Introduction: The SARS-CoV-2 (COVID-19) pandemic has brought about instability in healthcare providers worldwide; this includes rural settings that had fewer cases of COVID-19 in the first year of the pandemic. This article examines the impact of COVID-19 on the surgical services offered at the Balfour Hospital, Orkney Islands, Scotland in the UK and the impact the pandemic had indirectly on the service in 2020. Methods: The authors conducted a retrospective study concentrating on surgical services including emergency hospital presentations and the number of cancer diagnoses, specifically colorectal. Colorectal malignancies were specifically investigated as in the Balfour Hospital they are primarily diagnosed by surgeons. Focus was on diagnosis and outcomes between June 2020 and October 2020, in comparison with the previous year. This time period was chosen because surgical services reconvened after a period of inactivity due to the COVID-19 pandemic. The types of emergency admission into the Balfour Hospital during this time were examined, as well as delayed surgeries and the impact of Rural and Remote Health rrh.org.au