Realistic Medicine - Doing the right thing: Chief Medical Officer annual report 2022 to 2023

Chief Medical Officer's (CMO) third annual report, and the seventh on Realistic Medicine. It reflects on the challenges our system is facing and asks professionals to practise Realistic Medicine, in order to deliver value based health and care and a more sustainable system.


5 July 2023, marks 75 years of the National Health Service and the National Assistance Act coming into force.

The Act introduced the duty on local authorities to provide accommodation for older and frail people and a power to promote the welfare of disabled people. It made clear a public responsibility to provide services to people who, because of age, illness or disability, need support.

The NHS touches all of our lives. Founded in 1948, the NHS was the first universal health system to be available to all, free at the point of delivery. Today, nine in ten people agree that healthcare should be free of charge, more than four in five agree that care should be available to everyone, and that the NHS makes them most proud to be British.

This is because, since 1948, the NHS and social care services have always evolved and adapted to meet the needs of each successive generation. Scotland has made a significant contribution to improving outcomes for the people we care for.

Ultrasound was first used for clinical purposes in Glasgow in 1956. Obstetrician Ian Donald and engineer Tom Brown based their prototype device on the industrial flaw detector, a tool widely used in the Clyde shipyards. Ultrasound was in wide use in Glasgow hospitals by the end of the 1950s, but it wasn't until the 1970s that the technology spread into the rest of the UK. The Glasgow Coma Scale – used by medics across the world to rate patients' level of consciousness – was developed in 1974. It was first published by Graham Teasdale and Bryan J. Jennett, Professors of Neurosurgery at the University of Glasgow's Institute of Neurological Sciences at the city's Southern General Hospital. Breast cancer screening was introduced across the UK in 1988, following a report produced by Sir Patrick Forrest, a Professor of Surgery at Edinburgh University. This work built on pioneering efforts in Dumfries, Aberdeen and Dundee to screen women for cervical cancer. NHS Screening programmes were a world first.

As we mark 75 years of the NHS and the National Assistance Act, we should celebrate our achievements, as well as look ahead to the opportunities we have to shape our NHS over the next 75 years. In planning for the future, we must overcome some pretty big challenges. Threats from novel diseases remain; health inequalities are widening; demand for our health and social care services continues to increase; and the climate emergency is already affecting Scotland's health and wellbeing.

Every day I see dedicated people working hard to make a difference. Our system is driven by you, its people, and that's why our health and social care services are valued so highly by all in Scotland. However, there is clearly a pressing need to do things differently if we are to address these interconnected challenges and improve the lives of the people we care for.

I very much hope that you will recognise the challenges I describe in this report and agree that no matter where you work in our health and care system, we must focus on doing the right thing. By doing the right thing, we can move away from what often feels like industrial care performed by transactional technicians. By nurturing trust and belonging within our health and social care services we can re-connect to our purpose and deliver the careful and kind care that will create the fairer more sustainable system that we all wish to see.

Professor Sir Gregor Smith

Chief Medical Officer for Scotland



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