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

By Gemma Louise Hobson

Abstract

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

Publisher: School of Geography (Leeds)
Year: 2007
OAI identifier: oai:etheses.whiterose.ac.uk:216

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Citations

  1. (1999). A brief history of resource allocation in the NHS,
  2. (2002). A Case Study of Assertive Outreach in Urban and Rural Areas of Cornwall and Devon: Rural Health Allocations Forum.
  3. (2006). A Classification of Primary Care Trusts in England Based upon the New Definition of Rural Areas.
  4. (2003). A comparative study of typologies for rural areas in Europe. Paper read at 43rd European Congress of the Regional Science Association, at JyvÀskylL,
  5. (2004). A Fair Share for Cornwall? A Bibliography 264 Comparative Review of NHS Funding for Cornwall and Other Rural Areas.
  6. (1974). A framework for the study of access to medical care.
  7. (2001). A multilevel analysis of the effects of rurality and social deprivation on premature limiting long term illness. doi
  8. (1995). A National Health Service? The Restructuring of Healthcare in Britain Since
  9. (2002). A Review of Urban and Rural Area Definitions. Project Report. Office for National Statistics,
  10. (1992). A rural advantage? Urban-rural health differences in Northern England.
  11. (2004). Accountability and rural development partnerships: a study of Objective 5b EAGGF funding in South West England. doi
  12. (2000). Accounting for Rural Deprivation: Report to
  13. (2004). Agricultural turns, geographical turns: retrospect and prospect. doi
  14. (2003). Allocating resources for health and social care: the significance of rurality. doi
  15. (2004). Ambulance Services,
  16. (1977). An Index of Rurality for England and Wales. doi
  17. (1995). An Introduction to Social Constructivism. doi
  18. (2001). An investigation of the potential existence of "food deserts" in rural and urban areas of Northern Ireland,
  19. (1987). An Urban-Rural category for Wards, and Local Authorities. Population Trends,
  20. (1999). Approaches to Capitation and Risk Adjustment in Health Care: An International Survey: Centre for Health Economics,
  21. (2005). Area Cost Adjustment: A Review.
  22. (2004). Assessing the visual quality of rural landscapes. doi
  23. (2005). Association Board of Science.
  24. (2002). Briefing paper for SPARSE - Local Authority spending and Council Tax levels 2002-03 to
  25. (2006). Bulletin 2006/08: Re-organisation of Strategic Health Authorities (SHAs) and Primary Care Organisations (PCOs).
  26. (1998). Can Census Offices publish statistics for more than one small area geography? An analysis of the differencing problem in statistical disclosure. doi
  27. (2001). Car dependence in rural Scotland: transport policy, devolution and the impact of the fuel duty escalator. doi
  28. (1999). Care in the Country: Inspection of community care in rural communities:
  29. (1998). Changing methods of location planning for retail companies.
  30. (2004). Changing public library service delivery to rural communities in England. doi
  31. (2003). Changing ruralities, changing landscapes: exploring social recomposition using a multi-scale approach. doi
  32. (1994). Chapter 4. Developing Places: New Villages for Old. In Reconstructing Rurality.
  33. (2001). Chapter 5: the Development Worker. In Cultural Economies: A perspective on local rural development in Europe. Newcastle-upon-Tyne:
  34. (1987). Chapter Two: Concepts. In Rural Development: A Geographical Perspective. doi
  35. (2006). Characteristics of Primary Care Trusts in financial deficit and surplus -a comparative study in the English NHS.
  36. (1992). Conceptualizing countryside change: from post-Fordism to rural structured coherence. doi
  37. (1993). Constructing the Countryside. London: doi
  38. (2002). Coping with the Foot and Mouth Crisis in Cumbria: Consequences of Foot and Mouth Disease. Newcastle: Centre for Rural Economy.
  39. (2001). Countryside in Crisis, transmitted 01/04/2001: BBC One.
  40. (2004). Countryside Quality Counts: Tracking Change in the English Countryside. Nottingham:
  41. (2007). Creating the UK National Statistics doi
  42. (2007). Crime in England and Wales 2006/07 2nd ed, edited by
  43. (2002). Cross Regional Equity in Healthcare Funding. Working Paper series 3-Jan02, National Institute for Regional and Spacial Analysis.
  44. (2004). Cumbria County Council Policy Unit.
  45. (1996). Customer targeting, geodemographics and lifestyle approaches.
  46. (2004). Debating the gatekeeping role within primary care services.
  47. (2002). Defining "Rural" and "Rurality". doi
  48. (2000). Defining locality boundaries with synthetic data. doi
  49. (2002). Definitions of "Rural" - Summary. Online Paper: Office of Rural Health,
  50. (2002). Definitions of Rural. Agriculture and Rural Working Paper Series.
  51. (2000). Defra (Department for Environment Food and Rural Affairs). doi
  52. (2004). Defra Survey of Rural Customers'
  53. (2002). DEFRA: PSA 4: Rural Affairs: DRAFT Service Delivery Agreement.
  54. (1998). Delimiting 'Rural': Implications of an agreed 'rurality' index for healthcare planning and resource allocation. doi
  55. (2000). Deprivation and poor health in rural areas: inequalities hidden by averages. doi
  56. (1995). Deprivation, poverty and marginalization in rural lifestyles in England and Wales. doi
  57. (1996). Deprivation' and 'the rural': an investigation into contradictory discourses. doi
  58. (2000). Derivation of a needs based capitation formula for allocating prescribing budgets to health authorities and primary care groups in England: Regression analysis. doi
  59. (2004). Developing a New Classification of Urban and Rural Areas for Policy Purposes - the Methodology.
  60. (2003). Differences in economic development in rural regions of advanced countries: an overview and critical analysis of theories. doi
  61. (1997). Discourses of power and rurality: Local politics in Somerset doi
  62. (2003). Diversity Review: Options for Implementation.
  63. (2006). Does living in rural areas make a difference for health in Quebec? doi
  64. (2006). Draft report for SPARSE on the Effects of Rurality on the Costs of Service Provision,
  65. (1998). Drugs Prevention in Rural Areas: an evaluation report: Home Office Drugs Prevention.
  66. (1999). Editorial: Grey geography?
  67. (1993). Editorial: On'Problems and Solutions'. The Reproduction of Problems for Rural Communities in Britain during the 1980's. doi
  68. (2004). Emotionally intelligent research. doi
  69. (1994). Equity in the NHS Allocating resources for health and social care in England. doi
  70. (2002). Estimating Travel Related Effects of Population Distribution in the Provision of Domiciliary Care to the Elderly as a Basis for Improved Funding Decisions. Norfolk County Council,.
  71. (2001). Ethics and geographical equity in health care. doi
  72. (1997). European Commission Directorate General for Agriculture*. doi
  73. (2000). Executive Health Department).
  74. (1996). Fair Shares for All? Salisbury: Rural Development Commission.
  75. (2006). Finance Director.
  76. (1999). Foxing the Nation: the economic (in)significance of hunting with hounds in Britain. doi
  77. (1998). From Cradle to Grave: fifty years of the NHS. London: King's Fund. doi
  78. (1997). From Enumeration Districts to Output Areas: Experiments in the automated creation of a census output geography. Paper read at Statistical Commission and Economic Commission for Europe, Conference of European Statisticians,
  79. (2004). From risky to responsible: expert knowledge and the governing of community-led rural development. doi
  80. (2003). GIS-based visualisation of rural landscapes: defining `sufficient' realism for environmental decision-making. Landscape and Urban Planning doi
  81. (1997). Governmentality and territoriality: the statistical manufacture of Britain's "National Farm".
  82. (1980). Health and Social Security. doi
  83. (1996). Health and Societies: Changing Perspectives.
  84. (2003). Health Research In Remote And Rural Scotland Scottish
  85. (2005). Health Systems in Transition: Canada: Copenhagen, WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies.
  86. (2004). Health Systems in Transition: the Welsh Report: Copenhagen, WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policy.
  87. (1987). Health, disease and society. London: Routledge and Kegan Paul. doi
  88. (2004). Healthcare in Canada. Ontario: Canadian Institute for Health.
  89. (2002). House of Commons Environment. Food and Rural Affairs Committee.
  90. (2003). House of Commons Public Administration Select Committee. doi
  91. (2002). How Different Definitions of Rurality Impact Our Perception and Understanding of Rural Canada.
  92. (1996). How to Lie with Maps 2nd Ed. Chicago: doi
  93. (1977). Human Geography: A Welfare Approach. doi
  94. (2003). Hunting ruralities: nature, society and culture in `hunt countries' of England and Wales. doi
  95. (1982). Identifying areas of rural deprivation using social area analysis. doi
  96. (2004). Impact of the 2001 foot-and-mouth disease outbreak in Britain: implications for rural studies. doi
  97. (2004). Implementing the Rural Strategy.
  98. (1991). In search of a rural economy: patterns and differentiation in nonmetropolitan England:
  99. (1999). Independent Inquiry into Inequalities in Health: Report: London: The Stationary Office. doi
  100. (2003). Indicators of rural disadvantage: Guidance Notes. Wetherby: The Countryside Agency Publications.
  101. (2000). Indices of Deprivation doi
  102. (1994). International Migration and Demographic Change in the Developed World. doi
  103. (1999). Investigating trends in rural health outcomes: a research agenda, doi
  104. (1994). Is primary care essential? ' doi
  105. (2003). Is the NHS equitable? A review of the evidence.
  106. (2007). Is the rural idyll bad for your health? Stigma and exclusion in the English countryside. doi
  107. (1998). Is there a place for geography in the analysis of health inequality?
  108. (2004). Key Statistics for Urban Areas in England and Wales.
  109. (1997). Landscapes of poverty. Aspects of rural England in the late 1990s. London: Lemos and Crane.
  110. (1995). Lay Discourses of the Rural: Developments and Implications for Rural Studies. doi
  111. (1990). Let's 'do away with rural. doi
  112. (1997). Life expectancy in England: variations and trends by gender, health authority, and level of deprivation. doi
  113. (1997). Living lives in different ways? Deprivation, marginalisation and changing lifestyles in rural England.
  114. (2005). Local Government Finance Briefing Paper: SPARSE,
  115. (1986). Locality and Rurality: The Restructuring of Rural Social Relations. doi
  116. (1993). Locality and Social Representation: Space, Discourse and Alternative Definitions of the Rural. doi
  117. (2002). Low income amongst the older population in the United Kingdom: a rural/non-rural perspective, Aberdeen Papers in Land Economy: doi
  118. (1972). Man, Environment and Disease in Great Britain. doi
  119. (2003). Marginalised Metropolitan Ruralities: Defining Rural Bradford:
  120. (2003). Measuring age differentials in representations of rurality in The Netherlands. doi
  121. (2004). Memorandum of Evidence to the House of Commons Environment, Food and Rural Affairs Committee into the Governments Rural Delivery Strategy.
  122. (1998). Mental Health in Rural Communities: What are the issues? Stoneleigh Park: Rural Minds.
  123. (2004). Models to estimate average route lengths in different geographical environments. doi
  124. (2000). Modernising Local Government Finance: A Green Paper. doi
  125. (2006). Moving towards better health: A survey of transport authorities and primary care trusts in South West England. doi
  126. (2004). New forms of urbanization: beyond the urban-rural dichotomy. doi
  127. (2001). New rural governance?
  128. (1998). New Rural Territories: Regulating the Differentiated Rural Spaces. doi
  129. (1988). Not a definition of rural.
  130. (2001). ODPM (Office of the Deputy Prime Minister).
  131. (1994). OECD (Organisation for Economic Co-operation and Development). doi
  132. (1998). of Environment, Transport and the Regions). doi
  133. (1998). of Health) and the Welsh Office.
  134. (2000). of the Environment 'Transport and the Regions) and Maff (Ministry of Agriculture. Fisheries and Food).
  135. (2000). of the Environment Transport and the Regions). doi
  136. (1993). On Doing Rural Research (Or Breaking the Boundaries).
  137. (2000). On the measurement and generalisation of urban form. Environment and Planning A. doi
  138. (1995). On the outside looking in: medical geography, medical geographers and access to health care. doi
  139. (2004). Options for the 2004 MFF: Warwick Institute for Employment Research. Bibliography 266 DCLG (Department for Communities and Local Government).
  140. (1998). Participation in Rural Development: a Review of European Experience: Centre for Rural Economy Research Report.
  141. (2003). Patterns and Concentrations of Disadvantage in England: A Rural-Urban Perspective. doi
  142. (2002). Planning, Local Government and the Regions Select Committee,.
  143. (2002). Policy Commission on the Future of Food and Farming. doi
  144. (1996). Policy Review Section - Redefining the Rural Development Areas: The Limits of Spatial Targeting.
  145. (2004). Policy-relevant Surfaced Data on Population Distribution and Characteristics. doi
  146. (2004). Population-based Funding Formula 2003. Wellington: Ministry of Health,
  147. (2006). Post-productivism and rural land use: cul de sac or challenge for theorization? doi
  148. (2003). Public Health Authority.
  149. (2001). Public policy and population distribution: developing appropriate indicators of settlement patterns. doi
  150. (2001). Putting together ruralities: towards a symbolic analysis of rurality in the British mass media. doi
  151. (2005). Recent developments in the funding and organisation of the New Zealand health system. Australia and New Zealand Health Policy: doi
  152. (1998). Reconfiguring Rural Development in the UK: Objective 5b and the New Rural Governance. doi
  153. (2002). Reducing unavoidable inequalities in health: a new criterion for setting health care capitation payments. Health Economics. doi
  154. (2005). Regional Health Authority Global Funding: Methodology and Funding Manual: Edmonton: Alberta Health and Wellness.
  155. (2003). Regional planning tensions: planning for economic growth and sustainable development in two contrasting English regions. Environment and Planning C: Government and Policy 21: doi
  156. (1998). Regional policy, CAP reform and rural development in Britain: The challenge for New Labour. doi
  157. (1995). Regulation theory and rural research: theorising contemporary rural change. doi
  158. (2004). Researching the Rural Dimension of Local Public Service Agreements, CAX 166. West Yorkshire: The Countryside Agency.
  159. (2000). Researching the rural-metropolitan health differential using the `social determinants of health'. doi
  160. (2003). Resource Allocation: Weighted Capitation Formula. DoH,
  161. (1999). Resource Allocation: Weighted Capitation Formulas: Resource Allocation and Fund Team, Finance and Performance Directorate, National Health Service Executive, DoH (Department of Health),.
  162. (2005). Resource Distribution Formula Technical Paper -
  163. (2000). Response to the Formal Consultations on the Indices of Deprivation
  164. (2006). Response to the Local Government Finance Report (England) 2006/07: SPARSE,
  165. (1992). Review Essay: neglected rural geographies. doi
  166. (2004). Review of Evidence on Additional Costs of Delivering Services to Rural Communities.
  167. (2003). Review of Permitted Development Rights.
  168. (2003). Review of rural and urban factors affecting the costs of services and other implementation issues.
  169. (2003). Risk management: a general framework for rural development. doi
  170. (1997). Rural Area Typology in Finland - marginality within rural areas.
  171. (2003). Rural Communities and the Voluntary Sector: A review of literature.
  172. (2003). Rural Data and Rural Statistics -A Report to the Economic and Social Research Council.
  173. (2004). Rural definitions and short-term dynamics in rural areas of Finland in doi
  174. (2005). Rural Definitions for Health Policy and Research. doi
  175. (2002). Rural deprivation and service need: a review of the literature and an assessment of indicators for rural service planning -Defining Rural Areas: South West Public Health Observatory.
  176. (2000). Rural Deprivation: An analysis of the Indices of Deprivation
  177. (1997). Rural Developments CAP
  178. (1999). Rural Economies. London: The Stationary Office.
  179. (1995). Rural Europe: Identity and Change. doi
  180. (2003). Rural Evidence Research Centre.
  181. (2003). Rural Futures Website. www. ruralfutures. org/
  182. (2002). Rural governance and local involvement: assessing state - community relations in the Scottish Highlands. doi
  183. (2004). Rural Health and Healthcare: a North West perspective. Lancaster: North West Public Health Observatory.
  184. (2003). Rural madness: a geographical reading and critique of the rural mental health literature. doi
  185. (2005). Rural Policy and Planning. Pennsylvania: The Northeast Regional Centre for Rural Development.
  186. (2004). Rural Policy Handbook.
  187. (2002). Rural Policy: New Directions and New Challenges. Exeter:
  188. (2002). Rural population density: its impact on social and demographic aspects of rural communities. doi
  189. (2003). Rural proofing for health. An analysis of the consultation with Primary Care Trusts: Institute for Rural Health.
  190. (1972). Rural Sociology and Rural Development. doi
  191. (1993). Rural Studies: Modernism, Postmodernism and the 'Post-Rural'. doi
  192. (2000). Rural Voters [Online Digest].
  193. (2006). Rural youths' images of the rural. doi
  194. (1986). Rural-Urban Continuum. In The Dictionary of Human Geography, edited by
  195. (1998). Rurality, Local Rural Development and Social Exclusion in the UK Rural Development and Social Exclusion: Arkleton Centre for Rural Development Research, doi
  196. (2002). Setting the next agenda? British and French approaches to the second pillar of the Common Agricultural Policy. doi
  197. (1991). Social and Economic Restructuring of Rural Britain: A Methodology for Contextual Analysis.
  198. (2002). Social Modelling and Public Policy: Application of Microsimulation Modelling in
  199. (2004). Social or Economic Goals, Civic Inclusion or Exclusion? An Analysis of Rural Development and Practise. doi
  200. (1975). Social Theoryfor Planning. London: Routledge and
  201. (1978). Socioeconomic Classification of Local Authority Areas.
  202. (1997). Sparsity and its effect on the provision of fire services: DTLR, Formula Review Group - FR(01)09, Annex B.
  203. (1990). Spatial patterns of attendance at general practitioners services. doi
  204. (2005). State of Healthcare 2005. London: Commission for Healthcare Audit and Inspection.
  205. (2006). Strangers asking strange questions? A methodological narrative of researching belonging and identity in English rural communities. doi
  206. (1997). Study of Costs of Providing Health Services in Rural Areas. Progress report to the Resource Allocation Group.
  207. (2004). The ACORN Classification.
  208. (2004). The ACRE Network Organisational Data Report.
  209. (1998). The Barnett Formula. London: House of Commons Research
  210. (1998). The Classification of Rural Areas in the European Context: An Exploration of a Typology Using Neural Network Applications. doi
  211. (1998). The Contested Redefinition of the Countryside. An Analysis of Rural Discourses in the Netherlands. doi
  212. (2000). The Countryside Agency.
  213. (2003). The Death of Rural England -A Social History of the Countryside Since doi
  214. (2003). The Demography of Rural Areas: a literature review, A report for Defra. Countryside and Community Research Unit,
  215. (2003). The Differentiated Countryside, Routledge Studies in Human Geography.
  216. (2001). The diversity of diversity: a critique of geodemographic classification. doi
  217. (2004). The economic diversity of rural England: stylised fallacies and uncertain evidence. doi
  218. (1993). The economy and rural England: Strategy Review Topic Paper No. 4, Rural Development Commission.
  219. (1995). the Environment and MAFF (Ministry of Agriculture. Fisheries and Food). doi
  220. (1991). The expansion method: Implications for geographic research. doi
  221. (2003). The food-shopping experience: a satisfaction survey of older Scottish consumers. doi
  222. (2005). The future of services in Rural England -Towards a scenario for 2015: Defra.
  223. (1995). The geography of deprivation in rural Scotland. doi
  224. (1998). The Governance of Rural Areas: Some Emerging Research Issues and Agendas. doi
  225. (2004). The Governments Rural Strategy. Town and Country Bibliography
  226. (1991). The Health of a Nation: a consultative document for Health in England (Cmnd. doi
  227. (1971). The inverse care law. doi
  228. (2003). The Knowledge Economy and the Future of Rural Britain.
  229. (2000). The ONS classification of local and health authorities of Great Britain: revised for authorities in 1999. SMPS63. Population Trends 99.
  230. (2007). The Police Grant Report (England and Wales) 2007/08. London: The Stationery Office.
  231. (2003). The preservationist paradox: modernism, environmentalism and the politics of spatial division. doi
  232. (2004). The pursuit of equity in NHS resource allocation: should morbidity replace utilisation as the basis for setting health care capitations? doi
  233. (2006). The Quality and Accessibility of Services
  234. (1963). The quantitative revolution and theoretical geography. doi
  235. (1986). The rhetoric and reality of rural deprivation. doi
  236. (2004). The Role of Rural Settlements as Service Centres.
  237. (1966). The rural-urban continuum. doi
  238. (2005). The State of the Countryside doi
  239. (2002). Travel to Work Areas and the doi
  240. (2000). Understanding the Canadian Health Care System
  241. (2004). Understanding the use of rural space: the need for multimethods. doi
  242. (2004). Unfair formula? Not in my name says Barnett. Scotland on Sunday.
  243. (1988). Variations in the Conceptualization and Measurement of Rurality: Conflicting findings on the elderly widowed. doi
  244. (2001). Wales NHS Resource Allocation Review: Independent Report of the Research Team:
  245. (2004). What can rural* agencies do to address the additional costs of rural services? A typology of rural service innovation. doi
  246. (2004). What does the public want from agriculture and the countryside? A review of evidence and methods. doi
  247. (2003). What is a Rural Community. Handbook 1: Rural issues and contacts 03.
  248. (2001). What rural restructuring? doi
  249. (2005). Which general practices have higher list inflation? An exploratory study.
  250. (1990). Who is rural, or how to be rural?
  251. (2000). World health report doi

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