Care challenges in rural and island regions threaten long-term economic sustainability

Rural and island communities across Scotland face growing challenges in delivering both elderly care and childcare, as rapidly ageing populations, workforce shortages and rising costs place increasing strain on local services and economies, according to a new report. 

The report, led by SRUC and undertaken as part of the Scottish Government’s Strategic Research Programme 2022-2027, reveals new insights into how demographic change is driving a reshaping of demand for care in rural and island communities at a much faster pace than in urban Scotland, and examines spatial differences and how pressures have intensified over time. 

While many older residents continue working beyond the age of 65 and make vital contributions to fragile local economies, SRUC researchers warn that reliance on older workers may mask deeper structural pressures in health, social care and childcare provision. 

Professor Steven Thomson, lead author of the report, said: “Rural and island communities are experiencing a double challenge: rising demand for elderly care alongside persistent barriers to accessing affordable childcare. Both are essential to sustaining local workforces and economic activity, yet both are becoming harder to deliver in areas facing ageing populations, recruitment difficulties and higher operating costs.” 

The report finds that ageing populations, declining numbers of working-age adults and a shrinking care workforce are already limiting the capacity of rural and island areas to meet care needs locally. In some communities, a declining care-home footprint and difficulties recruiting health and social care staff mean older residents are increasingly reliant on informal, family-based or community support, often placing additional pressure on households already facing high living costs. 

At the same time, limited access to affordable childcare is constraining opportunities for younger families, particularly women, to participate fully in the labour market. These barriers reinforce population decline and undermine efforts to attract and retain working-age residents, creating long-term risks for economic sustainability. 

The findings underline the importance of a community-oriented approach to health and social care, one that reflects the realities of rural geography, dispersed populations and higher service delivery costs. Researchers also link care provision directly to economic outcomes, noting that healthy life expectancy, the ability to remain economically active in later life and the availability of childcare, are all critical to sustaining rural and island economies. 

Child poverty remains a serious concern, with one in five children in rural areas living in relative poverty. Families often face limited access to childcare, healthcare and transport, compounding financial pressures and reducing employment options. For older residents, higher fuel costs, poorer housing energy efficiency and reduced service access further exacerbate inequality and vulnerability. 

Based on the evidence presented, the report calls for coordinated, long-term investment to address care provision alongside housing, transport, digital connectivity and workforce development. 

Priority actions identified include: 

• Strengthening community-based health, social care and childcare provision 
• Tackling workforce shortages through targeted recruitment, training and housing support 
• Supporting demographic renewal by improving conditions for families and younger workers 
• Ensuring care, decarbonisation and infrastructure policies reflect rural and island realities 
• Embedding community voices in planning and decision-making.

As well as addressing the challenges of childcare and elderly care provision in rural areas, the report explores a range of other critical issues, including demographic change, experiences of poverty (including fuel poverty), transport and connectivity (including changing freight volumes at Scotland’s ports and the seasonality of car and passenger travel by ferries, and digital connectivity), housing and energy costs, and changes in agriculture (including changes in livestock numbers, workforce engagement rates, payment levels to farmers, and supported activity on common grazings).  

The research was led by Professor Steven Thomson alongside researchers Jenny McMillan, Dr Francis Naab, Lorna Pate, Dr Ana Winship, Bryony Nelson, Dr Ian Merrell, Natasha Coleman and Dr Jane Atterton. 

Further analysis will be published over the coming year, drawing on new census outputs across demography, migration, housing, education, labour markets and health. 

The report is available here: Rural & Islands Insight Report 2025Rural & Islands Insight 2025 

And also in figshare here: https://doi.org/10.58073/SRUC.30268243 

This Novel Insights on Scotland’s Rural and Island Economies (NISRIE) project is funded within the Rural Futures Theme of the Scottish Government's 2022-27 Strategic Research Programme on Environment, Natural Resources and Agriculture. 

Posted by SRUC News on 22/12/2025