By the time Scotland went into lockdown exactly four years ago this weekend, many NHS services had already been suspended.

Routine cancer screening was paused, non-urgent elective procedures were put on hold, and chemotherapy was temporarily halted for some cancer patients until more was understood about the dangers from Covid.

Less headline-grabbing at the time was its pernicious impact on rural healthcare services, some of which were withdrawn only to eventually resume in a virtual or scaled-back form - or not at all.

In Dumfries and Galloway, four cottage hospitals - in Kirkcudbright, Moffat, Thornhill, and Newton Stewart - were mothballed.

They have never re-opened and a proposal to close them permanently and sell off the sites is one of six options now under consideration by the region's Integrated Joint Board (IJB), with a final decision due in September.


"The threat of closure of cottage hospitals has been around for a long time, but - call me cynical - a lot of people feel that the pandemic offered an opportunity," said Dougie Campbell, an independent councillor whose Dee and Glenkens constituency encompasses Kirkcudbright.

"The cottage hospitals were closed on the basis that they would be a difficult space to try and prevent the spread of the virus."

Prior to the pandemic, Kirkcudbright cottage hospital had 14 inpatient beds providing palliative care, outpatient services, and step-up/step-down care to help keep frail elderly patients out of - or speed their discharge from - acute hospitals, for example with post-operative rehabilitation.

Today, patients have to travel around 30 miles to the Royal Infirmary in Dumfries or nearly 50 miles to the community hospital in Stranraer.

The Herald: The hospital in Kirkcudbright was one of four mothballed at the beginning of the pandemic which have never re-openedThe hospital in Kirkcudbright was one of four mothballed at the beginning of the pandemic which have never re-opened (Image: Colin Mearns/Herald&Times)

Mr Campbell, a founding member of the Kirkcudbright Community Hospital Action Group, said: "We've got very poor public transport. We've got a very significant ageing population.

"We lose young people and gain people who come her to retire - including me. I came down from Glasgow in 2011.

"Things aren't looking good for us locally, but as long as the final decision hasn't been made about the cottage hospitals we'll keep fighting.

“Across the board, services are reducing and reducing, and it feels as though rural services are an easy target.

"Our frustration is that they don't seem to realise how difficult it is for people to access services.

"We've had situations where people have been terminally ill and family members have had great difficulty getting to visit them because they are either in Dumfries or Stranraer."

The Herald: The size of the population over 65 is growing in Dumfries and Galloway, while the working age and child populations have been shrinking over the past 20 yearsThe size of the population over 65 is growing in Dumfries and Galloway, while the working age and child populations have been shrinking over the past 20 years (Image: NRS)

Concerns have also been raised about IJB plans to buy up 31 "flexi" beds instead in the region's privately-owned care homes - including five in the Kirkcudbright area.

The initiative is expected to cost around £1.2 million, but there are warnings that social care in Dumfries and Galloway is already stretched and under-staffed and that care homes are ill-equipped to provide rehab and palliative care for hospital patients.

In a letter to NHS Dumfries and Galloway's chief executive, Jeff Ace, dated March 7, Pauline Drysdale - chair of the council's social work committee - said she and her colleagues had "grave concerns" about the plan.

She noted that Care at Home provision in the region is already running at a shortfall of around 3,500 hours per week "due to a shortage of frontline staff", with these issues also affecting care homes.

The Herald: The village of Kirkcudbright has a large older populationThe village of Kirkcudbright has a large older population (Image: Colin Mearns/Herald&Times)

Roughly 90 care home beds are unoccupied because there are too few staff to operate them safely, leading to fears that if existing available beds are ring-fenced for the IJB it could ultimately lead to even longer waits for elderly people in need of a care home place.

Ms Drysdale added: "If staff cannot be recruited to work in the social care sector, we have grave concerns that any change to care home purpose and function will simply result in less long-term care home places.

"When combined with a lack of Care at Home service provision, more rather than less of our elderly residents may require an extended stay in acute NHS establishments."

Despite its elderly population - 27% of Dumfries and Galloway residents are over 65 - the number of care home beds in the region has shrunk by 12% over the past decade, four times faster than the Scottish average.

Meanwhile, the number of acute hospital beds fell from 398 in 2016/17 to 313 by 2021/22.

According to figures for January, an average of 95 acute beds - 30% - were occupied at any one time by a patient ready to be discharged. The national average is 14%.

The Herald: Kirkcudbright High StreetKirkcudbright High Street (Image: Colin Mearns/Herald&Times)

The current proposals by the IJB follow its Right Care Right Place programme, a process of community engagement and consultation launched in October 2022.

In its report on March 5, it said that "high numbers of people in the cottage hospitals could be better supported in other settings" and that feedback regarding resuming bed-based services at these sites had come "mostly from hospital action groups, staff and elected members rather than members of the general public".

No final decision has been taken on their future, with other options under consideration including using them for a blend of outpatient clinics and day treatment or even transferring them into community ownership.

It comes as NHS Dumfries and Galloway predicts that it is headed for a budget deficit of £35 million by the end of the financial year in April.

Against this "very stark financial situation", fears are now mounting that the cuts could go beyond the cottage hospitals.

Councillor Willie Scobie, whose constituency covers the Stranraer area, said: "We're obviously concerned about the cottage hospitals - that's a longstanding issue - but since the health board announced that they've got this £35m deficit, they slipped in below the radar that they were going to 'review' the Galloway Community Hospital.

"That's a huge concern. We're talking about potentially reducing the Galloway hospital - that does operations, A&E  - down to a minor injuries [unit]."

The Herald: Councillor Willie Scobie has also been campaigning to restore maternity services in the regionCouncillor Willie Scobie has also been campaigning to restore maternity services in the region (Image: Colin Mearns/Herald&Times)

NHS bosses in the region faced heavy criticism earlier this month when they failed to attend a public meeting on the issue on March 8, but insisted that the review is unrelated to its budget deficit.

The withdrawal of the hospital's birthing suite in 2019 has previously been blamed for cases of "layby babies" as mothers gave birth in cars and ambulances parked at the side of the A75 after running out of time to get to Dumfries.

The health board said it had struggled to attract midwives, but an independent review last year recommended that a maternity hub with on-call midwives should be set up. No decision has yet been taken.

Mr Scobie said: "It's horrendous what's going on down here with maternity services.

"We've had women giving birth at the side of the road. One woman travelled 7000 miles back and forward to Dumfries during her pregnancy. Unbelievable."

Both Mr Scobie and Mr Campbell have voiced concerns that the councillors who sit as voting members on the IJB are not doing enough to challenge or scrutinise decision-making.

A motion due to go before the next full council meeting on March 28 will urge them to "take more of an interest in the threat to local healthcare services".


John Locke, a retired GP who spent 35 years as a partner at the Solway Medical Practice adjoining Kirkcudbright cottage hospital, said one of the biggest losses was palliative care.

He said: "For years, almost nobody who needed end-of-life care died in the hospice in Dumfries - that was unusual in Kirkcudbright.

"Nearly everyone was cared for locally, apart from the odd really complex person."

He added that being able to keep patients in the cottage hospital, with healthcare staff who knew them, had also helped to avoid over-treatment.

Dr Locke said: "I always thought it was part of my role as a GP to keep people away from the 'big hospital'.

"They tend to get a lot done to them that they don't need because they see doctors and nurses who don't know them - lots of assessments and scans and blood tests.

"Although a cottage hospital might look a bit more expensive to run, and they are a bit more expensive because you've got economies of scale, a lot of the other things are less expensive and that's why.

"We would take somebody into the cottage hospital and we would know their level, so to speak, and we'd have a fair idea when they were back to that level.

"Whereas if you don't know the person, maybe you've got unrealistic worries or expectations.

"So there's a lot of people coming [into hospital] now with a twice-a-day package of care and going out with a package of care three times a day, and that's often why they're waiting - because they're waiting for that extra bit of care to be added on.

"And of course, social services don't have the time to review these packages, so they're often started up and just keep going."

The Herald: Geoff Dean (inset) said rural communities felt 'ignored'Geoff Dean (inset) said rural communities felt 'ignored' (Image: Colin Mearns/Herald&Times)

Geoff Dean, who retired as a senior manager in Dumfries and Galloway's social work department and is now the spokesman for the Save Kirkcudbright Hospital Action Group, said the Right Care Right Place consultation "hasn't really listened to people".

He said: "The biggest feeling is that once again it's rural communities being ignored and everything centralised.

"We had an incident recently where an older person fell over and they had to wait an hour for a taxi to take them to Dumfries where previously they'd just have popped up the road [to the cottage hospital]. They were losing a lot of blood.

"Sometimes you'll have a taxi turn up and say 'I'm not taking them, they're too ill'.

"I know it's difficult to provide a health service in rural areas but we just think they should be looking at how they spend the money, not just saying 'we're going to close things because they cost us money'.

"They're not looking at the broader picture."

A spokesperson for NHS Dumfries and Galloway said its consultation, community engagement, and recent workshops had "produced several options for delivery of community health and social care" in the area. 

He added: "The next stage of the consultation process is to appraise these options and will involve stakeholders including people from the communities for each respective area.

"The options appraisals process will be carried out during April. 

"Once appraised the options will go out to the wider community for formal consultation. This will be a 12-week process running from April to July 2024.

"The formal consultation will be open to anyone.  We will be welcoming interest and input from individuals and community groups, all of whom have an important part to play in the overall process.

"The results of this consultation will be presented to Dumfries and Galloway Health and Social Care Partnership in August, and in September 2024 the Integration Joint Board will make its decision on how to proceed.

"NHS Dumfries and Galloway, Dumfries and Galloway Council, and the other members of the Partnership will then put the IJB’s decision into effect."