Reaching under-connected rural areas and localities (RURAL)

North Yorkshire Hospice Care operates as a family of services including Just ‘B’ bereavement service, Saint Michael’s Hospice in Harrogate and Herriot Hospice Homecare.

Herriot Hospice serves the very rural communities across Hambleton and Richmondshire covering an area of over 1,000 square miles. The biggest town is Northallerton with a population of just under 17,000.

• There are several challenges for people who need to access care and support in the area:
• It is difficult for people to get to the places where services are delivered. Patients typically have to travel around 40 miles to get to the nearest hospital, often on narrow country roads with return journeys taking around 3 hours. Even if someone has their own transport, they may not be able to drive if they are unwell.
• Public transport is limited and timetables don’t support appointment times. Taxi journeys are expensive.
• Mobile phone reception and internet access can be limited in rural communities, which makes it difficult for people to access digital health support.
• Farming communities can be reluctant to access care. They may not want to (or be in a position to) leave their farm. This means that people from the farming community do not seek clinical support until their problem becomes acute.
• People in farming communities are also often asset rich but cash-poor. If a farmer becomes ill and is unable to work, this can have a devastating impact on their income, which in turn affects their health. However, they may not be eligible for financial support because they own property.
• Because people aren’t able to access services early enough, they miss out on advance care planning (ACP) so they are less likely to receive care and/or die in their preferred place.
   

Herriot Hospice has taken several steps to remove barriers to accessing palliative and end of life care, providing services that feel more appropriate to people in the local community.

They developed a Care Connector service, which supports people for up to 12 weeks (from home, over the phone or at the hospice). The Care Connector not only supports those with a palliative diagnosis, but also people who find themselves socially isolated due to their circumstances or rurality.

Support includes goal setting, signposting, filling in forms and making grant applications, as well as arranging transport and interaction with local groups.

The hospice also holds a weekly drop-in wellbeing service, which many people find more accessible than a structured support group. This drop-in is held in a market town that many local people visit on a weekly basis for shopping etc

Other support includes:

• recruiting a team of volunteer drivers to help improve transport for people who need to access hospice services
• engaging with the local community through young farmers meetings, cattle markets etc to raise awareness of hospice services and reduce stigma around accessing care
• engaging with the local community through country fairs and agricultural events such as the Nidderdale, Wensleydale and Great Yorkshire shows 
• focusing on early intervention and pre-bereavement care to break down stigma and fear of the unknown before people need more in-depth care
• using a ‘funeral wish’ pack to engage people with advance care planning earlier (framing it as helping to reduce the burden on loved ones down the line)
• connecting people with other support services, for example Citizens Advice team for specialist financial support.

Key facilitators

Herriot Hospice Homecare was pleased to receive a grant from the Masonic Charitable Foundation via Hospice UK's grants programme, which enabled them to develop this work.

Using hospice branding and wearing uniforms helps people recognise and get to know the hospice team, and they are seen to be a part of the community rather than health and social care.

The hospice works closely with community organisations such as libraries and other charities, who offer access to IT and Wi-Fi.

A network of ‘community anchors’ was set up by North Yorkshire County Council during the COVID-19 pandemic, to raise awareness of the services that are available in the local area. It’s really helpful to be able to connect people with a member of staff or volunteer from the community anchor who can link them up with support available in their locality.

Keeping the criteria for accessing the hospice’s wellbeing service quite broad has enabled anyone with a palliative diagnosis to receive care (rather than limiting the service to those in the last year of life).

It’s also been really important for the hospice to have good relationships with local GPs, as they are a key point of referral into services.

Challenges

Rurality is not often recognised or addressed as an issue that affects equity of care. Not being able to access services in the same way as patients from urban areas, can create health inequalities.

The hospice wants to ensure everyone in the community can access care, regardless of where they live. However it is becoming increasingly more expensive for staff to visit patients at home.

Some palliative care at home attracts statutory funding but petrol costs are not funded, which is a financial burden in circumstances where there is a 70-80 mile radius between patients. The additional support provided by Herriot Hospice Homecare's care connectors is fully funded through charitable activities and there is a constant effort to make this work sustainable. 

After a three-year, £1.8 million capital project, North Yorkshire Hospice Care is planning to open a new hospice in Thirsk in the newly refurbished Lambert building. Herriot Hospice at the Lambert will provide a six-bed in-patient unit, bereavement suite, a base for home and wellbeing teams and a community hub and café. This will bring palliative care and bereavement support right to heart of the rural community, further widening access and reducing travel distances.