Listen in Craven

Experiences of Craven communities

Cost of living crisis

Financial worries were a clear undercurrent in the conversations, as the cost of living crisis continues to impact households across the country, Craven being no exception. This has wide implications for health and care, including access to safe housing and keeping warm in winter; unpaid carers and volunteers needing to return to work; paying for care and equipment; stress and anxiety about money; paying for transport, food and activities (both social and exercise).

Travel and transport

Availability of travel and transport in Craven is a significant factor in experiences of health and care in the area. Access to a car is a huge factor, as public transport can be limited in rural areas, with many residents relying on family or volunteers to drive to appointments. Transport is important beyond medical appointments, as it can limit the extent to which people can participate in their communities. Some even remained in unsuitable accommodation purely because it had good transport access.

Rural postcode lottery

Some residents commented on how access, funding and availability of services was highly variable across Craven, and over local boundaries for example into Lancaster. This disparity relates to NHS medical and dental, Council and community services and is likely exacerbated by lack of transport links. Some areas appeared to offer better opportunities for health and care, and ultimately a better quality of life for residents, while other areas had noticeably reduced access.

Voluntary sector

There was a strong and well-used voluntary community and social enterprise presence in some Craven communities. In particular, volunteer-run transport and support groups were filling gaps in provision. However this dependence on volunteers may cause challenges as there were examples of not having enough volunteers to run groups, which may worsen as the cost of living crisis pushes volunteers into paid employment. It is important to note that most conversations took place within volunteer-run activities, and that previous research has indicated a much lower level of awareness of organisations more broadly within Craven.

Language of self-care

There appeared to be a well-developed understanding of self-care among Craven residents, and interestingly this related to mental health more so than physical health, even if the activities themselves were physical e.g. walking groups. Residents talked confidently how they chose activities and behaviours for their mental wellbeing, and having strong social links was a key aspect of this. It is possible that mental self-care may be practiced in response to lack of readily available mental health services

Experiences of Craven health and care system

Consistent care

In all aspects of health and care, consistency is valued. For Craven residents, they would like to have consistent access to services and similar waiting times no matter where they live. For residents with additional needs, consistency is even more important, for example being seen by the same health professional and appointments being in familiar locations.

Holistic care

Additional needs are often met when Craven residents attend specialist services, however they do not cease to have additional needs when in other ‘mainstream’ services, which are less equipped to meet these needs. If the system was getting it right, the patient would be viewed more holistically, as a ‘person not a diagnosis’. Allowing a space (e.g. in SystmOne) for patients to give context about themselves, may help services can offer practical support and understanding. Services also need training e.g. on learning difficulties, LGBTQ+ issues, and resources to offer additional help e.g. quiet zones on wards or autism-friendly cervical screening.

Bureaucracy barriers

Various examples were offered by Craven residents illustrating where process and bureaucracy was getting in the way of timely and quality health and care provision. Certain pathways require assessments or sign-off from particular services (e.g. CAMHS) or roles (e.g. GP), and when these are stretched this ‘bottle-neck’ can delay treatment and conditions can worsen.

Challenges with primary care

Difficulties accessing GP appointments are well-known and documented in other research. Craven residents expressed their frustration and distress. There is a mixed experience; a few local practices seem easier to access, in contrast with those where patients struggle to make contact, access online services, or book appointments. GPs are often seen as the first point of care, so difficult access to GP can feel like patients are being prevented from accessing any support at all.

Choices in access methods

It is clear that there is no ‘one size fits all’ method of both making appointments or attending services. Face-to-face, telephone, online, post, home visits – all can be seen as excellent or terrible depending on the person, their needs and their circumstances. Other research has illustrated this in detail with examples, but the message is clear – options are essential.

One side of the coin

The programme engaged with a wide array of Craven communities, but naturally disproportionately represents views of those who are engaged with community groups, and leave the house regularly. The positive health and care support they receive, illustrated in this report, throws into sharp relief the invisible community of non-engaged individuals for whom such support is absent.