A group of respected leaders from across Scotland’s health and care sectors have issued a striking open letter calling for urgent reform, cross-party collaboration, and a whole-of-society rethink of how health is created—not just delivered—in the country.
Cracks in the System Are No Longer Deniable
Scotland’s health service is in trouble. That’s the core message delivered by 13 senior professionals from medicine, public health, academia, charities, and social care. Their open letter, published in The Scotsman on 10 June, paints a sobering picture: dedicated NHS staff continue to do extraordinary work, but the system they operate in is stretched, clunky, and sometimes, just plain broken.
Many parts still function, no doubt. But according to these experts, the overall structure is no longer fit for purpose. Care is too often reactive, inequalities are deepening, and public trust is fraying. The authors aren’t pulling punches—they’re urging politicians, civic groups, and the public to drop the tribal lines and get real about fixing this.
It’s Not Just About Throwing Money at the Problem
This wasn’t a moan for more funding. The authors acknowledge that cash alone won’t plug the holes. In fact, they argue that without a clear, shared vision for health—something bigger than the NHS—the money could keep pouring in without solving much.
One striking line reads: “Health care is not the sole responsibility of the NHS.” That might make some pause. But it reflects a growing consensus in global health: the conditions people live in—housing, income, education, food—matter just as much, if not more, than what happens inside hospitals.
They want Scotland to look beyond patches and fixes. To stop treating illness and start creating health. Sounds idealistic? Sure. But with rising chronic illness and a widening health gap between rich and poor, the ideal may be the only way forward.
This Isn’t a Blame Game
What’s refreshing is what the letter doesn’t do. It doesn’t finger-point. It doesn’t slag off any particular party or minister. In fact, it says quite clearly: this mess didn’t start last year, or five years ago. It’s the result of years of overlapping pressures—social, demographic, financial, cultural.
And no single party, government, or person can fix it alone. That line matters. Because it sets the tone for what they are calling for: genuine, grown-up collaboration across party lines, across sectors, across political cycles.
One sentence hits especially hard: “Transformation is beyond the capacity of any one political party.” That’s not a dig—it’s a dare. A dare to build something together, even if credit’s hard to claim and results take years.
So What Needs to Happen?
They don’t pretend to have a blueprint. But they do sketch out a few principles that could shape real reform.
-
Start with honesty. What’s working? What isn’t? No spin, no deflection.
-
Talk to the public—openly, even when the answers are uncomfortable.
-
Learn from countries like Denmark and Australia, where reform wasn’t easy but did happen.
-
Stop planning in election cycles. This will take a decade, maybe more.
Their call includes a nod to history too. They reference the “Edinburgh Conversations” of the 1980s—discreet Cold War dialogues that built trust when diplomacy froze. They want something similar for health: off-the-record, safe-space discussions to develop options, not posturing.
What Does That Look Like in Practice?
That’s the million-pound question. But here’s what some of it might mean, based on the direction this group is pointing in:
| Problem Area | Proposed Shift |
|---|---|
| NHS capacity & inefficiency | Focus on prevention, streamline bureaucracy |
| Short-term politics | Build long-term consensus through cross-party work |
| Rising health inequality | Tackle broader social determinants |
| Workforce burnout | Value and support care workers across all sectors |
| Public trust erosion | Engage communities in honest, open dialogue |
Even that rough sketch makes one thing clear—this is about reshaping priorities, not just services. And it won’t be neat.
Who’s Behind the Letter?
The names attached to this open letter carry weight. From emergency physicians and public health consultants to charity leaders and dental directors, this group isn’t coming from one ideological corner. They represent medicine, nursing, local care, academia, and grassroots health support.
Some of the key signatories include:
-
Dr David Caesar, Emergency Physician & Medical Director
-
Professor Liz Grant, University of Edinburgh
-
Jane-Claire Judson, CEO of Chest Heart & Stroke Scotland
-
Dr Donald Macaskill, Chief Executive, Scottish Care
-
Charlotte Waite, British Dental Association Scotland
Each of them has seen different pieces of Scotland’s health system. They don’t all speak the same professional language—but their message is in harmony.
Will the Political Class Listen?
That’s the wild card. The Scottish Government hasn’t formally responded yet, though ministers have previously acknowledged that the system is under “extreme pressure.” Whether that turns into bold reform or more defensive management is the real test.
The letter’s call to drop party rivalries won’t land easily in an election-obsessed environment. But its timing is calculated—published just weeks after cross-party discussions on other national issues, and while pressure mounts on the SNP over health failures.
And there are early signs that something might be shifting. A few opposition MSPs have privately supported similar “whole-of-Scotland” reform ideas in recent months. But political will is fragile—and without pressure from civil society, the idea could evaporate.
