Publication - Corporate report

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.

82 page PDF

2.6 MB

82 page PDF

2.6 MB

Chief Medical Officer - annual report: 2020 to 2021

82 page PDF

2.6 MB


1. Scottish Government. Long-term monitoring of health inequalities: January 2020 report. Available from: [Accessed 9th February 2021] 

2. The Scottish Public Health Observatory. Healthy Life Expectancy: Scotland. 2019. Available from: [Accessed 9th February 2021]

3. Fenton L, Wyper GM, McCartney G, Minton J. Socioeconomic inequality in recent adverse all-cause mortality trends in Scotland. J Epidemiol Community Health. 2019; 73(10):971-4

4. Fenton L, Minton J, Ramsay J, Kaye-Bardgett M, Fischbacher C, Wyper GM, McCartney G. Recent adverse mortality trends in Scotland: comparison with other high-income countries. BMJ open. 2019; 9(10)

5. Walsh D, McCartney G, Minton J, Parkinson J, Shipton D, Whyte B. Changing mortality trends in countries and cities of the UK: a population-based trend analysis. BMJ open. 2020;10(11)

6. Toffolutti V, Suhrcke M. Does austerity really kill? Economics and Human Biology 2019; 33: 211–223

7. Rajmil L, Fernández de Sanmamed MJ. Austerity policies and mortality rates in European countries, 2011–2015. American journal of public health. 2019;109(5):768-70

8. Van der Wel KA, Saltkjel T, Chen WH, Dahl E, Halvorsen K. European health inequality through the 'Great Recession': social policy matters. Sociology of health & illness. 2018; 40(4):750-68

9. Wickham S, Bentley L, Rose T, Whitehead M, Taylor-Robinson D, Barr B. Effects on mental health of a UK welfare reform, universal credit: a longitudinal controlled study. The Lancet Public Health. 2020;5(3):e157-64

10. Katikireddi SV, Molaodi OR, Gibson M, Dundas R, Craig P. Effects of restrictions to income support on health of lone mothers in the UK: a natural experiment study. The Lancet Public Health. 2018;3(7):e333-40

11. Garthwaite K, Bambra C. Shifting the goalposts: a longitudinal mixed-methods study of the health of long-term incapacity benefit recipients during a period of substantial change to the UK social security system. J Social Policy 2014;43(2):311–330

12. Portes J, Reed H. The cumulative impact of tax, social security and public spending decisions in Scotland: Summary Report. Equality and Human Rights Commission, 2019. Available from: [Accessed 9th February 2021]

13. Richardson EA, Taulbut M, Robinson M, Pulford A, McCartney G. The contribution of changes to tax and social security to stalled life expectancy trends in Scotland: a modelling study. Journal of Epidemiology and Community Health, 2020.

14. Wright S, Patrick R. Welfare Conditionality in Lived Experience: Aggregating Qualitative Longitudinal Research. Social Policy & Society 2019; 18:4, 597–613

15. McKechnie K. CPAG Early Warning System report on Universal Credit and childcare costs. Glasgow, CPAG Scotland, 2019. Available from: [Accessed 9th February 2021]

16. McKechnie K. CPAG Early Warning System: A report on the two child limit. Glasgow, CPAG Scotland, 2018. Available from: [Accessed 9th February 2021]

17. McKechnie K, Davis M. CPAG Early Warning System: A report on the benefit cap. Glasgow, CPAG Scotland and One Parent Families Scotland, 2018. Available from: [Accessed 9th February 2021]

18. McKechnie K. CPAG Early Warning System: Universal credit - December 2018. Glasgow, CPAG Scotland, 2018. Available from: [Accessed 9th February 2021]

19. Rlaeigh V. What is happening to life expectancy in the UK. The King's Fund. Avaialble from: [Accessed 9th February 2021]

20. Ho JY, Hendi AS. Recent trends in life expectancy across high income countries: retrospective observational study. BMJ. 2018;15;362

21. Hiam L, Dorling D, Harrison D, McKee M. What caused the spike in mortality in England and Wales in January 2015? J Royal Society Medicine 2017:0(0) 1–7

22. Green MA, Dorling D, Minton J, Pickett KE. Could the rise in mortality rates since 2015 be explained by changes in the number of delayed discharges of NHS patients? J Epidemiology and Community Health 2017;71:1068-1071

23. Douglas M, Katikireddi SV, Taulbut M, McKee M, McCartney G. Mitigating the wider health effects of covid-19 pandemic response. BMJ. 2020; 27;369

24. Bavli I, Sutton B, Galea S. Harms of public health interventions against covid-19 must not be ignored. BMJ. 2020;371

25. National Records for Scotland. Direct Health Impacts of COVID-19. Available from: [Accessed 20th February 2021]

26. Maxwell E. Living with Covid 19. A dynamic review of the evidence around ongoing Covid 19 symptoms (often called Long Covid). NIHR Centre for Engagement and Dissemination. 2020

27. COVID-19 rapid guideline: managing the long-term effects of COVID-19 NICE guideline [NG188] December 2020. Available from: [Accessed 9th February 2021]

28. National Records for Scotland. Excess Deaths. Available from: [Accessed 9th February 2021]

29. Scottish Health Public Health Observatory. COVID-19 Wider Impacts. Available from: [Accessed 9th February 2021]

30. Scottish Government. Coronavirus (COVID-19): framework for decision making – assessing the four harms. December 2020. Available from: [Accessed 9th February 2021]

31. Public Health Scotland. COVID-19 wider impacts on the health care system information tool. Available from: [Accessed 9th February 2021]

32. Public Health Scotland.Non-COVID-19 excess deaths by cause. August 2020. Available from: [Accessed 9th February 2021]

33. Scottish Government. Covid-19 in Scotland. People Avoiding Contacting GPs. Available from: [Accessed 9th February 2021]

34. Scottish Government and COSLA. Scotland's Wellbeing , The impact of COVID-19. December 2020. Available from: [Accessed 9th February 2021]

35. Scottish Government Covid-19 in Scotland. Loneliness. Available from: [Accessed 9th February 2021]

36. Scottish Household Survey 2018: Annual Report. September 2019. Available from: [Accessed 9th February 2021]

37. Scottish Government. Crisis Grants. Available from: - crisis_grants [Accessed 9th February 2021] 

38. Clift AK, Coupland CA, Keogh RH, Diaz-Ordaz K, Williamson E, Harrison EM, Hayward A, Hemingway H, Horby P, Mehta N, Benger J. Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults: national derivation and validation cohort study. BMJ. 2020; 20;371 

39. National Records of Scotland. Deaths involving coronavirus (COVID-19) in Scotland, week 6 (8 to 14 February 2021). Available from: [Accessed 20th February 2021]

40. National Records of Scotland. Deaths involving coronavirus (COVID-19) by ethnic group. 2020. Available from: [Accessed 9th February 2021]

41. Scottish Government. Impacts of COVID-19 on Equality in Scotland. September 2020. Available from: [Accessed 9th February 2021]

42. Scottish Government. Person-centred care. November 2019. Available from: [Accessed 13th February 2021]

43. Scottish Government. COVID-19 Framework for Decision Making. Shielding: A way forward for Scotland. June 2020. Available from: [Accessed 13th February 2021]

44. General Medical Council. Good medical practice. March 2013. Available from: [Accessed 13th February 2021]

45. The Support Investigators. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA 1995;274:1591-8.

46. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ. BMJ Publishing Group Ltd.2010; 340: c1345. doi:10.1136/bmj.c1345. PMC [2844949]. PMID [20332506]

47. Taylor DR, Lightbody CJ. Futility and appropriateness: challenging words, important concepts. Postgrad Med J 2018;94:238–43.

48. Willmott L, White B, Gallois C et al. Reasons doctors provide futile treatment at the end of life: a qualitative study Journal of Medical Ethic.2016;42:496-503.

49. Lightbody CJ et al. Impact of a treatment escalation/limitation plan on non-beneficial interventions and harms in patients during their last admission before in-hospital death. BMJ Open 2018; 8: e024264. doi: 10.1136/bmjopen-2018-024264

50. Bouttell J et al. Economic impact of reduction in non-beneficial interventions following the introduction of a treatment escalation / limitation plan. Int. J. Qual. Health Care. 2020; 32(10):694-700 doi: 10.1093/intqhc/mzaa132

51. Taylor DR et al., A case-controlled study of relatives' complaints concerning patients who died in hospital: the role of treatment escalation / limitation planning. Int. J. Qual. Health Care. 2020; 32: 212-218. doi: 10.1093/intqhc/mzaa008. 

52. Wilder-Smith A et al. Antimicrobial use and misuse at the end of life: a retrospective analysis of a treatment escalation/limitation plan. J. R. Coll. Physicians Ed. 2019; 49: doi: 10.4997/JRCPE.2019.XXX 

53. Becherucci F, Roperto RM, Materassi M et al. Chronic kidney disease in children. Clin Kidney J. 2016;9(4):583-591. doi:10.1093/ckj/sfw047

54. Barnett K, Mercer S, Norbury M et al. Epidemiology of multimorbidity and implications for healthcare, research and medical education: a cross-sectional study. Lancet. 2012; 380(9836): 37-43. doi: 10.1016/S0140-6736(12)60240-2. 

55. Scottish Government. Polypharmacy Model of Care Group. Polypharmacy Guidance, Realistic Prescribing 3rd Edition, 2018. Available from: [Accessed 22nd February 2021]

56. Mair A, Fernandez-Llimos F, Alonso A, Harrison C, Hurding S, Kempen T et al. The Simpathy consortium. Polypharmacy Management by 2030: a patient safety challenge. 2nd edition. Coimbra SIMPATHY Consort. 2017: Coimbra SIMPATHY Consort. Available from: [Accessed 22nd February 2021]

57. Implementing Simulating Innovation in the Management of Polypharmacy and Adherence Through the Years: Project Executive Summary. September 2020. Available from: [Accessed 13th February 2021]

58. Randomised Evaluation of COVID-19 Therapy. RECOVERY. Available from: [Accessed 22nd February 2021].

59. A Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia. REMAP-CAP. Available from: [Accessed 22nd February 2021].

60. Genetics of Mortality in Critical Care. GenOMICC. Available from: [Accessed 22nd February 2021].

61. University of Oxford. The Oxford Vaccine. Available from: [Accessed 22nd February 2021]

62. Marmot M, Allen J, Goldblatt P, Herd E, Morrison J. 2020. Build back fairer: the COVID-19 Marmot Review. The pandemic, socioeconomic and health inequalities in England. London: Institute of Health Equity

63. Popham F, Boyle P. Assessing socio-economic inequalities in mortality and other health outcomes at the Scottish national level. Final report for the Scottish Collaboration for Public Health Research and Policy. University of St Andrews; 2011. Available from: [Accessed January 2016].

64. National Records of Scotland. Life Expectancy in Scottish Areas 2016-2018. 2019. Available from: [Accessed 22nd February 2021]

65. McCartney G, Collins C, MacKenzie M. What (or Who) causes health inequalities: theories, evidence and implications? Health Policy 2013; 113: 221– 227.

66. Piggot J, Williams C, McLeod S, Barton J. 2004. A Qualitative Study of Support for Young People who Self-Harm in Residential Care in Glasgow in Scottish Journal of Residential Child Care. Pg 45-54.

67. Scottish Government. Health and homelessness in Scotland: research. 2018. Available from: [Accessed 22nd February 2021]

68. Van Cleemput P. Health care needs of Travellers. Archives of Disease in Childhood 2000; 82: 32-37.

69. Walsh D, Buchanan D, Douglas A, Erdman J, Fischbacher C, McCartney G, Norman P, Whyte B. Increasingly diverse: the changing ethnic profiles of Scotland and Glasgow and the implications for population health. Applied Spatial Analysis & Policy 2019; 12(4): 983-1010

70. McCartney G, Popham F, McMaster R, Cumbers A. Defining health and health inequalities. Public Health. 2019; 172: 22–30, doi: 10.1016/j.puhe.2019.03.023.

71. Walsh D, Lowther M, Reid K, McCartney G. Can Scotland achieve its aim of narrowing health inequalities in a post-pandemic world? Public Health in Practice 2020; 1: 100042,

72. McCartney G, Hearty W, Arnot J, Popham F, Cumbers A, McMaster R. Impact of Political Economy on Population Health: A Systematic Review of Reviews. American Journal of Public Health. 2019; 109: e1_e12,

73. Scottish Government. Food insecurity and poverty - United Nations: Scottish Government response. 2021. Available from: [Accessed 22nd February 2021]

74. Norström F, Virtanen P, Hammarström A, Gustafsson PE, Janlert U. How does unemployment affect self-assessed health? A systematic review focusing on subgroup effects. BMC Public Health. 2014;14:1310. doi:10.1186/1471-2458-14-1310

75. Unicef. The United Nations Convention on the Rights of the Child. 1990. Available from: (not%2520set)%26co%3D(not%2520set)%26ke%3D(not%2520set).1613929131470&_adal _cw=1613929100472.1613929131470&_adal_"> 1613929100.2.1613929100.1613929100.ad182c7c-f49c-433e-8a99-7922e949dedc. 1613929131470&_ga=2.102704513.1802404994.1613929100-762329450.1613929100. [Accessed 22nd February 2021]

76. Scottish Government. Scottish Child Payment: Equality Impact Assessment. 2020. Available here: [Accessed 22nd February 2021].

77. Scottish Government. Equity Audit. Deepening the understanding of the impact COVID-19 and school building closures had on children from socio-economically disadvantaged backgrounds and setting clear areas of focus for accelerating recovery. 2021. Available from: [Accessed 22nd February 2021]

78. Scottish Government. Access to free sanitary products: BRIA. 2018. Available from: [Accessed 22nd February 2021]

79. Luchenski Serena, Maguire N, Aldridge R, Hayward A, Story A, Perri P. What works in inclusion health: overview of effective interventions for marginalised and excluded populations. 2018; 391(10117): 266-280

80. Scottish Government. A fairer Scotland for all: race equality action plan and highlight report. 2017-2021. Available from: [Accessed 22nd February 2021]

81. Davidson EM, Douglas A, Villarroel N, Dimmock K, Gorman D, Bhopal RS. Raising ethnicity recording in NHS Lothian from 3% to 90% in 3 years: processes and analysis of data from Accidents and Emergencies. Journal of Public Health. 2020;, fdaa202,

82. Malcolm M, Frost H, Cowie J. Loneliness and social isolation causal association with health-related lifestyle risk in older adults: a systematic review and meta-analysis protocol. Syst Rev. 2019;8(1):48. Published 2019 Feb 7. doi:10.1186/s13643-019-0968-x

83. Scottish Government. Scotland's Digital Strategy. Evidence Discussion Paper. 2017. Available from: [Accessed 22nd February 2021]

84. National Records of Scotland: Avoidable Mortality.2019. Available from: [Accessed 15th February 2021]

85. Scottish Government. Scottish Health Survey 2019 - volume 1: main report.2020. Available from: [Accessed 15th February 2021]

86. Semple S, Dobson R, Sweeting H on behalf of the Tobacco in Prisons (TIPs) research team et al. The impact of implementation of a national smoke-free prisons policy on indoor air quality: results from the Tobacco in Prisons study. Tobacco Control 2020; 29:234-236.

87. Public Health Scotland. Alcohol related hospital statistics. Scottish financial year 2019 to 2020. Available from: Alcohol Related Hospital Statistics 17 November 2020 - Data & intelligence from PHS ( [Accessed 22nd February 2021]

88. O'Donnell A, Anderson P, JanéLlopis E, Manthey J, Kaner E, Rehm J et al. Immediate impact of minimum unit pricing on alcohol purchases in Scotland: controlled interrupted time series analysis for 2015-18BMJ 2019; 366 :l5274

89. National Records Scotland. Alcohol Deaths. 2020. Available from: [Accessed 15th February 2021]

90. Scottish Government. Preventing obesity in early years. 2020. Available from: [Accessed 22nd February 2021]

91. Scottish Government. A healthier future: Scotland's diet and health weight delivery plan. 2018. Available from: [Accessed 22nd February 2021]

92. Nagamatsu LS, Flicker L, Kramer AF et al. Exercise is medicine, for the body and the brain British Journal of Sports Medicine 2014;48:943-944.

93. Nieman DC, Pence BD. Exercise immunology: Future directions. J Sport Health Sci. 2020 Sep;9(5):432-445. doi: 10.1016/j.jshs.2019.12.003. Epub 2019 Dec 30. PMID: 32928447; PMCID: PMC7498623.

94. Scottish Government. Drug-related death statistics 2019. 2020. Available from: [Accessed 15th February 2021]

95. Barnsdale L, Gounari X, Graham L. The National Drug-Related Deaths Database (Scotland) Report. Analysis of Deaths occurring in 2015 and 2016. Edinburgh, ISD Scotland, 2018.

96. Hart JT. The Inverse Care Law, The Lancet, 1971;297(7696): 405-412.

97. Mercer SW, Fitzpatrick B, Guthrie B et al. The CARE Plus study – a whole-system intervention to improve quality of life of primary care patients with multimorbidity in areas of high socioeconomic deprivation: exploratory cluster randomised controlled trial and cost-utility analysis. BMC Med 14, 88 (2016).

98. Mercer S, Fitzpatrick B, Gourlay G, Voit G, McConnachie A. Watt GCM. More time for complex consultations in a high-deprivation practice is associated with increased patient enablement. British Journal of General Practice. 2007; 57 (545): 960-966.

99. Marmot M. Fair Society, Healthy Lives: The Marmot Review. London: Strategic Review of Health Inequalitites in England post-2010; 2010.

100. Frenk J, Chen L, Bhutta ZA et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet. 2010; 376(9756): 1923-1958

101. Greenberg N, Docherty M, Gnanapragasam S et al. Managing mental health challenges faced by healthcare workers during COVID-19 pandemic. BMJ. 2020; 368:m1211

102. Lai J, Ma S, Wang Y et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020; 3(3): e203976.

103. Hadlaczky G, Hökby S, Mkrtchian A et al. Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: a meta-analysis. Int Rev Psychiatry. 2014; 26(4): 467-75. doi: 10.3109/09540261.2014.924910. PMID: 25137113.

104. French T. A Vision for Technology and Digital in Social Care. Scottish Care. 2020

105. Cavanagh N, Cockett G, Heinrich C et al. Compassion fatigue in healthcare providers: A systematic review and meta-analysis. Nurs Ethics. 2020; 27(3): 639-665.

106. Mid Staffordshire NHS Foundation Trust Public Inquiry. 2013. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive summary.

107. Unwin J. Kindness, Emotions and Human Relationships: The blind spot in public policy. Dunfermline: Carnegie UK Trust 2018. Available from: [Accessed 13th February 2021]

108. West M, Eckert R, Collins B et al. Caring to Change: How compassionate leadership can stimulate innovation in healthcare. The King's Fund. May 2017

109. Wake M, Green W. Relationship between employee engagement scores and service quality ratings: analysis of the National Health Service staff survey across 97 acute NHS Trusts in England and concurrent Care Quality Commission outcomes (2012–2016). BMJ Open. 2019; 9:e026472

110. West M, Dawson J. Employee Engagement and NHS Performance. The King's Fund. 2012

111. Scottish Government. Everyone Matters: 2020 Workforce Vision. 2013

112. West M, Dawson J, Kaur M. Making the difference: Diversity and inclusion in the NHS. The Kings Fund. 2015

113. Qureshi K, Meer N, Hill H. 'Different but Similar? BAME Groups and the Impacts of Covid-19 in Scotland. In: Meer N, Akhtar S, Davidson N. Taking Stock: Race Equality in Scotland. London: Runnymede. 2020

114. Scottish Government. Response to recommendations of the Expert Reference Group on COVID-19 and Ethnicity. 2020. Available from: [Accessed 13th February 2021]

115. General Medical Council. National Training Survey: summary of results. October 2020. Available from: [Accessed 13th February 2021]

116. Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 2019; 111(4): 383-392

117. IPCC. Summary for Policymakers. In: Global Warming of 1.5°C. An IPCC Special Report. Geneva, Switzerland : World Meteorological Organization, 2018

118. IPBES. Summary for policymakers of the global assessment report on biodiversity and ecosystem services of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services. Bonn, Germany : IPBES secretariat, 2019

119. Haines A, Elbi KL, Smith KR, Woodward A. Health risks of climate change: act now or pay later. Lancet. 2014; Vol. 384, pp. 1073-5

120. World Health Organization. "Ambient air pollution: A global assessment of exposure and burden of disease." 2016

121. Barton H, Grant M. A health map for the local human habitat. The Journal for the Royal Society for the Promotion of Health. 2006;126: 252-253

122. Costello A, Abbas M, Allen A, Ball S et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. The Lancet. 2009; 373: 1693-1733

123. European Environment Agency. COVID-19 and Europe's environment: impacts of a global pandemic. November 2020. Available from: [Accessed on 23rd December 2020]

124. Arora, S, Bhaukhandi K.D, and Mishra, P.K. Coronavirus lockdown helped the environment to bounce back. Science of The Total Environment. 2020; p.140573.

125. World Meteorological Organisation. Greenhouse Gas Bulletin. November 2020. Available from[Accessed on 23rd December 2020]

126. Health Care Without Harm and ARUP. Health Care's Climate Footprint: How the health sector contributes to the global climate crisis and opportunities for action. 2019. Available from: [Accessed 19th February 2021]

127. Watts N, Adger WN, Agnolucci P, Blackstock J et al. Health and climate change: policy responses to protect public health. The Lancet. 2015; Vol. 386, pp. 1861-1914

128. General Medical Council. Outcome for Graduates. 2018. Available from: [Accessed 23rd December 2020] 

129. Licchetta, M, & Stelmach, M. Fiscal sustainability analytical paper: Fiscal sustainability and public spending on health. Office for Budget Responsibility, 2016 Available from: [Accessed 19th February 2021] 

130. The Organisation for Economic Co-operation and Development. Tackling Wasteful Spending on Health, OECD Publishing, Paris,2017. Available from: [Accessed 19th February 2020]

131. Aus der Beek T, Weber FA, Bergmann A, Hickmann S, Ebert I, Hein A, Küster A. Pharmaceuticals in the environment—Global occurrences and perspectives. Environmental toxicology and chemistry. 2016;35(4):823-35

132. Wellcome, US Centers for Disease Control and Prevention and UK Science and Innovation Network. Initiatives for Addressing Antimicrobial Resistance in the Environment: Current Situation and Challenges. London : Wellcome Trust, 2018. Available from: [Accessed 19th February 2020]

133. Mortimer F, Isherwood J, Wilkinson A, Vaux E. Sustainability in quality improvement: redefining value. Future healthcare journal. 2018 ;5(2):88 

134. Janson C, Henderson R, Löfdahl M, Hedberg M, Sharma R, Wilkinson AJ. Carbon footprint impact of the choice of inhalers for asthma and COPD. Thorax. 2020 ;75(1):82-4