About you
What is it about your job that you feel would surprise the public?
Every week I still see patients and after 30-odd years I continue to feel hugely privileged that I am able to work with people to offer direct one-to-one care. It’s a very special thing to be invited into someone’s life as a health professional and I have never forgotten that. Being a National Clinical Director involves deploying every skill that you learn as a jobbing clinician and more.
What’s been the biggest change you’ve seen since you started working in the NHS and social care?
I have seen our approach to some diseases change from bewilderment and resignation to optimism and triumph. When I trained in the mid 1980s, many cancers were considered untreatable, HIV became feared and heart attack was largely palliated. All that has changed for the better thanks to the dedication, commitment and clear purpose of the whole system.
If you could make one change to the NHS and social care over the next 10 years, what would it be?
To ensure there is clear sustainable support for active, productive and healthy ageing for the whole population, while continuing to meet the needs of those people who require help to live meaningfully in their communities. We can’t stop ageing (it’s part of being human) but we can influence how we age and we can support more people to age well.
Change from the top
If you could give Matt Hancock one piece of advice, what would it be?
Keep population health and active ageing at the top of your agenda – on which digital has huge potential to help. It means making good use of the data we collect through health and social care services, and the data that people are prepared to share, for the purposes of improving their health and how they experience care.
What do you wish people at the top of the NHS understood?
That many people age well, that decline and dependency in later life is not inevitable, and that ageing is not purely a health and care issue. A systematic and system-wide approach, which doesn’t just look at disease and deficits but works with prevention and focuses on assets and the lived experience, has real potential to reframe our whole health and social care system for the better.
Policy in practice
What policy have you seen successfully implemented, and why did it work?
I would say this, but in 2017/18 NHS England implemented the systematic identification of frailty through general practice in a ground-breaking way – enabling the NHS to tackle population ageing in a completely new way, at scale. It was academically validated, based on an extensive and respected body of international ageing research, it was simple, easily embedded into electronic systems, and required minimal work by GPs.
What policy have you seen fail, or not be as successful as first intended?
I don’t think we have got the approach to care planning right yet. The idea that we can codify the intricacies of a person’s life, needs and preferences in a documentary fashion needs a lot of further thinking through. The new comprehensive model of personalised care is much more considered and has real potential to empower and achieve meaningful care for people at scale.
What policy and/or change in behaviour are you currently trying to implement, and how’s it going?
I am leading the national implementation of the integrated care for older people programme, Ageing Well. It seeks to deliver a number of key NHS Long Term Plan commitments focused on population health management for people with moderate frailty and increasing the capacity and responsiveness of community systems. So far so good, although while all of the infrastructure exists somewhere, it’s not yet universal so will take time to achieve.
Bonus question
The NHS is under pressure because...
Some would consider it a victim of its own success as an efficient, highly effective and universally trusted health care delivery mechanism – in that sense it will always be under pressure as our population ages and expands. But we must also remember that some of the pressure rightly comes from within. As a nation we have been enormously resourceful in our ability to build and develop health care in all of its manifestations, and long may that continue.
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