Realistic Medicine: Taking Care Chief Medical Officer for Scotland Annual Report 2023-2024

I would like to share my annual report Realistic Medicine: Taking Care. This report has important messages for doctors and dentists in postgraduate training. Many of you are already senior clinicians – innovators, leaders and thinkers driving positive change in NHS Scotland.  

This report launches into an uncertain world. The accumulation of events bringing insecurity – the global pandemic, conflict-related humanitarian disasters and the energy and cost-of-living crises – have compounded existing challenges and rattled the resilience of health and care systems across the world. 

On top of this, the most significant long-term threat to human health remains the climate emergency and its impact on planetary health. 

Despite the uncertainty we face, I remain optimistic that we can meet the four concurrent challenges to population health in Scotland: the ongoing threat of infectious disease; widening health inequalities; the need to create a more sustainable health and care system; and the need to address the planetary crisis. I remain optimistic because I continue to be struck by your dedication and kindness in working towards a sustainable future.  

It’s obvious to me that as we manage uncertainty, we have a pressing need to do things differently and I remain convinced that practising Realistic Medicine will help us to respond, adapt and deliver the change needed for our communities and our planet to thrive. 

Last year, in Doing the Right Thing, I spoke about the way we deliver care. I shared my thoughts on the need to resist the industrialisation of care because this leads to generic and transactional relationships between professionals and the people we care for. This industrialisation gets in the way of human connection, which is fundamental to the art of caring. 

In this year’s report, Taking Care, I’d like to develop this theme further. I believe that by nurturing trust, by understanding both the biology and the biography of the people we care for, we can make meaningful connections and deliver careful and kind care. 

Taking this approach will help to create not only the fairer and more sustainable system that we all wish to see, but also the outcomes that really matter to the people we care for. There are actions we can take to enable this kind of care.

This year, I am thrilled to be celebrating our proud tradition of research and innovation and the 50th Anniversary of the Chief Scientist Office. I will also share my reflections on our progress towards improving lives in communities across Scotland and beyond.  

In his recent report, the Auditor General highlights the challenges our system is facing. He identifies Value Based Health and Care as an opportunity to address them and recommends that Government and health and care professionals must work together to deliver it. He has emphasised the need to empower our colleagues to practise Realistic Medicine and recognise how it can impact positively on outcomes and sustainability. 

I hope that the content of this report will resonate with you, lead to further innovation and new and sustainable ways of working and I very much hope it will help us connect in a meaningful, human way with the people we care for. 

Professor Sir Gregor Smith
Chief Medical Officer for Scotland