Aidan HalliganBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2687 (Published 20 May 2015) Cite this as: BMJ 2015;350:h2687
- Matthew Limb, Croydon
It is said that Aidan Halligan⇑ used his gift as a communicator to become England’s deputy chief medical officer and the youngest doctor to secure the post. Forewarned that his interviewing panel was overrunning badly, he charitably set aside his presentation and improvised a tale that clearly won over his inquisitors. Johnny Wardle, a friend of Halligan who would establish the NHS Staff College with him and knew his narrative powers well, says, “Aidan had a story for every occasion, always with a message.” Except this one wasn’t true, say insiders, and shows how stories about Halligan, a highly charismatic, maverick figure, and stellar communicator, could sometimes take on a life of their own.
Aidan Halligan was an outspoken patient advocate who held high office in the NHS and set up groundbreaking projects for underserved homeless patients and deprived communities. He was the NHS’s first director of clinical governance and was widely regarded as an eloquent champion of high quality, safe care. A captivating leader and original thinker, he frequently challenged the medical establishment.
Halligan was made England’s first chief of safety at a hospital trust by Duncan Selbie, now head of Public Health England who both expected and wanted him to speak his mind. “Aidan had three rules for joining me—‘don’t tell me who to speak to, don’t tell me where to go, and don’t stop me doing anything’. We had five extraordinary years.”
Ian Kennedy, another friend and former chairman of the Healthcare Commission, says Halligan “spoke truth to power.” “He had 100 ideas before breakfast and because he was so inspiring and so good at generating enthusiasm everybody wanted a piece of him and he was unstinting in giving that.”
Born in Dublin, Halligan qualified in medicine at the city’s Trinity College in 1984—his wife, Carol, also qualified there. He completed postgraduate training in obstetrics and gynaecology at the Rotunda Hospital in Dublin and the Leicester Royal Infirmary. He was professor of fetal and maternal medicine, and honorary consultant at University Hospitals of Leicester NHS Trust from 1997 to 2003. Between 1999 and 2006 he held high profile national roles, notably as head of the NHS clinical governance support team, deputy CMO to Liam Donaldson (2003-05), and director of clinical governance for the NHS.
He helped clinical governance issues to become mainstream in trusts, confronted racism, bullying, and harassment and thought deeply about leadership, what motivated staff, and how people and organisations could learn from mistakes.
Donaldson, a close friend and his former boss, says that Halligan was “not always running around in a charismatic way” and could very often “play it straight.”
“He had an unusual blend of motivation that was very, very patient centred. He would stand up against the profession, if necessary defending the interests of patients . . . On the other hand, he would connect very sympathetically with a strand in the profession that felt the way the NHS had gone had betrayed their core values. At times he wasn’t on the doctors’ side, in fact he was vehemently critical, and then at other times he was incredibly supportive to people who were toiling at the coal face without recognition.”
Kennedy says Halligan was skilled in challenging senior doctors and managers whenever he came across poor teamwork, poor communication, or poor outcomes. “He would say, ‘I’m holding up the mirror, if you don’t like it, it’s for you to do something about,’ he was remorseless in that . . . Equally, he was very good at praising where praise was due. People really responded to him and it would make them go the extra mile for patients.”
In the mid-2000s and with the NHS in financial crisis, Halligan publicly challenged target setting for having distorted healthcare priorities. He argued for leadership built on better clinical understanding rather than simply “throwing money at the problem.”
Halligan left the civil service—friends say he found the deputy CMO role constraining and frustrating. He came close to joining the Irish health service as chief executive but turned it down amid controversy when the matter became public. Muir Gray, a public health consultant who worked with him on several projects, believes he would have been wasted as a chief executive, and that he was “better in roles that he created himself.” “He was a natural leader, not a natural bureaucrat,” says Gray.
In 2006 Halligan joined the private sector to run a training firm, Elision Health, backed by venture capitalists, but he would rejoin the NHS shortly afterwards.
Donaldson says that while he was “very successful” and a “fantastic” director of clinical governance, “he did have periods when things didn’t work out for him.”
“He sometimes felt he wasn’t getting anywhere with what he was trying to argue for, for a new kind of relationship between doctors and patients . . . He was very upset about the Mid Staffordshire situation and very critical of the senior management of the NHS. He was very passionate about those things when they went wrong.”
Kennedy said that Halligan started radical projects with the rare quality “of being willing and able to translate an idea into action.” In 2007 he became director of education at University College London Hospitals (UCLH), where he commissioned a learning hospital education centre with simulation theatres and viewing rooms and was seen as successful in improving both quality of care and team leadership.
He tackled injustices head on, rounding up like-minded collaborators with what Kennedy calls a “kind of pied piper quality” that drew people to the causes he felt passionately about.
Halligan was moved to act on homelessness and health after a homeless patient died outside UCLH after being thrown out for “causing trouble.”
He was appalled at systemic failure that meant staff neglected homeless patients with multiple, complex problems. He created a pathway team in the hospital, recruiting a specialist GP and the best nurse he knew. They worked across the wards providing better, humane, personalised care. The programme was effective and became the national charity Pathway, which now has 10 teams in 10 hospitals around the country.
Halligan appointed Alex Bax, who had been health adviser to former London mayor Ken Livingstone, as the charity’s chief executive. Of Halligan, Bax says, “He had incredible drive and he was always three or four steps ahead in his thinking. We see our existence as one of Aidan’s legacies. It fills quite a substantial space where there was no focus at all before.”
In 2010 Halligan established the NHS Staff College, a senior leadership development programme delivered in conjunction with the military. It draws on military selection and assessment techniques to offer programmes that are “multi-disciplinary, experiential, and personally challenging.”
“Aidan set it up with no commission, no regular income, just a determination that this was the right thing to do,” says Brigadier Johnny Wardle, the College’s chair.
Halligan produced a blueprint for the college after returning from a visit to the Camp Bastion field hospital in Afghanistan. “He was just so impressed with the extraordinary intensity of the A&E operation there, the results, the teamwork,” Wardle says.
“Bastion changed people’s lives, it certainly changed Aidan’s life. He came back determined to replicate the leadership and cultural experience he had witnessed and to help colleagues at home fulfil their potential as leaders, so as to improve the care of those in their charge.”
Bax, who manages the college part time, says, “The army looks for leaders whom people will trust and follow and who are absolutely committed. You could say in a way that’s what Aidan was trying to be.”
Halligan wrote that, at its core, leadership was a purely moral and emotional activity, defined by values and integrity, and requiring the ability to engage and inspire. Doing the right thing on a difficult day was his “mantra,” says Wardle, and he “delivered on this every day.”
From 2008 to 2013 Halligan combined his role at UCLH with his chief of safety post at Brighton and Sussex University Hospitals, the first position of its kind in the NHS. He appointed the first independent patient safety ombudsman, Delilah Hesling—with a “whistleblowing remit” across the hospital.
Roger Kline, a research fellow at Middlesex University Business School, has written how Aidan introduced him to Hesling, herself a former victimised Brighton whistleblower.
She told Kline, “Aidan created ripples of good practice wherever he went. He did much more than support me in this role. It was his vision, he designed and created it.”
In his most recent role, Halligan was director of Well North, a partnership between Public Health England, where he was leadership adviser, the University of Manchester, and nine local authorities across the north of England.
Selbie, its chairman, said it summed up “everything Aidan worked for and believed in—reducing health inequalities and worklessness, a leading cause of poor health, and bringing both hope and opportunity to underserved people and communities.”
“He was the best speaker I ever heard,” says Muir Gray. “I told him once he was so good he induced an altered state, a trance almost in those who heard him.”
Wardle says, “It was not what he said, or even what he did. The true essence and enduring spirit of Professor Aidan Halligan was how he made you feel.” He leaves a wife, Carol, and three daughters.
Cite this as: BMJ 2015;350:h2687
Aidan W F Halligan (b 1957; q 1984; MA, MD, FROG, FFPHM, MRCPI, FRCC), d 27 April, 2015.