Rural families are hit by poverty and poor medical cover

slower, but after falling between 2011 and 2014, has been rising. And in older age groups the death rate, which had been falling until 2011, has remained static.

In her report on west of Scotland rural areas, released last March, Dr Irvine found that since the economic downturn of 2008, the death rate in Forth Valley, Argyll and Bute, Dumfries and Galloway and Ayrshire and Arran had increased far more than in Greater Glasgow.

Between 2009 and 2016 it rose by 1.4% in Greater Glasgow and Clyde, but 5.4% in Forth Valley, while the increase in the other rural areas was between 3 and 4%.

We told last year how doctors were concerned the new GP contract was letting down patients in rural areas. They warned new payment structures did not properly reflect the wide range of extra services offered by medical practices in countryside postcodes.

Former GP Peter Murchie, professor of primary care research at the University of Aberdeen, carried out a study which showed people in rural areas are 5% less likely to survive cancer. A study in northeast Scotland also found that people living more than an hour from their nearest major hospital also have poorer cancer survival rates – despite being more likely to be diagnosed and treated faster.

He said: “Providing access to specialist healthcare and also access to GPS with the ongoing recruitment crisis is a real challenge. It’s disproportionately affecting rural areas. There’s the issue of provision of services that are appropriately staffed or people having the burden to travel to care. We think that might be important to post- cancer treatment. Beyond that is the policy and service organisation. There is a drive to centralise services.”

Some communities have been fighting for access to better service. Islanders on Raasay, for example, have been battling with NHS Highland for three years for a nurse on the island. The post was not filled after the last nurse left in 2015.

“NHS Highland say they could not find a replacement but we believe they did not try hard enough and that this is financial decision,” said Raasay Community Council leader Anne Gillies. “We have nurses who come in on the ferry from Skye but not if the weather is bad and it can be often, especially in winter. “Healthcare is geared to urban areas. All we are looking for is equality of access.”

Rhoda Grant, Labour MSP for the Highlands and Islands, said: “I have constituents telling me that the elderly are suffering from malnutrition. Some are fed crackers and cheese instead of a meal because carers only have an allotted time to feed and assist them. Many employed carers are working unpaid in their free time to feed and care for elderly. There is an acute shortage of GPS and more centralisation of medical services. I find the increase and stalling of deaths worrying – especially the increase in younger people.”

NHS Highland says deaths in specific age groups may fluctuate from year to year and that other recent studies have noted the stalling in life expectancy increases across the UK.

It said: “We recognise the importance on the health of children and young people and would want to carefully watch the possible trend that Dr Irvine has identified over the next few years, to see if it returns to a more expected value, or continues to be an outlier. In such circumstances we would want to investigate possible causes of such a finding over a number of years.”

Hugo van Woerden, director of public health, said: “NHS Highland is a healthy place to live, with strong and vibrant communities and we are proud of the services that are provided to its population by a dedicated health and social care workforce.”

The Scottish Government said: “Any instance of a rise in death rates is a concern for the Scottish Government and for health boards. We carefully monitor such data and, were a trend to become sustained, we would need clear evidence of any underlying factors.

“However, what is clear is that we have a record number of GPS working in Scotland – and in NHS Highland, GP numbers in 2018 were at their highest since 2012.”

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