Scotland’s Chief Medical Officer (CMO) says the NHS must embrace innovation if it is to meet its goal of becoming a fairer, climate-resilient and sustainable system as his latest report warns of ‘immediate and worsening’ climate change impacts on health.

In his 2023-24 report, CMO Professor Gregor Smith emphasises the importance of integrating realistic medicine – with its focus on shared decision-making and personalised care – into more healthcare settings.

Professor Smith writes that progress has been made here and efforts to align healthcare practices with environmental sustainability are also advancing but that more urgent action is needed:

‘I would like to inject some realism into the conversation: mitigating and adapting to the planetary crisis must be our number one concern as we work towards our climate-resilient, low-carbon, equitable and sustainable health and care system of the future.

‘We must act quickly, collectively and decisively.’

The report says that to fully tackle this crisis Scotland must continue to collaborate and strengthen its links with industry and the third sector while developing community-led care.

Building on last year’s call to resist ‘transactional’ healthcare that “gets in the way of human connection”, Professor Smith says that by nurturing trust and understanding patients’ history and biology, better care can be delivered.

Embracing innovation

Introducing the report in a pre-recorded video, Professor Smith told health and care staff while greater urgency is needed, he remains positive about tackling the health threats of climate change:

“It’s clear to me that health and care professionals globally must use our trusted position and their influence to help us to mitigate and adapt to the planetary crisis with greater urgency.

“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, your kindness and work towards a sustainable future.”

Research, he said, is “vital” to delivering care that matters, as “the more we understand about the biology and biography of people”, the greater the scope to tailor healthcare to the individual.

The CMO details how innovation is central to Scotland’s pursuit of wellbeing and equity, writing that he is ‘proud’ of the research Scotland has given the world – the lives it has improved and the lives it has saved.

Professor Smith says precision medicine – using biological and genetic aspects of care to tailor healthcare– will help power earlier diagnosis, interventions and targeted treatments.

He adds that supporting patients to play an active role in Scotland’s “vibrant research community” will help produce better outcomes.

Chief Scientist for Health, Professor Dame Anna Dominiczak, says that 2024 brings “huge opportunities” for implementing evidence-based innovation in primary care, secondary care and in the community:

“This CMO report is helping us to stress the importance of research and innovation in everything we do across health, the NHS, academia, our clinician scientists – across the board.

“Together we can bring to Scotland and the world the best possible and most efficient health innovations. This type of investment in people and ideas will bring better health to us all.”

Health inequalities

Health inequalities must be addressed through radical reform focused on prevention and a whole-system approach is needed, says the CMO.

This includes recognising that the planetary crisis is a public health and human rights crisis that will worsen and drive new forms of inequity.

The report outlines that ‘successful action’ requires tackling the structural and wider environmental causes of health inequity alongside addressing people’s individual experiences and needs.

Global warming, increasing rainfall and storms all affect physical and mental health as well as changing the way diseases are spread.

The CMO explains that with the food chain vulnerable to climate changes at home and abroad, barriers faced by those already struggling to access healthy nutritious food during the cost-of-living crisis could worsen.

He outlines the importance of making healthy weight a priority, particularly as people in more deprived communities are disproportionately burdened by ill health and mortality linked to poor nutrition.

This comes weeks after public health leaders pushed for more action to improve access to sustainable healthy food and physical activity opportunities.

Supporting the workforce to deliver care

The report  reflects on the challenges raised by Audit Scotland’s recent assessment of  the NHS, which identified ‘value-based health as an opportunity’ and underlines the importance of empowering the workforce.

The CMO believes that health, care and community organisations fostering ‘careful and kind care’ will improve staff and public wellbeing:

“If we are to improve health and wellbeing for careful and kind care, we can promote more sustainable healthcare to the people that we care for our communities, and to help reduce the impact of healthcare on our environment.

“We must ensure that our health and care professionals are provided with the support to enable this sense of service to thrive.”

He says that ‘small, manageable’ improvements and finding out what matters to the people they care for will help Scotland create a society where everybody thrives.

Read more: Realistic medicine to help the climate; Glasgow: Working together for a healthy city; NHS Scotland unveils plan to cut plastic packaging; PHS: Poor transport is widening health gaps; A question of action; Analysis: Why people are left behind; Medics warn pollution is risking children’s health