Meeting of the Parliament 12 December 2024
I remind members that my wife is a practising GP.
I want to start by reading out some recent communications that I have received from medical staff in NHS Grampian and NHS Highland.
One message, which was sent to me yesterday, says:
“Raigmore hospital NHS Highland delayed discharge went over 100 for the first time today, that's nearly 1/4 of the hospitals 476 beds. We had thought 50-60 delayed discharge was bad earlier in the year.”
Another message, sent to me last week, says:
“How much have you been kept in the loop of the current storm in NHS Grampian? Are you aware of the Orthopaedic service downgrade at Dr Grays? There is no winter plan that’s been shared with clinical staff. There is a strong link that the major incident declared at ARI was in part due to the increase in Orthopaedic workload since shutting down services at DGH and I’ve been informed the senior executive are presenting a report to the Board which will in effect give a plan to reduce the capacity’s of DGH, possibly including reducing the ED remit, in the future to save money.”
I am sure that my colleague Douglas Ross will pick up on the issue of Dr Gray’s hospital, but I urge the cabinet secretary to help us in the north by looking into the issues around Dr Gray’s and some of the things that are going on there.
This week, I also received a letter from residents of Barra, who are still reeling after the shock announcement that there is no intention to build a replacement hospital on Barra, even though that had been a firm commitment from 2008. The islands of Barra and Vatersay have been without a permanent doctor since the summer of 2022, and residents are now faced with a one-hour flight or a six-hour drive to get to their nearest accident and emergency department.
This summer, I joined other MSPs and the cabinet secretary to hear from residents in Uist about their struggles with accessing healthcare, a situation that still continues.
I could also talk about the fact that NHS Grampian has the lowest bed base in Scotland at 1.4 beds per 1,000 people, and that NHS Highland has the second lowest, with two beds per 1,000 people. If NHS Grampian matched the provision in NHS Highland, it would have an additional 349 beds, but if it matched the Scottish median figure of 2.4 beds per 1,000 people, it would have 608 additional beds. What a difference that would have made in the recent crisis.
There is no doubt in my mind that rural Scotland’s NHS is disadvantaged and needs to be fixed. Scotland is mainly rural and, therefore, there must be an acceptance that there has to be basic coverage of NHS services in the islands and rural areas. That is only fair.
If the SNP is not going to listen to what people are saying about the vast gap that is being created, perhaps it is now time for a campaign that defends rural Scotland’s right to healthcare.
The committee’s report notes that rural GPs told the committee that there are particular difficulties with providing suitable staff training within remote and rural practices, given that rural GPs are often required to operate as “jacks of all trades”. It also says that there was a consensus in the evidence that was given to the committee that
“current pay rates and working conditions offer insufficient incentive for staff to remain in remote and rural areas.”
The Scottish council of the British Medical Association has called for higher pay and better training and facilities in remote areas. Dr Iain Kennedy, the chair of BMA Scotland, said:
“What we can see is that the rural-urban divide is getting greater and that of course is widening health inequalities … We haven’t recruited enough doctors in general, across Scotland. When we have a shortage of doctors, rural areas and deprived areas are the first places to be affected.”
GP surgeries in rural Scotland are closing at more than twice the rate of those in many central belt health boards.
The main problem here is the SNP Government’s one-size-fits-all health funding formula, which is not delivering for rural areas. That funding formula does not consider depopulation, a greater requirement for small-scale service delivery or an ageing population—all challenges that disproportionately impact rural areas. The Scottish Conservatives would introduce a review on a separate rural NHS funding formula to fix those issues.
The committee report highlights housing as a significant issue. In particular, the lack of
“availability and affordability of housing ... came up extensively throughout the inquiry.”
Research by Scottish Land & Estates, which I think has already been mentioned today, revealed that more than £100 million of funding that had been earmarked for rural and island communities was diverted to housing projects in Edinburgh and Aberdeen. Added to that, only 19 homes have been delivered in rural areas for key workers by the rural affordable homes for key workers fund—just 19.
I truly believe that the failure to deliver a basic health service in our remote and rural areas is one of the main factors driving depopulation in the Highlands and Islands, as well as in other parts of Scotland.
I welcome the committee’s report, but it must not be another document left on the shelf to gather dust. Rural health costs more to deliver but, in a country that is proud of its rurality, that should not matter.
I want to get behind the points that the cabinet secretary made on the rural delivery plan, but it is so hard for me to do so when it is his Government that has been in power for 17 years. It is time that the Scottish Government properly invested in rural health and social care in order to deliver better, fairer health outcomes for our rural Scotland.
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