After years of uncertainty and a gradual but seemingly unstoppable process of downgrading services, the prospect for Scotland's rural general hospitals now looks promising. The report from the working group on the future of the six hospitals has recognised that the needs of their communities cannot be met by the policy of providing centres of excellence backed by community facilities offering a restricted range of expertise. Whenever a local hospital is threatened with closure or a diminution of the services it offers, there is an inevitable reaction against the idea and in recent years we have seen campaigns to save services in Wick, Oban and Fort William. The hospitals there, along with those in Stornoway, Lerwick and Kirkwall, will be given a new lease of life by the plans to train doctors in a wider range of skills to become more general consultants. It is a welcome recognition that in a country as diverse as Scotland, a single model will not fit all.

In rural areas, emergencies include injured people who have been rescued from the mountains or the sea, as well as accidents at work or on the roads. It is often vital that they get appropriate medical treatment fast. In many cases the additional risks of being transported long distances by ambulance outweigh the benefit of being treated in a specialist centre. The same argument is made by mothers campaigning to retain maternity services in the rural hospitals: they want to be able to give birth in their local hospital, knowing there is medical back-up if necessary, rather than risk the baby being born on the way to hospital.

The recommendation that services at these hospitals must be consultant-led is the most far-reaching one. The working group has concluded that at least nine specialists will be needed to offer the full range of general services in each hospital: three consultant surgeons, three anaesthetists (led by a consultant) and three medical specialists. That in itself is a welcome indication of a new era. Some of the hospitals have experienced difficulty in recruiting suitable staff in recent years due to the uncertainty over their future, but the shortage of staff has itself compounded the problem. If these hospitals are now to have general surgeons, who can deal equally well with fractures, emergency caesarean sections and removing an appendix, backed up by equally versatile anaesthetists, both staff and patients can have a new confidence in the service they provide. To achieve that, however, will require a new training regime, which will require to be properly resourced.

The new blueprint will be seen in some quarters as a reversal of the recommendations by Professor David Kerr for centres of excellence in the major teaching hospitals, backed by networks of district hospitals. There is no argument that some very complex conditions require specialist care, but these proposals will not remove that option where it is necessary or desirable. The vision which informed the Kerr model was of the NHS in Scotland working as an integrated entity. Since the furthest flung hospitals have always transferred patients to all parts of Scotland, it is no threat to the general principle if they also provide round-the-clock medical and surgical care for their own communities.

If we want a National Health Service that lives up to its name, it must provide a level of service that is equal (although not necessarily the same) for patients in the far north and west and in the islands as for those in the densely populated centre.