Harry Burns: Scotland's health is far behind where we should be

Harry Burns has recently returned from the Galapagos Islands – the “cradle of science” which so influenced the thinking of Charles Darwin and shaped the development of modern science.

The once-in-a-lifetime trip is perhaps fitting for a man who devoted his career to the advancement of medicine in Scotland, serving as the country’s chief medical officer for almost a decade and emphasising action on inequality and in a person’s early years to improve their chances for life and health. 

A Barrhead man and father of six, Burns was co-chair of the Scottish Government’s Early Years Taskforce and a member of its Council of Economic Advisors, also becoming a professor of global public health at the University of Strathclyde, amongst other roles. 

Now he describes himself as retired. But he’s still receiving invitations to speak here or write there, and he can’t quite turn away from his life’s work, despite now having the time to venture out to the islands off the coast of Ecuador. “You just can’t believe it, it’s incredible,” he says of the archipelago. 

“I still feel very committed,” Burns says of his field of expertise, public health. “There’s not enough hard science being applied to projects.

“We are far behind where we should be, given the science.” 

Burns let go of a boyhood fascination with aviation to devote his life to medicine, studying at the University of Glasgow before joining the workforce at the Royal Infirmary in the city’s east end, where his surgery specialism sparked interest in the underlying causes of the illnesses that had led patients to his operating table. A move into public health followed and saw Burns lead Scotland’s response to the swine flu outbreak of 2009. Though out of office by the Covid pandemic, he gave evidence to MSPs about his view on how the national response should work, emphasising a need for consistency across the country and better data-sharing across borders.

“Pandemics are complex systems where lots of different interests come together, and managing such complexity is hugely difficult,” he told MSPs at the time. It is a point that could well be applied to our health and social care systems in general. 

As much as 40 per cent of the Scottish budget was spent on health in 2023-24. That £19.1bn spend included an increase which was largely used to meet inflation and pay commitments and, despite an uplift in staffing, the number of patients seen remained lower than before the pandemic. Underneath the headlines is a network of boards and agencies which can often feel remote to patients on the ground who simply want fast, effective treatment. Time after time in the Scottish Parliament chamber, members have raised the cases of constituents left waiting too long for treatment, and it has often been said that our system is “broken”. Burns disagrees.

“The health service is not broken. Ask the frontline staff what problems there are, what they think will fix it and allow them to implement that. Instead, politicians want to tell people what to do and shout at them if they don’t do it.”

There is some measure of frustration in Burns’ words, particularly about the need for long-term vision. “There’s nothing you can do about it – politicians want results tomorrow, but you’re not going to make that,” he shrugs.

Want of a long-term approach, and also of consistency, has contributed to our public health problems, he argues. “In a Scottish context, we could be miles ahead. There were some places that were really good, like Dundee, and Lanarkshire has tried hard. You get areas where the chief executive of the local authority buys into it and does their best, but then things change, and it fades away.”

After so long at the forefront of public health, Burns can talk not only about the big interventions like the smoking ban – his mother, who is 101, gave up cigarettes at age 72 – but the local initiatives or individual conversations that have cemented his conviction that early years interventions are crucial in addressing Scotland’s public health needs in the long term.

Meeting in Glasgow’s historic Hutcheson’s Hall, a former hospital built to meet the needs of the city’s 19th century inhabitants, Burns variously recalls encounters with a young offender in Polmont who turned his life around, with housing workers who were dealing with troubled tenants, and with a young child at group event who was so unable to cope that he hid under the table.

“It was a terrific project in an area in the east end of Glasgow that had been identified as having difficulties,” he recalls of the latter. “I got asked to go and watch and the organisers were getting the kids to talk about what they wanted to do in the future. For each child, a papier mache figure would be made in the shape of whatever they wanted to be. This one boy had absolutely shut down and was hiding under a table in the corner. They told me when he’d first started, he wouldn’t let anybody near him – he’d kick out. As the day went on he began to change and get more involved. The time came to sit in a circle on the floor and say what you wanted to be, and I’m sitting next to him and I feel him stiffening, and he says ‘I cannae do that, I’m too shy’. I said don’t worry, I’d do it for him, but he got up and he did it – this wee boy who had been absolutely terrified – because he had been looked-after and respected, and he began to feel that sense of control for himself. 

“I’m sure there are good things happening, but most opportunities like that are wasted. It’s hugely significant.”

Burns, who recently welcomed a new granddaughter, remains convinced that this is where our interventions should be focused, creating chances for preventative action. While discussion around the impact of adverse childhood experiences (Aces) has increased in recent years, Burns contends that too little is being done to address this. 

Research conducted in California in the mid-1990s found that the more Aces a person had experienced, such as abuse, neglect or exposure to adults abusing drink or drugs, the greater the incidence of depression, alcohol addiction, promiscuity and suicide attempts in later life. A study from Wales produced similar findings but also concluded that people with four or more Aces are four times more likely to develop heart disease.

The Scottish Government says it is “committed to preventing psychological trauma and adversity and supporting those of us who have been negatively affected throughout our lives, whether as children, young people or adults”, and is “providing intergenerational support to children, parents/carers, families and adults to better prevent psychological trauma and adversity”. But Burns, who is working on a book, wants to see greater investment in this, arguing that it will save the public purse big money later on. “It’s bloody expensive not to do anything.

“Young people who experience neglect and violence, their brain changes the way it develops. The limbic system becomes more active, making them more anxious and aggressive, the memory doesn’t develop as well and the prefrontal cortex slows down its processes,” affecting reasoning. Those most affected “get in trouble for all sorts of reasons”, he says, and he argues that the issue is well-known from health visitors to casualty staff, who he wants to see better empowered to address the problems they face in daily work. “They have the answers,” he says. 

Such a method will work and has worked before, he says, citing successes in mortalities caused by falls, trips and slips in older people and by ventilator-acquired pneumonia, both thanks to localised interventions by NHS staff. Public health, he says, has to address society as much as illness, with education to the fore.

“Smoking is obviously really bad to do. Therefore, to try to discourage people and make them realise what they are doing is damaging their health is important. And it’s better to make people understand why they shouldn’t do these things than to ban them. But I personally wouldn’t allow cigarettes because they are just mad.

“The NHS is really important in terms of making sure people know and understand what they are to do to stay healthy. The Aces thing isn’t just about stopping parents doing bad things, it’s about allowing the parents to feel positive about their kids and we do that by helping them get jobs, helping them with housing. Make people feel good about themselves and they will take control of their lives, and we’ll save a shedload of money. 

“We have clever politicians. I like John Swinney, I like Nicola [Sturgeon] – I thought she was terrific actually, I’m really sad she’s going – I recognise that they’ve got their hands tied on a lot of things. I’m not saying put more money into the health service, I’m saying put more money into creating wellbeing – create successful people who get jobs and pay taxes.”

In this, Burns’ message could be compared to that of the UK Government, which is slashing spending on benefits to spur more people back into work. Tests for the Personal Independence Payment (Pip) will get tougher and incapacity benefits frozen, with payments to those aged under 22 set to fall. “They’re just trying to save money,” Burns says of ministers. “But having said that, if people have some kid of chronic illness, helping them recover and begin to live a fuller life is a good thing.”

Before the announcement by Liz Kendall, UK Government health secretary Wes Streeting proffered that the problem of long-term benefits dependency had been exacerbated by the over-diagnosis of mental health conditions. Burns “can’t say if there is or isn’t” an over-diagnosis problem – it’s not his field of expertise – but he counters that this too is an area where Aces could figure.

“If you’ve had trauma and difficulties and have lost your job and things have gone badly for you, then all of these things will add up to create a kind of adverse state in your mind about your life. We have got to start off in the early years and support families into making sure these kids grow up in a positive situation.”