Does the hon. Gentleman agree that we need to have an infrastructure-first principle, because the reason that residents get so frustrated with development is that they cannot see those extra GP appointments coming online once those homes have been built?

[Blake Stephenson]

The hon. Lady front-runs entirely a point I will make later, and I thank her for doing so.

Unfortunately, that early optimism about neighbourhood healthcare was somewhat tempered by a response I received to a written question, indicating that the Government expect neighbourhoods to have a geography of around 50,000 people. I am afraid that that will do nothing for people in Mid Bedfordshire. It will mean either that rural communities on the edge of urban catchments will be split up and served by “neighbourhood” health hubs in nearby major settlements, which will likely be Hitchin, Bedford, Luton or Milton Keynes, or that one rural “neighbourhood” will cover the vast majority of rural communities, meaning that constituents will have to travel to a central location to access the services that they need. In either case, that is what already happens now.

People in rural communities can only get to healthcare services in big towns that are often a distance away. They deserve better than to be viewed as the hinterland of larger urban areas. They deserve a neighbourhood health service designed not as a one-size-fits-all solution, but as genuinely local to their needs. I appreciate that funding is not unlimited and that tough choices need to be made, but those tough choices always seem to result in rural communities losing out when it comes to access to healthcare.

[Aphra Brandreth (Chester South and Eddisbury) (Con)]

My hon. Friend is making an excellent speech. Does he agree that allocating NHS resources on a strictly per head basis disadvantages rural communities, particularly when nearly a quarter of rural residents are over the age of 65 and the rural population is ageing faster than in urban areas? Will he join me in encouraging the Minister to commit to reviewing the funding formula to reflect age profile, travel times and sparsity?

[Blake Stephenson]

Absolutely. I do join my hon Friend in asking the Minister to respond to that specific point in summing up. I know many MPs who represent rural communities have concerns about the fairer funding formula. In fact, it is not fair, particularly for rural communities. It would be helpful if the Minister were to reflect on that in his speech.

I would like the Minister to give serious consideration to amending the Government’s plans on neighbourhoods. Neighbourhoods in urban communities can likely afford to be larger. The relative impact of that in many urban communities will be minimal. However, in rural areas, we need neighbourhoods in the region of 10,000 not 50,000, so that people living in small rural towns such as Flitwick and Ampthill in my constituency do not have to leave their towns to access “neighbourhood health services” and so that people living in villages large and small only have to travel to the next village over and not to a big town many miles away.

My concern over the Government’s plans for healthcare in rural areas does not end there. In Bedfordshire, we have recently seen our integrated care board—initially serving Milton Keynes, Luton, Bedford and central Bedfordshire—absorbed into a huge conglomerate ICB covering Hertfordshire, Bedfordshire, Cambridgeshire, Peterborough and Milton Keynes. That is an area of around 3.5 million people. It is hard to see that the new ICB will be able to give the level of attention to people in our rural communities that they need and deserve.

In Wixams, a new town being built in my constituency, a GP surgery has long been promised. It was promised when shovels first went into the ground in 2007, and it has been promised ever since, but the empty field remains, waiting for a building and some doctors. Wixams now has roughly 5,000 residents, and it made up about 0.4% of the population of the previous ICB area. It needs its promised GP surgery, but residents have found it incredibly difficult to get action from the ICB. Under the Government’s new ICB arrangements, Wixams’ residents represent just 0.1% of the ICB’s population. It seems obvious to me that an already small but growing community that needs healthcare services will find that this centralisation of leadership structures will make it even harder for them to get the healthcare they need.

To give credit where credit is due, the new ICB leadership have been very responsive to my representations on Wixams. After nearly two decades of delay, it feels like we are finally making some progress, together with the Mayor of Bedford and the hard work and commitment of local councillors Graeme Coombes, Marc Frost and Andrea Spice—all of whom I thank for their hard work. However, the point remains the same: when the area covered by ICBs is made bigger, the influence of our smaller rural communities and their healthcare needs becomes smaller.

What the Government are doing in Bedfordshire is in no way an isolated incident. I understand that the 42 ICBs that existed before will be reduced to just 26 super-ICBs once the Government’s process finishes. That means thousands of rural communities across England will have less control over their local healthcare overnight, and it was confirmed almost in the same breath as the Government’s plans to bring healthcare closer to communities. That is particularly short-sighted when put against the Government’s plans for mayors. The Government have previously spoken of their desire to line up the boundaries of mayoral areas and integrated boards. Even as part of the 10-year health plan, they stated that their aim is that:

“integrated care boards should be coterminous with strategic authorities wherever feasibly possible.”

What a fantastic idea. Doing so would give proper political accountability to integrated care boards. It would mean that the rural village has a proper elected voice at the table when decisions about the future of healthcare are being made, and a representative that they could hold accountable at the ballot box if their local healthcare needs were left wanting. That is exactly what rural communities need to ensure they get the healthcare they deserve.

The proposals, like so many others, seem to have been put back on the shelf and watered down. Now ICBs will be coterminous with lots of strategic authorities. In Bedfordshire, we are to be forced to have a mayor covering Bedford, Luton, Milton Keynes and central Bedfordshire. Our new ICB would therefore be covered by three mayors, including a mayor for Hertfordshire and a mayor for Cambridgeshire and Peterborough. That dilutes the political pressure our mayor can bring and the impact that rural Bedfordshire communities covered by that mayor can reasonably have.

If the Government change course back to the sensible idea of having an ICB and a strategic authority be coterminous, that will have been a whole lot of money wasted in two needless restructurings that could have gone into more doctors and nurses. It makes absolutely no sense—we need more doctors and nurses. In Bedfordshire, in the decade since 2016, we now have 18% more patients per fully qualified GP. That reflects the reality that in that same decade, our rural communities have been targeted for more and more development—a point made by the hon. Member for Chichester (Jess Brown-Fuller).

In central Bedfordshire alone, more than 20,000 houses have been built in that period, with many more in Luton, Milton Keynes and Bedford, including significant build-out in Wixams, as I mentioned earlier. There is barely a village in Mid Bedfordshire that has not been expanded significantly over the past decade. We expect to see many thousands more built in the coming years, including potential new towns at Tempsford and expansions east of Milton Keynes.

The old argument for healthcare with development no longer works. The argument would go, “Build a large development or new settlement. Give up a bit of what makes your rural community special, and in return you’ll get the new GP surgery or healthcare hub. You’ll get the infrastructure your community needs”. That just does not happen anymore. Now we get the houses, but the field where the GP surgery was promised remains empty, just as it has for two decades in Wixams.

The same argument has been made for the Government’s flagship new towns: build a big new town from scratch and it will come with the right infrastructure. However, the Department of Health and Social Care has not been able to confirm to me that additional funding will be provided for GP surgeries, and there does not appear to be future funding provided from the Treasury. That leaves open the prospect that GP surgeries in new towns will be funded at the expense of new GP surgeries in areas such as Wixams and other rural communities across the country, which have been waiting far too long. I would be grateful if the Minister could assure me on that point specifically.

The overall point is clear: where rural communities see development, they need infrastructure to cope with it. That is common sense; it is simple, and it is what our constituents want to see. They need to see that infrastructure arrive before the houses are occupied, and not for the burden on overstretched existing infrastructure to be relieved at some indeterminate point in the future.

It has been proposed a few times in this Session, but I fundamentally believe something must be done to allow councils and ICBs to benefit from developer contributions from the day that planning permission is granted, not as development is happening. That could be achieved by something as simple as the Government providing funding up front and reclaiming it from the developer via section 106.

This is one of the biggest issues facing my residents. When the wait to see a GP soars because of a new housing estate next door, nobody wins. I know this is not confined solely to rural areas, but it is in rural areas where existing infrastructure is strained to capacity, and where a good proportion of the Government’s 1.5 million homes are expected to be built.

I will bring my remarks to a close, and I look forward to hearing the views of others in this debate. There are particular challenges for rural communities in accessing healthcare. For too long the approach has been to centralise care in larger and larger towns, and in doing so take it away from villages and small towns. The Government’s move to centralise local healthcare decision making over much bigger areas risks leaving rural residents further behind.

The planned shift to a neighbourhood health service is welcome, but it must be a truly neighbourhood-based service. While a neighbourhood of 50,000 people might make sense in our big towns and cities, it risks leaving our rural small towns and villages out in the cold, served only as a bit on the edge of a larger urban area. Equally, as services move more and more online, consideration must be given to the challenges in rural communities that cannot get good broadband or wi-fi, for reasons beyond their control. Finally, we must ensure that development in rural areas comes with the local healthcare infrastructure that we know communities need. For too long, that has not happened, and communities such as mine in Mid Bedfordshire have paid the price.

[Several hon. Members rose—]

[Dr Rupa Huq (in the Chair)]

This is a popular debate, so there will be a time limit of three minutes to begin with, but it might drop down. The first exemplar of perfect timing will be Samantha Niblett.

16:45

[Samantha Niblett (South Derbyshire) (Lab)]

Thank you, Dr Huq—it is a pleasure to serve under your chairship. I am really grateful to the hon. Member for Mid Bedfordshire (Blake Stephenson)—I will call him my hon. Friend; we were in the armed forces parliamentary scheme together—for the opportunity to speak in this important debate on healthcare in rural areas.

In my constituency, we are proud of our strong sense of community, but too many of my constituents face growing barriers when it comes to accessing healthcare. For many residents, the first challenge is distance: GP surgeries are fewer and farther between, community hospitals have been hollowed out, and public transport is limited or unreliable. When appointments are moved online or centralised miles away, what is described as efficiency can feel more like exclusion, and older residents, carers and those without access to a car are too often left struggling.

Rural practices find it harder to attract and retain GPs, nurses and allied health professionals. Smaller patient lists and higher operating costs make practices less financially viable, placing additional strain on already overstretched staff. The result is longer waiting times, fewer appointments and growing frustration for patients who simply want timely care close to home.

Those pressures are compounded by wider inequalities. Rural communities tend to have older populations and higher levels of chronic illness, yet funding formulas do not always reflect the true cost of delivering care across a large, sparsely populated area. It is also worth mentioning that South Derbyshire has a high number of falls, which accounts for a large proportion of emergency hospital admissions for people over 65, and has other negative consequences such as impacting people’s confidence and their sense of independence. Mental health services are also particularly patchy, leaving many people waiting far too long for support, if they can access it at all.

Tracey Thorneloe, one of my constituents in South Derbyshire, experiences debilitating pelvic girdle pain as part of a chronic health condition. While pelvic girdle pain is normally experienced during pregnancy or childbirth, she began experiencing this pain six years ago and has had great difficulty accessing physio. There are no specialist physios for her condition in South Derbyshire, and access to hydrotherapy is very limited.

Wheelchair provision is also an ongoing issue in my constituency. My constituent Amanda Storer has told me of her year-long battle to get a wheelchair for her son Derrick, who has Down’s syndrome. A wheelchair allows him to be more independent and allows Amanda to get out and about more as he grows. We have helped her as much as we can, but we have been struggling too.

All that does not have to be the case; with the right investment and planning, rural healthcare can thrive. We need fairer funding that properly reflects rural need, stronger incentives to recruit and retain healthcare professionals in rural areas, and a renewed commitment to community-based services. Digital healthcare has a role to play, but it must complement, rather than replace, face-to-face provision.

16:48

[Charlotte Cane (Ely and East Cambridgeshire) (LD)]

It is a pleasure to serve under your chairship, Dr Huq. I congratulate the hon. Member for Mid Bedfordshire (Blake Stephenson) on securing this important debate.

The delivery of quality rural healthcare has been neglected for too long. After years of chronic underfunding, and a pandemic from which many areas have not fully recovered, health outcomes in rural areas are on a dangerous downturn. In my own constituency, local populations are growing fast, while GPs and hospitals struggle under the strain. Dental provision in Cambridgeshire is particularly poor, with more than 2,300 people for every single dentist providing NHS services.

The picture is particularly bad among children; recent data showed that at least 45% of children have not seen a dentist in the past two years. That is simply not good enough. We know how important it is for children in particular to see a dentist: good oral hygiene has a strong link to heart health, as infections and inflammation can increase the risk of cardiovascular diseases. It is vital that all children have ready access to a dentist to prevent such debilitating conditions and to introduce important hygiene practices.

Delivering rural healthcare is not simply about hiring GPs, dentists and other healthcare professionals; it is about delivering access, with reliable transport and connectivity infrastructure that is integrated with local healthcare. In rural areas like mine, many rely on cars for travel, but many older and vulnerable residents are left to manage with public transport, which is too often unreliable and does not always take them where they need to go. A constituent might be referred to a GP in a neighbouring village that is only a short distance away, but entirely inaccessible by foot and served by perhaps only a few buses a day, or in some cases no buses at all. The Government and local ICBs must start using such real-terms information when assessing access to healthcare, to avoid rural communities being left even further behind.

I am encouraged that new technologies allow at-home testing and monitoring, which can prevent the need for regular access to GPs and hospitals, but many of my constituents face connectivity barriers as a result of poor broadband and poor mobile reception. Does the Minister agree that the Government must bring forward a strategy to end the neglect of rural healthcare, with new services for left-behind areas and a comprehensive approach to rural connectivity?

16:51

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

It is a pleasure to serve under your chairship, Dr Huq. I thank the hon. Member for Mid Bedfordshire (Blake Stephenson) for securing this important debate.

I represent a semi-urban, semi-coastal, semi-rural constituency, and I know that delivering healthcare across a wide and dispersed population brings very real and practical challenges. I want to speak briefly about three things: hospital trust funding, staff recruitment and transport.

Unfortunately, our funding formulas do not fully recognise the additional costs of providing services over a larger geographical area. Major cities can rely on one large hospital with everything in one place, covering a range of specialities. My local trust serves a similar population size, but it goes from the south of Lancaster all the way to Barrow, around the beautiful Morecambe bay. It is not safe or practical for one hospital to try to do the whole job, yet the funding arrangements do not fully recognise those costs and tend to treat them as inefficiency, rather than as an inherent part of delivering over that geography.

Although funding rightly takes into account deprivation, deprivation can look different in different areas of the country. In my constituency, we have a mix of wealthy and low-income households in the same larger geographical area, and that often determines the funding. Pockets of deprivation get diluted and sometimes miss out on vital funding pots or targeted interventions that would really help. At the same time, my population is older, with higher rates of dementia, which is caused not only by ageing, but by poor cardiovascular health and inequalities.

Hospitals in coastal and rural areas often have persistent issues with staff retention. Professional development opportunities are often focused on the big cities, so services such as major trauma, where people need to go to do their training, are more likely to be there.

For patients living in rural areas, the cost of and lack of access to transport place huge burdens on their time and finances. I do a lot of work with Lancaster Bus Users’ Group and Sedbergh and District Public Transport Users. We all know the challenges facing rural bus services. One of my constituents was waiting in A&E with her sick child, but they had to leave the hospital before they were seen, because they simply could not afford a nighttime taxi journey.

Progress has been made; I really welcome the 10-year health plan, particularly the shift from hospital community care, which will ensure people are seen closer to home. However, I urge the Minister to consider the points I have made today about recognising the true scale of the real and unavoidable costs of serving dispersed rural communities.

16:54

[Katie Lam (Weald of Kent) (Con)]

It is a pleasure to serve with you in the Chair, Dr Huq. I thank my hon. Friend the Member for Mid Bedfordshire (Blake Stephenson) for securing this debate on such an important topic.

Any Member who represents a rural constituency can attest to the practical challenges that our healthcare system faces in the countryside. It can often be difficult to sustain genuinely local GP services, and that forces people to travel long distances to access care. Where services do exist, they are often unable to provide the full suite of care owing to resource shortages or manpower deficiencies. Hospitals, of course, are even further away.

The current make-up of the workforce and workload cannot meet those challenges, so I was heartened by this Government’s plans, introduced earlier this year, to prioritise British medical graduates over foreign-trained doctors, though there is still much work to be done on ensuring that our medical training system rewards our most talented graduates.

I have also been heartened by some of the Health Secretary’s rhetoric on Pharmacy First, and the need to reduce the workload on doctors, so that the public can access basic services without contributing to the NHS waiting list. It is a superb initiative, and was launched by my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins) under the previous Conservative Government. Clearly we need to move the healthcare service towards a model that reduces the workload on doctors, trains more of our workforce here and rewards our best-performing practitioners. That would be better for doctors and patients alike, and would be particularly welcomed in rural areas, where it is often much more practical to have a pharmacy in a village than a full GP surgery.

In principle, the Health Secretary’s public statements on this issue represent a step in the right direction, but since coming to power, this Government have conceded to medical unions such as the British Medical Association, which takes an altogether different line. For example, on Pharmacy First, a scheme that allows people to be treated for simple conditions at their local pharmacy, the BMA said that patients are

“being seen by less-skilled people to further enable the steady downgrade of patient expectations”.

It has since retracted those comments, but that the sentiment exists within the BMA at all is deeply troubling. On physician associates—a group of healthcare professionals who can carry out certain assessments and tests to reduce the workload of doctors—the BMA has launched legal action over whether they can even be called “medical professionals”. Fortunately, it lost the case, but again, its overwhelming hostility towards the reforms that our healthcare system needs in rural areas is concerning.

Enabling local health services such as pharmacies to provide care is particularly important in the countryside, where it will never be possible to sustain a large hospital in a rural area. I very much welcome the Government’s rhetorical direction on Pharmacy First and on reforming the NHS workforce, but will the Minister tell us what this Government intend to do to face down groups such as the BMA, which stand in the way of the reforms that we need to provide high-quality care to the British public?

[Several hon. Members rose—]

[Dr Rupa Huq (in the Chair)]

Order. Potentially the final three-minute speech will be Henry Tufnell, and then we might have to drop the time limit to two minutes.

16:57

[Henry Tufnell (Mid and South Pembrokeshire) (Lab)]

It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for Mid Bedfordshire (Blake Stephenson) for securing the debate. I am unique in this debate in the sense that I am a Welsh MP, and Wales faces unique challenges in respect of cross-border healthcare. Like many other hon. Members’ constituencies, Pembrokeshire is at a disadvantage because of its rurality. We have a fantastically beautiful coastline and beautiful countryside, but we are disadvantaged in terms of accessing these essential services.

I have conducted a constituency-wide survey, in which 85% of respondents said they found it difficult to secure a GP appointment, and 88% did not have access to NHS dentistry. Time and again, the problem is the distance to essential treatment. They are being required regularly to travel out of county. The recent downgrading of our local hospital in Pembrokeshire by the Hywel Dda University Health Board was a catastrophe for local residents, who are forced to travel further and further afield.

When residents are forced to travel across the border, there are often difficulties in transferring medical records, with real-world implications for my constituents. One constituent, who has been diagnosed with cancer, faces the choice of travelling to Bath or paying thousands of pounds to get treatment privately closer to home. The therapy they need is widely available in England but is not offered anywhere in Wales. Similarly, one constituent was referred to a hospital several hours away, in Bath, for specialist treatment for an autoimmune condition, requiring that individual, who is in their 80s or 90s, to undertake extensive travel and round trips.

I could go on with the examples, but suffice it to say that, while the record settlement that has been put forward by the UK Labour Government to our colleagues in Cardiff Bay is incredibly welcome and much needed, it does not get at the root of the problem of delivering healthcare right across the board. My constituents continue to live with poor access to healthcare.

I therefore ask the Minister to commit to exploring how to ensure better communications and transfer of patient records between practices in England and Wales. Does he agree that the UK Government must work with the Welsh Government to ensure that rural communities, such as mine in Pembrokeshire, do not continue to suffer the consequences of a postcode lottery for healthcare?

[Several hon. Members rose—]

[Dr Rupa Huq (in the Chair)]

We have done the maths; we can allow Members two minutes and 30 seconds.

16:59

[Dr Roz Savage (South Cotswolds) (LD)]

It is a pleasure to serve under your chairship, Dr Huq. I thank the hon. Member for Mid Bedfordshire (Blake Stephenson) for introducing the debate and doing such a great job of painting a picture of the bigger systemic issues—as I do not have very long, I will not repeat those, but will focus instead on two specific issues that I face in my constituency. It is only fair to let the Minister know that I will ask him for a meeting at the end of the debate, because I feel I have just about exhausted all other possible avenues.

Those two examples of the system failing rural constituencies affect Cirencester community hospital and the Tolsey GP surgery in Sherston. Cirencester hospital offers vital community services to a wide rural catchment, but over recent years the hospital has seen a gradual reduction in services. It lost its minor injuries unit in 2016; blood services were removed in 2020, and the day surgical unit is now undergoing a trial closure—I am very concerned that these trial closures have a nasty habit of becoming permanent. Residents are very concerned because they have seen that pattern before.

I do not quite understand how that fits with the NHS 10-year plan, which emphasises care closer to home, when patients will potentially now have to travel considerable distances. By definition, people who need hospitals tend to be elderly, sick or parents of small children, and I do not need to repeat yet again how poor our rural public transport is. There is a great deal of public passion about this. Our petition has gathered getting on for 2,000 signatures in just a matter of days. As new housing developments arrive, the increased population of Cirencester will only increase the demand for services at that hospital.

The second example is Sherston surgery. A developer has offered to build a lovely new custom-built facility to replace the existing one, the lease for which expires at the end of the year. I have lost count of how many meetings I have had with the ICB, which has acknowledged that its toolkit is not well suited to rural areas, yet it still has not agreed to that offer. I am out of time, but I look forward to meeting the Minister in due course.

17:02

[Amanda Hack (North West Leicestershire) (Lab)]

It is a pleasure to serve under your chairship, Dr Huq. I thank the hon. Member for Mid Bedfordshire (Blake Stephenson) for giving us the opportunity to talk about how living in a rural area can impact our access to healthcare.

As time is short, I will focus on two things. When I became an MP, one of the first things I was contacted about was the experience of getting a service on a Sunday. A resident of Ashby was given an appointment at an out-of-hours service in Leicester city. The taxi just one way cost about 40 quid. That is just one example of how the rural penalty is creating real problems in healthcare.

I am glad to see the Minister in his place, because I want to focus specifically on pharmacy and that is his area of responsibility. I have met many of my local pharmacists over the time that I have been a Member of Parliament. Our community pharmacies are often our lifelines, yet access to them is not equal, and certainly not simple, for many of my constituents.

North West Leicestershire is not just a semi-rural constituency, but a proud post-industrial one with a strong coalmining past. However, that means that we have our own unique health issues, particularly respiratory ones. For example, 8% of my constituents are living with asthma—higher than the average for the east midlands and the whole of England. Many residents rely on regular inhalers, medication reviews and preventive advice delivered via their local pharmacy, which is a vital service.

If the local pharmacy is facing a shortage, or a rural pharmacy does not open as frequently, that can have detrimental impacts. In a city, people can pop along the road to the next nearest pharmacy. Castle Donington, which has the highest rate of asthma in my constituency, has just one pharmacy. It does an amazing job for my constituents, but the next nearest pharmacy is more than 5 miles away. With 62% of our bus services cut under the previous Government, it is not easy to just hop on the bus to the nearest town. The isolation of our pharmacies has a detrimental impact in a rural area, because there is simply nowhere else to go.

When patients cannot access their medicines promptly, their conditions can worsen. They will turn to a GP for urgent appointments or to their nearest A&E. Pharmacy provision can provide us with an invaluable capacity for our entire healthcare system, the rural services of which have been hit the hardest.

17:04

[Rachel Gilmour (Tiverton and Minehead) (LD)]

It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for Mid Bedfordshire (Blake Stephenson), my colleague on the Public Accounts Committee, for securing this debate. Many hon. Members have today outlined problems in their constituencies that, I am afraid, are all too familiar in mine. I represent a disproportionately elderly population, which brings with it great wisdom as well as greater health challenges, particularly given that parts of my constituency are some of the least densely populated in England.

Shabby transport connectivity hobbles every aspect of my constituents’ lives. Perhaps no more acutely is this reality felt than in access—or the lack of access—to healthcare. For people in the West Somerset corner of my constituency, it can take two hours and two buses to reach Musgrove Park hospital in Taunton. I am told that a return fare would cost my constituents an eye-watering £180 in a taxi, which is simply unaffordable to most local people. These barriers delay diagnoses and treatment.

I am thankful to the Minister for Care for being a responsive member of his Government, but I cannot hide my disappointment at the decision to snub Minehead’s calls for a permanent CT scanner installation. The decision was supposedly reached because such a move was deemed uneconomical. It proved to be a game changer for so many local people, but it is indeed uneconomical because terrible transport links suppress demand.

To conclude, remoteness has not been given the weighting it should in the Government’s local government funding settlement. I implore the Government—and I hope the Minister takes this away—to undertake a real, forensic look at just how important rurality and remoteness is as a factor for the cost of healthcare delivery in rural areas.

17:07

[Jim Shannon (Strangford) (DUP)]

It is a real pleasure to serve under your chairship, Dr Huq. I want to give a special thank you to the hon. Member for Mid Bedfordshire (Blake Stephenson) for securing today’s debate on this matter. It is important that I am here, as a representative of a vastly rural constituency, to highlight the situation faced by my constituents.

I have been fortunate to live in the country all my life; I have now lived on a farm for some 47 years, just outside a small village in my constituency of Strangford on the Ards peninsula. Healthcare is a nationwide issue that impacts every individual, and we want to get it right. Rural populations often live far from hospitals or specialist clinics, making timely care more difficult. The limited public transport and long travel distances can cause delays, especially in emergencies, for the likes of ambulances and so on.

Around one in 10 patients live more than 5 miles from a practice, showing the extensive travel required for a 10-minute GP appointment, in which only one issue can ever be addressed. There are those in my constituency who find it almost impossible to get appointments, and GPs now state that they can take appointments only in the case of emergencies, when we all know that is the purpose of A&Es. GPs are for general issues that may impact someone’s day-to-day life, and there are not enough of them to go round. Everybody has mentioned development, and there is massive development on the Ards peninsula. Every village has grown, and demand is greater than ever it was before.

I shall quickly mention dentists in Northern Ireland. Some 114 dentists in Northern Ireland have handed back their NHS contracts to the Department of Health and Social Care, with many moving to private practice. Those patients then move on to a £25 a month retainer. As a result of these contract returns, more than 53,000 NHS patients were removed from dental practice lists over that period. For a rural constituency, that means there is no choice but to pay in the private sector.

There are continuing issues regarding GP provision and dental care across Northern Ireland, especially in my constituency. The issue is heightened in rural areas, and I will continue to raise these issues for those who have trouble. I understand that health is devolved, but the issue across the board remains the same. I hope we can strive to do better for my constituents and all our constituents, as well as for rural constituencies in general. Location should never dictate the provision of healthcare, be it someone’s GP or dentist, both of which every citizen of this nation has a right to.

17:09

[Richard Foord (Honiton and Sidmouth) (LD)]

It is a pleasure to serve with you in the Chair, Dr Huq. I am grateful to the hon. Member for Mid Bedfordshire (Blake Stephenson) for securing this debate and for talking about the one-size-fits-all solution, which I completely recognise. He is right to say that neighbourhood health hubs need to apply to proper neighbourhoods—things that we would identify with. In rural areas we would identify with towns of 10,000, not 50,000.

There are unique challenges associated with rural healthcare, and all too often it feels like those challenges are invisible from Westminster and Whitehall. Rural and coastal areas are not the same as urban areas. Last month, the Government said that tackling the gap between urban and rural healthcare would be a core focus of their 10-year health plan. That was very welcome, but after years of neglect by the Conservatives, it feels like rural communities, including those in Devon, are increasingly cut off from GPs, ambulances and cancer treatment, and the decline continues.

The south-west already has the fewest GP practices of any region. It also experienced the largest percentage fall in the number of GP practices—2% of practices in the south-west closed between 2024 and 2025. The data for rural healthcare compares poorly with urban areas. Liberal Democrat research found that waiting times for life-threatening ambulance calls are 45% longer in rural areas. Waits of four weeks or more for cancer diagnoses are three times longer in rural areas.

My hon. Friend the Member for Ely and East Cambridgeshire (Charlotte Cane) talked about accessibility in rural areas, and she is quite right to do so. Just getting to the GP takes longer—a third longer by car and twice as long by public transport. That disparity is set to rise if we continue to see bus routes curtailed and rail infrastructure left to crumble.

Honiton and Sidmouth, which I represent, sits in the bottom quarter of constituencies in the country for access to healthcare by public transport, walking or cycling. For those outside the main towns, the situation is worse. The village of Stockland, for example, is in the bottom 0.2% nationally for transport access to healthcare. The hon. Member for Strangford (Jim Shannon) talked about accessibility issues in transport. He is quite right, but that is only part of the challenge.

Rural areas also have older populations, which places a greater strain on already stretched services. My hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour) was spot on about how older populations place so much greater a strain on health services in rural areas. Poor digital connectivity means that the shift to online healthcare and digital access often excludes older residents, many of whom have no desire to acquaint themselves with digital devices. They also suffer from isolation and loneliness, shaped by distance and limited local services.

One example that I think illustrates this issue well is dementia in rural areas. In Honiton and Sidmouth 1.6% of patients have been diagnosed with dementia, whereas the national average is just half that—0.8% across England as a whole. My constituent Heather Penwarden is the chair of Dementia Friendly Honiton. She says that dementia care in Devon

“seems at an all-time low”.

She should know that, because she has been volunteering in this space for 16 years. One carer, through tears, asked Heather:

“How bad does it have to be before I get some genuinely helpful and sustained support in looking after my dear husband through his dementia?”

Heather’s group initially worked alongside community psychiatric nurses from the Devon partnership NHS trust. Dementia Friendly Honiton raised an incredible £350,000 to pay for an Admiral nurse through an embedded scheme. That nurse attended memory cafés, gave regular advice and prevented crises for those with complex cases, but due to a freeze on NHS recruitment and an apparently “outdated” model of fundraising and hosting, there is little chance of the role being filled again by the Royal Devon University hospital.

The Liberal Democrats are calling for a rescue plan: recruiting more GPs and social care workers to provide proactive community support and ease pressure on ambulances, acute hospitals and A&E; creating a national care agency to provide consistent funding for free personal care; and creating a small surgeries fund to protect rural and remote services from underfunding. If we are serious about closing the disparity between urban and rural, we must recognise that rural communities have different health needs.

17:14

[Gregory Stafford (Farnham and Bordon) (Con)]

It is a pleasure to serve under your chairmanship, Dr Huq. I am extraordinarily grateful to my hon. Friend the Member for Mid Bedfordshire (Blake Stephenson), who has campaigned tirelessly for a GP surgery in Wixams in his constituency. I was delighted to hear that his campaigning is beginning to bear fruit, and I wish him well with that.

The challenge that my hon. Friend mentioned resonates strongly in my own constituency. There has been significant housing growth in areas such as Bordon, yet the supporting infrastructure, particularly primary care, has simply not kept pace. Residents move into new homes only to discover that securing a GP appointment is harder than it should be.

Hon. Members across the House have made a consistent and compelling case this afternoon. Rapid housing growth places a real strain on local practices, and patients then struggle to access timely appointments. Infrastructure funding is too often misaligned with development, and co-ordination between local authorities, NHS bodies and developers remains insufficient. Healthcare must arrive with the new homes, not years afterwards.

The Government’s 10-year plan puts having care closer to home at the centre of NHS reform. That ambition is entirely welcome, but as hon. Members have raised, the national neighbourhood health implementation programme begins with pilots in 43 areas, and each designated neighbourhood must serve a population of around 50,000 people. That population threshold presents a fundamental challenge for rural and semi-rural areas, where individual villages and market towns fall well below that figure. Although larger geographical regions might technically meet the requirement, genuinely rural communities cannot qualify as stand-alone neighbourhoods and are therefore excluded from the first phase—and potentially always.

If the 50,000 population threshold is rigidly applied, smaller communities will only ever be served indirectly, folded into large neighbourhoods covering multiple dispersed settlements. That risks diluting the focus on their particular needs, and residents might continue to face long travel times, limited access to primary care and fewer co-ordinated services, as hon. Members have described. That is especially concerning given the demographic trends.

Healthwatch England highlighted in 2023 that the NHS long-term workforce plan projects a 55% increase in the number of people aged over 85 living in rural areas by 2037. Demand is rising most sharply in precisely those areas excluded from the pilot phase. In areas like mine, where hospital access already involves significant travel, the case for strong, well-resourced local primary and community care is self-evident. Excluding rural and semi-rural constituencies from the first wave risks entrenching disparities rather than reducing them.

I also have concerns about cuts and mergers in ICBs. The institutional knowledge and expertise built over many years risk being disrupted during the transition. For example, the Frimley integrated care board, which serves the northern part of my constituency, is being abolished, so the local leadership and co-ordination that previously existed will be lost and responsibilities will be redistributed. Change on such a scale requires clarity of governance, funding and accountability. Without it, delivery will vary and confidence will suffer.

Access to primary care, pharmacy and dentistry remains central to this debate, particularly in rural and underserved communities. Since 2024, more than 200 pharmacies have closed in England. In the first three months of 2025 alone, 31 medium-sized and 24 large pharmacy branches closed. For villages and small towns, the local pharmacy is not a luxury; it is a frontline health service Although schemes such as the pharmacy access scheme and Pharmacy First are supported and welcome, there are significant problems with their roll-out, as highlighted by my hon. Friend the Member for Weald of Kent (Katie Lam), with unions like the BMA trying to undermine that very significant investment.

I have a number of questions for the Minister. For rural and semi-rural constituencies such as mine, the details of the policy matter enormously. First, will the 50,000 population threshold be applied flexibly in rural and semi-rural areas? If so, how will smaller communities be guaranteed equal access to neighbourhood services? Secondly, what is the timetable for expanding the scheme beyond the initial 43 pilot areas? When can constituencies such as mine and that of my hon. Friend the Member for Mid Bedfordshire expect to be included?

Thirdly, how will the continuity of neighbourhood health delivery be safeguarded during the merger and abolition of ICBs, and who will ultimately be held accountable for that if implementation falters? Finally, will the Minister publish clear and measurable criteria for success, particularly in relation to rural access, travel times and coverage of elderly populations so that the House can judge whether care closer to home is being delivered in practice and is not merely a promise?

17:19

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Dr Huq. I congratulate the hon. Member for Mid Bedfordshire (Blake Stephenson) on securing this vital debate. I am also grateful to other hon. Members for making excellent contributions this afternoon.

We know that the NHS faces pressures all over the country, with rural communities experiencing unique health and wellbeing challenges shaped by geography, demography, infrastructure and access to services. Our 10-year health plan is a commitment to rewire our NHS, with the three shifts to improve access to healthcare for everyone—no matter where you live or how much you earn. Those three shifts—from hospital to community, sickness to prevention and analogue to digital—will support neighbourhood and community health services in getting the investment they need, and will greatly expand and improve access to digital services, bringing healthcare closer to everyone’s home.

The hon. Member focused quite a lot of his speech on our emerging neighbourhood health strategy. I will provide some further detail in response to some of his points. He highlighted the important differences between urban and rural. We recognise that neighbourhood services will need to look different across rural and urban areas to best meet the needs of each community. That is why their delivery will be locally led, with local systems determining how neighbourhood health is designed for their area. That work will start in the areas of greatest need, including rural towns and villages.

The hon. Member and others also asked about the definition of neighbourhoods in rural areas. First, neighbourhoods are natural communities that are recognisable by local residents. Secondly, neighbourhoods will typically have a population of around 50,000 people, but coherent geography is more important for defining neighbourhoods than population size. Thirdly, the geography of the neighbourhood will be determined locally by integrated care boards in partnership with their strategic partners, particularly local authorities.

The hon. Member also asked how rural areas will benefit from neighbourhood health. Neighbourhood health provides the unifying framework that will bring together what is already under way across primary care, community services, urgent care, prevention, digital, estates and population health more broadly. The neighbourhood health service will make it easier for people to access care closer to where they live, including in neighbourhood health centres. Delivery will be locally led, with systems determining how neighbourhood health is designed to meet local population need. That will factor in how services may need to look different across rural and urban areas.

The neighbourhood health service will also move us towards a fully digitally enabled health service. We are striving for digital services to improve access, experiences and outcomes for the widest range of people based on their preferences, as any digital healthcare benefit will be limited if people remain digitally excluded. We are working closely with the Department for Science, Innovation and Technology on the issues raised around improving access to broadband.

To deliver neighbourhood health services, the 10-year health plan introduces two new contracts, including one to create multi-neighbourhood providers covering populations of around 250,000 people. That will unlock the advantages and efficiencies possible from greater-scale working across all GP practices and small neighbourhood providers within the footprint. We will start in the areas of greatest need where healthy life expectancy is lowest, which includes rural towns. By targeting places where healthy life expectancy is lowest, we will deliver healthcare closer to home for those who need it most. Neighbourhood health plans will also be drawn up by local government, the NHS and its partners. The integrated care board will bring those together into a population health improvement plan for its footprint and will use that to inform commissioning decisions.

The medium-term planning framework, covering 2026-27 to 2028-29, sets out proposals for the further use of advice and guidance, asking systems to ensure all referrals go through a single point of access. That delivers a robust approach to triage so that patients are cared for closer to home, and there are fewer out-patient appointments in secondary care. That framework will also require a significant reduction in the number of clinically unnecessary follow-ups.

Turning to general practice, which came up a lot in the debate, we absolutely recognise the challenges facing rural communities in accessing GP services. We are expanding capacity across England, including to the areas that need it most. We are investing over £480 million extra into GP services this year, including investment in the primary care workforce, ensuring places like Mid Bedfordshire get the resources and GPs that they need.

Since October 2024, we have invested £160 million into the additional roles reimbursement scheme, which has supported the recruitment of over 2,000 GPs—smashing our manifesto pledge of 1,000 additional GPs. Furthermore, the introduction of a practice-level GP reimbursement scheme, worth £292 million, will enable practices to hire additional GPs or fund extra sessions with existing GPs. We are also seeing the results of those broad efforts. I am absolutely delighted that patient satisfaction has risen by over 15% since July 2024, from 60% to 75%, and an additional 6.8 million GP appointments have been delivered compared with the same period last year.

We know that patients are struggling to access NHS dentistry services, particularly in rural areas. To address that, we are reforming the dental contract to match resources to need and to improve access. As a first step, our 2026 reforms are focused on improving the dental contract to deliver the right care to the right people, including those in rural areas, while incentivising NHS dentists to provide more NHS care, with additional urgent appointments and new pathways for patients with complex needs. We are also continuing to recruit dentists under the golden hello scheme, which offers dentists £20,000 to work in underserved areas.

Urgent and emergency care is also a challenge for rural areas. We are ensuring that the country gets the care it needs, when it needs it. We launched our urgent and emergency care plan for 2025-26, supported by a substantial £450 million of capital investment. That will enable the upgrade of hundreds of ambulances and the expansion of urgent and emergency care capacity, reducing A&E wait times and getting more ambulances back on the road, more quickly.

Rural adult social care services are really important. Local authorities are responsible for shaping their care markets to meet the diverse needs of local people. However, the Government are also committed to ensuring adult social care funding reflects the costs that different communities face, which is why we have updated the formula used to distribute funding for adult social care to local authorities to include a remoteness adjustment. That means that the funding distribution better reflects the cost of providing care in different parts of the country. To give the local picture in the constituency of the hon. Member for Mid Bedfordshire, between 2025-26 and 2028-29, central Bedfordshire is set to see its notional allocation for adult social care services increase by £11.3 million, which is more than a 7% cash increase above budgeted adult social care spend.

I want to say a quick word on finance. To support remote or sparsely populated areas, the ICB target allocations formula includes an emergency ambulance cost adjustment to reflect longer travel times in sparsely populated areas; a travel time adjustment to the community services formula to reflect the additional time it takes patients to travel between appointments in sparsely populated areas; and an adjustment to support hospitals with 24-hour A&E services that are remote from the wider hospital network and have unavoidably higher costs. Those adjustments help to support rural communities in accessing the health services that they need.

I hope that I have managed to touch on some of the issues raised. It is a wide-ranging topic because rural healthcare, by definition, requires many different services. We absolutely recognise the challenges, and we recognise that we still have a mountain to climb before we can get our NHS back on its feet and fit for the future.

We believe that through the three shifts—from hospital to community, treatment to prevention and analogue to digital—and the strategies that we are pushing through on workforce, digital, better support for general practice, and neighbourhood health, we can get our NHS back on its feet and fit for the future. Once again, I thank all hon. Members present and I congratulate the hon. Member for Mid Bedfordshire on securing this debate.

[Dr Rupa Huq (in the Chair)]

I call Blake Stephenson to wind up in 20 seconds.

17:29

[Blake Stephenson]

I shall speed through, Dr Huq. I thank the Minister for summing up and covering an awful lot of ground—I am certainly grateful for that. He gave a lot of additional information, so I am sure he will forgive me if I go back to Hansard to look through it and follow up with a letter if anything is unclear. It has been a wide-ranging debate and there was a lot to cover. I thank all hon. Members for standing up for their communities, putting rural communities on the Government’s agenda and making sure that they get the healthcare services they deserve.

17:30

Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).