Our Path Ahead: Chief Medical Officer for Scotland Annual Report 2025–2026

Chapter 2: Harnessing Disruption

We have entered a period of profound and accelerating disruption. Some of the forces reshaping our health and care systems are familiar, but many are new, emerging with a scale and speed that challenge traditional ways of working. The landscape in which we care for people is no longer defined solely by clinical need and service design but by powerful external disruptors that influence how information flows, how decisions are made, how care is delivered and how our environment sustains health.

Individually, these disruptors present challenge and opportunity. Together, they represent a fundamental shift in the way systems must operate. We cannot rely solely on assumptions or pathways that served us well in the past. To continue delivering safe, person-centred, sustainable care, we must adapt proactively, thoughtfully and with purpose. Disruption is not something we can avoid; it is something we must harness for the benefit of the people we serve so that our responses protect, rather than undermine, the humanity of care.

Health Information Integrity

Access to high-quality information is essential for people to make informed health and care decisions. Trust in that information matters just as much as its availability. When information is inaccurate, misleading or poorly communicated, it can undermine confidence, distort decision making and cause harm.

Powerful digital tools now enable false or misleading information to spread faster and more widely than ever before. In this context, public trust becomes more fragile but no less important. Health professionals continue to be among the most trusted voices in society; that trust brings responsibility. How we communicate, what we challenge and how we engage carries weight.

The terms misinformation and disinformation are commonly used to describe false or misleading information: disinformation is deliberate, while misinformation is often shared in good faith out of concern for others. Both can cause harm, but these labels are not neutral. Framing our approach as health information integrity helps avoid judgement, recognises different motivations and keeps our focus on ethics, responsibility and trust. Preserving information integrity means ensuring the availability of ‘accurate, reliable information free from discrimination and hate,’ while fully respecting the right to freedom of expression.

Autonomy is a core principle of medical ethics, described by Beauchamp and Childress and protected in law; people with capacity have the right to make their own health decisions, even when those decisions differ from professional advice. To exercise meaningful choice, however, people must first have access to accurate information they can trust.

Spread and Impact of False Health Information

With a single click, content can now circulate globally, reaching millions before its accuracy can be assessed. Designed by humans and shaped by commercial and engagement-driven incentives, algorithms determine what people see, how often they see it and which voices are amplified. When these systems prioritise attention over accuracy, false or misleading information can spread rapidly. Many of these algorithms now rely on artificial intelligence which can reinforce bias or amplify faulty information.

Part of the challenge is not only the volume of information, but the way humans process it. A range of cognitive and social factors make people more susceptible to false beliefs, including:

• Intuition over analysis – relying on quick, intuitive judgments rather than slower, more critical thinking;
• Illusory truth – favouring familiar claims that feel true simply because we have encountered them before;
• Cognitive failures – moments when we set aside our usual mental checks, especially when busy or overwhelmed;
• Emotion– where false narratives engage us through fear or anger;
• Worldview alignment – stories that fit our existing beliefs are more readily accepted; and
• In‑group reinforcement – information that affirms our identity or criticises groups we distrust feels intuitively credible

These tendencies affect all of us, including those with good health or media literacy.

False information can be sticky; once introduced it can have long lasting effects, even when proven to be untrue. Just as in other aspects of care, prevention is more effective than cure.

Compromised information integrity has real and measurable consequences for health. The spread of false information can lead to direct and indirect harm to key public health interventions and undermine messaging; can harm our ability to communicate effectively with those we care for; often targets women and minority groups; and can destroy trust in institutions, leading to non-compliance with public health measures in emergencies such as pandemics. It can affect decision-making and slow the presentation of illness, harming outcomes and increasing costs. Monetised disinformation, such as marketing ineffective health supplements and treatments, can decrease trust in healthcare. And there is some evidence health disinformation is being used to drive people towards conspiracy and extremism.

Information integrity is also a matter of national security. In times of geopolitical instability, health is a recognised target in the information space. The WHO describes how disinformation may be deliberately created to sow confusion, erode trust in scientific and civic institutions or generate division. Increasingly sophisticated tools expand the potential for harm.

Responding to Harm and Protecting Trust

Health systems must respond to this disruption by adapting to the realities of the information age. A proactive approach to information integrity- strengthening trusted voices, anticipating vulnerabilities and supporting early intervention- is essential to limit harm from false and misleading health information, monetised medical and lifestyle products, emerging AI tools, as well as the substantial information demands created by pandemics and other public health emergencies. Together, these forces reshape how people seek and understand health information and require systems that are prepared, coordinated and resilient.

The tools and actions enabling us to protect public trust through safeguarding information integrity are set out in the Scottish Health Information Integrity Strategy. This marks the beginning of the first coherent and comprehensive response to false and misleading health information anywhere in the world.

Individual health professionals remain trusted voices within our communities. Part of our role must be to use our voice to share truth and challenge that which may be false. To do this effectively, compassion and time are essential. Managing interactions with sensitivity can avoid reinforcing mistrust and playing into false beliefs.

In an age where information is shaped by polarisation and echo chambers, human relationships hold the power to change minds. These relationships remain one of our strongest tools for countering false information, but trust cannot be assumed. It must be built, nurtured and protected. This requires time: time for connection, compassion and continuity, which together create the conditions in which people feel safe to ask questions, express uncertainty and engage with reliable sources of care.

Artificial Intelligence with Care

Artificial Intelligence (AI) is often described as the steam engine of the Fourth Industrial Revolution. Its influence is already visible across many parts of society, including health and social care, whether systems are ready for it or not.

AI brings both opportunity and risk. For health and care professionals, the key question is not only whether AI will change practice, but how it will do so, and how we ensure that new tools are governed and used in ways that are safe, ethical, evidence based and centred on people.

AI is Not One Thing

AI is often spoken of as a single technology, but in practice it encompasses a range of tools, used in different ways and carrying different risks. In health and social care, AI can be broadly grouped into three categories:

• Person facing tools, which people interact with directly — for example, chatbots
• Decision support tools, used to inform professional judgement, such as image analysis in cancer detection
• Administrative tools, which support tasks such as documentation, scheduling or summarising information

Understanding both the type of AI being used and its intended purpose matters. Different tools raise different risks, which must be assessed in context.

Promising Uses of AI

There are encouraging examples where AI tools offer potential benefits:

Case study: Breast Cancer Screening

The University of Aberdeen, in partnership with NHS Grampian, explored how AI can be used to support radiologists in breast cancer screening. Published in Nature Cancer, the GEMINI prospective evaluation involved 10,889 women and assessed how an AI tool could be integrated into breast screening.

Overall, the primary AI workflow demonstrated a 10.4% increase in cancer detection (around one additional cancer found per 1,000 women screened). Recall rates were maintained, while clinician workload was reduced by up to 31%.

This work demonstrates how clinically led, carefully evaluated AI, used to support rather than replace professional judgement, could contribute to better breast screening programs.

Case Study: Ambient Voice Technology (AVT) or ‘AI Scribes’

AVT tools record a consultation or interaction and transcribe this to text. Several local authorities are piloting the use of AI scribes to support social work staff. Some GP practices are using similar tools. A major study showed a 23.5% increase in direct patient interaction time during appointments, alongside an 8.2% reduction in overall appointment length when AI-scribes were used. One Scottish local authority trial found social workers were saving, on average, six hours of admin per week.

These examples highlight how AI is being tested and evaluated, with real world benefits emerging in some contexts. Important questions remain in others.

Risks

AI systems introduce a distinct set of risks. These do not arise from technology alone, but from how AI is designed, trained, used and regulated within complex health and care settings.

One such risk is bias. Health knowledge has always reflected the biases of its time. Where AI systems are trained on unrepresentative or incomplete data, or reflect existing biases in historical records and research, they may reinforce inequalities and cause harm. A UK independent review found racial discrimination and inequities are embedded in AI cancer screening tools, genomics scores and optical devices. Not only are racial biases embedded in AI models and training datasets, but racism is also systematically reproduced in outcomes, clinical trials, evaluation and governance of AI. A US study found some chest X-ray algorithms underdiagnosed conditions in females and people from Black and Hispanic communities, increasing the risk of delayed care and worse outcomes. Similarly, a UK study of AI tools used to summarise care notes identified systematic gender bias, with women’s care needs consistently downplayed. The Ada Lovelace Institute highlights harmful and inequitable outcomes of ambient voice technology for health and social care records. These findings echo other UK studies calling for co-design of AI that centre expertise by lived experience and increase public participation in evaluating the impacts of AI use in health and care services.

AI tools can lack transparency because of technical complexity or because intellectual property rules limit scrutiny of algorithms, making it harder to understand how outputs are produced and challenge results. AI performance can vary across settings and over time, leading to quality and safety issues. Alongside this, the large volumes of data required to train AI systems raise risks around privacy, data protection and human rights. Wider considerations include the environmental impact of AI and unclear liability around AI-related harms.

There are potential implications for workforce roles and skills. Overreliance on AI risks diminishing the human role in decision making. We must guard against this. AI tools do not think, understand or exercise judgement; they do not hold experience or wisdom. Their strength lies in handling and presenting information, not in interpreting meaning, context or consequence. Used uncritically, AI may give a false sense of added knowledge or reassurance, particularly where experience is limited, without signalling uncertainty or error. AI must therefore be designed and used to support, not substitute for, professional judgement — helping people and professionals to weigh evidence, values and individual circumstances together. It cannot, and should not, replace the human work of understanding what matters, judging risk and working with people to decide on the best course of action.

Generative AI and Chatbots

Not all AI tools are at the same level of maturity or safety. Generative AI tools, including large language model based chatbots, present particular risks. Many people use chatbots for health advice. Technology companies are beginning to market tools specifically for this purpose. Early evidence suggests some products may provide inaccurate or potentially harmful advice.

These systems generate responses based on patterns in large datasets, not an understanding of evidence. Their inner workings are not transparent — the well recognised ‘black box’ problem — and they may draw on incomplete, outdated or biased information. ‘Answers’ offered can be convincing, while still being wrong. They offer plausible text, not understanding.

For health and care professionals, this creates several risks:

• Misleading information may influence professional judgement, even when used informally or ‘to sense check;’
• These tools do not reliably distinguish high-quality evidence from misinformation;
• Errors may be difficult to detect, particularly when answers appear confident and plausible.

There are also risks for the people we serve. Some may rely on AI-generated information instead of professional advice, potentially delaying care, or they may act on false reassurance or inaccurate guidance.

At present, the evidence base is not robust enough to support the use of general purpose generative AI chatbots as a source of medical advice or clinical decision making, whether used by those seeking health guidance or delivering care. These tools have not been shown to be safe or reliable substitutes for evidence-based sources or professional judgement. While governance and procurement frameworks are evolving, professional responsibility has not changed. Health and care professionals remain accountable for the advice we give and the decisions we make, whether information comes from AI or elsewhere. To ensure the regulation of AI in health moves with the pace of innovation, the MHRA has launched a National Commission into the Regulation of AI in Healthcare to advise on a new regulatory framework, with recommendations expected later this year.

As trusted voices in our communities, health and care professionals have a role in helping people understand both the potential benefits of AI and its limitations. This includes being clear about for what AI tools can and cannot be relied on and reinforcing the importance of evidence based sources and professional advice.

Responsibility, Governance and Safeguards

Responsible use of AI depends not only on individual professionalism, but on clear governance and oversight supporting safe and appropriate use. Some AI tools are already being adopted ahead of organisational guardrails, agreed procurement frameworks or widely understood rules about responsibility, creating risks to both patient safety and trust.

The answer is not to disengage, but to engage responsibly: using AI only where there is appropriate evidence and clarity about its intended use; ensuring multidisciplinary governance for adoption; being transparent with those we serve about where and how AI is used; and supporting our workforce and those we care for to build confidence, skills and understanding. Scotland’s AI Strategy provides clear commitment to a framework for the safe, ethical and effective use of AI, helping to ensure innovation is shaped intentionally, rather than emerging unchecked.

Shaping AI for Good

AI should never replace relationships, compassion or professional judgement — the foundations of safe and meaningful care. By taking on tasks done well by technology, AI can help ease pressures so we can deliver the careful and kind care that matters to people- with more opportunity for human connection, better coordination and more sustainable services.

Health and care professionals have a vital role in shaping how AI is developed, evaluated and adopted, so tools reflect the realities of practice and uphold the standards of evidence based care. AI can be designed to optimise for many different goals; not all of them reflect what matters most in care. If AI is framed primarily as a route to ‘seeing more patients in less time,’ there is a risk that industrial efficiency is prioritised over quality, sustainability and the conditions that support careful and kind care.

This is not inevitable. When designed and used well, AI can support more meaningful interactions, allowing staff to spend less time on screens and more time with the people we care for, building relationships. These relationships are closely linked to better outcomes and experiences of care.

Harnessing this disruption requires deliberate choices—not only about the tools themselves, but about how care pathways are designed. AI must support improved outcomes and experiences, reduce burden for the workforce and improve cost-effectiveness, while keeping people and relationships central to care. Simply using technology to accelerate existing processes risks adding complexity and stripping out the time and continuity that underpin trust. More meaningful improvement comes when AI is used to enable thoughtful pathway redesign—reimagining services in ways that make best use of technology while protecting and strengthening the relationships at the heart of careful and kind care.

AI will become integral to care. Its value, like a stethoscope’s, lies in knowing how it works and when to rely on it. We should expect transparency, demand safeguards and invest only in tools that improve outcomes, experience, equity and sustainability. Handled well, AI can strengthen rather than strain the humanity of care.

Digital and Technology-Enabled Care

Digital technologies are reshaping how care is delivered- where interactions take place, how people access information and what they expect from services. In doing so, they disrupt established models of care while creating new possibilities and new pressures.

Across Scotland, digital tools such as telecare, video consultations, remote monitoring and home-based diagnostics can support models of care that are more proactive, responsive and convenient. These innovations do not replace the need for clinical judgement and personal connection but can enhance them when used well.

Tools such as MyCare.scot can help rebalance power by giving people easier access to their health and care information. Over time, the Digital Front Door aims to simplify appointment management and reduce the need to repeatedly retell their story. Further work to develop a shared digital health and care record, as committed to in the Care Reform (Scotland) Act 2025, will be essential to reduce duplication, improve safety and support more joined up care.

Good information governance underpins the safe use of digital innovation. As part of clinical governance, it ensures data and digital tools are used securely, transparently and responsibly, protecting trust.

When designed well and used in support of relationship-based care, digital advances can enable high-value care. They offer a chance to reshape services to be more joined-up, responsive and better aligned with what matters to people who use them.

Designing for Equity

Digital and AI tools can expand access to services and improve coordination of care, but they can also amplify existing inequalities. If those who most need care are least able to use digital routes, these tools risk deepening the inequalities we seek to reduce. An equity lens means recognising digital barriers as part of a person’s context and ensuring technology never becomes the price of entry to care. Services should be co-designed with users, accessible for different abilities and languages, usable in low-bandwidth environments and available alongside non-digital options. Done well, digital tools widen access rather than narrow it.

Digital Exclusion Matters

Digital exclusion impacts people who do not or cannot fully use digital technology. This may be because of limited access to a suitable device or internet connection, lack of skills or confidence, mistrust of online services or difficulty keeping up with technological change. But exclusion is not only about access or skills. It can also reflect fear of discrimination, concern digital pathways will replace face-to-face care or lack of agency and choice.

Some groups are disproportionately affected. In Scotland, around one in ten people do not use the internet. Among those offline, the majority are older (72% retired, aged 65+), living in the most deprived socioeconomic group (55%), report a disability (51%) or live alone (58%). Nearly half receive benefits and a third do not use a mobile phone. Rural communities face additional challenges due to poor connectivity. These factors may overlap, compounding exclusion. For many professionals, these characteristics will be familiar: the people we care for most often are also most likely to experience digital barriers.

Actions for Progress

To ensure digital advances do not amplify inequalities, we must design services that reach everyone. This requires understanding the needs of all users and involving communities most at risk of exclusion using co-design. This approach shapes services around people’s realities, rather than expecting people to fit services.

Audit Scotland reinforces this approach, noting that examples of good practice include services involving people early, identifying barriers with communities and acting to address them. The Human Rights Principles for Digital Health and Social Care offer a solid foundation for a rights-based approach to designing services.

Case study: Digital Lifelines Scotland

Digital Lifelines Scotland (DLS) was created to tackle digital exclusion and improve outcomes for people at risk of drug related harm. DLS seeks to remove barriers; it provides devices and connectivity, supports people to develop digital skills and helps staff develop digital confidence. The programme introduces digital services that improve accessibility, strengthens collaboration and works to embed digital inclusion into local systems.

By February 2026, DLS had supported 5,900 people, distributed 3,228 devices and 3,992 connectivity packages, funded 37 organisations and trained 587 digital champions. Participants report increased trust, confidence and capability; improved engagement with support services; better connections with family, friends and peers; and new ways to stay safe and reduce immediate risks of harm. Many also highlight how digital access has opened the door to wider opportunities, from managing finances to taking up volunteering, employment or securing housing.

Good design requires that digital routes never become the only door into services. Telephone contact, in-person appointments and assisted digital support in trusted community settings like libraries remain essential. National organisations emphasise that digital inclusion must be built in from the outset and supported through practical local pathways. The Digital Inclusion Programme has helped over 3,600 people build digital access and skills, and learning from this work is informing wider approaches to inclusion across health and social care.

Digital innovation is welcome when it widens the front door, not when it raises the threshold. Our task is to ensure new tools serve everyone by protecting choice, removing friction and designing with communities at risk of exclusion. It does not end with design. It also means recognising when digital routes become a barrier, adapting our approach and advocating for improvement so that no one is left behind.

Getting the Basics Right

Many of us recognise a familiar challenge: the promise of advanced digital innovation contrasted with daily frustrations with technology. NHS staff consistently report basic barriers to effective use—insufficient IT support, limited funding for implementation and unreliable connectivity. These issues create inefficiency and risk. When the basics feel fragile, it becomes harder to see how more advanced technologies could help in practice.

To realise the benefits of emerging technologies, they must fit into and meaningfully improve the way good care is delivered. Care is inherently relational. Digital systems should be designed to support relationships rather than dictate interactions or workflows. When digital systems or technologies disrupt established, efficient and person centred ways of working, they can add burden, contribute to burnout and reduce productivity.

At the same time, many will wish to develop new skills where technologies meaningfully improve care. Supporting development means creating opportunities to learn safely, progressively and in context.

Getting these basics right matters. Strong foundations create the conditions in which digital advances can truly enhance practice, access, experience and performance.

Cybersecurity

As digital tools reshape the way care is delivered, they also reshape the risks we face. Greater reliance on digital infrastructure brings new vulnerabilities. Threats to data integrity and data protection can arise from many sources, from human error to outdated technology.

Cybersecurity protects more than data; it safeguards trust, safety and care. Cybersecurity failures have clinical consequences. Even short disruptions can delay urgent treatment or interrupt essential services. If records become inaccessible, critical decisions may be compromised. And while some harms are immediate, others accumulate over time. Backlogs and recovery work can stretch services already operating under pressure, increasing risk of harm.

Defence is Everyone’s Business

Defending against cyber threats requires system level preparedness and individual vigilance. National support helps protect NHS Scotland’s digital services, with the NHS Scotland Cyber Centre of Excellence and the Scottish Cyber Coordination Centre providing expertise. Resilience depends on coordinated action across the system—from national leadership and support to governance and oversight at Board level.

Cybersecurity is not just an organisational issue; it is everyone’s business. Everyday actions, like using multi-factor authentication, recognising phishing attempts, reporting suspicious activity and keeping systems updated, form the first line of defence.

The Planetary Health Crisis

The planetary health crisis is one of the most profound disruptors of our time. Unlike technological change, the climate emergency reshapes health and care through rising need, altered disease patterns and sustained pressure on infrastructure.

Climate change, pollution and biodiversity loss together remain the greatest threat to global public health. Scotland is already experiencing these impacts—and without decisive action, they will intensify.

In the face of disruption on this scale, incremental progress is not enough. We must accelerate and expand our response.

Need for Accelerated Action

Scotland’s health service was the first in the UK to commit to becoming a net zero organisation. Despite promising initiatives, the pace of change is not yet matching the pace of the crisis. The NHS Scotland Climate Emergency and Sustainability Strategy (2022–2026) is nearing completion, with a refresh underway. This presents a critical moment: we must embed planetary responsibility across the system.

The work of our anchor institutions, local authorities and national partners is showing what is possible when health, environment and equity are treated as interdependent priorities. Community-driven greenspace projects, sustainable procurement models, active travel initiatives and cross-sector adaptation planning all point to a future where health and climate goals reinforce one another. These examples must now move from being inspiring outliers to the way we operate.

Empowering Practitioners

System level change requires leadership, resources and policy, but it is also shaped by the thousands of everyday decisions made by those who plan and deliver care. Many colleagues tell me they want to act but feel unsure where to begin. Let me be clear: individual action matters. Collectively these actions shape culture, expectations and professional norms.

Simple, evidence based steps—from appropriate medicines use and minimising waste, to promoting prevention, exploring alternatives and integrating nature based approaches—can protect the planet while improving health. These actions align with SIGN guidance on sustainability and climate principles for healthcare.

‘We Care, fiercely’ by Jane Oldham, Transfusion Practitioner, emerged from a quality improvement project on labour ward and invites reflection on how ‘just in case’ actions can unintentionally shape harm, burden and care.

Education underpins our response to disruption. In every form of change, the adaptability of the workforce is critical. This emergency is no different: health and care professionals must be equipped to respond to changing patterns of disease, evolving community needs and new models of care. The work of the European Network on Climate & Health Education (ENCHE) demonstrates how climate and health principles can be embedded within professional education.

Case study: European Network on Climate & Health Education

The healthcare sector is facing the growing impacts of climate change, while contributing around 5% of global emissions. Health professionals must be equipped to respond to this challenge through adaptation (dealing with the impacts) and mitigation (preventing further climate change) by practicing sustainable healthcare and Realistic Medicine.

The European Network on Climate & Health Education (ENCHE) is chaired by the University of Glasgow and has two key targets: to engage 10,000 medical students in education for sustainable healthcare (ESH) by 2027 and to support four member countries to advocate for mandatory ESH within national medical curricula.

ENCHE has recruited 55 medical schools across 16 countries and reached over 2500 students. A major challenge is lack of faculty confidence to deliver ESH. ENCHE organised a faculty development course for clinical educators (available here) with an attendance of around 2000 participants.

ENCHE supported the Scottish Consortium for Sustainability in Medicine to develop a white paper supported by all Scottish medical schools, launched at Scottish Parliament in February 2026. This work funds a Scottish Clinical Leadership Fellow and the creation of a governance board to link strategies in education, clinical practice and policy. The white paper is now being used internationally as an example of collaborative national strategy for advocacy.

Linked Problems, Linked Solutions

The challenges we face are profoundly interconnected. So must be our solutions. Actions that reduce emissions, enhance biodiversity or improve environmental resilience often bring health co-benefits. Cleaner air reduces hospital admissions. Active travel improves both physical and mental wellbeing. Sustainable healthy diets improve health and may ease pressure on services. Access to nature reduces stress, promotes social interaction and enhances quality of life. Approaches that align planetary and human health are therefore good for people, good for care and essential to the long-term sustainability of our services; they must be available, affordable and accessible.

Commitment Into Action

In previous reports, I have explored in detail the climate emergency and its profound connection to human health. I have also set out what is required. We must:

• address the health impacts of the climate emergency head on;
• adapt services to withstand the environmental changes we can no longer avoid; and,
• reduce the impact of healthcare itself by eliminating waste, practising sustainably and embedding stewardship into our culture.

The need for decisive action is well-established. Implementation is now urgent. Progress will depend on action at every level, and the workforce must be equipped to contribute meaningfully to this transition. If disruptive innovation demands that systems evolve to meet new realities, the planetary health crisis represents the most consequential disruptor we face. Meeting it with purpose, pace and collective action is not optional, but central to delivering careful, kind and sustainable care.

Conclusion

We are living through a period of profound disruption. It brings risk to trust, equity and care, but it also creates opportunity to shape a system that is more humane, resilient and fair. The status quo is not sustainable and is not an option.

How we respond matters. Each choice we make helps determine whether disruption erodes what matters or strengthens it. Acting as trusted voices, using digital tools with care and purpose, designing systems that widen rather than narrow access and taking responsibility for the security and sustainability of systems are not someone else’s tasks. They are expressions of the same professional duty: stewardship in the service of our communities.

The planetary crisis magnifies that duty further. The interconnected challenges of climate change, pollution and biodiversity loss cannot sit at the margins of health and care. They must be woven into how we think, decide and act, individually and collectively.

Systems that serve will not be delivered by one person, profession or nation alone. When everyday actions align with shared values, momentum builds. Together, we have the ability and the responsibility to shape disruption in ways that protect care, sustain trust and steward our environment and our systems for the benefit of future generations.