Chief Medical Officer, Bupa (1995–2012)

Well, it's quite a long and convoluted story. I trained as a surgeon, but in a way it goes back even before that. As a medical student I was one of those rather noisy ones — I ran the medical society, the sort of person who stands up in the lecture theatre and says, there's a drinks party on tonight. We used to run big events in the medical school that a lot of students from the main campus came to. The union was having its annual election for president, and it had been run by international socialists and Communist Party people for some years. Someone said to me, you're known on the campus, Andrew — why don't you stand? I was in my fourth year at med school, so it wasn't a good time, but I thought, for a laugh, why not. So the trusty band, including my sister, who was at the union at the time, stood for the election. Normally about 600 or 700 people voted, and they all pretty well voted for these guys. This time 3,500 people voted: the 700 voted for them as usual, and the rest voted for me. That was a bit of a shock, because we'd really done it for a laugh. I had to go to the dean, who I hadn't even spoken to, and ask, can I have a year out to be president of the union?

The point is that I wasn't at all political — my campaign was about better, cheaper beer in the union. But because of it I became much more interested in the political world, in education. I actually stood for the presidency of the National Union of Students that year on the back of it, against Charles Clarke, who later became a minister in the Blair government. I didn't win, obviously. But it changed my thinking from being just a medic to having a much broader view of things. Then when I became a junior doctor I got very involved in the BMA Junior Doctors Committee, and I became the lead negotiator for the country's junior doctors. We were campaigning for reduced hours — you must have heard about those good old days, 104 hours a week, one-in-two rotas, all the rest of it. So I got a lot of that campaigning, media campaigning, experience.

I came to the end of my training as quite a different character to where I'd started. I became very interested in management and policy and moved out of surgery, which I did enjoy, and joined the staff of the BMA. That was an interesting time, because I'd been a BMA politician — so at the same time as leaving clinical medicine, I was also moving from being an elected junior-doctor politician to being a kind of BMA civil servant. I ran the northern offices of the BMA for a few years and then became the Scottish Secretary of the BMA. That brought me experience with ministers and politicians in Scotland, a whole new area of policy — and many arguments with Mrs Thatcher's ministers at the time. We had quite a lot of fun up there, winding them up.

Being at the BMA, I learned much more about consultants and GPs — I was working with them, supporting them, getting a whole range of what the profession was about. As a junior doctor you're very immersed in hospitals, so I got a very broad experience and started building a huge network without even realising I was doing it. These are all important words these days, but back then it wasn't so common to talk about a network — you were just meeting lots of people and keeping in touch. Then at the BMA I got to a plateau. I was on the senior management team by the age of just under 40, and there was nowhere to go, really. They weren't going to put a 40-year-old into the chief executive job — very conservative organisation. So I was sitting there thinking, what will I do? And a job offer came up from Bupa, from Bupa hospitals.

They have 35 hospitals. Frankly, as a junior doctor I hadn't been very supportive of private medicine — you'd seen consultants zipping off down the road to the private hospital, leaving you to run the outpatients. It wasn't an area I was particularly interested in. But I said to my wife on the morning of the interview, well, they've asked me, so I'll humour them, go along and see what it's all about. And unlike the BMA at the time, these were young men and women with a clear strategy. They knew where they were going, and you got a distinct impression they were going to achieve it. I just thought, this is so different to what I've been in at the BMA — and I found myself saying, yes, please. So started a very different career. I lost some friends by moving into the dreaded private sector, as others have when they've made that move. But it was fascinating: I was back into medical work, responsible for clinical governance and quality standards and driving quality improvement across 35 hospitals.

And to my real surprise, only a year later I was upgraded to be medical director — chief medical officer — of the whole Bupa group, which was growing rapidly. During those years Bupa was already in Spain and Saudi Arabia, but we moved into Australia and New Zealand, India, China. Bupa was a big commercial company, but it used its leading doctors as the friendly, professional face of the company — people like me. So I got a huge amount of experience, not only on the medical side but in lobbying and media and promotion. Although I normally got wheeled out when things went wrong — I suppose I was known as a fairly safe pair of hands. "We'll put Andrew up, and he'll defend us in a friendly, professional sort of way if at all possible." I had to appear on the Watchdog programme with Anne Robinson two or three times, which was pretty horrendous. But so far so good — that's my main career roles. I've spoken an awful lot, so let's have a breath. Any questions you want to ask on that?

I think one of the key things is to keep in touch with those people — to keep linked in to them. I've used the word "LinkedIn" there, haven't I? We didn't really have LinkedIn in those days, but I do support that approach — it's a really good platform for keeping in touch with colleagues. Back then you just had to keep connected: go round at conferences chatting to people you'd met before, attend the big gatherings. I said to one of my early mentees: when you go to a conference, don't just sit there. It's hard, but try to stand up and ask a question and say who you are — because if it's a sensible question, people will come up to you afterwards.

They've got common ground with you, and that's a way to make a name for yourself. If you ask stupid questions, you probably won't manage it — but have a good question ready and don't be afraid of standing up. Take people's email addresses and follow up afterwards: hi, I really enjoyed chatting to you. Build up a mini database of people who might be useful for what you're doing at the time — you can't be too broad. And the good thing is they contact you too. The reason I'm doing what I do these days is that people ring me up and say, do you want this job or that job, or do you know somebody who could do it? That's very good, for all sorts of reasons.

Yeah, it was. Let me tell you about an event that wasn't a good one for Bupa, but I learned a huge amount from it. We didn't have many mistakes — but when you make a mistake in healthcare and it's in the public domain, it's a big mistake. The impact on reputation can be very high. I was in my office one Tuesday morning — I remember it vividly — and I got a phone call from one of our hospitals. For the last three Saturdays they'd been doing NHS waiting-list sessions: every Saturday morning a surgeon would come from the local NHS hospital and do maybe ten cataracts. This was the Tuesday after the third Saturday. And the guy rang me saying, we have a problem — as in Apollo 13. The patients who'd had their cataracts done on the first Saturday were starting to get quite serious symptoms in their eyes. Which meant the next two weeks' worth were also going to get the same problem.

It transpired that the methylcellulose solution the surgeon usually used in the NHS was different from the one we used in the private hospital. The bottles looked very similar. He used methylcellulose for injection; we used methylcellulose eye drops for the same purpose. And immediately you begin to see the problem — we call it the Swiss cheese model. Normally there are lots of controls that stop things happening. But you had a consultant who wasn't used to working in our hospital, and a bottle that looked the same. The nurses presented him with the fluid drawn up and thought, this is unusual — but he said, it looks the same, that's the one, give it to me. And in went the injections. The drops solution had a preservative in it that the injection one didn't, and that was causing a lasting reaction. So we found out very quickly what had happened.

I wrote to the manufacturers that morning saying, you've got to change these bottles, because this mistake has occurred and we have nearly 30 patients who are now going to be affected. I also wrote round all our hospitals immediately: watch out, this can happen, be careful. And I said to our corporate communications director — a very forceful guy — we're going to have to go public today, because the patients are going to start phoning the press if we don't. If we don't own up and say what we've already done to make sure it doesn't happen again, we'll be on the back foot forever. He wasn't particularly happy at the thought. But I know from experience: once patients get the bit between their teeth and think there's a cover-up going on, the stories go on endlessly. So the chief executive signed it off, and I did the press conference — of course they said, you can do it, Andrew. We had about five camera crews and radio; it was a big do.

Our communications guy said, well, we'll have to sack the nurses, won't we? And I said, no, we won't. They played their part in trying to tell the surgeon — it was a multiple-issues thing, not one person — and I am not going to be announcing anything like that. At the press conference, because we were up front, I was asked about the nurses, and I said exactly that. We got about 24 hours of bad press, not surprisingly. But because we'd found out what it was, made sure it wouldn't happen again, and told the manufacturers — done all the right things very quickly — it didn't go on. And I don't think one of those patients sued us. Not one. Which to me was amazing, because some of them had to have reoperations and had a really bad time until it all settled down.

So, big learnings from that. One: don't be afraid to apologise and be open about what's happened — the more you try to cover up, the worse things can get. We've seen that in politics and everywhere. Two: don't sack or discipline people who were part of something that was beyond their control at the end of the day. Sorry, long answer to your question — but there's a lot of learning from that kind of experience. I've argued very powerfully ever since that we have to be open: open reporting and open cultures to report and learn are fundamental to quality in healthcare.

The role has always been — and let's be clear about this — mainly about cold elective surgery. That's what private hospitals are good at. Outside London most of them are quite small, maybe 100 to 120 beds, doing cold elective surgery routinely — and they're very good at it. Hip replacements, knee replacements, cataracts, hysterectomies: I've always argued they're a very good place to have those done, just as good as the NHS. What those hospitals are not good at, and don't select those patients for, are people with multiple morbidities who are likely to need intensive care. That's not their area of expertise. They get accused of cherry-picking, but that's not what they do — they do cold elective surgery, which doesn't routinely require complicated ITU support. London is different: there are some very big private hospitals there with the full range of medical and surgical treatment, good ITU support, doing much more complicated surgery.

During the worst of the COVID crisis, pretty well all the private hospitals in the country stopped doing private work and stepped up to help out the NHS. Obviously, to keep themselves going, they've had to go back to some private work — but private hospitals are generally doing quite a lot of cold elective work for the NHS on contract now, where they have capacity. Sometimes the NHS doesn't want to use them because of the old-fashioned "we're not going to go there" approach. But forward-thinking NHS chief executives can see they can release some of the pressure in their hospitals by using local private hospitals, and I'm sure that will continue.

But it's a small sector. Only 10% of healthcare in the UK is provided through the private sector, so it's not going to completely change the situation for the current NHS problems — six million patients waiting on waiting lists because of COVID. They can help where there are particular bottlenecks and local crises, but it's limited support. What they do provide is a service to people — particularly big companies — who want their staff or executives not to be off sick for six months waiting for a procedure, but back to work quickly. For them it's about a productive workforce. Two-thirds of the insurance base in the UK comes from companies: small and medium-sized enterprises and large companies.

The first thing I always say to people I mentor is: always have an open mind. You may have wanted to be a neurosurgeon since the age of seven and be absolutely on that path — but very few people can become neurosurgeons, it may not work out, and you're in that tunnel. So as you go round your rotations — medicine, psychiatry, surgery — keep an open mind. You might come to dermatology thinking one thing and find it fascinating, and the doctors you work with might say, you're really good at this, why don't you carry on? So have an open mind as you go through the specialties. If you're absolutely determined to be one type of person you may get there, because passion is really important — but most people aren't. When it came to going to the private sector, instead of just saying absolutely not, I thought, I'll give it a try. And I surprised myself by going there, and by how enjoyable it became. An open mind is very, very important.

Then there are two other aspects. Some of the people I mentor are working night and day — they're working so hard — and I just say, you've got to have a break every so often. Have another string to your bow, because it's a very pressurised job, and it's been particularly bad over the last two years. And otherwise it's back to networking, building up your contacts. If there's a consultant you work with who you really think is great, there's no harm in asking whether they might mentor you while you're in that particular job. It's more difficult with shift work these days, but if you get on well with somebody, keep up with them if you possibly can, and don't be afraid to ask them for advice. Most consultants will respond positively to people who share an interest and don't just disappear. So don't be afraid to put your head above the parapet. It's the same at conferences: have the confidence to feel you can stand up and ask a question. Someone will say, oh, he's a clever dick, or she's a clever dick — but it's quite important to get people to know you and build up your network if you can. Those people will be potentially very helpful to you in your future.