Chief Medical Officer's annual report 2024-2025: Realistic Medicine - Critical Connections

Foreword

Five years ago, we found ourselves amid a health and societal crisis as a pandemic caused tragedy and turmoil across the world. The impacts were profound and lasting, affecting not only our health, but impacting people socio-economically too. Those moments will be indelibly marked in my memory, as will the power of the human connections that I relied on to help me navigate my own experience of that time.

Connection is critical not only in the hardest of times – connection and belonging are essential for our wellbeing. It’s why people seek out conversation, companionship and community. At the 78th World Health Assembly of WHO in May 2025, member states approved a first ever resolution on fostering social connection for improving health and its essential role in addressing loneliness, social isolation and inequities in health.

The challenges we face as health and care professionals still feel ever present. System pressures mean that we are rightly focussed on trying to improve access to the care we provide and yet, while a focus on efficiency is undoubtedly required, we must be mindful of the risk of losing vital connection to the people we care for and the consequent risk of providing sub-optimal, industrialised care. We must not, inadvertently, become distant from the people we care for. This is neither good for our patients nor for us as professionals. In pursuing system renewal, we must ensure that connection and purpose lie at the heart of reform. It is connection that will sustain us.

We must do what we can to foster wellbeing – support healthy ageing, encourage greater upstream prevention of disease and support our communities to overcome loneliness and isolation. If we can support people to remain healthier for longer, not only can we achieve significant improvements in their health, but we can also enable people to remain economically active and have an active role in their families and communities. Their experience of life and connection may well be enhanced too.

We can achieve these ambitions and create a carbon-neutral, climate-resilient, equitable and sustainable system by practising Realistic Medicine. We must provide careful and kind care, recognise the critical importance of continuity and relationship-based care and take account of biography as well as the biology of the people we serve. Careful care that is founded on principles of quality, safety and the tailored use of best evidence; that recognises people’s experience of illness is unique to their circumstances and priorities, not just their biological data. Kind care respects a person’s most precious resource, their time, energy and attention, and ensures that healthcare’s footprint upon these resources is minimally disruptive.

The triple planetary health crisis – climate change, loss of biodiversity and air pollution – continues to be the greatest global threat to human health. It remains, in my view, a public health emergency. Our connection to the planet is fundamental to all life around us and we must increase our efforts to reverse the harmful footprint that humans continue to leave on its health. Our connection to the planet can also enhance our health and well-being. Harnessing nature for this purpose can create a virtuous cycle of improving human and planetary health through greener, more sustainable, pathways of care.

In my report this year, I highlight the importance of the human relationship in health and care and describe the approach that I continue to champion for both our citizens and our workforce. Careful and kind care is what I want to receive myself and for those closest to me. We must nurture relationships and cultivate connections with the people we care for and with each other. By protecting and strengthening our connections across organisations, we can maximise our contribution to the communities we serve, our system and our planet.

Professor Sir Gregor Smith
Chief Medical Officer for Scotland

Enabling careful and kind care

Focus on understanding what matters to the people we care for and focus on helping them achieve their goals.

As care providers we often enter people’s lives at a moment of vulnerability; we must respect this, and hear and seek to understand the voice of those we serve in order to deliver the outcomes that matter to people we care for. Shared decision making sits at the heart of doing the right thing.

Balance biography and biology when applying evidence-informed practice.

We must ensure the right balance between the science and the art of care; the best care has biometric and biographical care in equilibrium, balancing evidence, professional judgement, people’s preferences and compassion.

Kindness and compassion sit at the heart of the way we deliver care.

We are all human and vulnerability is exhausting; we all have physical and emotional limits and a tolerance to risk that is dynamic as a consequence. We should reasonably expect the people and system in which we work to acknowledge and respect this, ensuring that we are supported to practise compassionately and manage clinical risk appropriately.

Collaboration is key to providing care that people value and greater job satisfaction.

We should give way on professional and personal prerogatives in order to be part of something greater; define what we do as individuals as part of a wider multidisciplinary team and nurture and protect civility, trust and belonging within it. Our teams are greater than the sum of their individual parts, and they will help to support and sustain us.

Use resources wisely to provide sustainable care for our service and our planet.

However well intentioned, some care can be wasteful, risking harm to people and the environment; using a value based approach allows us to balance personal and population-based care better so maintaining, and making best use of, all our resources.

Measure the right things including outcomes that matter to people.

Measurement works best when it is meaningful, proportionate, transparent and used for the purpose of improving quality; when measurement drives transactional care it risks moral injury and harm to staff as well as the people we care for and must be avoided.