Health challenges for rural Scotland

Sir, – Dr Iain Kennedy is right to highlight challenges facing health services across rural Scotland (NHS in Scotland “has big rural problem”, says top Highland doctor, January 4) but it’s essential palliative and end-of-life care is not overlooked.

Scotland has an ageing population, and higher elderly populations in remote and rural areas. By 2040, the biggest increase in palliative care demand will be for over-85s, meaning a large proportion of future need will be in remote and rural areas, but there are long-standing challenges to overcome:

Availability of resources for palliative and end-of-life care providers, including specialist palliative care teams, social care workforce and carers;

Accessibility – the challenges terminally ill people, families and carers face accessing palliative care, including access to medicines and pharmacy support;

Accommodation - how palliative care providers meet terminally ill people’s needs, including out of hours, but also relates to limited rural housing stock for workers, and ensuring patients’ accommodation is fit to receive palliative care at home;

Affordability – the “rural premium” means rural and remote areas face significantly higher costs in housing, energy, food, and transport before costs associated with terminal illness (£12-16,000 per year).

The Scottish Government and National Centre for Remote and Rural Health and Care must prioritise the “four As” in the short, medium and long-term priorities for the centre, and the government’s upcoming remote and rural workforce strategy.

Ellie Wagstaff,

Marie Curie Scotland.