Bringing care closer to home: Improving palliative care in remote, rural and island communities (Hospice UK, 23 June 2025)

Summary

People living in remote, rural and island communities face unique and significant challenges accessing health and care services. Long distances to travel, poor public transport and a chronic shortage of health and care staff leave people struggling to get the care they need. In some rural areas, a lack of services means that people’s basic human rights, including their right to health, are not being met. For those at the end of life, these challenges are even greater.

This report is the first comprehensive policy report addressing the palliative care needs of adults and children in remote, rural, and island communities across the UK.

Content

Key findings

• Nearly two thirds of people living rurally said that they or the person they cared for with a life-limiting condition did not receive the care and support they needed.
• Two thirds of rural health and care staff said there are not enough staff with the right skills to support people with life-limiting conditions. In particular, there is a lack of social care staff.
• People are being forced to choose between where they live and the care they receive. Too many people at the end of life face moving hours away from family and friends to access care. They need more support to stay at home and in their local community.
• Families of children with life-limiting conditions living rurally face significant additional barriers to accessing care and support. Rural services for children with complex needs are scarce, local staff often lack familiarity and confidence, and sustaining an equitable palliative care service is hard when there are few families spread across vast distances.
• In rural areas, stretched staff and limited resources require a creative, community-driven approach. People need the flexibility to arrange care around what they need, drawing on existing community strengths and support.

Key recommendations

What can be done now:

• Local health and care systems, along with local authorities, should assess and be held accountable for the commissioning and delivery of palliative care and social care services that meet the needs of adults and children with life-limiting conditions living rurally.
• Hospice care providers, GPs, community nursing teams, community pharmacists, social care staff, out of hours teams and other staff should identify opportunities to work more closely together to address gaps in palliative care in rural communities, particularly care at home, improve palliative care education and training, and improve access to medication.
• Hospice care providers should work in partnership with local communities to better understand what adults and children with life-limiting conditions living rurally need; what community groups, networks and resources are already available; and how best to build on these, for example through compassionate community initiatives.
• Local health and care systems, and local authorities, should ensure people living rurally are aware of and are supported to use direct payments and personal budgets so they have greater flexibility and control to arrange care that meets their needs.
• Local health and care systems should ensure sustainable funding and fairer commissioning of hospice and palliative care services that reflect the higher cost of delivering services in rural areas.

Priorities for service development and investment:

• Governments across the UK should commit funding and resources to enable a shift to more palliative care delivered in the community.
• Local health and care systems should commission, fund and ensure the delivery of a 24/7 single point of access palliative care helpline for patients, unpaid carers, and health and care staff to access support and specialist advice.
• Local health and care systems, and local authorities, should increase support, resources and training for unpaid carers who are caring for someone living rurally with a life-limiting condition, in partnership with local services and local communities.
• Local health and care systems should ensure the provision of a minimum standard of welfare and social security advice for people with a life-limiting condition and their carers in rural communities.
• Governments and local health and care systems should review and implement consistent policies to reimburse travel and accommodation, and provide funded transport, for people with life-limiting conditions and their carers travelling to access services.

Long-term priorities:

• Governments across the UK should publish, implement and monitor national workforce plans that improve the recruitment and retention of health and social care staff in rural areas, and ensure there are sufficient staff with the right skills to meet the growing need for palliative care for adults and children.
• The Department for Work and Pensions, the Scottish Government and the Northern Ireland Executive should ‘rural proof’ the welfare system, so that people living rurally are not disadvantaged and can access the financial support they are entitled to.
• Governments across the UK should invest in improving the digital, communications, transport and housing infrastructure in remote, rural and island communities.
• The UK Government should review whether commissioning children’s palliative care at a regional or national level would better meet the needs of rural families.