Rural Care: Can’t see the Solution for the Work

February 2022 saw the launch of a major inquiry into rural health and care. It was the beginning of a three year investigation undertaken by the All Party Parliamentary Group (APPG) for Rural Health and Care; one of the most extensive of its kind. 

The inquiry was set up to identify, and ultimately address, inequalities in rural health and care. The Rural Services Network [Ref.1] reported to Nigel Edwards, Chief Executive of the Nuffield Trust and a witness for the enquiry, commented that the inquiry, “put a greater focus on a range of challenges felt acutely in remote areas”. Indeed a greater focus on the challenges but sadly, as yet, little progress. 

Our company operates in Cumbria’s Eden Valley. According to the Office for National Statistics, it is the most sparsely populated area in England. As such we see these inequalities, “acutely”, firsthand. I’ve titled this article by adapting, ‘Can’t see the wood for the trees because the solutions to the problems faced by the rural care industry are swamped by a relentless workload on a diet of monopsony.

In the inquiry’s report [Ref.2, page 22], Edwards referenced Public Health England’s Fingertips Tool, an interactive data resource where providers can browse health indicators at different geographical levels, benchmark against the regional and national averages and export data to use locally. Sadly, the service was removed nine months later, despite Edwards saying this would help us “get a grip on whether a change in resource allocation is needed”, which from our experience is clearly the case. 

Two glimmers of hope, the 12th and the 4th

The inquiry’s report makes twelve recommendations for change, the 12th being, ‘Empower the community and voluntary sector to own prevention and wellbeing’. Eden Country Care is an integral part of ‘the community’. We employ local carers who can navigate our country lanes, draw on the generous support of the community in difficult times and understand the sensibilities of our elderly residents. It was encouraging to see the 12th recommendation, but almost a year later, this has not translated into any change, nor have we been ‘empowered’. The sentiment has, however, motivated us to exercise our ‘fingertips’. More on that later.

In our many meetings with officials over the years, representatives of our care business have attempted to point out the differences and challenges in maintaining a high-quality service in a rural setting.

Defra identified two key challenges [Ref.3, page 10] for any potential rural home care provider. The ‘lower population density’ and ‘plenty of distance’ adding that, “older residents have a strong preference to age in place, in their rural community if not in their home itself”. It’s our task to help them achieve that goal, but the odds are stacked against us.

The unemployment rate in Eden is extremely low, forcing care providers to tempt staff from other sectors. To achieve this they need to overcome the care industry’s poor image and its less than attractive financial rewards as illustrated by a recent BBC News article [Ref.4]. This situation is only set to become worse. The National Audit Office [Ref.5] predicts 57% more adults are expected to require care in 2038 compared to 2018. Over the same period, the workforce is projected to grow by only 29%. This demographic trend is felt even more acutely in rural locations where there is a higher percentage of older people than in urban areas.

A study by the King’s Fund [Ref.6, page 72] frames this depressing picture saying, social care providers are, “under pressure, struggling to retain staff, maintain quality and stay in business”, adding, “collaboration and innovation are taking place despite the odds, but no one was very optimistic about the future”. It’s a grim picture but at least it’s well framed.

As the climate becomes evermore unsettled, care workers in Eden, who often travel long distances in the face of floods, snow, ice and fallen trees, are expected to reach remote homes across unlit, ungritted and often un-signposted roads. We, their employers, must take into account the risks they face working in these conditions where mobile phone signals are often poor, if available at all. The old rural properties they visit frequently have low doorways or beams and various trip hazards such as random steps in doorways and stubborn draft excluders. On one occasion one of our carers had to negotiate a foot wide hole in a bedroom floor. Collectively the lived experiences of our care staff give life to the APPG’s 4th recommendation, a ‘Rural health proof housing, transport and technology policy’. [Ref. 2, page 8].

Looking beyond the picture for a solution

We must not paint too negative a picture about the plight of our elderly rural residents. When carers are asked what they like most about their job they invariably say it’s the people they care for. They say our elderly rural clients are warm and friendly and have such interesting life stories to tell. Other positives about their work include the lack of traffic, mostly polite drivers, the beautiful views whilst driving around and all those interesting extra jobs our clients ask to attend to, like feeding the hens and even watering the cattle.

Despite the grim picture painted by the National Audit Office, depressingly framed by the King’s Fund, we’ll hang that on the office wall and collaborate on solutions from the bottom up with our rural home care partners. If you would like to know how, please write to and she will give you a fingertips introduction into the benefits of a home care taxonomy and our risk benchmarking program.

Heather Tarney, Director, Eden Country Care.

12th June 2023




[1] Rural Services Network, Rural Services Network, February 2022

[2] APPG Rural Health & Care, February 2022

[3] Rural Ageing Research Summary Report of Findings, DEFRA, December 2013 

[4] Staff leave social care for more money, BBC News, January 2023

[5] The adult social care market in England, National Audit Office, March 2021

[6] Social Care for older people. Home truths, The Kings Fund, September 2016