National Centre for Remote and Rural Health and Care: evaluation

Chapter 1: Introduction

Policy Context

Rural Scotland accounts for 98% of the country’s land mass, 70% classified as remote rural and 28% as accessible rural and is home to around 17% of the population.^[1]

These communities face distinctive challenges that impact health and wellbeing outcomes. Although life expectancy remains higher than the national average, rates of mental health conditions, drug and alcohol-related disorders and other health inequalities are disproportionately high. Many of these issues have been exacerbated by the COVID-19 pandemic. ^[2]

Structural factors compound these challenges. Outward migration and an ageing population have reduced the available workforce, while high levels of chronic disease increase demand for care. Recruitment and retention of health and care staff remain persistent problems, and the lack of economies of scale drives up costs for infrastructure, transport and service delivery. Addressing these issues requires a cost-effective, evidence-based approach to planning, delivering and evaluating healthcare services for remote, rural and island communities. ^[3]

Overview of The National Centre

The Scottish Government established the National Centre for Remote and Rural Health and Care (National Centre) in October 2023, commissioning NHS Education for Scotland (NES) as its strategic delivery partner. The National Centre had an available budget of £2.97m over a three-year period (April 2023 – March 2026) which incorporated a development phase, a substantive two-year delivery phase, and a six-month extension. The National Centre operates as a hub for information, training, research, leadership, and networking for Scotland’s rural health practitioners. The National Centre’s overarching aim is to improve care for remote, rural, and island communities by strengthening the sustainability, capacity and capability of primary care and community-based services.

The National Centre’s work is organised around four pillars:

• Education and Training: Expanding access to tailored learning resources and professional development opportunities.
• Research and Evaluation: Building the evidence base for rural health and care and embedding evaluation into service design.
• Recruitment and Retention: Supporting workforce stability through practical frameworks and collaborative approaches.
• Leadership and Best Practice: Developing leadership capacity and sharing models of excellence across rural health systems.

Purpose of the Evaluation

The evaluation covers the substantive two-year delivery period from October 2023 to September 2025, and not the development phase or six-month extension. The evaluation was commissioned to assess the National Centre’s progress on the basis of an agreed business case and a set of defined targets. The evaluation examines the extent to which the Centre has delivered against these targets, the benefits and challenges experienced by stakeholders and opportunities to strengthen its impact. The evaluation did not look at an economic evaluation of the National Centre, or at longer term outcomes for remote, rural and island communities. Findings will inform decisions about the National Centre’s future, including whether and how its remit should expand beyond primary care to encompass wider aspects of rural health and social care.

This report provides an assessment of achievements, challenges and areas for improvement during the funded period, recognising that some impacts are still emerging but that delivery against agreed objectives can be measured.