Contextual; 999 – Where’s Your Emergency?

This article aims to explore some of the gaps between healthcare availability between rural and urban areas in the UK and how this could affect some of the most vulnerable in the population.


Urbanisation sees cities worldwide grow into hubs of development. But what does this mean for rural areas? Of course, there are differences between the lives of people in rural and urban residences, however, in the UK we expect all people to have good access to high quality healthcare. But is this truly the case for everyone?

The charts shown below made from a survey of 95 people, give a clear indication that people in rural areas have longer to travel by car to reach their GP. When considering the journey by public transport, the impact upon this journey is a lot greater for those living in rural areas than urban areas.  This suggests that there is a dependency in rural areas on people owning cars and with insufficient public transport, primary care may become much more difficult for some people to access.

Interestingly, when asked to consider both timeliness and quality of care, satisfaction rates between urban and rural residents were both similar (68% and 74% respectively). When asked about their local GP one interviewee said that she “felt a sense of personal familiarity” with her GP who is based in a “close-knit, rural community”.

These trends suggest that rather than being a gulf in quality of healthcare between rural and urban areas the main issue is accessibility and the extra time needed by rural residents to reach primary healthcare.

The problems with accessing healthcare do not lie solely within people’s proximity to GPs, it is also evident in emergency situations. Emergency service response times unexpectedly differ throughout the UK, with the worst region being the mainly rural county of Norfolk. The City of London sees typical ambulance response times sit between 4-5 minutes, compared to over 15 minutes in Norfolk and sees 75-80% of life threatening cases responded to within 8 minutes. This is the target time set by the NHS, which is matched in only 15% of cases across Norfolk (Totally Communications, 2014).

The issues that ambulance services have with reaching rural areas is that one depot must cover a wide-range of towns and villages, an issue ever present in Norfolk which has the 8th lowest population density of all English counties (Park, 2018). Any obstructions, including adverse weather and wearing down of roads can cause a major problem for ambulances trying to gain access to remote settlements, especially as many rural locations in the UK are accessible by just one main road. (ASN, 2011) (Skerratt, 2018)

When considering strokes, these factors could combine to cause severe issues for patients in rural areas. In the event of a stroke, every minute is crucial. “An estimated 2 million brain cells die every minute during a stroke” (McDonald, 2017) so the sooner that the correct therapy can be applied, the less long-lasting effects, such as “permanent brain damage or disability” (McDonald, 2017), that the patient will suffer. This directly relates to the speed that an ambulance or first response unit can reach the patient for diagnosis to occur and the correct treatment to be initiated.

After the initial therapy phase of a stroke, patients will undergo a series of recovery processes. These processes will need to be with specialists who may only be stationed at certain, larger hospitals, usually found within urban areas (Stroke Association, 2012). Following a stroke, patients “will not be allowed to drive for at least 1 month” (Stroke4Carers, 2018) and so their dependence will fall upon other people being available to assist them or indeed on public transport. A study into use of public transport by stroke patients showed that 58% of interviewed candidates had not used a public bus service since their stroke with 46% of candidates saying that they “wanted to use transport but had lost their confidence” (Logan, 2003). This relates back to the reliance upon cars to reach medical services for people in rural areas revealing how stroke patients, who are not able to drive, may struggle to access the healthcare they need.

Throughout the years schemes have been suggested to tackle the issue of healthcare access in rural areas. In the 2001 RARARI1, mobile health units were suggested as possible solutions (MacVicar, 2013). However, these units would only provide a temporary solution for one community before moving on to the next. Another alternative healthcare option is “telemedicine” which allows for patients to “receive expert healthcare advice without the need to leave home” (Bio, 2018). Although this is good progress, it will be limited as for major decisions or diagnosis to be made, the user will still need to travel to a specialist who may be stationed far away.

To conclude, the increasing population density of UK cities has lead to more major healthcare services being built within urbanised areas. This has created an inequality in accessibility of primary care between rural and urban communities. However, it must be remembered that there is no perceived inequality in the quality of the healthcare once it is accessed.

As cities continue to grow they will be the focus for funding in new medical buildings and developments potentially leading to continued isolation between the rural public and healthcare centres. A way that designers can help to tackle this issue is by designing products or services that can help to reduce the impact that distance has on the way that people receive healthcare. This could help to offer extra healthcare solutions without the need for major investments in infrastructure.


Ambulance Service Network (2011). ‘Ambulance Response Times in Urban and Rural Areas’, Briefing, Issue 226, p2.

Bio (2018).’ Rural communities, digital, and access to healthcare’, The Bio Agency, Available at: (Final Access Date 31/10/18)

Logan PA and Dyas J (2003).’Using an interview study of transport use by people who have had a stroke to inform rehabilitation’, Clinical Rehabilitation, Vol. 18, Iss. 6, p703-708.

MacVicar R and Nicoll P (2013).’NHS Education for Scotland: Supporting Remote and Rural Healthcare’, NES Board Paper, Aug 2013, p5

McDonald, C (2017). ‘Spotlight on Stroke, Q&A with Dr. Colin McDonald’, Interview by Garber J, Novent Health, May 24.

Park, N for Office of National Statistics (2018). ‘Population Estimates for the UK, England and Wales, Scotland and Northern Ireland: mid-2017’, p22 appendix MYE5.

Skerratt, S. (2018), Recharging Rural, Report to the Prince’s Countryside Fund, London: The Prince’s Countryside Fund, p24.

Stroke Association (2012). ‘When a Stroke Happens’, Publication 4, Version 1. Available at: (Final Access Date 30/10/18)

Stroke4Carers (2018).’Driving After a Stroke’, Final Access Date 01/11/18, Available at

Totally Communications (2014). ‘Ambulance Response Times by Totally Communications, Freedom of Information Request for NHS Data’, (Final Access Date 02/11/18),