Scotland has a rich history of leadership and innovation in medicine. Many of the fundamental discoveries which have shaped and revolutionalised modern healthcare worldwide, originated in Scotland, or have been led by Scottish doctors. St Andrew's University established one of the oldest medical schools in the world in 1450 and all 5 Scottish Medical Schools continue to maintain impressive reputations across the UK and internationally. The roll call of world renowned Scottish medics is lengthy: John Hunter, the distinguished anatomist/surgeon; James Young Simpson who discovered anaesthesia; Joseph Lister whose work on antisepsis revolutionised surgical outcomes; Alexander Fleming's discovery of penicillin; Ian Donald’s introduction of foetal ultrasound scanning into routine obstetric care; and Alfred Cuschieri's pioneering work on laparoscopic surgery - the list goes on.
Current health care challenges facing Scotland and, indeed the whole of the UK, point to the need for renewed efforts on the part of the medical profession in Scotland to put its shoulder to the leadership wheel.
This Report highlights numerous areas of health protection which have required that kind of leadership over the past year to keep potential threats to public health from communicable disease, under control. Unfortunately, current public health threats from non-communicable disorders such as obesity and physical inactivity, are less amenable to that kind of control. These challenges parallel that posed to the health service by cigarette smoking. In 2006, Scotland was the first of the UK nations to ban smoking in public places, with almost immediate and significant health benefits - amongst other things, a 17% reduction in acute coronary syndrome admissions to hospital. This could not have happened without medical leadership. Doctors were the first in society (following Sir Richard Doll's seminal work in the 1950s) to understand the damage to health caused by smoking, and quit the habit - until then, they had smoked just as much as the rest of society. The profession once again needs to step up to that health improvement plate and show the way, for example, by greater engagement with the Health Promoting Health Service (HPHS) programme highlighted in this Report. The HPHS actions focus on secondary care and the lifestyle risk factors of patients and their families, as well as staff and visitors. The actions cover areas such as smoking, alcohol, food and health, and physical activity. All doctors should be raising these lifestyle risk factors with patients, and either giving brief advice or signposting them to where they can access that advice and support to tackle the problem. As medical undergraduates we are all taught to take a clinical history which covers smoking and alcohol. A question around physical activity levels now needs to be added to that history taking. It is a myth to say that this takes more than a couple of minutes in a consultation and the impact of a doctor raising these issues, as the evidence shows, is very powerful.
Medical, and indeed multidisciplinary clinical leadership, has never been more necessary as we face the health and social care challenges posed by an ageing population in Scotland. These, allied to current financial constraints on health care budgets, will require innovation and strong clinical leadership if we are to achieve the 2020 vision that "by 2020 everyone is able to live longer healthier lives at home, or in a homely setting". Health and social care integration is coming ever closer in Scotland, but will require fully engaged clinical and managerial leadership to achieve the vision. The section on promoting Professionalism and Excellence in Scottish medicine in this report highlights the need for doctors to reach out to colleagues in health management - using paired learning - if we are to achieve the best available health and social care outcomes for Scotland.
Doctors need to make common cause with management colleagues (both clinical and non-clinical) in a joint endeavour to find solutions for the health challenges highlighted above. The NHS in Scotland has never been in greater need of leaders with the vision and skills to deliver radical change. The Scottish medical workforce must and will play a full part in that transformation.
Email: Mark Johnstone
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