Key messages

• community participation is presented as central to effective integrated care
• neighbourhood-level approaches benefit from drawing on community assets and local knowledge
• case studies show how co-production can improve service responsiveness and trust
• addressing social determinants of health requires collaboration beyond traditional health services
• community-powered approaches support prevention and early intervention.

Policy implications

• neighbourhood health and care models should embed co-production as a core principle
• partnerships with voluntary and community sector organisations are essential
• service design should reflect local priorities and lived experience
• integrated care systems may need to shift power and decision-making closer to communities.

Gaps

• evidence is largely descriptive and based on case studies
• limited use of consistent metrics to assess impact
• lack of long-term evaluation of outcomes and equity effects.

Commentary
This report positions community participation as a foundational element of neighbourhood health and care. By emphasising co-production and asset-based approaches, it reframes integration as something built with communities rather than delivered to them.

The case studies illustrate how engaging residents can improve trust, relevance and responsiveness of services. From a care equity perspective, these approaches are particularly important for addressing social determinants of health that sit beyond the reach of clinical services alone.

The report also highlights the role of voluntary and community organisations as connectors between statutory services and local populations. Their involvement can support prevention, early intervention and more holistic responses to need.

However, the evidence base remains largely qualitative. While the principles are clearly articulated, there is limited evaluative data on outcomes or how community-powered approaches reduce inequalities over time. For neighbourhood health and care, this underlines the importance of pairing community participation with robust evaluation to understand impact and sustainability.

Key statistics 

• people aged 65 and over make up 24.2% of the population in the South West Peninsula, the highest proportion in England 

• the South West Peninsula is the only predominantly rural region in England with higher levels of economic deprivation than urban areas 

• rural and coastal communities in the region often experience longer travel distances and limited transport options for accessing services 

• ageing populations in these areas are expected to increase demand for community-based and end-of-life care services 

Key messages 

• geographical location strongly influences access to palliative and end-of-life care services 

• rural and coastal communities often face barriers including travel distance, limited service availability and workforce shortages 

• community engagement is essential for designing services that meet local needs and cultural expectations 

• partnerships between universities, health services and community organisations can help identify gaps in care provision 

• addressing both geographical and economic disadvantage is necessary to improve equitable access to end-of-life care 

Policy implications 

• expand community-based palliative care services in rural and coastal areas 

• improve transport and outreach services to support access to health and social care 

• strengthen partnerships between local communities, health services and researchers to design locally appropriate services 

• increase workforce recruitment and retention strategies in underserved areas 

• integrate palliative care planning into broader strategies addressing rural health and social care inequities 

Gaps 

• the study focuses on one region of England, which may limit the generalisability of findings to other areas 

• limited quantitative analysis is presented on the scale of service gaps across different rural or coastal regions 

• further research is needed to examine how workforce shortages affect palliative care access in remote communities 

• more evidence is required on the effectiveness of community-led solutions for reducing inequities in end-of-life care 

Commentary 
This study explores how geographical location and socioeconomic disadvantage shape access to palliative and end-of-life care in rural, coastal and low-income communities in southwest England. The South West Peninsula has one of the oldest populations in England, with more than a quarter of residents aged 65 or older. This ageing population increases the need for palliative care and community support services. 

People living in rural and coastal areas often face practical barriers to accessing care. Services may be located far from where people live, and public transport options can be limited. For people with serious illness or reduced mobility, travelling long distances for care can be particularly difficult. These barriers can delay access to support or make it harder for people to receive care in their preferred setting. 

Economic disadvantage can further increase these challenges. Some rural and coastal communities experience higher levels of deprivation alongside limited service availability. This combination can make it harder for individuals and families to access consistent and high-quality end-of-life care. 

The study highlights the value of working directly with local communities when planning services. Through partnerships between researchers, healthcare providers and community organisations, the project gathered insights into the specific needs and priorities of different communities. This approach helped identify gaps in services and possible ways to improve care delivery. 

From a care equity perspective, the findings show how location can shape access to health and social care services. People living in rural and coastal communities may experience structural barriers that are less common in urban areas. Without targeted policies and investment, these barriers can lead to inequities in access to palliative care and support at the end of life. 

Overall, the report suggests that improving palliative care access requires locally tailored solutions. Strengthening community services, improving transport and addressing workforce shortages could help ensure that people living in rural and coastal areas receive equitable support at the end of life.