1 Introduction 3
1Demography, socio-economic trends and population health impacts. 6
3.1 Demographics 6
3.1.1Population Projections 6
3.1.2Age distribution of population 7
The biggest net loss of people is in the 17 to 20 age group – particularly young women. This is common across all Scottish island health boards though it is greatest among Western Isles population. Out migration of young persons is to some extent compensated by immigration but the net effect remains negative. In-migrants to Western Isles after period of increase has been declining in recent years and this is particularly among overseas working age in-migrants. This is reflected in the drop in National Insurance Number allocations to overseas nationals working in the Western Isles since 2007 particularly in the EU Accession States which has dropped from 80 to 30 in 2009 (Source: DWP) 9
3.2 Life expectancy / neonatal mortality 9
3.3 Socio-economic challenges and Rural Deprivation: 9
3.3.1Employment status 10
3.3.2Income deprivation 11
3.3.3Rural Deprivation 11
4.2 Hospitals / Specialised service 15
5Health Care Professionals 18
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6. Urban comparison area 20
7 Education and Training 26
7.1 Medical Education 26
Undergraduate medical training is the responsibility of Universities throughout Scotland. Workforce planning for intake numbers to University is the responsibility of the Scottish Government Health Department, informed by local NHS Board workforce planning. NHS Education for Scotland (NES) are responsible for the design, development, commissioning and Provision of post graduate medical training in Scotland. The delivery of postgraduate medical training requires a partnership approach between Deaneries, NES and local Health Boards. The quality of the training is overseen by the General Medical Council (GMC). There are four Deaneries in Scotland – the North Deanery is responsible for 5 Health Boards: Western Isles, Orkney, Shetland, Grampian and Highland. All North of Scotland Deanery Foundation Programmes (134 posts) offer as a minimum 4 months in a remote or rural placement, Aberdeen-based with a placement in one of the 6 Rural General Hospitals (RGHs). NHS Western Isles works with the North Deanery and is a Local Education provider – offering training placements across all specialities for doctors in Foundation years (FY) one and two and Specialist Trainees (ST). Modernising Medical Careers (MMC) and the new junior doctor appointments process, UK MMC Career Framework, effective from 01 August 2007, have resulted in delays in matching junior doctors to training positions and have left boards with unfilled posts. This appears to have had a disproportionately large effect on remote and rural and island Health Boards. 26
