One of the satisfying aspects of running a blog is the quality of response it can elicit. It doesn’t matter if the replies agree or not with the original but that they are insightful and written to inform (I get plenty of the other kind). I have broken out this contribution to Alasdair Stephen’s blog because it lends perspective and analysis to the topic as well as a different outlook and optimism. My thanks to Steven Asaneilean in Skye. He writes:
Housing is a long-standing issue in Skye and elsewhere – as it was 20 years ago. I, like Alasdair, could no longer afford to buy the land and build the house that I did in 1998 (land cost then £18,000, now £70,000 for example).
But the problems begin when we look at these challenges to rural areas in isolation. We need an umbrella approach that looks at housing, transport, school, sustained (and well paid) employment, etc.
I am sceptical too about Alasdair’s faith in IT. My own interest is in healthcare delivery to remote communities. To quote a recent iScot article:
“The Dewar Committee Report of 1912 led to the formation of the Highlands and Islands Medical Scheme which itself formed the blueprint for the NHS over 40 years later.
One of the issues highlighted by the Report was the poverty of telecommunications in rural areas – “There is abundant evidence to show that liberal extension of telephone communication in connection with the medical service would be a great public boon, and pre-eminently in the case of insular and remote centres where a trained nurse is stationed. She could discuss a case with the doctor and take his detailed instructions. At present efforts are often made to communicate by telegraph, which for purposes of medical inquiry and advice, is cumbersome and unsatisfactory. The Committee were surprised to be told that the Post Office was contemplating the withdrawal of telegraph service from some of the remote Western Islands. We strongly deprecate any such action”.
Sadly 100 years later perhaps not much has changed. The Offcom report “Connected Nations 2015 (Scotland)” found that “it remains the case that the individual nations of Scotland, Wales and Northern Ireland, as well as rural England, see lower availability of communication services”.
On every measure Scotland fares worse than the rest of the UK. For “old fashioned” 2G voice coverage Scotland stands at 95% compared to 98% in England and 97% for the UK as a whole. For outdoor 3G voice and data the figure for Scotland is 79% compared to 88% for the UK and 91% for England. And for superfast broadband coverage the figures are 73%, 83% and 84% respectively.
But when we “drill down” to rural Scotland the differences are even starker. The coverage for super fast broadband in rural Scotland is as little as 31% and whilst urban Scotland enjoys average download speeds of 31Mbits/sec in rural Scotland the figure is only 11Mb/s. Overall in Scotland only about 14% of premises are unable to get download speeds in excess of 10Mb/s. But in rural Scotland it’s 57%, with Argyll and Bute fairing even worse at 70% and the Western Isles at a whopping 90%.
Around 20% of premises in Scotland are complete or partial “not spots” for indoor voice and outdoor data coverage. But in rural Scotland the figure is 73%.
Dr Andrew Inglis, a Consultant in Emergency Medicine who works for Scotland’s Emergency Medical Retrieval Service, says “a modern reliable mobile phone network across remote and rural Scotland would benefit the NHS in terms of improved quality of healthcare and reduced costs. The use of phone, camera, video and computer technology can enhance the delivery and sustainability of locally delivered care with savings in time and cost. Rural general practice is challenging with recruitment and logistics difficulties. Communication is a key issue. Out-of-hours cover for remote general practice can be problematic and many rural areas have concerns regarding emergency ambulance provision”. He distributes regular updates on communication issues but hasn’t done so now for about 11 months. When asked why recently he said it was because nothing had really changed in that time.
There is a growing body of evidence from across the world as to the value of out of hospital photographic and video links e.g. with road traffic accidents and other case of trauma, dermatological conditions, etc.
In addition, the ability to transmit data remotely can be invaluable – a ECG in someone with chest pain or the home monitoring of someone with a chronic medical condition – reducing the need for costly and time consuming visits to hospital clinics and allowing early intervention from local primary healthcare teams. A project in the Western Isles showed that the use of such technology reduced appointment cancellations and as a result reduced travel costs for visiting consultants.
A poor rural mobile network prevents communities from taking advantage of these advances in technology and ends up costing the NHS more.
In 2015 the Scottish Government, working in partnership with COSLA, BT, Highlands & Islands Enterprise and the EU Regional Development Fund, launched an ambitious £412 million project aiming to extend high speed broadband to around 95% of Scotland by the end of March 2018. But a target of 95% of the population still excludes quarter of a million people.
And there are major challenges for delivering such services to rural Scotland compared to other rural parts of the UK. For example, longer line lengths and longer distances from exchanges results in serious signal deterioration between the fibre cabinet and the end users of the service.
The Scottish Government’s programme is being monitored by Audit Scotland who published their latest update on 18th August 2016. It talked about the “good progress” being made but acknowledged that “extending coverage to rural areas remains a challenge”. So far the Government scheme is ahead of target but “the remainder of the roll out will be more challenging”.
Caroline Gardner, Scotland’s Auditor General said “It’s encouraging to see good progress being made in rolling out fibre broadband. However, there is a lot still to be done by the Scottish Government if it is to achieve its vision of a world class digital infrastructure, particularly in improving download speeds in rural areas. It’s important that it continues to monitor the cost and progress of broadband roll out so that these communities aren’t excluded”.
There is also another potential “dark spot” on the horizon over which Scottish Government has no control.
The Emergency Services Network (ESN) is the means by which emergency services communicate within and among themselves. The UK Government put the current Airwaves service up for tender and awarded the contract for providing a new system to EE – a company which recently advised some customers in rural Scotland to switch to alternative providers as they could no longer guarantee a service in their locality. It’s clear that if EE are to match the existing Airwave service they will have to significantly improve their current level of remote rural coverage.
Those of us working in remote rural healthcare can look with some degree of envy at other parts of the world. The following was gleaned from a recent email exchange with international colleagues.
In Labrador, Canada telehealth via 3G wireless is provided to all remote communities and between a general hospital in Goose Bay and a specialist hospital in St Johns, Newfoundland. This service is available 24 hours a day, 365 days a year. The emergency department in Goose Bay uses telehealth to support the management of cardiac arrest or major trauma by remote teams on the ground. The Labrador telehealth system also supports primary care in the management of acute and chronic disease and provides access to specialist opinion. The service is felt to save money and save lives.
Meanwhile remote rural healthcare workers in Queensland, Australia use telemedicine as a routine part of their medical practice. Tiny Thursday Island in the Torres Strait routinely uses telemedicine to link with specialist centres over 1000Km away.
And a conference held in Inverness earlier this year heard how a community-led health service uses telecommunication to support healthcare assistants to provide services to remote Alaskan communities sometimes with as few as 20 households; in northern Sweden the remote area of Norrbotten, an area larger than Scotland but with only quarter of a million people, has universal 4G coverage; the Peruvian part of the Amazon basin mobile phones, charged with solar energy, are being used to help local women to provide healthcare in their own villages; in Kenya nomadic people are using mobile phones to access healthcare consultations remotely; and in Rwanda they are aiming to provide 4G coverage to over 95% of their population to allow a new generation of doctors and healthcare workers to work in remote parts of that country.
British Telecom seems to be aware of the challenges. They have recently launched a trial project covering only 20 household in the Township of North Tolsta in Lewis. A new technology, Long Reach VSDL, aims to overcome the loss of speed caused by the long distances from the fibre cabinet to the end users.
Other rural communities in Scotland are taking matters into their own hands. The local community development trust on the island of Coll have teamed up with the Scottish Futures Trust and Vodafone to have a community-owned mast providing 3G and 4G signals for the island as an alternative solution to the provision of broadband.
In Argyll a community-led and community-owned project, GigaPlus Argyll is being supported by Highlands & Island Enterprise in their attempts to download speeds from 2Mb/s to as much as 50Mb/s in Colonsay, Mull, Iona, Jura, Islay, Lismore and Craignish.
So whilst the doubts of Hollyrood’s opposition parties and the caution expressed by Audit Scotland are undoubtedly justified there are definite glimmers of hope out there. And perhaps by 2020 we here in rural Scotland can have the kind of telecommunications network that other remote parts of the world already take for granted.by