Speaking to the public in a pandemic: Jason Leitch

Key

• SA:      Siva Anandaciva

• JL:       Jason Leitch

SA:        Hello and welcome to the King’s Fund podcast where we explore the big issues and ideas in health and care.  I’m Siva Anandaciva your host for this episode and I’m delighted to be joined today by Jason Leech.  Jason has had a really interesting leadership journey which is part of the reason we wanted to talk to him today.  Starting out as a dentist by training, he went on to become Scotland’s national clinical director in 2011.  And during the COVID-19 pandemic he became a familiar face to many of us as he had to translate really complex science into Public Health messages during a time of crisis.  Jason, it’s great to have you with us, welcome to the podcast. 

JL:          Well, thank you very much for having me, it’s a treat. 

SA:        So, look, I wanted to start by talking a little bit about you and learning a little bit more about your story.  So, for listeners who aren’t familiar, could you just give us an overview of your leadership journey so far?

JL:          Yeah.  It’s a bit boring.  So, let’s do it fast and get to harder questions will we.  So, you summarised some of it.  I’m a boy from the middle of Scotland, just between Glasgow and Edinburgh.  Went to Glasgow University, did dentistry a long time ago, so, I mean 1986.  Graduated in 1991, did dental practice for a year.  Realised that 40 years of that was either going to kill me or kill those around me.  So, I trained as an oral surgeon which is everything between the eyes and the chin, basically, apart from the nose which ENT steal and do for us.  And I did that for 15 years.  Lots of facial trauma in Glasgow, lots of wisdom teeth.  And I was average as a surgeon.  I mean, I was fine, I quite liked it, it was fun, but I got a bit bored.  And I realised, maybe in retrospect, maybe at the time, that there was something more to the 700 facial fractures a year that Glasgow was doing that was perhaps beyond the repair shop.  And the repair shop is what we were doing, and we were doing it very well. 

              People used to come from overseas to see the Glasgow surgeons do fractures, because we were so good at it.  But we were only good at it because we had 700.  So, I ended up in the States doing a Public Health Degree trying to learn, I think, how the population caused the 700 facial fractures and caused the worst dental decay in western Europe.  So, I ended up doing a Masters in Public Health which kind of blew my repair shop mind off a little bit.  And I also had the wonderful privilege of working for the Institute for Healthcare Improvement, then it gets quicker, then I started to work for the government.  So, I did part time patient safety lead for the Scottish government at a time when we had our own version of mid Staffordshire going on. 

              We had a new SNP government and Nicola Sturgeon who will reappear in this story, of course, was the new Health Secretary, much to her surprise.  And we designed the Scottish Patient Safety Programme which I did with thousands of other people for many years, became the lead for Quality and then, subsequently, as you described, I became the national clinical director, a new role in Scotland, that was alongside the Chief Medical Officer and the Chief Nurse, theoretically, a little bit more operational than either of them.  And then COVID came, and we needed a face for radio, and I became that … unfortunately, for the population, I became that face. 

SA:        Why did you feel the pull to a national role?

JL:          I think it’s partly opportunistic and partly ambition.  We had our perfect storm.  It’s written up actually, you can find it.  And it looks more linear looking back than it does at the time of course.  But, as I described, we had a number of people die in an “elderly care” hospital of C.diff in the period when I was in America, so, the mid 2000s, a little bit like mid Staffs in England.  And the SNP government came in and we had already pitched it to the outgoing Labour government, and they were keen.  But when you get a new government you have to re-pitch, it’s a bit like Dragon’s Den.  You go back in, and you say, “We’ve got this shiny thing to change digital or to change the education of the children.” 

              So, we went in, and we pitched to Nicola Sturgeon.  She was the brand new Health Secretary and Salmond was the First Minister.  And we said, “Look, these 30 odd people have died, it’s absolutely tragic, but we have a thing that we think if we implement it, across a country, for the first time in history, we think we can fix patient safety.  And we’ve pitched a 30,000 reduction in mortality, and we’ve pitched a 15% reduction in harm in all of us.  And it was just too good an opportunity to miss.  So, we brought this implementation theory that allowed us to take to the Health Service, the 169,000 Health Service employees in Scotland, a, kind of, mission to say, “Right, here’s the thing, this is what we’re going to do.  We’re going to take this mountain together.”  And that’s what we did. 

            It took us three years to show any mortality reduction, it took us probably ten years to complete the mission that is still an ongoing piece of work, because safety is never done.  And I had the privilege of being in a room, with those people, and they said, “Well, will you come and be the Clinical Lead for Safety?”  And I did it part time, did surgery part time.  So, I was still on call at the weekends, I still had surgical kit, in the back of my car, going to fix a fractured jaw in (inaudible 00:05:30) in Stirling.  And then, gradually, I moved away from surgery and became a full time faceless bureaucrat.

SA:        A face for radio and a faceless bureaucrat.  I’m trying to keep up with these visual analogies.  I did want to talk a little bit about … actually, quite a lot about COVID.  But I wanted to start by talking about you and your experience during COVID.  Because you came into this role, you were doing good work on patient safety, and improvement, and then COVID happens.  And I think clearly in your National Clinical Director you’re your work was always important, the words you had would have had impact, regardless, but this was next level.  So, I just wanted, if it’s okay, to take you back and try and understand how much pressure you were under, how you coped with it, how it felt, and what you learned about yourself through that time?

JL:          In the moment Siva, and this is maybe hard to explain, you don’t feel that chronic pressure.  You feel acute stress in the moment, of course, because you’re running every day, you’re running 16 hours, you’re on 14 different interviews, and radio stations, and you’re trying to do the best for the country, and you’re trying to help the politicians with the science, and all of that, you’re running, running, running.  The personal stress doesn’t happen, I don’t think, in my experience, until you stop, and then it hits you like a bit of a train, and that’s true of many of us.  The beginning was exactly as you’ve read, and heard described, and I’m sure you had a role in there at some point.  Nobody knew what was happening, nobody knew what it was, it was impossible to know what it was, the science was catching up.  In retrospect the science caught up very quickly.  But, at the beginning, we know there’s an infectious agent that kills a group of the population, ill defined group of the population, and we had to act very, very fast just like they had to do in Singapore, and Sierra Leone, and Scotland, and everywhere else.

              And I was in the big room with the then First Minister Nicola Sturgeon, the Deputy First Minister, the Chief Medical Officer, the Chief Nurse, and me, and a few senior civil servants.  And she gave out tasks, literally gave out tasks, because she was in charge.  And there was never any question about who was in charge.  But she had learned, during Swine Flu, that she needed a clinician beside her.  She never did a press conference alone, not in three years.  And I and initially Catherine, CMO Catherine, and then CMO Gregor Smith, shared them amongst us.  And I then became, for the rest of those days, the kind of voice who went on radio stations, and TV shows, and did Lorraine.  Probably the proudest moment of my mother’s life was when I got on Lorraine on ITV.

SA:        Yeah, I was … before you joined the recording, I was speaking to our producer Nat.  Because I was watching clips of you on YouTube yesterday.  And it really takes you back.

JL:          That’s not a fun way to spend your day.

SA:        Oh, it’s not even the worst weekend … weeknight I’ve had, believe me.  No, it was good.  But, one thing is, it does immediately take you back to that time.  And the other thing is back … you know, you were talking about the early days of the pandemic, it was such a weird unnerving experience to see newsreaders who were in a mild state of panic, when interviewing you, basically saying, “But what’s the answer, what’s the answer, what should we do, what should the public do?”  And I just can’t imagine the pressure that put you under.  And I did want to come back to pressure but you sort of joked earlier about a face for radio.  Did anyone ever explain why it has got to be you, why you’re going to be fronting this?  I mean, even just talking to you I can see you’re a good communicator.  But did anyone sit you down and say, “You’re good at this, this is why we’re going to put you up for it.”

JL:          You’re kind.  No, not specifically.  Although I can talk out loud in a straight line, and I talk like normal Scottish people talk.  So, those two things helped.  And I can think on my feet, usually, although there are a number of those YouTube clips you would find where I failed to think on my feet quite quickly enough and they became front page news.  Because when there’s no other news … COVID was the news every day, every day, we’ve forgotten.  And when you slip up in October, and cancel Christmas, which I did, I cancelled Christmas live on Radio Scotland, in October, it was maybe a little bit early.  And that became front page news in the middle of October that Leech cancelled Christmas.  I have the front page of the Daily Star, which is not a paper I take every day, where I am the Grinch, where my face has been superimposed on the Grinch, because I cancelled Christmas in October. 

              So, there are … it’s the weirdest experience to suddenly be thrust into that spotlight.  My mum says, “This story is a (s.l. pocketful 00:10:19).”  She says, “This isn’t true.”  I have a vivid memory of when I was a little boy telling a lie, when I was five or six.  And my mum leaning down to me and saying, “At times of crisis son, revert to the truth.”  That stayed with me during the whole period, and that’s what I try to do.  So, those clips went a little bit viral, others … if I didn’t know, I had this weird fascination with telling them I didn’t know.  So, I was quite often on PM on Radio 4.  So, I would say, “Do you know what, we do not know what this new variant does, but we know this.  We know you can’t go to the mosque, and you can’t go to the church, and you can’t go to the synagogue, because if you do this will happen.”

              So, it was … I was trying to speak a language that the population could understand and give the information that we had.  But then the news would change during the interview.  I mean, sometimes I was on TV, and they would say, “Oh, we’ve just heard from South Africa, and they’ve got a new variant, with a new number, do you know anything about this?”  And I would say, “Well, of course I don’t know anything about it, it has just happened live.  Let me get back to you tomorrow.”  So, that way of being as open, and honest, as you can, in the moment, but still sounding as though you understand your brief is the key communication skill I think.  And most people … most people, the vast majority of people, understood that science is not a fixed moment, it’s not just one point in time.  And people appreciated the fact that you were able to express that inability to be sure in your communication.  I think most people appreciated that.

SA:        I wanted to ask you quite a lot about your approach to communication, because it has been so remarked upon in a positive way.  And it sounds like there was some … I don’t know, almost foundational … or things that are just the way you are in terms of revert to the truth, don’t try and doll up the message, or dress up the message.  But did you ever sit there and think, “I’ve got to get better at this” or, “I’ve got to learn this as a skill.”  Or was there simply not enough time?  Did you notice yourself getting better?

JL:          I certainly tried to get better.  I mean, not to spare her blushes and irrespective of her politics.  Nobody could argue that Nicola Sturgeon isn’t a good communicator.  She can speak, and she can speak on her feet, and she’s very agile.  So, I was with her a lot.  John Swinney who isn’t quite so well known, UK wide, but very well known in Scotland, and increasingly well known UK wide, again, very calm, very considered, doesn’t hesitate.  So, I watched them a lot.  I also watched myself back, in the early stages.  So, I learned to not pause as much, to not hum and haw as much.  I learned to try and take three messages, three statistics, into each interview, and try and get those messages across if that’s what we were trying to do.  So, today might be the day we have to close the schools, or the day we reopen cinemas, or the day we allow you to go worship again. 

              So, those things were really important (s.l. for it 00:13:44).  It didn’t matter what they were asking me, I had to learn to pivot, to say, “Yeah, I hear you, yes, that happened yesterday, because somebody broke the rules, and I know you want to talk about that.  But just let me say, first of all …” whatever the new thing was that day.  And then the media would always want to talk about the rulebreaker, or the thing that had happened, or the controversy of Cummings or … I would have to answer those questions too, but we would try … and it’s a horrible skill, politicians do it all the time.  “Yes, but I think the important thing is such and such.”  I tried not to do too much of that but in Public Health messaging you can get away with some of that because you’re not the politician.  So, I wasn’t being attacked by the media initially in the way that the politicians were being attacked. 

              And I didn’t have formal training Siva but let’s not pretend there isn’t an army of people … a small army of people, helping you in the Scottish government, who run the Communications Department, who put together the bids with the media, who know the journalists, who can then give me advice about how you’re doing.  Some of that advice is fairly blunt, some of it is positive and reassuring.  Some of it is, “What on earth were you thinking when you said such and such to so and so.”  And, so, you pile that learning on top of one another.  The biggest stretch for me was probably not so much the media interviews, but then they decided to put me in the TV adverts.  So, that’s a whole different skill, that’s standing in front of a thing and reading out loud.  And then they made me … once I had mastered the reading out loud thing, they then made me move, and read out loud, which I was rubbish at.

              So, now I have to act.  I have to wash my hands at an imaginary sink, I have to use a towel that isn’t there, but I also have to remember the lines.  It felt like being a soap opera actor, and I was rubbish at it, really rubbish.  It took, like, ten hours to record 30 seconds.

SA:        We’ll return to the podcast in a moment.  Are you stepping into a new role, enhancing your clinical expertise, or looking to strengthen your organisational development skills?  We have a range of courses, and programmes, on a variety of popular leadership topics which provide thought leadership, research, and practical insights, to support individuals, leaders and teams.  Find out more about our programmes, and free courses, by clicking on the link in the show notes.  Welcome back.

JL:          Do you know what a pasting table is?

SA:        No.

JL:          So, a pasting table is a table that pretty much every family has in their loft.  And it is brought down, once every five years, to wallpaper the walls.  And it’s a big, long table and you put your wallpaper on it.  Every house had one in the seventies, and eighties, because everybody wallpapered their own homes.  But, in my home, the pasting table was used as an extension of the dining table when you had more people round for dinner.  And that was a fairly common thing, I thought.  So, I was asked, one day, “We’re having people for Christmas, Christmas is a thing, or birthdays are a thing, but you’re asking us to space out, you’re asking us to use different cutlery.  You’re asking us to have … we can have eight people, but we’ve got to sit 2m apart and all that.  How on earth can we do that?  We’ve got cramped houses.” 

    So, I said, “Get the pasting table out of the loft.”  And about six people in the country understood what I was talking about.  And all these newspaper columns said, “This guy is so out of touch.  He thinks we’ve all got pasting tables hanging about in our cupboards.”  So, there is something about your own context, and the language you use.  And I remember when I cancelled Christmas in October on the morning breakfast show, on Radio Scotland, and my phone rang, and it was the First Minister.  And you know when the First Minister phones you, after a radio interview, it’s probably not to congratulate you.  Occasionally she would say you had done well, but that morning it was, “Did you just cancel Christmas?”  I said, “Well, not really.”  But it did become cancelling Christmas.  So, sometimes … my danger is over speaking, not under speaking, as you’ve already learned.  So, the thing I sometimes had to do was just turn it down to nine, rather than turn it up to 11.

SA:        And you’ve just mentioned it there, but I was really interested in whether … did anyone ever tell you you were doing a good job, or was it just expected?  You’re in for a tough time, just buck up, deal with it?  And did you sometimes find yourself thinking, “Do you know what, it would just be nice if someone said, “Well done.”

JL:          I’m doing my best here.  It’s slightly pompous, isn’t it?  I mean, your family are lovely.  My mum and dad, who are 82, and 83, they watched everything.  In fact, I knew COVID was becoming a thing of the past when I sent my mum a … this is true.  I sent my mum a text message to say, “We’re about to start the press conference.”  And she wrote back, “Thanks very much but I’m watching the tennis.”  So, I realised, that day, that maybe it was time to stop the daily press conferences and the First Minister, and I discussed it.  So, my family were lovely and hugely supportive.  And I have a whole set of sarcastic friends who keep my feet firmly on the ground, many of whom were dentists, of course, who are cynical by nature and by practice.  So, they were hugely supportive.  So, I did have good people, and I had a very good team of individuals, including that small crucible of individuals, across the UK, who did this for a living.

              Chris Whitty, Jonathan Van Tam, the Welsh, the Irish, we were a peer group.  It’s a small peer group, but it is a peer group that we’re able to support one another through that.  And I think that’s one of the lessons actually that it is a lonely role in crisis.  I think even worse for the politicians.  Imagine being in the seat that’s having to make the decisions, in the four UK countries, I mean that’s enormously difficult.  And then you go to the Health Secretaries, in the four UK countries, who I got to know very well because we were on weekly calls with my Health Secretary with the other three Health Secretaries.  So, those jobs I thought were hugely lonely and difficult.  And, therefore, a room where you can freely talk about how difficult that is I think is really important, and I’m not sure we allow that, we allow the human elements of senior leaders to be quite as appreciated as it should be.

SA:        You’ve talked a little bit about it already and cancelling Christmas.  But when you did face criticism for some of the things that you’ve said, coming from whatever courses, how did you … you know, how did it feel, how did you deal with it?  Both the logistics, but also emotionally, how did you deal with that?

JL:          I think I have to split it into during COVID, and post COVID, because it has got much more difficult post COVID.  During COVID it was, I think, mostly fair, and mostly justified, and I was, in the main, able to respond appropriately.  And much of that criticism was in the moment where we were making really difficult decisions and we were able to say, “You know what, we know we said that, but now we’ve changed our mind because of this.”  And I wasn’t making the decisions, remember.  I was voicing the decisions that had been made by others, politicians, rightly, they’re democratically elected.  Nobody elected me fortunately.  And we were also the ones giving the science to the politicians.  But I’m not the science.  There’s thousands of Public Health workers, the WHO, all the others are the UK Public Health Bodies, we are the ones doing the science.

              And I was the kind of final bridge with Gregor into that (s.l. work 00:21:13), so, rightly criticised.  One thing annoyed me, maybe more than one.  Politicians who criticised us, when we have no right of reply, because we were Civil Servants.  And we are obliged to follow the Civil Service code.  And that makes us impartial, that makes us serve the government of the day.  People didn’t, and still don’t, understand that.  So, my politics are irrelevant.  I was a Civil Service to an SNP government.  It wouldn’t have mattered if that government had been Conservative, or Labour, or Green, I was a Civil Servant serving that government.  So, I gave them the best advice I could, they made the decisions, I then described those decisions to the population.  That got confused a little bit and some politicians criticised me openly during the COVID pandemic.  And I can’t reply to that, I am prohibited from replying to that.  So, that’s tricky.  And somebody who wants to speak out found that particularly tricky.

SA:        Sorry Jason.  Before you moved on, what did you do?  Did you just … I don’t know, screw him into a hole?

JL:          A couple of times I responded and got in trouble.  And the code is there for a good reason.  Because the impartiality of the Civil Service is a crucial building block to a democratic society, it’s crucial.  But so is the code for the MSPs and the MPs, that they shouldn’t criticise the Civil Service, it works both ways.  So, there’s a story in there about how we manage those relationships.  And when you suddenly become a visible Civil Servant, which is very unusual, the country, as a whole, could only name five Civil Servants if you’re lucky.  And that’s why people like Simon Case become in the public eye because he’s the Head of the whole UK Civil Service.  He becomes the figurehead and the only public figure.  And then when you get to the advisers like Chris Whitty, like Gregor Smith, like me, that, in the public eye, becomes a little bit woollier because they think, “Are they not clinicians?”  And nobody really cares, or knows, they just see us on TV.  So, that became tricky.

              And sometimes I had to just bite my tongue and put up with it.  And, to their credit, the politicians in power, UK wide, Scotland wide, they then defend us openly and that worked most of the time during the pandemic.  I wanted to balance it though with first time I went out for dinner, during COVID, when we were allowed, my wife and I went for dinner, and two bottles of wine came to the table from complete strangers.  I walked down the street and an elderly couple … I was out for a run.  I run most days, although you wouldn’t know to look at me.  I was running, and I was outside my house, and an elderly couple came up to me weeping, literally weeping, about a year into COVID telling me how I had saved their lives and how they were listening every day, and they hung on every word, and they were so grateful.

              So, the vast majority of people were hugely grateful for the advice I, and others, were giving them and the ability to translate that into language they could understand.  There wasn’t much else on TV Siva.  So, it was important that we were trying to help them.  So, I still get selfies on the train, I still get people telling me that their granny loves me.  They sold cushions with my face on them on Etsy, at Christmas time, for elderly people.  I’m very popular in care homes.  I’m not quite so popular if you ran a business, or a restaurant, or a soft play, when I “closed you down.”  But the population are hugely grateful for what we did, the majority of the population.

SA:        Bottles of wine and people coming up to you crying because you saved their life must feel amazing but, at the same time, did you think, “I can’t walk into this soft play, I can’t …” you know?  Did you feel very conscious of, “Is that person walking down the street looking at me, do they recognise me?  Is this a good or a bad thing?”  Things you never would have had to consider in your professional career before. 

JL:          As every person thrust into the spotlight would tell you, it’s a mixed bag and it’s mostly joyful.  It’s mostly lovely, people were very gracious, people were very pleasant.  But, yes, you do become more aware of your surroundings.  Initially that was almost entirely positive and then there was a day when a guy yelled at me in the street.  And, the same day, a lady yelled at me on the train, literally yelled at me, said I had ruined her life, I had killed people.  And I realised, oh, this is not as simple as perhaps it sounds.  I’ve had the police in my house, I’ve had calls from senior police officers to say there’s a threat.  I’ve had very nasty mail to my office, and my secretary, who has had to open really horrible stuff.  She has also opened many more thank you cards than she has opened horrible mail.  So, let’s keep it in perspective.  But you tend to remember the online attack with a gun, and bullets, rather than the 50 thank you cards that came that same week.  So, yes, it has been tricky.

              And that has got a little bit more difficult with the enquiry and post enquiry.  So, for all of us, I think, all of us in these roles, we would all say that the … let’s call it the ‘toxicity’ has got worse post COVID than during COVID.  So, I am now more conscious of walking down the street, and being on the train, and in public places, than I ever was during the COVID pandemic.

SA:        I’m sorry, sorry to hear that you’re having to consider things like that, that you probably never thought you would have to in your career and when you were thinking, “I’m trying to do the best job I can.”

JL:          Yeah.  And maybe it’s the cost of putting your head above the parapet, maybe it’s the cost of the most existential crisis the world has faced, in our lifetimes, and there was always going to be a cost.  It is what it is Siva.  I will continue to go about my business as best I can.  And I am, I should also say, entirely comfortable with being held to account for what I and others did during that period, I just think it should be done fairly.  I think it should be done in a way that teaches for the future, learns for the future.  Nobody wants to learn more about how to be better in a pandemic than the people who lived through the pandemic.

SA:        And did you ever feel … sort of relying on your clinical training again where things go wrong in clinical practice every day that you try and … you know, there is … where there’s malignant wrongdoing, maligned wrongdoing, you know, there will be blame and accountability, but when the system fails you try and learn from it.  Did you ever find that bit of your life coming back and saying, you know, “What would a learning approach be to tackling pandemics?”

JL:          I think that should be a paragraph in the module response for the enquiry, what you’ve just said.  Retrospection is one thing, and I understand we’re trying to avoid that.  But, in retrospect, everything feels much more linear than it is at the time.  And the same is true of a diabetes diagnosis or a fractured mandible.  When you look back you think, “Okay, assault, theatre, ward, discharge, infection, home.”  What you don’t realise that during that whole process there were four children, there was a sister who wasn’t speaking to the guy who was beaten up and who was then violent to the assailant.  And the hospital was actually jammed, so, therefore he was in four beds not one bed.  And suddenly you think, “Oh, this is more complicated than it said in the textbooks.  It said I could just fix the guy’s jaw, put him in a bed, send him home, he wouldn’t get an infection, and all would be well.” 

              Well, it turns out, individual healthcare isn’t like that never mind a global pandemic isn’t like that.  So, I did … for example, I did Scotland’s faith leaders, every Wednesday, for two years.  I would speak to the Head of all of Scotland’s faiths, and the Head of the Baptist Church, the Head of Glasgow Central Mosque, the Chief Rabbi, all in the same place every day, every week.  And they were the most lovely, gracious … just as you would imagine.  All fighting for their version of faith to get back.  So, the Muslims didn’t really care about singing, but they cared about shoulder to shoulder worship.  So, distancing was a real problem for the Muslim community.  The Baptists, and the Church of Scotland, actually quite like space between the parishioners, they don’t like to talk to anybody.  But they wanted to sing, and they hated the masks. 

              So, now you’re in an environment where you’re thinking, “Okay, we need to try and find a path through here that keeps everybody safe, but also deals with all of those emotions.”  And faith is such a huge thing for huge swathes of the population.  And then I’ve got another group of people over here who are saying, “No, forget the faith people, let’s get the pubs open.”  So, that kind of really challenging scenario is where the rubber hits the road.  And that’s where some of those tensions then came from.  And when we look back, and you write a chapter on pubs, or a chapter on mosques, I think you lose some of that complexity that those of us who were dealing with it were going through at the time.

SA:        And Jason I’ve really enjoyed talking to you about the past.  I did want to ask you a bit about the future, just to finish off.  And two things really.  One is, you know, at the King’s Fund we mainly focus on the English health and care system.  But, as others have said, you know, every healthcare system has something to teach and something to learn.  So, I wanted to ask you, first of all, is there anything … when you look at the health and care system in Scotland, is there anything from England you think Scotland could learn?  And I am going to ask you the other question which is, what can we learn from Scotland?

JL:          Yeah.  I think there are things in both directions Siva for certain.  I mean, the system in England is huge.  We have five and a half million people.  And you would need to divide yourselves by ten or 12 to get to units of that size.  I think we’re all struggling with the same things, we’re all struggling with access, we’re struggling with money and workforce.  I think your new experiment in integration, we’ve all been through a number of these versions, whether you’re calling them ICS’s or ICB’s, or whatever your latest integration is, I think that’s hugely important for the UK that England gets that right.  And then we, on our same journey, we’ve got integrated joint boards.  We’re about to launch the National Care Service, similar intellectual thinking, but done slightly differently.  I think there’s huge learning and lessons in how we do that. 

              My latest favourite is back to my original degree and it’s a thing called Child Smile.  Child Smile is an attempt to remove us from the bottom of the league table of dental decay in under five year olds, and it has been completely revolutionary.  We have gone from the worst in Europe, to the middle of the pack, and approaching the top of the pack now, doing nursery toothbrushing, all kinds of interventions in under-fives, Fluoride vanish, Child Smile dental practices.  So, a lot of new mums, and dads, in Scotland now know about Child Smile.  And it has been implemented using similar methodologies to the safety programme, and using the workforce, and using public communication with the citizens, and I think it’s a fantastic example.  And I think every country should try and learn from it.

SA:        And finally, then I wanted to ask about you.  After everything you’ve done you’ve still got more road in front of you.  What are your plans?

JL:          Well, I’ve just come back from holiday, which was lovely, and my phone barely rang, it was such a treat.  Because about two months ago I resigned as the National Clinical Director deciding with Lynne, my wife, that maybe new challenges would be next.  So, I’ve left government.  I think I’m self-employed, she thinks I’m unemployed, it’s all in the definition.  And I’m working independently a little.  I’m working a bit for IHI, the Institute for Healthcare Improvement.  I’m helping some colleagues with some new ventures, I’m speaking a little around the country.  So, I’m 55, whether there’s another job, an actual job, it doesn’t feel like that right now, in the summer of 2024, but I wonder if there might be in the future.  And I’m looking forward to new challenges.  I’m missing my colleagues, I’m missing being in the crucible of government, and I’m also not missing being in the crucible of government, if you’re allowed to be both things at the same time.  So, it feels good to have a little bit of a rest.  I had a decent holiday and now we’ll see what the future holds.  And I’m not entirely sure, you may have to have me back depending on what happens.

SA:        I’d love to.  I’ve really enjoyed talking to you Jason, thanks for all the time you’ve given us today. 

JL:          Thank you for having me.

SA:        The show notes for this episode and all our previous episodes can be found at www.kingsfund.org.uk/kfpodcast.  And you can get in touch with us via X, our account is @thekingsfund.  The producer for this episode was Natalie Cleverley and it has been edited by Bespoken Media.  Don’t forget to subscribe, share, rate, and review this episode wherever you get your podcasts.  And, of course, thank you for listening, we hope you can join us next time.