Committee
Health and Sport Committee 15 March 2016
15 Mar 2016 · S4 · Health and Sport Committee
Item of business
Chief Medical Officer’s Annual Report 2014-15
Dr Catherine Calderwood (Scottish Government)
Watch on SPTV
Thank you very much, convener. I am delighted to be here to talk about my first annual report. I believe that this is the first time that the chief medical officer’s annual report has been taken as an item of business in the Health and Sport Committee. There are several firsts. My report, which is entitled “Realistic Medicine”, contains, as is traditional, the state of the health of the nation in the statistics in its second part. In the first part of the report, I wanted to write to doctors throughout Scotland, reflecting what I had been hearing from them as I travelled around the country in my first few months as chief medical officer. I heard about the pressures in the national health service and about doctors’ desire to keep caring for their patients, as they always have done, but their finding that that is difficult, at times. I also heard that some doctors are disillusioned or unhappy in their jobs and that morale is low. I heard from them that they are worried about advances in medicine and about whether people are having treatments and procedures that are perhaps not what they would choose in the same circumstances. There is quite a lot of evidence in the literature of where doctors would choose less treatment and fewer tests and procedures than they offer their patients, and that there is perhaps a disconnect between what they feel the people they are treating prioritise and what they would prioritise. I wanted to talk to them about that. I also wanted to reflect personalised care—patient-centred and patient-focused care. My children asked me: “What is an out-patient, mummy?” and I described that as a patient who is not in the hospital. My 12-year-old daughter said, “Isn’t that a person, then?” We are moving from the person as patient to the person who is in need of treatment in the NHS as part of their much wider lives, and who will live the rest of their lives with no other concerns to do with the NHS. We have started a conversation, which has been extremely well received. I have had letters and emails and there has been Twitter activity all over the world. In a single week, “Realistic Medicine” was retweeted and reached 133,000 people. I have had nothing but positive responses on Twitter. People have said that it is a conversation that they welcome—not just doctors, but nurses, pharmacists and members of the public. I will finish my opening remarks by quoting a general practitioner in Aberdeenshire: “Your document is probably the first CMO annual report that I have ever actually read. I was really impressed that it appears to challenge the status quo. It chimes with my feeling that we should be moving to finally confront what I see as the elephant in the room: the adverse effect of our own actions on demands that fall upon the NHS that we so often blame on patients.” Many similar comments and personal stories have been shared with me because we have started the conversation. I am very pleased to be here, and to hear the committee’s questions, which I hope to answer.
In the same item of business
The Convener (Duncan McNeil)
Lab
Good morning and welcome to the 14th meeting in 2016—indeed, to the last meeting in this session—of the Health and Sport Committee. As I normally do at this ...
Nanette Milne (North East Scotland) (Con)
Con
Yes. My train was 50 minutes late, so I apologise.
The Convener
Lab
It is great to have the chief medical officer along. If members will indulge me, however, I want first to take the opportunity in the last meeting of the ses...
Nanette Milne
Con
I do not know whether any other member was, but I was on a previous health committee with Duncan McNeil, when the smoking ban went through. You were very kin...
The Convener
Lab
Thank you very much, Nanette—that was nice of you. We need to press on. Our first item of business is evidence from the new chief medical officer for Scotla...
Dr Catherine Calderwood (Scottish Government)
Thank you very much, convener. I am delighted to be here to talk about my first annual report. I believe that this is the first time that the chief medical o...
The Convener
Lab
Thank you. Our first question is from Malcolm Chisholm.
Malcolm Chisholm (Edinburgh Northern and Leith) (Lab)
Lab
I think that we are going to deal with the report in its two parts, so I will ask about obesity later. You have introduced the first part of the report, and ...
Dr Calderwood
The point has been raised by others; you are not alone in thinking that the report may be taking a controversial line on that issue. Dr Cameron, who is a f...
Dr Angus Cameron (Scottish Government)
It is important to recognise that the graph shows a steady decline from the 1950s in the rate of heart disease in the population. The important thing is to d...
Malcolm Chisholm
Lab
Statins are a grey area; I presume that medication for high blood pressure is not, although it is referred to in that same paragraph.
Dr Calderwood
Again, other interventions are very effective in reducing blood pressure—for example, weight loss, stopping smoking and taking more exercise. The blood press...
Malcolm Chisholm
Lab
I have a final question, convener. Although the first part of your report is addressed to doctors, obviously your narrative is about talking to patients abo...
Dr Calderwood
I will bring in Dr Kramer in a moment. That is a question that I have asked myself. I had to start somewhere with the report; the doctors were the obvious pl...
Dr Graham Kramer (Scottish Government)
In my other job, I am a GP in Tayside. Malcolm Chisholm has asked a very good question about a real issue. There is a worry that patients may opt for more co...
The Convener
Lab
Moving beyond statins and on to the effects of other interventions, I suppose that that is where the GP’s confidence to recommend a befriending group rather ...
Dr Calderwood
The walking groups that have been set up are a good example. They are run by charities that want to come in and offer such alternatives, which are about frie...
Dr Cameron
It is very difficult to build up capacity in communities to provide alternatives to the biomedical approach. Kaiser Permanente, the American healthcare group...
The Convener
Lab
I understand the point, but integration of health and social care is a structural thing. We are dealing with a cultural thing—patient demand, the need to do ...
Dr Kramer
I will give a quick response. You are right that there is patient expectation, and GPs are working in a time-famine situation and having to come up with prag...
Mike MacKenzie (Highlands and Islands) (SNP)
SNP
Good morning, Dr Calderwood. I hope to explore a similar issue, but with a more rural focus, because I represent the Highlands and Islands. When I recently ...
Dr Calderwood
There is a lot of evidence that more junior doctors do more investigation and treatment than more senior doctors, which absolutely comes back to your point t...
Mike MacKenzie
SNP
That is useful, but I suppose that my point was not so much about junior doctors as about other health professions—for example, nurses doing work that previo...
Dr Calderwood
Traditionally, we have seen people from rural areas, in all sorts of professions and occupations, move to the cities. Increasingly, though, we are beginning ...
Nanette Milne
Con
I found your report very exciting, because it links to the committee’s work on palliative care and Sir Lewis Ritchie’s work on out-of-hours care. Given the p...
Dr Calderwood
I am pleased that you brought that up, because I had considered including a chapter on value-based medicine. However, coming back to Mr Chisholm’s point abou...
Professor Craig White (Scottish Government)
On the parallels that have been drawn with the committee’s work on palliative and end-of-life care, it is no coincidence that you feel a resonance with some ...
Nanette Milne
Con
I was interested in Dr Calderwood’s comments about commissioning in the NHS in England. The comparison here would be with GP fundholding, which, given that m...
The Convener
Lab
We wish you well with this and the committee understands what you are saying, because we have touched on that value base in a number of pieces of work, inclu...
Rhoda Grant (Highlands and Islands) (Lab)
Lab
The report seems to focus on doctors. One of the quotes in the report is: “I want to start a conversation among doctors about changing healthcare.” It seem...