Providing rural areas1 with appropriate health services is a key challenge for governments across the globe (Hanlon and Kearns, 2016). Rural areas can be characterised (Weinhold and Gurtner, 2014) by dispersed low population numbers, lack of economies of scale, difficulties in the recruitment and retention of healthcare professionals, and uneven infrastructure development. The COVID-19 pandemic offers a new lens through which to consider strengths and weaknesses of contemporary rural society (Maclaren and Philip, 2021), including healthcare, and how it has thrown challenges in rural places (Malatzky et al., 2020a) into sharper relief in relation to other place-based social, cultural, economic, environmental, and political issues. Whilst the initial aim of this project was to solely consider the COVID-19 pandemic, the storms of 2021 and 2022 - which we go on to discuss - present an additional factor to consider within the context of evaluating the impact of sudden and unexpected challenges on the delivery of rural healthcare.

This research draws on primary data from two complementary projects. The first project is a pilot study that aimed to explore the public's perspectives on accessing and receiving healthcare in rural areas of Scotland, within the context of a changed environment due to the COVID-19 pandemic. This research considered what people living in rural communities valued about health services, and if COVID-19 had changed this, and explored what changes might be sustainable into the future for rural areas and what changes might be time-limited to the pandemic. The second project's primary aim was to explore the motivations of doctors to live and work in rural areas (reported elsewhere: Locock et al., 2023, Maclaren et al., 2022, Maclaren et al., 2022, Maclaren et al., 2024). However, as the project was planned prior to the pandemic, delayed because of it, and started amidst it, many of the doctors interviewed had their own reflections on delivering healthcare within that changed environment and the opportunity was taken to engage in a discussion on this. The research therefore brings together both public and doctor perspectives to explore the contemporary experience of rural healthcare, against the backdrop of crises, including the pandemic, and the associated challenges that brought.

In this paper we discuss the underlying context within the literature on rural areas, healthcare delivery and the COVID-19 pandemic, followed by a review of our qualitative methodological approach. We then present findings from the two complementary qualitative research projects across two areas. First, we present a summary of the contemporary experience of rural healthcare and second, a reflection on how this has been impacted by both the COVID-19 pandemic and extreme weather events experienced within Scotland. Both these events show how relationally entwined the delivery of rural healthcare is with debates on sustainable rural communities, the climate emergency, digitalisation of health services and recruitment and retention of healthcare staff in rural areas. We anticipate that this study's findings will be helpful in informing local priorities for rural health services. As clinical services are restructuring and re-prioritising the services and care offered, and public perspectives are often lacking, this research offers valuable findings to inform what to do now as well as possible interventions for the future.