Hannah writes.. rural realities
Rural realities: Why the new Northumberland Public Health Report reflects the heart of what we do
Northumberland County Council has published its 2025-2026 Director of Public Health Annual Report, and its findings make for both sobering and hopeful reading. Titled ‘Rural Realities: Health Inequalities in Rural Northumberland’, the report shines an important spotlight on the hidden health challenges faced by communities across one of England’s most rural counties – challenges that Adapt (NE) has been working to address – since we were founded more than 30 years ago.
We’re proud that Healthwatch Northumberland contributed to this report, helping to shape its understanding of how rural residents experience, and too often struggle, to access health and social care. However, the report’s findings resonate far more broadly across everything we do here at Adapt (NE), from community transport and independent travel training, to social prescribing, mental health outreach, and advocacy.
What the report tells us
Nearly half of Northumberland’s 320,000 residents live in areas classified as rural. The median age of rural residents is 50–54, a full decade older than their urban counterparts. While rural areas often enjoy a reputation for healthier living, the report is clear that this headline is far too simple. For example, key findings of the report include:
- Only 19% of rural residents live within a 20-minute walk of a GP, compared to 94% in urban areas. People are not just inconvenienced, they are presenting later for serious conditions, with evidence of lower cancer screening uptake and delayed diagnoses.
- Around 15% of rural households have no access to a private vehicle, yet public transport connectivity is poor across much of the county, particularly when travelling cross-county rather than into Newcastle.
- Mental health in farming communities is a public health priority. In the UK, three people in agriculture die by suicide every week. The suicide rate for male farm workers is three times the male national average and men in rural areas are the least likely of any group to reach out for support.
- The ‘rural premium’ is real. Higher transport, food, fuel, and housing costs place disproportionate pressure on lower-income rural households. Around 11% of rural households experience fuel poverty.
- Digital exclusion compounds all of the above. Between 3–6% of Northumberland lacks reliable broadband, cutting people off from online services, remote work, and virtual health appointments.
- Deprivation is harder to see in rural areas. Because pockets of poverty are scattered across more affluent landscapes, standard measures like the Index of Multiple Deprivation can mask real need, meaning some of the most vulnerable people go without support.
How this connects to our work
Reading this report, we are struck by how consistently its findings point toward the kinds of practical, people-centred solutions that Adapt NE has been delivering across Northumberland for more than three decades. This includes:
Community transport
The report identifies transport as one of the most fundamental barriers to health equity in rural Northumberland. Without the ability to get to a GP, a hospital appointment, or even a community group, other forms of support simply cannot reach people. Although 78% of residents live within 1km of an hourly bus service, for many of our community transport users, due to their health or disability, navigating this 1km is virtually impossible. Our community transport work addresses this directly by providing reliable, flexible options for people who cannot drive or afford taxis, and ensuring that the most vulnerable are not left behind when public routes are inaccessible. However, with the emerging fuel crisis we have significant concerns about impact this will have on communities, widening inequalities and deepening hardship. We are also mindful of the financial position of our community transport and the knock-on effect this will have on our sustainability.
Independent travel training
The report highlights that rural residents are 40% less likely to walk or cycle than urban residents, and that navigating sparse, indirect public transport is a real barrier to health and social connection. For autistic people and people with learning disabilities, those barriers are considerably higher. Adapt (NE) delivers independent travel training for autistic people and people with learning disabilities as part of the Good Life Collaborative, a regional partnership of community-rooted organisations supporting over 125,000 people with a learning disability and autistic people across the North East and Cumbria. By building the practical skills and confidence to travel independently, this work opens up access to employment, healthcare, and community life, the building blocks of a good life that sit at the heart of this report.
Healthwatch – an independent voice for health and social care
Healthwatch Northumberland’s direct contribution to this report is a testament to the power of structured advocacy and public participation. When people’s experiences of healthcare access are gathered, amplified, and placed in front of decision makers, policy changes. The report explicitly calls for community voices to be heard, particularly in smaller rural locations, and for policies to be assessed for their rural impact from the outset. In June 2025, the government announced its intention to close Healthwatch England and the local Healthwatch network. The recent review of Healthwatch by The King’s Fund outlined that “whatever replaces Healthwatch must build on the core conditions that enabled it to have a positive impact: a voice independent of government…capacity to gather unsolicited, varied and rich community insight, including from seldom heard groups: and a geographical scale that supports both local insight and system or national-level influence”. At Adapt (NE), we are continuing to deliver Healthwatch across Northumberland until legislative change is enacted, and we will continue to advocate for the value of independent voice within our health and care system as the changes outlined in the Ten Year Plan are implemented.
Social prescribing
The report makes clear that health cannot be separated from the conditions of daily life, which are where we are born, live, grow and work. It points to the success of Warm Hubs, village hall programmes, Family Hubs, and leisure wellbeing activities in reaching people who would not otherwise access formal services. Social prescribing sits at the intersection of all of this: connecting people to community assets, reducing isolation, and addressing the upstream causes of poor health that clinical services alone cannot reach. The recent launch of our Community Hub, funded through the Household Resilience Fund has already demonstrated the value of safe spaces to provide social connection, practical support, resources and signposting.
Mental health outreach
The report’s section on mental health is particularly striking, noting that population-level statistics can mask real need and that rural residents face compounded barriers to accessing specialist care. Working alongside EveryTurn, our mental health outreach focuses on one of the most underserved groups in any setting, people living with severe mental illness (SMI). Our work helps ensure that people with SMI in rural Northumberland are supported to attend their mental health reviews and physical health checks; appointments that are easy to miss when transport is unreliable, confidence is low, or the system feels hard to navigate. Given that the report explicitly links distance and transport barriers to later presentation and poorer health outcomes, this work is more critical in rural areas than anywhere else.
Advocacy
The report’s findings also resonate deeply with our statutory advocacy work across Northumberland. When people face decisions about their care, their liberty, or their rights, the additional barriers of rural life can make navigating those processes feel insurmountable. Here at Adapt (NE) we deliver seven types of statutory and non-statutory advocacy across Northumberland, including IMCA, IMHA, Care Act Advocacy, NHS Complaints Advocacy, and Relevant Persons Representation. Independent Advocacy is about ensuring that the people whose voices are least heard, for example, those living with severe mental illness, those subject to Deprivation of Liberty, those navigating complex care systems and who need an advocate, are supported to be heard clearly and on their own terms.
A report that both validates and challenges us!
There is much in this report that validates work already underway across Northumberland’s voluntary and community sector. The strength of local leadership, the depth of community networks, and the innovation of grassroots organisations are rightly celebrated. I have been incredibly impressed at the richness, diversity and collaboration across the local VCSE and public sector.
But the report is also a challenge. It calls for rural needs to be embedded in all policies from the outset. It calls for better data to make hidden deprivation visible. It calls for sustained investment in the kinds of community-based, preventative solutions that are too often the first to face funding pressures. And it calls for a genuine Communities First approach, one where organisations like Adapt (NE) are not just service providers, but co-designers and co-deliverers of the support that rural communities need. This is an ambition we welcome, and we look forward to continuing to deepen and strengthen relationships and partnerships across sectors.
