This letter first appeared in The Scotsman on 10 June 2025
We are a diverse group of committed senior figures, with wide-ranging experience of the delivery of health care and social care in Scotland, who share a belief that the health of our people is central to the success of our nation, and that we need to re-imagine how health is created in Scotland.
The Current Situation
We recognise that many people are well served by the NHS in Scotland, and that thousands of dedicated and hard-working people ensure that compassionate and effective, sometimes life-saving, care is provided on a day-to-day basis. And yet, as has also been acknowledged, the current system of delivering health care and social care in Scotland is unsustainable, often stretched beyond capacity, overly complicated, difficult to navigate, often inefficient and is perceived as not always meeting the needs of people living in Scotland. The health of the nation is deteriorating and health inequalities are widening. Reform is urgent and critical.
A Vision
We understand that simply spending more money will not solve all of the problems we face. But a vision at the centre – of a whole ecosystem of health, a service of health care and social care for all and a culture that promotes equality and fairness and honours all who work in health and care and for a healthier nation – can make Scotland unique. And we recognise that reform of the NHS is only part of the picture and that wider issues require to be addressed, including the vital role of the third sector and local government. Health care is not the sole responsibility of the NHS. We need to look beyond the NHS to the broader determinants of health and prioritise prevention and health creation as a national imperative, while recognising the role of social care in its own right.
The Need for the Long View
We appreciate the enormous challenge that this presents to decision-makers, and the value therefore of safe and meaningful deliberation. We also recognise that it is not helpful to view the future health of the country and the problems currently facing our health care and social care systems as the responsibility of any one political party, government or individual minister.
In reality, the challenges to health and the crises in our NHS are caused by a combination of complex and inter-related factors which have arisen over many years, for which there are no quick or simple solutions. Transformation is beyond the capacity of any one political party, government or group of stakeholders, who should not be expected to carry that burden alone.
While there are urgent short-term needs requiring immediate attention and action, longer term change is essential and will make the biggest difference. We feel that the necessary consideration of what this will entail cannot be dependent on the needs of short-term party politics or conditioned by the next parliamentary election. We need a longer-term vision, shared by us all as a common responsibility, with a whole of Scotland commitment.
A Call for Cross-Party and Cross-Sectoral Working
We believe that there is potential for cross-party and cross-sectoral acceptance of common ground on certain issues, including what is and is not working well, which could then be discussed with the general public, openly and candidly, in the quest for effective, fair and sustainable long-term solutions. There are no easy answers, hard choices will need to be faced, and delivering the necessary reforms will take more than one electoral cycle.
We believe that, to achieve the necessary longer-term change, we will need politicians to be willing to work across parties and with all stakeholders, not least to ensure the consistent delivery of that change over several political cycles. We see evidence of such an approach in other countries, such as Denmark and Australia.
A Commitment to Work Together
We note that politicians and civic leaders in Scotland recently came together to discuss other important matters, expressing a commitment to working together, and have recognised that solutions will be manifold and complex, requiring a collective response, with a shared responsibility to map a way forward for Scotland. We believe that the current situation in health, health care and social care requires a similar collective approach.
We are committed to work together to support a Scotland-wide approach to reform of health, health care and social care. To help achieve this, we wish to encourage making space for fresh thinking and candid conversations about change with politicians and other stake-holders, conducted through respectful private, informal, Chatham House Rule exploration of the key issues, development of options and identification of possible ways forward. We take as our model the Edinburgh Conversations of the 1980s which did so much to ease tensions during the Cold War. What worked then could work again now in our approach to the nation’s health.
A Shared Mission to Improve Scotland’s Health
In short, ours is a plea for a shared mission, for the humility and courage to recognise that we require new ways of discussing, delivering and improving the nation’s health and creating sustainable health care and social care systems for the future.
Dr David Caesar, Emergency physician and Associate Medical Director for Medicine
Dr Sarah Doyle, Chief Executive and Nurse Director, Queen’s Nursing Institute Scotland
Professor Andrew Elder, President, Royal College of Physicians, Edinburgh
Professor Liz Grant, Assistant Principal (Global Health) & Director of the Global Health Academy, University of Edinburgh
Jane-Claire Judson, Chief Executive, Chest Heart & Stroke Scotland
Dr Elizabeth Kelly, Chair, Improving Wellbeing and Working Cultures Strategic Board
Dr Tamasin Knight, Consultant in Public Health Medicine
Dr Donald Macaskill, Chief Executive, Scottish Care
Dr Alastair MacGilchrist, Chair, Scottish Health Action on Alcohol Problems (SHAAP)
Tejesh Mistry, Chief Executive, Voluntary Health Scotland
Rami Okasha, Chief Executive, Children’s Hospices Across Scotland (CHAS)
Professor Stephen Turner, former chair, Academy of Medical Royal Colleges and Faculties in Scotland
Charlotte Waite, National Director, British Dental Association, Scotland