Very recently Aberdeen and Edinburgh University made the first ever geographical and ancestral gene link in the UK. It’s been discovered that 1 in 100 living in Orkney have a gene that makes it more likely they will develop breast and ovarian cancer. A gene that can be traced back 250 years to the founding settlers. This made news all over the world and made quite the headline story within the genetic science community. It goes without saying that although this certain gene will increase the likelihood of a person developing these cancers, that doesn’t mean to say that someone definitely will.
However, the reality is that in some cases this exact gene will cause cancer. Meaning that the residents of Orkney, just like those anywhere else will need accessible and comprehensive healthcare in order to treat the cancer. Yet, in places like Orkney and other very rural and remote areas in the most northern parts of Scotland trying to access just the basic healthcare can be timely, sparse and costly. Costly not in the sense that those residents have to pay for healthcare but the fuel and the travel expense can start to stack up. Recent times have made rural and remote healthcare in the highlands harder to access and harder to provide. When up against issues that the rest of mainland and southern Scotland wouldn’t be able to comprehend.
Unfortunately, there are several examples of patients waiting extraordinary long lengths of time for care and treatments. One women had to wait almost 200 days until her cancer treatment began after her breast cancer diagnosis. While another man on the islands of Orkney was left waiting nearly two years to begin treatment for prostate cancer. Moreso for the people of Orkney who require specialist care or treatments they’ll have to travel to Aberdeen to be seen to.
The cracks have started to multiply as under funding and mismanagement keep putting the NHS under inscrutable pressure. But when the environment it’s trying to operate in is so delicate the problem is without a doubt exasperated.
The workforce in the NHS is being pushed to its limits, with many packing it in realising they can find the same salary elsewhere with half the stress. While some are taking early retirement as the hassle isn’t worth it. Scotland’s healthcare personnel vacancies are rising to an alarming number. In the Highlands vacancy rates are up at 14.5% while down in parts of the central belt this is down at 2.6%. All over Scotland there are thousands of vacancies for nurses and allied health professionals alike. However, the challenges to fill those vacancies within the rural highlands depend on aspects that are area specific.
When speaking to a retired health professional who still lives in a rural area of the Highlands he makes it very clear that accommodation is still hard to come by in a lot of rural areas in the Highlands making it one of the most pressing barriers to people finding jobs there. For new doctors, nurses or allied health professionals there is a lack of affordable housing. Soaring house prices and an increase in holiday lets have left the prospect of moving to the islands unattainable, if people don’t have access to modern housing they wont move. This then begs the issue why don’t we provide accommodation for nurses, and doctors in these areas, the way it used to be back in the day.
The knock-on effect is GP practices up and down in these areas struggle to fill doctor posts. However, he believes that many forget that to be a doctor in this part of the world, you first have to be content with a different life, one that means you wont be living right next door to the pub or a handful of restaurants and shops, it’s a much quieter way of living.
Above all else health professionals such as doctors and nurses in rural and remote areas need to be highly skilled. Unfortunately an ambulance may be an hour away and there are no specialists on hand, so nurses and GPs need to have that extra bit of training and expertise in order to ‘plug the gap’. When working on islands such as Orkney, GPs have no option but to be some of the best generalists in Scotland, and quite often finding someone who will do the job can be difficult.
This isn’t however the only area that is struggling, dentistry has taken a big hit within the Highlands. After multiple closures and an inability to fill the vacancies of retiring dentists, the residents of Ullapool are having to make the hard choice between private dentistry care and very long journeys to access NHS care. Up and down Scotland people are struggling to find dentists that are accepting new patients, it’s a real problem right now that doesn’t seem to be getting better. And for those living in Ullapool the 100 mile round-trip to Inverness for a check-up would be enough for anyone to be put it off. An issue that could end up costing the NHS a lot more in the long-term if there is no preventative care in place.
Although the dentistry profession is particularly scarce as of late it isn’t on its own. GP practices have in some cases struggled to grapple with partners deciding to retire or quit. Meaning many health boards have had no choice but to step in and save them, just like the island based Barra Medical Practice.
Healthcare provision in the remote and rural of the Highlands has always been expensive, per head it costs more as travel is such a central aspect of it. This is further exasperated by a funding model that assumes a standardised method that doesn’t take into account these inflated costs. From traveling to patients, to patients also having to travel further to be seen, perhaps having to get a ferry or plane to have routine procedures that most of us can take for granted.
The stresses that people in the rural and remote of the North of Scotland have can be quite significant. Many will have to travel a significant distance to access services and treatments such as MRIs, cancer treatments and minor surgeries, usually these take place in Inverness but sometimes this can be further afield in Aberdeen, such as maternity. Then in the most serious and specialist cases patients may have to travel to Glasgow.
However, what are you going to do if the lifeline of flights to the mainland have been axed? Logan air have suspended some flights for up to a whole six weeks, which the NHS Western Isles estimates could affect around 500 patients. The strikes mean that people in the Western isles will have trouble getting to the mainland, as well as medical professionals being unable to get to the islands. Many of the most pressing care for patients will carry on but now people will have to use ferries, taking more time in general, time off of work etc. For some using ferries it is simply not practical, taking longer time away from family and work responsibilities and having to either drive of use public transport is not a great alternative when undergoing treatments. Additionally, health boards in both Edinburgh and Glasgow have stated that they don’t have the capacity to accept more patients. The medical repercussions of patients not being able to access medical services could have a long-term effect, but it also puts extra pressure on those living on the islands. To live remotely is a commitment and it would be a great shame if populations started to dwindle even more.
But do the government truly understand these hardships? In the past couple of years they decided the best way to attract more people to the islands was to offer a cash sum of £50,000 to young families if they relocated. This got scrapped in the face of criticisms from islanders who rightfully pointed out that this is in no way addressing the current problems of de-population, such as access to accommodation. Perhaps if they investigated the reasons people feel compelled to leave in the first place then this issue would begin to rectify itself.
Recent events really have put the pressure on those living in rural environments, overall making it a much more difficult and expensive place to settle down. From closures, budget cuts, travel disruptions and workforce vacancies, all contributing to a swirl of issues for those living in the most northern parts of Scotland.