The medical director of Bupa

So you’re planning to retire from Bupa this year?

I’m sort of avoiding the retiring word: I’m moving on. I’ve been doing this particular role for 16 years, so I think it’s good for me to have a change, and it’s probably good for Bupa to have a change too.

You originally trained in surgery—what made you choose this career path instead?

The NHS was going through a bit of a bad time and my specialty, which had been trauma, was becoming more like orthopaedics. It was a moment when I thought, well what am I going to do? I was very active in medical politics at the BMA, and a job came up at the BMA on the management side. I thought I’ll give that a try for six months if I get it and see if I take to that side of things. I did take to it; I loved it really. I was with the BMA for about 13 years, and by the time I was approached to come to Bupa I’d well left surgery. The big jump was when I joined the BMA, where I really did miss surgery. I don’t miss it now, but I certainly did for a while.

Has the role of group medical director changed in the time you’ve been here?

It’s changed hugely. When I started we were very UK oriented, but over the past 16 years we’ve grown a whole portfolio (care homes, insurance, hospitals, wellbeing, corporate wellbeing) with business in Australia, Spain, Saudi Arabia, India, and China. We didn’t have care homes for the elderly when I started; we’ve now got 19 000 residents in our care homes in the United Kingdom and quite a few thousand in Australia, New Zealand, and Spain as well. The job has become bigger and in a sense accountable for more. When you’re a surgeon you’re dealing with patients one to one; as you take on this sort of role you still have a responsibility for patients or customers, but it’s a much wider one.

As part of an international company, what do you think are the big challenges for global health at the moment?

I think across the world there are the same things that we’re facing here: the growing elderly population, increasing customer demand and expectation, and the cost of new technology. These are things that are driving up the cost of healthcare, and one of my jobs is to help keep healthcare affordable. But I think the great thing about being an international company is you can learn from the experience of Spain or wherever it is and share it. It’s all the same challenges. It doesn’t matter whether you’re Chinese, Australian, or Saudi Arabian; at the end of the day we’re trying to provide safe, cost effective care with a good outcome for our customers.

What are you proudest of achieving so far in your career?

I think it’s persuading this company to invest in the routine measurement of outcomes, because we’ve started a completely new way of thinking about patient care. Now the NHS is doing it. I chair the committee in the Department of Health that does that, and I think it’s a really important thing that we should be able to measure routinely. The patient recorded outcome measurements (PROMs) mean you can pick up the health gain that you’re achieving as opposed to just the failures. I’m a passionate arguer for the value you get from listening to your patients.

You pioneered the PROMs system that was rolled out in the NHS. Are there any other practices you have at Bupa that you think could benefit the NHS ?

I’m all about sharing; I think it’s a partnership of the private sector working with the NHS in the UK, and we can learn a lot from each other. Interestingly, we have stolen with pride the NHS outcomes framework (we’ve modified it slightly) because I think that’s great work that they have done. Our mission is to help people live longer, healthier, happier lives—but measuring “longer,” “healthier,” “happier” is very hard. We believed that the outcomes framework was a good opportunity to see if we can measure what we’re doing, and we’re getting on with that in parallel with the NHS. There are times when they’re doing something that we can draw from, and there are times when we’re doing something that they can draw from.

What is your typical day at Bupa like?

You really don’t know what’s going to happen from one day to the next, so it’s very hard to talk about a typical day. That’s one of the exciting things about the job: there’s huge variety. It’s often not an office day; I’m overseas at least once a month probably visiting businesses. Obviously a key part of a job like this is networking and knowing what’s going on.

There’s been a lot of coverage of how the new NHS bill may affect private sector involvement in the NHS. What do you see as Bupa’s response ?

I think our position is that the generality of what they’re trying to do (of giving more purchasing power to primary care) is a good thing. We’re all trying to encourage people, especially with chronic illness, to be treated more in the community—and trying to encourage more responsibility in primary care to drive that is an important thing. What we haven’t got involved in is the politics of the primary care trusts and clinical commissioning groups. It’s what happens on the ground with the doctors themselves that’s crucial. They have to carry on treating patients with all this noise in the system, and I think that making it easier for them with better data systems is key. I think fundamentally the information revolution will drive more of a change in health culture than structural change.

I think the privatisation debate is a bit of a red herring. At the moment, about 3.5% of NHS hospital sector work is done by the private sector. It’s a tiny proportion, and why is it just the hospital sector where this seems to be an issue? We’ve had privatisation in the care home sector for years. Most care homes and nursing homes are run in the private sector; 70% of our residents and most of the other care homes too are funded by local authorities. No one makes a fuss about privatisation there, so it’s an odd sort of discussion. We try to stay out of party politics—it’s not our job to be involved with that—but we watch with interest.

You think this information revolution will be pivotal to improving healthcare then?

The more that patients become informed, the more that they have access to data and information about outcomes and all those sorts of things, the more they themselves will drive a change in the system. I think that’s where we will see better improvements coming in healthcare. I really believe that we should get more data out into the public domain, which will help not only patients but GPs as well. I think the two working together, if they get those data, can be much more powerful to move change in healthcare than this restructure stuff.

Do you have any advice for young doctors now?

It may seem tough when you’re a junior doctor, but it’s well worth sticking it out. If you don’t feel that direct one to one patient contact is for you there’s so much you can do using your medical training in other ways to help improve the lot of people who need healthcare. One of the great things about medicine is the spread and variety of what can be done. I just think it’s a great career, so stick it out: it gets better and better.