Call to Netherlands to supply doctors and health professionals is an early warning sign, writes Ken Mann

Mulit-culturalism is a good thing. But when does a good thing become too much of a good thing, and cause us to reflect ruefully upon past mistakes?

Some rapid clarity is in order - what follows is nothing to do with border controls, although in this case the subject of borders is largely delete by virtue of the fact that the people involved in this discourse will come from another EU nation. Indeed, a northern European nation sharing pretty much all of our values.

The issue here is about whether as a nation - you can make that mean Scottish or British, depending upon your leanings - we are producing enough professionals to meet a fundamental need in society.

This week has been dominated by another news agenda but did you hear about the moves by NHS Highland to actively recruit doctors and other health professionals from The Netherlands? It has taken space in a major Dutch newspaper and established a micro-site accessible on the internet as a bridgehead to that strategic end.

The Dutch are an upstanding bunch, punching well above their weight of numbers in all manner of knowledge-based, highly advanced technical and professional matters as well as a strong heritage that is international in scope. Their mainly eloquent command of English once again reminds us of our own generally lacklustre grasp of other languages, notwithstanding the practical reasons set in history for that situation. They are not unlike the Scots/Brits, then. But why the need to so proactively go abroad?

With what I find to be an uncomfortable lifestyle-focused tone, Elaine Mead, chief executive of NHS Highland, expounds: "Ours is a beautiful area where the quality and pace of life are exactly what many professional people are looking for.

"We already have a multi-cultural workforce and actively seek to recruit people from outside the UK. The fact that there are now regular flights between Amsterdam and Inverness might help to persuade doctors and other professionals in Holland to consider working with us."

Sorry to be pedantic, but "Holland" is not The Netherlands - the latter being the 12 provinces presumably from which Ms Mead hopes to attract talented staff, the former being two of the largest - North Holland and South Holland, known collectively as Holland. You can tell I'm already getting warm under the collar, but my frustration is not aimed at Ms Mead. My final analysis may surprise.

Inverness is home to a modern 500-bed district general hospital serving a predictably wide geographical area - representing 42 per cent of Scotland's land mass and a population of 320,000. There are 23 other hospitals in the territory. The list of medical specialities required is extensive - this is not a limited exercise in A&E supply-and-demand firefighting. In expanding its workforce, NHS Highland is searching for those disciplined in oncology, radiology, rheumatology, anaesthetics, neurology, ophthalmology, urology, paediatrics, psychiatry, general surgeons and physicians, oral and maxillofacial surgery (treatment of diseases affecting the mouth, jaw, face and neck), trauma and orthopaedics, and obstetrics and gynaecology.

NHS Highland is also behind a recruitment campaign for more GPs to work in some of the more remote and rural communities.

Elaine Mead adds: "We are confident that there must be many GPs, either newly qualified or experienced, who would relish the lifestyle and career opportunities working in some of our more remote areas would provide.

"There are also very real positives to practising in such an area. The workload is enormously varied, it's possible to spend more time with patients and doctors can truly make a difference - working with communities, colleagues and others helping to shape services."

Scottish Government support has been made available to the health board through the Being Here programme. A notably healthy £1.5 million has been granted to help it devise and test innovative ways of recruiting healthcare professionals, and particularly GPs, in remote and rural areas. Working in the Highlands may not float everyone's boat, as the existence of the campaign surely attests.

Arguably, that's a more acute feeling among young medics who may be keen skiers/boarders, or walkers/climbers/mountain bikers, but prefer to retreat to their year-round bigger city attractions. Even so, the Highland region has its own brand of all-seasons draw, so what's up?

It's an ugly fact that in an advanced and sophisticated economy like Scotland we simply don't have enough doctors and other specialists to go around, particularly - but not exclusively, as you can see - in emergency medicine and at times of peak demand.

Scotland has some of the finest medical schools in the world but what I think we are seeing in the NHS Highland example is a combination of a narrower geographic appeal (which would otherwise be no big deal) with a matter that is, to a lesser extent, affecting the engineering professions.

Blame successive governments of all colours on education policy in state schools and university funding slides. Prospective doctors need top grades in Highers to enter medical courses. The fallout from the past decade when the maths and science subjects necessary to book a place were not sufficiently encouraged, persists - strangling the feeder routes. Multiple mismatches exist in applicant numbers/capabilities versus available places.

This patient has complications - and will be under observation for some time.