Chief Medical Officer - annual report: 2020 to 2021

This report is focused around five key themes: the health of the nation, delivering personalised care, reducing health inequalities, sustainability of our workforce, and green and sustainable healthcare.


An interactive version of this document is also available.

I vividly remember reading about historical pandemics at medical school and wondering what it must have been like to provide care for people in such an intense and fluid environment. When the first Realistic Medicine report was published 5 years ago, I suspect that there were few who fully anticipated the imminence of the scenes we have witnessed in health and care across the globe, or the impact that the latest pandemic would have, and continues to have, on all of us. This year has brought many challenges and sadness. I recognise that it has been tough for all of us. The way we have united to support one another, continued to provide world-class care in a new and complex landscape, rapidly develop guidance, shown brilliance in innovation, and demonstrated real resilience throughout this extremely stressful and frightening time has been remarkable. I would like to thank you all for the courage, commitment and determination you have shown. 

Thanks to the amazing innovation and ingenuity of scientists worldwide, we now have treatments to support people with COVID-19, and vaccines that will aid the control of the virus. This critical research, and advanced technologies such as genome sequencing, will help us continue to identify new strains as they emerge, determine the threat that they pose and respond appropriately. I'm very proud of the contribution our scientists, healthcare workforce, and the people of Scotland have made.

This is my first annual report as Chief Medical Officer for Scotland. It not only provides the opportunity to reflect on our shared experience of the pandemic and highlight areas of good practice and innovation over the last year, but also identify areas that require more attention. The report is focused around five key themes: the health of the nation, delivering personalised care, reducing health inequalities, sustainability of our workforce, and green and sustainable healthcare. 

The effect that the COVID-19 virus has had on the country has been devastating for many. However, it has also compelled us to redesign and improve many aspects of health and care services, and to rethink the way we practice. We must recognise the cost and repercussions of not learning from our experiences during the pandemic. Although we have come a long way, we want to go further.

Many of you have told me that by practising Realistic Medicine you have been able to make a positive impact on the people we care for, and that during the pandemic it has become more important than ever. Realistic Medicine has guided shared decision making and personalised the care we provide in what have been exceptionally difficult circumstances. We have had to rapidly adapt our ways of working in this new landscape and deliver many innovative treatments at pace. We have had to balance new and emerging risks, ensure we minimise harm, and avoid wasting precious health and care resources. Realistic Medicine leads have been appointed in Health Boards and I have arranged for increased funding to provide more Realistic Medicine clinical lead and programme manager time. Our local leads will work collaboratively with their Boards to create networks that will support us all to practise Realistic Medicine. Realistic Medicine is also firmly embedded as a key enabler within the NHS Clinical Prioritisation, Remobilisation and Rehabilitation Frameworks. I believe that by practising Realistic Medicine we will be able to address many of the challenges we face as health and care professionals, now and in the future.

Just as in the pandemics I read about in medical school, the COVID-19 pandemic has exposed and exacerbated the health inequalities that exist across our society. I came into the position of Chief Medical Officer for Scotland during a period of uncertainty, when problems required rapid solutions, and there were major changes to our healthcare practices. This, combined with the extraordinarily difficult experiences of those working in health and care during times that have never been so trying, has re-emphasised the importance of working in strong supportive teams. Our workforce have shown great commitment and determination in rising to the challenges generated by the COVID-19 virus, but for some it has come at a cost to their own physical or mental health. As we begin to recover our health and care system, we cannot lose sight of this. We must do all that we can to support and sustain our colleagues. 

The COVID-19 pandemic has highlighted the need for change. We should not only be dealing with the consequences of the pandemic; we also need to broaden our focus to confront other urgent issues, such as the climate crisis. As we remobilise services, we need to consider how we can build towards a greener society and a more sustainable healthcare system. 

This year's annual report reflects on the above themes and encourages us to build on this momentum for change, as we "Recover, Restore, Renew" our health and care services. 

Dr Gregor Smith
Chief Medical Officer for Scotland



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