Delivering a Better Health Future for Scotland
A report on the Scotland’s Future Series symposium by third year Medical Students Nimue Romeikat and Rosa Morgan-Young
Thanks to funding from the University of St Andrews Scotland’s Future Series, the School of Medicine hosted the ‘Delivering a better health future for Scotland’ symposium on 5 March. Bringing together experts from across the UK and USA, the day was split into two sessions, focusing on the themes of ‘Identifying the key health and social care challenges facing Scotland’ and ‘Universities – Working for health improvement in the community’. The event was attended by a broad spectrum of interconnected partners in Scotland’s health and social care, including strategic leaders and staff from NHS Fife and Scottish Government, as well as University staff and students, representatives of local patient engagement groups and members of the public.
Morning session – ‘Identifying the key health and social care challenges facing Scotland’
The day started with a warm welcome by Professor Dame Sally Mapstone. It was exciting to hear how so much of St Andrews recent news has been driven by the incredible work of our medical school. Highlighted were the Making Waves campaign, our new undergraduate programme MBChB (ScotCOM), the partnership with NHS Fife benefitting patient care and medical research, and the incredible work being undertaken by Scottish Brain Sciences. Following on from this, we were very excited to be addressed by our new Dean, Professor Deborah Williamson. She too highlighted the incredible progress our school has made – both in research and medical education.
Our morning focused on the health and social challenges currently facing Scotland, while the afternoon armed us with plenty of plans to address and overcome them.
Professor Sir Gregor Smith, Chief Medical Officer for Scotland since 2020, set the tone by sharing his perspective on four key population health challenges – infectious disease, improving life expectancy, sustainable health and care services, and sustainable use of resources. We learnt that not only have improvements in population health come to a halt, but Scotland’s health is worsening. On top of this, he raised that one fifth of healthcare spend has no impact – highlighting the critical role of sustainable care and the fine balance of over- and underdiagnosis. A key takeaway was to be mindful of the emerging shift from holistic clinical practice towards the industrialisation of care. He ended his talk by presenting a possible approach to all issues raised: Realistic Medicine.
Following this Dr. Chris McKenna provided us with a local NHS Fife perspective. By utilising immersive patient stories, he showcased how current clinical practice can be improved with whole systems healthcare delivery and the importance of working together with patients and communities. While he highlighted our success at transforming the system – with changes being established in our services, structure, and care delivery – he stressed that we now must now focus on sustainably implementing our set goals.
The next talk was presented by Dr. Linda DeCherrie, Vice-President for Clinical Strategy and Implementation at Medically Home USA. She started off with an introduction to her journey in home-based care. We were given a detailed insight into how the Hospital at Home (H@H) programme can support home-based care delivery for more than 20 health systems and substitute acute inpatient care. A truly intriguing approach with promising results! Following on from this Professor Graham Ellis, Deputy Chief Medical Officer for Scotland, outlined how the programme had performed in Scottish communities. Since 2020 H@H has advanced considerably in its geographic reach and patient uptake. Notably, when comparing H@H to standard care, costs decrease while patient satisfaction rises. We will closely follow the evolving implementation of this programme.
Professor Alexander Baldacchino then delivered an enlightening presentation on a locally pressing topic – reducing illicit drug deaths. With Scotland having the most drug deaths per capita in comparison to other European countries, there are many areas which are being explored to innovate the treatment of drug addiction. The research he described ranged from pure neuroscience such as discovering new receptors to the implementation of virtual and augmented reality. We were astonished to hear about the sheer amount of new emerging technologies such as the RescuePatch, a transdermal combination patch delivering antidotes and enabling therapeutic intervention delivered by non-professionals in the community. It was truly inspiring to see the multiple approaches explored to improve care in this area.
A panel discussion concluded the morning, made up by the wonderful speakers and further enriched by our members of staff. As medical students it’s exciting to see the exchange between healthcare professionals with varying visions for the future. The conversation started off with a question on whether the current structure of the NHS is receptive to change. It was concluded that instead of solely focusing on major changes to the structure, we should also maximise our existing resources and think about creating better pathways of care to avoid artificial barriers. A point we thought important to highlight as well was the emphasis on avoiding the concept of “productivity” in healthcare, a term often used by stakeholders and the media, but one that is highly damaging to delivering good patient care.
The first part of the day offered us profound insights and provoked curiosity for the rest of the day.
Afternoon session
Lunch provided an excellent opportunity for networking, fostering discussions among leading clinicians, researchers, and policymakers within the Scottish medical community. Attendees explored a range of research posters submitted by students, faculty, and external researchers before reconvening in the lecture theatre for the afternoon’s presentations. While the morning sessions primarily addressed systemic challenges, the latter half of the conference shifted the focus towards innovation, solutions, and strategic growth within NHS Scotland – very motivating to us as students looking forward to entering the workforce!
The afternoon session commenced with a presentation by Ayesha Jaco, M.A.M., and Eve Shapiro, M.P.H., representing West Side United. Their discussion highlighted the critical role of Anchor Institutions in enhancing healthcare access and economic resilience, with a particular focus on the intersection of racial inequities, poverty, and health outcomes in Chicago. The organisation’s mission—”to eliminate the life expectancy gap between the Loop and the West Side by addressing the social determinants of health”—served as a compelling case study, offering insights applicable to communities facing similar health disparities, including those in Fife. Notably, their initiatives, such as the development of a hospital-run laundry facility to create employment opportunities, underscored the potential for systemic interventions to drive meaningful change at the community level.
This was followed by a presentation from Professor Chris Butler of the University of Oxford, who advocated for increased patient agency in healthcare improvement. His analysis reaffirmed the continued relevance of the Inverse Care Law (1971) and its impact on the generalisability of medical research, citing the concept of the Inverse Research Participation Law. To address these disparities, Professor Butler outlined 13 strategies to enhance patient involvement in research, including “evidence-based self-sampling” and “public inclusion in all five phases of research.” His call for a global alliance to advance patient agency in primary care research was a key highlight, reflecting a broader movement towards patient-centred innovation in healthcare.
Professor Ewen Harrison of Edinburgh University, then delivered a brilliant presentation on Scotland’s use of AI and robotics in surgery. He opened with a thought-provoking fact: major complications occur at virtually the same rate across all hospitals, but likelihood of death after a major complication varies drastically among health systems, a phenomenon known as Failure to Rescue. Professor Harrison then outlined the 3 areas in which Scottish teams are employing AI or robotics in surgery: to prevent complications, predict complications and to detect complications. A particular highlight was the video demonstration of the CAMELs computer programme in action. The programme colour coded the key anatomical landmarks for a laparoscopic cholecystectomy in real time, and it was easy to see how this technology could support surgeons and reduce complications. An important take-away from Professor Harrison’s presentation was that Scotland is at the forefront of health technology development, with the sector expanding as investments and interest grow.
In a pivot from the surgical advancements discussed in the preceding talk, Professor Adam Gordon gave an enlightening presentation on research in social care. He emphasised the structural and organisational differences between health care and social care in Scotland, highlighting the difficulties faced by those working in the social care sector. By highlighting some of his own research conducted in social care settings, including the largest RCT ever to work in care homes, Professor Gordon reinforced the value of the social care sector in research. He finished with a call to action to healthcare researchers to work with social care research, and recognise the expertise available in the sector, to expand research networks and infrastructure.
The afternoon concluded with Professor David Crossman and Professor Lindsay Donaldson discussing health education and research in the community. They spoke candidly about the shortcomings of medical education, particularly the focus on academic achievement over values-based education. They suggested multiple different strategies to cope with the obstacles in our medical education system, with some of the most notable being widening medical school access, funding educator time, and a focus on whole-person care. To finish, they discussed the value of innovation in enhancing clinical effectiveness and patient safety. The strong focus on improving patient well-being and efforts to enhance community engagement for the benefit of society’s health as a whole was incredibly motivational.
Our views
This event was not only incredibly insightful but also highly motivating. As medical students, it was refreshing to hear the future of NHS Scotland discussed in a positive light, with a strong focus on innovation and development. The passion and dedication shared by all the speakers was evident, and it was particularly inspiring to be addressed by the CMO of NHS Scotland. A specific highlight for the two of us was the focus on the use of technology to improve healthcare delivery and surgical technique. In addition to the valuable insight we gained from attending the conference, we both have a newfound pride in our University. St Andrews Medical School hosted some of the most important figures in the Scottish health system, and facilitated a brilliant day of connection and learning that we are proud to have been involved in. It was a great opportunity for us students to gain new perspectives and build upon our network – we are looking forward to the next event!
Politics Student, Lucy Tabberer also attended the event and gave the following analysis of the Chief Medical Officer, Sir Gregor Smiths presentation on ‘Realistic Medicine’:
As the National Health Service faces mounting challenges, from rising demand to funding pressures, is the institution living up to its values of care, compassion and responsibility? In Scotland, improvements in population health have stalled, with the number of people dying earlier increasing, and the gap in life expectancy between the richest and the poorest growing. As the burden of disease is forecast to increase by 21% in the country over the next 20 years, changes need to be made to counteract current trends and ensure action is taken to tackle inequalities in health. In response to this, in March of this year the University of St Andrews brought together healthcare professionals, policymakers and community members at a symposium ‘Delivering a better health future for Scotland’, to discuss these challenges and propose new strategies for improving outcomes in care in the coming years. This article will discuss current levels of health inequality; the role of Realistic Medicine and community-based care; finally looking at the role of such approaches in the future of Scottish healthcare.
Recent reports on health outcomes are highlighting worrying trends. Not only are people dying younger they are spending more of their life in ill health, and although this may be an alarming fact for any Scottish citizen, the poorest 20% are almost twice as likely to suffer an early death than the general population. In Fife, where the University of St Andrews is based, men in the most affluent areas live on average 13.9 years longer than those in the most deprived areas, a gap that has increased by 3.2 years over the past decade. The widening gap in health inequalities is not just a crisis for the few, but a threat to the very foundation of the NHS; a service built on the principles of universal care and equity. In consequence, as more people experience prolonged ill health, pressures on healthcare services will intensify, straining resources and undermining the NHS’s ability to provide high-quality care for all regardless of region or background. If these disparities continue to grow, the core commitment to health equality risks being eroded, affecting every citizen, regardless of their place in society.
The symposium at St Andrews School of Medicine, part of the University’s Scotland’s Future Series, highlighted these challenges, and shed light on issues facing healthcare at both a local and global level. On the day, there was an emphasis on how a renewed focus on sustainability, equity and patient-centred care could help to address the root causes of health inequalities and foster long-term improvements in public health, showcased through various case studies both at home and abroad. The University of St Andrews has demonstrated leadership in this area through ground-breaking initiatives in undergraduate medical education such as ScotGEM (Scottish Graduate Entry Medicine) and ScotCOM (Scottish Community-Oriented Medicine), emphasising community-based learning and placement-based teaching. Delivered alongside regional health boards and NHS education, these programmes centre around community orientated medicine and offer a valuable opportunity for future doctors to develop a holistic approach to medicine and address regional healthcare needs. At the symposium, Professor Sir Gregor Smith, the Chief Medical Officer for Scotland, highlighted in his presentation that almost half of health outcomes can be attributed to socioeconomic factors and people’s physical environment, making it imperative that medical studies are integrated with social realities. Programmes like those at the University of St Andrews have a vital role to play in this, however if the scale of current issues are to be met, changes must extend beyond education alone.
To create a system that is both sustainable and equitable, the concept of Realistic Medicine may offer a solution. As outlined in Taking Care: Chief Medical Officer for Scotland Annual Report 2023 to 2024, Realistic Medicine prioritises shared decision-making, personalised care, and the reduction of unwarranted variations in treatment and outcomes. The industrialisation of healthcare—marked by rushed consultations, excessive interventions, and an overwhelming burden on both patients and staff—must be replaced with a model of ‘careful and kind’ healthcare. This means ensuring treatment is responsive, minimally disruptive, and centred around the needs and values of individuals. By tackling inefficiencies, reducing waste and harm, and managing risk more effectively, Realistic Medicine seeks to improve outcomes while maintaining the core principles of the NHS: care, compassion, and equity. Emphasising innovation, this approach offers a way forward in addressing Scotland’s deepening health inequalities. If embraced fully, it has the potential to build a healthcare system that not only treats illness but actively prevents it—ensuring a fairer system and better health for all.
However, to tackle current healthcare issues, such shifts towards Realistic Medicine and community-based care must be met with sufficient financial and political backing. Today, there are promising signs that the Scottish Government is investing in shifting the balance of care from hospitals to community care and in Scotland there are many good examples of how a more carefully designed community-based approach can succeed. With formal strategies and implementation plans, there is reason to believe Realistic Medicine and community-based care may help to address long-standing issues in Scottish healthcare.
Despite worrying trends in Scottish health, there is reason to be optimistic. As demonstrated at the University of St Andrews on 5 March, the leaders in academia, policy and NHS management are not only aware of the challenges the country is set to face, they are working towards a solution. Realistic Medicine, as part of a wider value-based approach, may provide a path towards a more sustainable and equitable future. To achieve lasting change and reverse emerging trends changes to health policy will require collective commitment, investment and cross-sector collaboration to ensure visions of care, compassion and responsibility can be realised within the NHS.
Further impact – Sir Michael Marmot: ‘What are the mutable drivers of health inequalities in the UK’
To increase the impact of the symposium and afford attendees an even richer experience the School of Medicine biennial American Medical Alumni Lecture was scheduled to occur later the same day as the symposium. This year presented by Sir Michael Marmot, his question “What are the mutable drivers of health inequalities in the UK” and themes of The Marmot Review – Fair Society, Healthy Lives, very much resonated with the themes of the day and the audience left thoroughly inspired.
Even further impact – Workshop: Improving health outcomes through Anchor Strategies: Lessons from the USA and Scotland
Keeping the momentum going and building on the symposium focus on ‘West Side United – Improving health and economic vitality through anchor institution partnerships’ a workshop was hosted by the School of Medicine on Thursday 6th March 2025, looking at lessons that might apply to Fife. Dr Linda DeCherrie, Medically Home USA, Ayesha Jaco and Eve Shapiro, West Side United provided more in-depth presentations on the work in the USA, before Carol Potter, NHS Fife Chief Executive responded with anchor strategy lessons from Fife for the USA, specifically mentioning Fifes work on sustainability, job creation, workforce development, collaborative healthcare initiatives and data sharing.
The workshop created an amazing opportunity for collaborative discussion between School of Medicine and Fife NHS senior management, Health and Social Care Partnership, and Planning and Transformation. As a result, an action plan has been drawn up identifying opportunities and associated challenges in Fife, including opportunities for collaborative research and ways to capitalise on NHS Fifes new status as a teaching board. The action plan will be taken forward as part of the exciting, newly strengthened, strategic partnership between the University of St Andrews and NHS Fife.
Next steps
Building on the Anchor Strategy Workshop there are plans for a ‘Fife Anchor Summit’, bringing together University, Health Board, Health and Social Care, Voluntary Groups, local residents and students; potentially forging new partnerships with local stakeholders including industry. Thank you to Scotland’s Future Series, for funding the symposium and helping to start this ball rolling!