SCOTLAND has traditionally had a low rate of home births, with just over 1% of babies born outside of hospital. However, Gillian Smith, director of the Royal College of Midwives in Scotland, says midwife-led birthing units could become more common.

She said: "If we have midwife birthing units, then whether you birth at home or in those units, it is the same philosophy.

"For example, in the Lochgilphead area, women who are booked for a local delivery don't make a decision about where they want to give birth until they go into labour, when they can go into the small unit there or birth at home.

"In the past two years, Glasgow – which has traditionally had a very low home birth rate – has set up a home birthing team because they recognise that women wanted something they weren't already offering. It has increased the number of home births."

Smith also raised concerns about midwifery being an "ageing profession".

"What we are going to do in the next 10 years is hit a demographic time bomb," she said. "Student midwife numbers have been cut in recent years as we didn't have the jobs. But the average age of a midwife in Scotland is now about 49, so we do have concerns. We have to have robust planning in place so that when the time comes we are in a position to up the numbers again to meet that time bomb."


WHEN Dr Emilia Crighton began her medical career in the early 1990s, she expected about 12 emergency admissions to her hospital ward every day. Within three years, that figure had more than trebled to 40 admissions a day. She said the rise was due to increased expectations of the public about what the NHS can do for them.

"People now know things can be done and they will expect more," she said. "But we can't eliminate everything, so we are going to live longer with chronic diseases that are going to be more complex. You will need to be able to look after yourself and know when to seek help."

At the moment, patients who are seriously injured are rushed to the nearest A&E. But, in the near future, they could be taken to one of a few highly specialised units in Scotland.

The Royal College of Surgeons of Edinburgh (RCSEd) wants dedicated centres set up in Scotland to improve the survival rates of trauma victims, with death rates in the UK 40% higher than in North America.

Consultant orthopaedic surgeon Ian Ritchie, vice-president of RCSEd, said: "The number of patients involved in multiple trauma is actually relatively small, but we could improve the care for them, not only immediately afterwards but also in terms of rehabilitation.

"We are learning from a variety of sources, including the British Army in Afghanistan."


Consultant orthopaedic surgeon Ian Ritchie, vice-president of RCSEd, said one of the biggest issues for the future would be the debate over how to many resources to should be allocated to expensive surgical procedures for individuals, versus spending on initiatives that could help more people.

"You need to consider that quite a lot of this high-tech surgery affects very few people," he said. "So you could make an argument that we really need to be looking at the public health issues which involve prevention – of particular relevance is the obesity epidemic.

"It is quite expensive to do surgery for people who are very overweight, which reduces the risk to an individual. But that is an expensive operation and maybe prevention is better than cure.

"Although we have got all the technology, we need to start thinking more about how we apply it, what is the cost effectiveness of it, how do we allocate resources when they are scarce for the benefit of the most people. All these are difficult ethical issues."


Over the next 10 years, the proportion of over-75s in Scotland will rise by more than 25% and by 2033 is likely to have increased by almost 60%. There will be growing numbers of older people with multiple health problems or dementia.

Professor June Andrews of Stirling University's Dementia Services Development Centre said dementia is often "medicalised", yet taking patients into an unfamiliar setting such as a hospital could worsen their condition. She said: "If the family, carers and people with dementia had more information, they could avoid getting into the expensive healthcare system ... The most important thing is to ... increase the extent to which people self-care."

Andrews said hospitals should consider design improvements which would help support elderly patients better, for example, reducing light and noise to eliminate any disturbance in sleep. "Otherwise you give them drugs to help them sleep and they have falls and other adverse incidents," she said.

"I was visiting a (new) hospital outwith Scotland recently and there had been absolutely no cognisance taken of the fact that a huge number of the patients were going to be old. The building is designed as if it was for young, physically mobile, cognitively intact people. What is the point in spending millions on a building like that? It is like designing a restaurant with no seats."


INEVITABLY, the NHS is at the forefront of technological innovations ranging from electronic patient records to advanced scanning machines which can detect diseases at an early stage.

Andrew Diston, head of global medical technology at Cambridge Consultants, predicts that the growth in the use of smartphones and wireless technology will make a dramatic change in health services over the coming decade.

He said: "There will be medical devices for things like inhalers, which can be monitored to tell the clinician that people are dosing correctly.

"With wireless technology, it's much easier to link a device to someone's smartphone or PC and provide real feedback, rather than having to have a trip to the GP."

Diston also predicts an increase in the use of neurostimulators – surgically implanted medical devices which deliver electrical stimulation to targeted areas in the brain.

They are currently being used to help alleviate the symptoms of Parkinson's disease, but Diston says they are likely to become used for a wider variety of conditions, such as depression.

"As the technology advances and people become able to deploy it, we will see a rapid change," he said. "You can use them for all sorts of things including stimulating the spinal cord to alleviate chronic back pain which affects lots of people."


WITH the increasing elderly population, more people are likely to develop cancer – but survival rates have also increased for many types of the disease. Now there is increasing focus on helping cancer patients get back to normal life.

Mike McKirdy, a consultant breast surgeon at the Royal Alexandra Hospital in Paisley and Inverclyde Hospital in Greenock, says the 10-year survival rate for breast cancer in the UK is now around 85%. Twenty-five years ago, only half of patients diagnosed with the disease survived for five years.

He said: "We are trying to improve the outcomes, not just in terms of survival, but people having a good quality of life and recovering physically and mentally from all the treatment.

"We have to operate on people, give them chemotherapy and radiotherapy and, for a number of them, ongoing treatment and all of that can affect people's quality of life."

One project which has been running in the Clyde area is a "rehabilitation" class for women who have had breast cancer. The MBrace initiative, funded by Macmillan Cancer Support, invites patients to come along to a 12-week programme of exercise classes after their treatment has finished, where they can get support from fellow patients and professionals. About 300 people have taken part so far.