Skye and Lochalsh

Skye and Lochalsh Seasonal population and its impact on primary and unscheduled care services Paper 3 of a population needs assessment for Skye and Lochalsh Health Intelligence Team Directorate of Public Health NHS Highland June 2019 The Health Intelligence Team are part of the Directorate of Public Health of NHS Highland and provide an expert resource of demographic and population health evidence. Health Intelligence Team Directorate of Public Health NHS Highland Larch House Stoneyfield Business Park Inverness IV2 7PA Telephone: 01463 704939 Fax: 01463 235189 Email: High-UHB.HealthIntelligence@nhs.net NHS Highland Public Health Directorate, Health Intelligence Team June 2019 2 Table of contents Table of contents ................................................................................................................... 3 Skye and Lochalsh Population Needs Assessment ............................................................... 3 Background ........................................................................................................................... 3 Tourism ................................................................................................................................. 4 Overnight stay visitor number estimates ................................................................................ 8 GP practice Temporary Resident registrations ...................................................................... 9 Unscheduled care seasonal patterns ....................................................................................13 Summary ..............................................................................................................................15 References ...........................................................................................................................16 Skye and Lochalsh Population Needs Assessment In this report we consider the seasonal population visiting Skye and Lochalsh and the associated impact on health service activity. This is the third report in a series that will contribute to a population needs assessment in relation to adult health and social care services for the area. Reference is also made to the area of South West Ross that includes Lochcarron. In the first report1 we looked at the demography and population dynamics of the area using available population estimates and projections. The second report2 reviewed the social context of the population health of the area through the lens of deprivation. A subsequent series of reports are planned that will look at mortality, morbidity and the implications for health and social care services. Further details of future reports are available in the Project Initiation Document (PID). The timescale for the epidemiological and comparative part of the needs assessment is from April to June 2019. Background The Skye Lochalsh and South West Ross (SLSWR) community reports a growing seasonal rise in the population of the area, driven by tourism. The estimated resident population of SLSWR in 2017 is 14,608 with 10,462 living on Skye1. Information on the levels and characteristics of tourism activity is available from a range of information sources at national and local level. However, this picture is partial with measures of local tourist impact being dependent on estimates most usually from the number staying in accommodation and day visitors. Visit Scotland, Visit Britain and The Highland Council provide estimates of visitor numbers based on surveys. Department for Transport publish traffic statistics for count points across the UK: site number 80594 covers the Skye bridge3. The best sources of information on the pattern of tourism in local areas are provided by detailed visitor studies. The Glasgow Caledonian University Moffat Centre4 has been commissioned to carry out an assessment of the impact of tourism on Skye and the results are expected to be available in early 2020. The effects of tourism activity on health care services will vary depending on the relative scale of visitor activity set against the levels of activity normally generated by local residents. NHS Highland Public Health Directorate, Health Intelligence Team June 2019 3 We can evidence that the tourist impact varies substantially by season of the year with particular pressures in the summer months. Visitors to the area access health services via NHS 24, Scottish Ambulance Service, Pharmacies, local GP Practices and Out of Hours services at Portree and Broadford hospitals. Health care in Scotland for holidaymakers from overseas is explained in the NHS inform leaflet5 and Portree Medical Centre have prepared a guide to accessing appropriate health care services6. In this report we look at how this may impact on health services for the local population where data are available; GP practices record temporary patient registrations and Out of Hours services data include patient postcodes. Non-resident use of secondary care services on Skye will be considered in work planned for the needs assessment on hospital activity (Project Initiation Document, Work-stream 3, Section 8.37). Tourism Visit Scotland reports that during 2017, the Highlands welcomed 534,000 international visitors, totalling almost 2 million bed nights, 17 percent of total international tourism in Scotland for 2017. In the same year, 2 million domestic visitors spent 8.6 million bed nights in the Highlands and Islands, 19 percent of total domestic tourism in Scotland. Over 14 million domestic day visitors went to the Highlands, 10 percent of the total day trips in Scotland in 20178. Figure 1: Visit Scotland, highest performing regional visitor attractions, 2017 Source: Visit Scotland Insight Department, Visitors to Highland and Islands8 https://www.visitscotland.org/binaries/content/assets/dot-org/pdf/research-papers-2/highlands-and-islands- regional-factsheet-2017-v2.pdf NHS Highland Public Health Directorate, Health Intelligence Team June 2019 4 The popularity of Skye for tourism has been accelerated by TV shows, adverts, music videos and social media9. The Isle of Skye is the most Instagrammed road trip attraction in Europe, according to recent social media analysis by Europcar10, with almost 21,000 posts; the Eiffel Tower has 12,463 posts. The Scotsman11 reports that Skye has become a popular destination for cruise ships between May and September. The Guardian9 writes that more than 30 cruise ships were scheduled to moor in Portree bay in the summer of 2017, each for less than a day and some with 2,200 passengers on board. Precise, up to date visitor data for Skye which distinguishes overnight stays and daytrips are difficult to obtain with most published survey results being at a national or regional level. It is widely reported that Skye attracts more than 500,000 visitors a year11,12.The Highland Council’s Principal Tourism Officer presented a paper on the challenges of tourism to the Isle of Skye and Raasay Committee in September 201813,14: “As we all know, tourism has been doing well and the estimated 2017 figures for Skye are 660k visitors, spending 1.6m overnight stays…This is reflected by the increase in tourism Highland-wide with Highland visitor attraction numbers up 10.5% to the end of June 2018” This is more than the 167,000 overnight visitors and 800,000 bed nights reported by Visit Scotland and Visit Britain as detailed in Table 1 and Table 2 below. However, Table 1 only includes international visits estimated as going to Portree town based on survey data. Visit Scotland do not list other towns on Skye; where international visitors advised other towns or were unable to give the name of a town but were able to give the county name, these are grouped by Highland instead; this grouping was estimated at 126,000 overnight international visitors for all Highland in 2017. The Skye Bridge was opened in 1995 and is the only road access onto Skye (although there are car ferries from Mallaig to Armadale and from Uig to Lochmaddy and Tarbert). Toll collection for crossing the bridge ceased in December 200415. The Press and Journal reported a drop in traffic over the Skye Bridge in 201816. Department of Transport publish traffic statistics based on counts and estimates3. The data for the Skye Bridge count site are illustrated in Figure 2 below, showing a 4 percent reduction between count years 2015 to 2017. No manual count is recorded between 2004 and 2015, possibly accounting for the step change as estimates for the intervening years are based on 2004 data. However, it should be noted that the manual counts on which these data are based were carried out in either September or October, therefore will not reflect a seasonal increase in traffic. NHS Highland Public Health Directorate, Health Intelligence Team June 2019 5 Figure 2: Annual average daily flow (both directions) of traffic at site number 80594 (Kyleakin roundabout to Stoney Road, Kyle of Lochalsh) from 2000 to 2018. Count years are indicated, all other years are estimates. Data source: Department of Transport, Road traffic statistics3 Transport Scotland operate an automated counter adjacent to the Department for Transport site referred to in Figure 2 above. The counter was not in operation for some months; this is represented by estimated data shown in dark grey on the graph below. There is a clear seasonal pattern with a 33 percent increase (additional 1,400 vehicles per day (both directions)) from April and May 2014 counts to the same months 5 years later in 2019. A request for data by vehicle

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