Rural communities feel ‘overlooked’ and change is too slow to give people the health and social care services they need, a new report has outlined.

Llais – established in April 2023 to replace the seven Community Health Councils who have represented the interests of people in the NHS in Wales for almost 50 years – has released its report shining a spotlight on rural health and social care, based on what they have heard through engagement with people in rural areas of Wales.

The message for health and social services, Llais said, is that “rural communities feel overlooked, and change is too slow.”

“Despite national plans and commitments, people in rural areas say they are still facing barriers that make it harder to get care,” Llais said.

“These challenges are not new, but they are becoming more urgent.

“This must not be accepted as “just how things are.”

The report said that access to care remains a struggle in rural Wales, with “people often telling us they value the care they receive once they can access it.”

“However, getting to that point can be difficult, especially in rural areas,” the report says.

“Many people told us they struggle to get appointments with GPs or NHS dentists.

“We’ve also heard that long waiting times for surgeries, such as knee or eye operations, can worsen health and disrupt daily life.

“As of mid-2025, over 550,000 people were waiting to start treatment in Wales, with more than 200,000 waiting over 36 weeks, delays that are especially difficult for rural patients who must coordinate travel, time off work, and arrangements for their recovery.

“Agricultural workers, in particular, said they must carefully plan time away from their farms, and treatment delays can have serious financial and practical consequences.”

Transport is one of the biggest barriers to accessing care, the report found.

“We’ve heard that sparse public transport and costly taxis make it difficult to attend short-notice appointments or reach hospitals, which may be over an hour away,” the Llais report says.

“Some people recovering from procedures like cataract surgery said travel was impossible without support.

“We’ve also heard that the Non-Emergency Patient Transport Service doesn’t always work well for rural communities.

“Some people told us they weren’t aware of the service, while others said it starts too late in the day to accommodate early appointments, especially when long travel times are involved.

“Sometimes, it is cancelled at very short notice, meaning people are stuck.

“These challenges are particularly difficult for unpaid carers, who told us they often lack the support they need to care for loved ones with complex needs.

“People also described limited opportunities for older and disabled individuals to connect socially or access wellbeing support, which they felt contributed to loneliness and isolation.

“This is supported by research funded by Health and Care Research Wales that highlights loneliness as a growing concern in rural areas, particularly among older adults and carers.”

Despite the difficulties, the report said “many people spoke about the resilience of their communities.”

“We’ve heard how neighbours support one another, and how people value the care they receive once they’re able to access it,” Llais said.

“People told us they want that care to be easier to reach, more consistent, and better aligned with the realities of rural life.”

Llais also reported on the important role being played by community connectors and third sector organisations to support mental health and wellbeing in rural communities.

“As local organisations, they understand the unique pressures of rural life like isolation, financial uncertainty and cultural barriers to seeking help,” the report found.

“Through awareness raising, peer-to-peer support and outreach programmes people said these groups are helping to reduce stigma around mental health, particularly in farming communities in West Wales and Powys.

“People tell us that it is often difficult, especially for children and teenagers, to get mental health support through public services.

“Long wait times and complicated processes were described as common barriers.”

Travelling for mental health support was also reported as a major challenge, especially in rural areas where public transport is limited and distances are much longer.

The report also heard praise for health and social care staff despite the challenges in rural Wales.

The report said: “People often tell us how kind, skilled, and helpful health and care staff are in rural Wales.

“Their support makes a big difference to those receiving care and their families.

“At the same time, we’ve heard concerns about workforce shortages, and evidence from the GMC Workplace experiences 2025 report shows that 81 per cent of doctors in Wales report inadequate NHS staffing.

“Additionally, we hear that rural social care faces persistent recruitment challenges due to low pay and long travel times.

“People told us there aren’t enough domiciliary carers to meet demand in rural areas, which can lead to reduced quality of care.

“We’ve heard that carers are often not fully paid for the time spent travelling between calls, and that some feel unsafe or reluctant to work in isolated areas, especially in poor weather or after dark.

“Others said low pay and lack of recognition make it harder to recruit and retain staff.”

The report found that people in rural communities emphasised the “importance of services working well together.”

“Some told us about positive experiences with integrated re-ablement teams, where health and social care professionals coordinate support to help people recover at home,” the report said.

“These examples show what’s possible when services are joined up.

“However, many people said that coordination and communication between different parts of the health and care system is patchy.

“We’ve heard that travelling from rural areas to access services in other parts of Wales or England can make things even more difficult.”

Staff at A&E departments and hospital wards were also praised in the report, but people remain concerned over waits for treatment.

“Staff are regularly praised by those we hear from, but we also heard it takes a long time to get an ambulance or to be seen by a doctor in emergency departments, and the wait can be uncomfortable,” the report found.

“People were worried about hospital conditions and facilities.

“Some described experiences of patients sleeping on chairs overnight, with limited access to food, drink, or basic comfort.

“While these issues affect people across Wales, they can be especially difficult for those in rural areas, where long travel distances and limited transport options add further strain.

“For rural patients, delays in emergency care can mean longer waits for ambulances to arrive, greater discomfort during transfers, and more complex logistics for family support and follow-up care.”

Llais said it is “calling on Welsh Government, Health Boards, and Local Authorities to find a better way to share and scale up approaches that reflect what’s already working in other parts of rural Wales, including community-led mental health initiatives, co-produced care models, and integrated re-ablement teams.”

“People told us they value services that are flexible, locally rooted, and built around community strengths,” the report said.

“Getting help early, in communities, came through strongly in our engagement.”

Llais is also calling on the Welsh Government “to ensure rural communities benefit from the ambitions in the 2024 Plan for Health and Social Care” and that the “current review of the Non-Emergency Patient Transport Service focuses on addressing the issues people face and making the service better for those who rely on it.”

The report also calls on NHS Wales, commissioners, specialist clinical networks, Regional Partnership Boards, and other relevant bodies to “ensure that regionalisation of specialist services is coordinated in design and development, communicated transparently, and shaped with meaningful involvement of people and communities.”

It also calls for the speeding up and expansion of mobile clinics, outreach services, and telemedicine, and to support people to use these services.

“These options reduce travel burdens and make care more accessible<” the report said.

“People want services that reflect rural realities and offer flexible appointment options.”

The report also calls to “change the funding arrangements and embed the third sector as a core delivery partner in rural health and care.

“Community groups are delivering vital services, but short-term funding undermines stability and continuity,” the report found.

“Multi-year funding, strategic involvement, and genuine partnership are needed.”

The report also calls to develop a rural workforce and recruitment plan.

“National campaigns aren’t addressing rural pressures,” the report said.

“People want locally trained staff who understand their communities.

“This plan should invest in rural education, recognise rural service, and ensure no community is left behind.”

Llais also called for bodies to involve rural communities in shaping the Integrated Community Care System because “people want prevention-focused, locally rooted services, and they want to be part of designing them.”

People also want to be more involved when plans are made to move or centralise services - often further away from where they live.

“People told us that when services are moved further away, they often face practical challenges, especially around transport and family support,” Llais said.

“But they also told us they don’t always understand why changes are happening.

“Communities need clear, timely explanations about how safety and quality will be maintained, what will replace local provision, and why regional centres are being located where they are.

“Without coordinated planning and communication, changes can feel confusing, unfair, or unsafe.”

Llais said it “has been hearing from lots of people in rural areas across all of Wales who have shared what they see as the strengths but also the struggles of accessing health and social care.”

“With roughly one in three people in Wales living in areas classified as rural, it is important that these voices are heard and acted on to avoid further health inequities.

“We’ve heard about informal networks, local initiatives, community connectors, and community-led solutions stepping in where formal services aren’t meeting people’s needs.

“These examples highlight the resourcefulness and innovation that rural communities bring to health and care, and they offer valuable lessons for everyone.

“But we have also heard about lots of challenges.

“While some challenges are shared across Wales, rural communities often face extra difficulties, such as long travel distances, limited transport options, and fewer nearby services.

“These issues can be especially difficult for agricultural workers, carers, older people, and disabled people.

“For example, we’ve heard of older couples who retire to rural areas and find themselves isolated if their partner passes away, with limited informal support or social connections nearby.

“In recent public consultations, including proposals to change services provided by Hywel Dda University Health Board, our regional teams in Powys, North Wales, and West Wales have heard a recurring message: rural communities often feel overlooked and that they must ‘fight’ to retain the services they rely on.

“Wales has a real opportunity to support rural communities in shaping more joined-up, locally rooted health and care services.

“With the right support, collaboration, and flexibility, rural areas can demonstrate how services built around community strengths, rather than one-size-fits-all models, can deliver better outcomes for local people.”

In response to what people have told Llais, they will now share the evidence gathered with the Senedd’s Health and Social Care Committee and Welsh Government to support a thematic review of rural health and care.

Llais said it will also “visit rural services where concerns have been raised and make representations based on what we find”, and “host regional summits to explore what’s working, and what isn’t, in rural areas.”

Llais will also continue engaging rural communities through its Health and Social Care We Want project, while its upcoming Integrated Community Care project will “explore how well joined-up services work for rural people, and what helps or hinders access.”

Alyson Thomas, CEO of Llais, said: “The voices we’ve heard show that rural communities are resourceful, but they are being asked to do too much to fill gaps in formal services.

“People want care that reflects the realities of rural life, not one-size-fits-all models.

“Welsh Government and NHS Wales must act now to turn plans into practical solutions that work for rural communities.”