The two quotes about industrialisation and healthcare 
come from Intelligent Kindness by Ballat and Campling.

The considerations on conferences are included in a
this BMJ perspective

This post is creative, made in my own time and intended 
to ask questions in the spirit of the Freedom to Speak Up 
recommendations by Sir Robert Francis.

My forebear, Alexander MacCallum Scott grew up in Polmont, 
Scotland. He became an MP and was Private Secretary to 
Winston Churchill. I mention this as he turned down an OBE 
for his work connected with the war (WWI)



Patrick Geddes: insights into improving health and wellbeing

Sunday, 17th September 2017.

To the Chair of Healthcare Improvement Scotland.

Dear Dame Coia,
I do hope that you may appreciate that I write out of the shared wish to make health and social care better in Scotland.

I realise that my concerns about the mechanistic approach of improvement science (derived from a different culture) may not be shared. My perspective, I like to think, is taken from a wee shift of stance and perhaps reflects my interest and learning in a range of different subjects.

My voice matters no more than any other, and like any other I can be wrong.

I speak up not because I am “brave” or “right” but out of conscience when I find harm. The history of medicine has repeatedly revealed that harm can result from most well-intended interventions. This is why I keep arguing that scientific method needs philosophy, ethics and grounding in the culture of life.

I am of the view that Healthcare Improvement Scotland has time to re-orientate itself around these principles. I am also of the view that your organisation might do well to keep a healthy distance from the Institute for Healthcare Improvement (IHI), Boston, which has a business and cultural ethos that is quite different to NHS Scotland.

As to regulation. I do not personally want to see over-regulation. Such can have harmful consequences. However Healthcare Improvement Scotland needs to be independent of the Scottish Government otherwise any “scrutiny” will not be viewed as such by the public. Your organisation works closely alongside the Scottish Government with links that started and continue through several IHI fellows.

Please forgive me for setting my thoughts out in this way but I have been reading the work of Patrick Geddes who was considered a “social maverick”. I found that in reading about his work that it seemed to me he has lessons that could be relevant to the organisation that you Chair?

I want to thank you again for being so kind to me. I realise that I may come across as an oddity but I am actually every-day.

Kindest wishes Peter

If you have any thoughts on how Patrick Geddes might improve your organisation I would be delighted to hear.

A film that considers how we may go about improving health and wellbeing:

By living we learn from omphalos

Delirium screening (some years later)

Over three years ago I wrote this summary of my concerns about mandatory delirium screening. The consequences for me in writing this were life changing: the reality of having the courage to care in NHS Scotland.

Time has moved on and we should consider recent statements on this subject:

6th June 2017: Dr Claire Copeland:
“Two heavyweights of the delirium world: Wes Daly takes on Professor Alasdair Maclullich: to screen or not to screen. Let the battle commence”

5th August 2017: Dr Sharon Inoyue:
“Very important. Studies show dramatic increase in antipsychotic treatment with mandatory delirium screening”

31st August 2017: Dr Dan Thomas:
“In the UK I would be very surprised if many with delirium in hospital left  on antipsychotics (which is good!)”. This is a speculative response to an article in the Journal of the American Geriatrics Society which had found that “most patients with delirium discharged  on a new antipsychotic had no instructions for discontinuation”

Whilst evidence cannot ever be complete there has been
consideration of antipsychotic use for delirium:


Courage to care