Using the Toolkit

The Rural Proofing for Health Toolkit has been written mainly for those who are responsible for planning and designing health and care strategies, plans and service delivery.  They may be from health and care commissioners, providers or other partnership bodies.

The Toolkit has been developed primarily with England’s health and care systems in mind, but its principles should be applicable elsewhere (not least around the UK).

Users of the Toolkit are likely to be working at the local or sub-regional level.  This could include Sustainability & Transformation Partnerships, Integrated Care System partnerships, Clinical Commissioning Groups, Primary Care Networks, Adult Social Care Directorates, Children & Young People’s Social Care Directorates, Public Health Directorates and Child & Adolescent Mental Health Service teams.  This list is not meant to be exhaustive.

The Toolkit may also prove useful to organisations representing the needs of health and care service users, including organisations from the voluntary and community sector.  Their interest could involve championing use of rural proofing and the Toolkit.

It is intended for application across different types of rural geographies, from remoter or sparsely populated areas through to mixed areas, where a rural hinterland adjoins larger urban settlements.

There is no fixed way to use the Toolkit.  Its application needs to align with local priorities and with local strategy or plan making processes.  However, based on evidence of rural proofing to-date, the following are suggested:

  • The six theme pages in the Toolkit can be used selectively to match the focus of strategy or plan making tasks.  However, it is recommended that all the theme pages are reviewed to see if they contain points of relevance.  This is likely to be especially true of the workforce theme, since that issue cuts-across the other themes;
  • Rural proofing should start early in the strategy or plan making process, so it can inform thinking from the outset.  It is less effective if it is applied later as a bolt-on;
  • Rural proofing should, for maximum effectiveness, be embedded within and used throughout the strategy or plan making process.  This might cover stages such as those illustrated in the graphic below;
  • Rural proofing should aim to be evidence based.  Valuable rural (and locality) evidence could be generated both by gathering consultation responses such that those from rural areas are tagged and by disaggregating available data geographically, as far as possible;
  • Rural proofing should be careful not to assume (inadvertently) that rural areas are homogenous.  Needs can vary according to location and settlement size.  For example, what works for villages near to a city or large town may not work for villages in remoter settings;
  • Where rural proofing indicates that proposals will create negative rural impacts, other options should be considered.  In broad terms they could include revising proposals, adding local flexibility to proposals, introducing rural-specific measures and taking mitigating action;
  • Subsequent monitoring or evaluation of strategies and plans can produce important lessons about service effectiveness and outcomes in rural areas, which can inform future change.  This can include lessons about what worked well and what didn’t in rural settings;
  • Designating an individual to champion rural proofing can help, with a role to ask rural questions.  Ideally, this is someone at an oversight level e.g. on a partnership board.  One option is to involve a local organisation which represents rural interests;
  • Rural proofing should be easier to undertake and deliver the best return where it is built into and carried out as an integral part of strategy or plan making processes.
Rural proofing in a typical strategy or plan making cycle