Silent collapse of Scotland's rural healthcare is so bad it's fuelling depopulation

Some elderly people have quietly stopped asking for medical help, even though they need it, because it can be so difficult to get

In remote and rural parts of Scotland – from the Outer Hebrides to the villages of Argyll – healthcare is quietly unravelling. While headlines focus on waiting times in urban hospitals and political debates over centralised health boards, many rural residents are being left behind, unseen and unheard.

For people in the Highlands and Islands, access to basic medical care is no longer guaranteed. It is becoming increasingly normal for patients to wait weeks for a GP appointment, travel several hours for routine procedures, or go without mental health support altogether. This is not what a functioning national health service should look like.

Over the past year, I have spoken with countless residents across Kintyre and the Islands who are struggling to access the care they need. Some have told me of long journeys by ferry and road simply to attend a consultant appointment. Others, especially the elderly and those without access to private transport, have quietly stopped asking for help – not because they don’t need it, but because they know how difficult it will be to get.

Many GP surgeries in rural areas are desperately short-staffed (Picture: Anthony Devlin) | PA

Too few GPs

These are not isolated cases. They are signs of a system under enormous pressure and one that is failing to provide even the most basic level of service to rural Scotland.

Recruitment is one of the most immediate and visible issues. Many GP surgeries in rural areas are desperately short-staffed, relying on locums or running at reduced capacity. In some places, entire practices have been forced to close or merge, leaving patients with little continuity of care. Those lucky enough to see the same doctor regularly are becoming a rarity.

Specialist services are even more stretched. Access to physiotherapy, speech and language therapy, and mental health support is minimal in many rural locations. Even services meant to operate at a community level, such as district nurses and health visitors, are finding it increasingly difficult to meet demand.

Meanwhile, ambulance response times in rural areas continue to raise alarm. Geographic distance alone already puts patients at greater risk, but when this is combined with under-resourcing and lack of emergency cover, it becomes genuinely dangerous.

I have heard from families who waited over an hour for help to arrive during a medical emergency — not due to incompetence or unwillingness, but because there was simply no one available any sooner.

Extraordinary dedication of staff

It would be wrong to place the blame for this situation on the shoulders of individual NHS workers. On the contrary, the frontline staff working across the Highlands and Islands show extraordinary dedication, resilience, and care.

But they are being asked to do more and more with less and less. The cracks in the system are growing, and goodwill alone cannot keep vital services afloat.

The problem is structural. The current model of delivering healthcare in rural Scotland is no longer fit for purpose. It depends too heavily on centralised planning, urban-based resourcing, and a one-size-fits-all approach that does not work in dispersed, low-population areas.

Lack of accountability

Technology, we are often told, will bridge this gap. And while digital health solutions such as video consultations can play a role, they are no substitute for a hands-on examination or an in-person diagnosis. Digital appointments also assume a level of broadband access and digital confidence that is simply not realistic for many, especially older residents.

Health and social care integration was intended to improve outcomes, reduce duplication, and provide more joined-up care. In practice, however, the integration of services has often resulted in confusion, gaps in provision, and a lack of accountability.

Lines of responsibility between NHS boards and local councils remain blurred, making it harder for patients and their families to get answers or to challenge poor service.

Rural depopulation

The consequences are not just medical – they are social and economic. Poor healthcare access undermines the viability of rural communities. Families are reluctant to move to or remain in areas where support is minimal.

Older residents face the prospect of having to relocate simply to be closer to services. The long-term impact is rural depopulation, further weakening the fabric of already fragile communities.

If the Scottish Government is serious about equality of access, then rural Scotland must be prioritised – not as an afterthought, but as a key part of national health planning. That means more funding for rural health boards, greater flexibility in recruitment, and incentives to attract healthcare professionals to live and work in rural areas.

Rural lives matter less?

It also means a renewed commitment to rural hospitals and health centres. These local facilities provide more than just care – they are anchors for communities. Every time one is closed or downgraded, it sends a clear signal that rural lives matter less.

In my own council ward, I will continue to push for greater transparency, proper staffing, and investment in frontline health and social care. But change is needed at a national level too.

Politicians must stop viewing rural health as an add-on to the broader NHS strategy. It is a core test of whether we truly believe in equal access for all – or whether we are content to allow postcode lotteries to define people’s health outcomes.

The silent collapse of rural healthcare won’t remain silent for much longer. Those of us living in these communities will continue to speak up, and we will keep demanding the same dignity, care, and attention that others rightly expect.

Rural Scotland is not asking for special treatment. We are asking to be treated fairly – before it’s too late.

Alastair Redman is an independent councillor for Kintyre and the Islands on Argyll and Bute Council