Personalising Realistic Medicine: Chief Medical Officer for Scotland's Annual Report 2017-2018

Introduction from the Chief Medical Officer

Introduction

Three years ago, when I framed my first Annual Report around six questions and called it Realistic Medicine, I asked you whether we could achieve a new paradigm of care for the people in Scotland. My vision reflected what was emerging from my conversations across the country about how people wanted to provide and receive care.

It was evident back then that the desire to provide a more personalised approach to care was dominating these conversations. Over the last 3 years, enthusiasm around the personalised approach has continued to build and it is now clear to me that it has become the central theme in people’s minds when they think about delivering Realistic Medicine. I hear this when I speak to professionals and to patients, I recognise this when I observe the changes that people have made to their clinical practice and I see this when I review the findings of our Realistic Medicine Survey and the recommendations of our Citizens’ Jury.

So, in acknowledgement of its importance, I am keen to explore ‘Building a Personalised Approach to Care’. How do we personalise Realistic Medicine for our patients and for our staff? How do we overcome the challenges in our system to deliver this care? How do the other domains of Realistic Medicine contribute to us achieving our aim?

I am aware that, for many, my Annual Report is the most prominent example of our work to deliver the vision of Realistic Medicine. However, our work programme does not end when the reports are published. Much has been achieved in creating the conditions that enable Realistic Medicine to flourish and, over the last 12 months, there have been some exciting developments that are critical to this.

• We have funded 20 Realistic Medicine Clinical Lead posts across NHS Scotland to champion Realistic Medicine in local health and social care systems. In addition, 8 Realistic Medicine Finance Leads have been appointed across the country to encourage closer links between clinical and finance colleagues and to promote a culture of stewardship and value based healthcare.
• In August 2018, we launched the Value Based Healthcare Improvement Project Fund, inviting bids from NHS Boards for local projects that will achieve value based healthcare. 50 applications were received and 11 projects were successful in securing funding for 2 years. If these projects evaluate well, there is a commitment from Medical Directors to continue to support roll-out once central funding comes to an end.
• In September 2018, we launched the Scottish Atlas of Healthcare Variation, in collaboration with Information Services Division (ISD) Scotland. To date, eighteen maps have been published within the Atlas. The Atlas work is discussed in more detail later in the report (see here).
• In October 2018, we explored the attitudes of health and social care professionals by conducting a Realistic Medicine Survey. In total, 2,464 responses were received. The survey has provided us with valuable insight into the barriers to practising Realistic Medicine as well as what our future priorities should be in order to achieve the 2025 vision. A summary of the survey results are presented in Appendix 1.
• In October 2018, we held our annual Realistic Medicine Conference in Dunblane. The theme of the conference was ‘Valuing People’ and over 300 people attended. Keynote speakers included Dr Al Mulley, a world renowned expert on personalised care and shared decision-making, and Professor Richard Lehman, a weekly columnist in the British Medical Journal and Chair of the Preventing Overdiagnosis through the Shared Understanding of Medicine (POSSUM) group. Those who attended also had the opportunity to get involved in workshops on practising shared decision-making, Schwartz Rounds and the Scottish Atlas of Healthcare Variation. The feedback received was overwhelmingly positive.
• In October and November 2018, we held Scotland’s first ever Citizens’ Jury on a health topic. Over 3 weekends, the Jury considered the question ‘what should shared decision-making look like and what needs to be done for this to happen?’. The Jury made 13 recommendations for consideration by the Scottish Government and presented them to the Chief Medical Officer on 6th February 2019. The Jury process and recommendations are discussed in more detail later in the report (see here).
• In December 2018, we launched a Realistic Medicine Website. It contains a range of information and resources to support professionals to practise Realistic Medicine and it can be accessed here: https://www.realisticmedicine.scot/. The site also provides details about the Realistic Medicine Leads for each area, inspiring examples of good practice, resources to support practice of Realistic Medicine, and a news feed with the latest updates from the Realistic Medicine team.

I could not do any of this on my own and I am grateful for the support of my Realistic Medicine team, who are deeply committed and work incredibly hard to ensure that these elements come together successfully.

But, whilst they create the conditions for Realistic Medicine to develop and grow, it is you, all around the country, who are making it come alive. Once again, I thank you for your continued support and congratulate you on your considerable achievements, many of which can be found within the rest of this report. You are the people who are delivering this vision. It is because of you that I am committed to Personalising Realistic Medicine.

Dr Catherine Calderwood MA Cantab FRCOG FRCP Edin

Chief Medical Officer for Scotland