TopicsProfessionalOne-to-one: supporting the support

One-to-one: supporting the support

Chief nursing officer for Scotland Professor Alex McMahon talks about his first year in post and important developments that will affect CPs.

This year will see two significant professional milestones for Professor Alex McMahon. On one hand, he has just celebrated his first year as chief nursing officer (CNO) for Scotland, having officially assumed the post in January 2022. The second anniversary is more personal: it will be 40 years since he started as a student nurse.

Given the decades he has worked through, Alex’s key observations are born from extensive experience. ‘Every profession evolves over time, and what we deal with now are people who live longer but with much more complex health needs, and many of those are in a home setting rather than a hospital setting,’ he says. ‘But there are a lot of core elements to the job that have never changed – the compassion element of it, and the ability to communicate effectively.’

While the basics remain, the changing circumstances that Alex mentions, and their knock-on effects, are at the root of many of the specific challenges he has to face as CNO. ‘One thing we need to think about as a profession is how we meet these demands,’ explains Alex. ‘Some of it is about capacity and having more people to do more caring but in different environments, such as in a community context, as well as in a hospital context. And we need different levels of skill, from healthcare support workers through to advanced nurse practitioners. That takes us to the issues of how we train and then retain staff, because we need more people with more skills.’

Alex continues: ‘From my perspective, it’s about trying to think of a longer-term model that will supply nurses and midwives who can work across all settings – not just in our big general hospitals, but across psychiatric services, community services and within district nursing and health visiting. We’re trying to ensure that we are creating good opportunities for people, but good retention opportunities as well.’

Wise communication

For many people, having such a packed and wide array of issues needing his attention could be overwhelming, but Alex’s 40 years in a range of healthcare roles in different organisations mean that he is well prepared for the challenge.

Alex started his career as a mental health nurse, and then did his general nurse training before working up to clinical nurse manager level. A slight career change saw him join the Royal College of Nursing, where he became head of policy; then he worked in the private sector as head of government affairs for a global pharmaceutical company. Next he joined the Scottish Government’s Centre for Change and Innovation, where he wrote Delivering for mental health (

Before taking on the role of CNO, a return to the NHS in a number of director roles eventually saw Alex as executive director of nursing, midwifery and allied health professionals for NHS Lothian.

‘I think the training I had as a mental health nurse in the 1980s has stood me in good stead throughout my career,’ reveals Alex. ‘One of the things that you are trained in is communication and observation: knowing when to speak and when not to speak, knowing when to stay in the room and when to leave the room. As you go through your career, that emotional intelligence also helps you with relationship building. You get to know people, how to understand them and how to get the best out of them.’

And of the biggest challenges he’s faced to date? ‘When I was anticipating taking on the role of CNO, I think everyone thought that the worst was behind us with “the end” of the pandemic,’ says Alex. ‘But actually, since I’ve been in post, there have been so many challenges both in the UK and internationally, as well as still dealing with Covid-19 and then flu for the first time in a while. I’d say my first year has been challenging in many ways, but it’s also been hugely rewarding.

‘When it comes to problems that people in Scotland face, I don’t think they are any different to the rest of the UK. There are issues around geography, remoteness and access to rural areas, and there are issues about health inequalities and deprivation – those can all be found elsewhere in the UK as well. But our community nurses, particularly our health visitors, school nurses and district nurses, are picking those issues up as they interact with families every day, and they are helping those families find the support they need.’

‘We’re trying to ensure that we are creating good opportunities for people, but good retention opportunities as well’

Uniquely Alex

Biggest lesson learned

‘Knowing when it’s important to step in and say something/support somebody, or when it’s important to let others speak and just listen. You can teach people the theory of it all, but you need to practise it in different environments.’

Most surprising fact

‘I had a real passion for graphic design – that’s what I was best at in school and I thought I was going to go to art college to be a graphic designer,’ reveals Alex.

Perhaps not what you’d expect from somebody with such a proud nursing career. But after a career guidance teacher at school said ‘Alex, I think you’d make a really good nurse,’ Alex applied for a nursing course.

‘After two knockbacks from art colleges, I got an interview for nursing. Shortly after, I got a phone call asking if I could start three weeks on Friday.’ And the rest, as they say, is Alex’s own uniquely distinguished career history.

New ways ahead

Alex and the Scottish Government are working on two significant new schemes to ensure people get exactly the right support and care. The first is the emergence of a national care service highlighting the importance of individualised care. It is called GIRFE – ‘Getting It Right For Everyone’.

‘With GIRFE, we’re trying to develop a model with the principle being that we put the person at the centre and work around them and their families to construct a community service,’ says Alex. ‘That way, it becomes almost unique to that local context, because areas like Glasgow or Aberdeen are quite different to Oban or the Western Isles.

‘There are challenges in how we provide that in a cooperative way between local communities and service providers. But nurses and community practitioners (CPs) working as part of a multi-disciplinary team will play a vital role in delivering those services.’

Finally, the second development is the Scottish Government’s groundbreaking ‘safe staffing’ legislation – officially the Health and Care (Staffing) (Scotland) Act. It is the first of its kind in the UK, and sets out requirements for safe staffing across both health and care services. According to the Scottish Government, the bill’s aim is to ‘provide a statutory basis for the provision of appropriate staffing in health and care service settings, thereby enabling safe and high-quality care and improved outcomes for service users’.

‘The safe staffing legislation is multidisciplinary, and it again builds on that principle of getting it right for patients and staff,’ explains Alex. ‘It’s about safety for patients and for staff in every care setting as well; not just in big hospitals but in community environments and care homes. With that, we need to look at how we support people to deliver the best care they can.

‘We have an implementation date of April 2024, but the process towards it has already begun and it will start to feel quite real to people in certain parts of the system.’

Alex hopes the two new schemes in Scotland will ultimately help support CPs in the great work they do, both during the current pressures faced and moving forward.


Hear more from Alex in our exclusive audio interview, including his direct message and thank you to CPs.

Image credit | The Scottish Government


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