Meeting of the Parliament 16 January 2025
I remind members that my wife is a general practitioner partner in a practice in Buckie and that I previously served for five years as a councillor in Moray.
When I first came to the Parliament, nearly a year ago now, the one thing that I really wanted to address was rural depopulation, and I focused on that issue in my first members’ business debate. In this debate, I want to focus on arguably one of the most fundamental issues that impacts rural depopulation: access to healthcare.
Following the debate on the Health, Social Care and Sport Committee’s inquiry into remote and rural healthcare, I raised some of the pressures that rural communities face, but I wanted more debate on such a big topic and to give other members an opportunity to highlight their local issues and stories. I am grateful to everybody in the chamber today.
I will not lie: there is an element of politics in this, as I fundamentally do not believe that the Scottish National Party Government has served residents of rural Scotland well. That is not just my view; I have heard too many stories of appalling failures to deliver healthcare from the people I represent—a lady who slipped and fell having to lie on her back for eight hours while waiting for a 20-minute ambulance journey; a man having a heart attack sitting outside a local district general hospital; the fact that it takes five, six or seven years to reinstate maternity services; and cancer diagnoses taking longer in rural areas than in urban areas. Those are appalling failures, but, as I know my colleagues will show, that is what is going on.
I think that I can split the issue into two areas. First, there are the macro problems: the big issues that fundamentally lead to poor health outcomes in rural areas—the topics that are discussed around the dinner table and are much discussed in this chamber, such as rural transport, connectivity, roads, local provision of services, housing and employment. Then, there are the smaller issues: the niche technical issues around rural healthcare delivery.
I asked a range of doctors across the north-east and the Highlands to tell me in their words what the issues are. They said that smaller teams are less resilient, so a small reduction in staffing has a bigger impact, whether temporarily or in the long term. They noted that there is less third sector community support than there was before, and they spoke of significant recruitment challenges.
One GP said that the role of a GP has fundamentally changed over the years, with most GPs now working part time, partly due to the workload and partly for a better work-life balance. A higher headcount is therefore required, which, in turn, is harder to deliver in rural areas. GPs need a realistic funding model that can sustain smaller establishments. The current system does not work.
Another GP spoke about the lack of any real push on remote and rural training programmes and said that a specialism in rurality should be encouraged in early work at medical schools. One doctor said that, due to their sheer size, larger hospitals tend to have a responsive and dynamic learning environment—something that is not easily delivered in smaller hospitals. There is also a lack of specialist trainees rotating through smaller rural hospitals to provide support to consultants and doctors in their foundation years. Another doctor pointed out that, when a long-term generalist who is amazing in their field is expected to retire in a few years’ time, there should be a mechanism by which another doctor can be brought in earlier to learn their core skills.
I am sure that the cabinet secretary is aware that, at present, maternity and orthopaedic services—and even basic screenings—are not being delivered in some areas. In my region, there are serious staff shortages in Elgin, Thurso, Campbeltown, Stornoway and Uist—I could continue. There are also recruitment challenges in general practice, as we saw with the first group of graduates from the Scottish graduate entry medicine programme. Of the 52 students who graduated, two have taken up posts in my region and eight others have taken up other rural posts.
If I had longer to speak, I could talk about social care, community nursing, mental health support, cancer diagnosis, vaccines and immunisations. We have unique challenges in rural Scotland, but we should never feel that we are being treated as second-class citizens.