Jason Leitch: It's not my job to understand the politics of the pandemic

Jason Leitch is the man that cancelled Christmas, that told us what to do, where to stay and even how often we could walk the dog.

It’s his face we picture in our mind’s eye every time we put on a face mask and his words that echo in our ears as we try to remember what FACTS actually stands for.

Ubiquitous is perhaps not what Scotland’s national clinical director expected to be when he started out his professional life as a dentist in Glasgow in the early 1990s - or even at the start of 2020 when his day job as a civil servant was mainly behind the scenes and focused on keeping patients safe from harm while they were being treated within the NHS.

But even he admits that after 18 months of appearing on the telly every other day, telling us how to live our lives, his 80-year-old mother is perhaps one of the few Scots not now reaching for the remote. 

Indeed, even the ‘Is Jason Leitch on the telly?’ Twitter account seems to have stopped tweeting about him. 

Love him or loath him, Leitch has been a calming presence throughout the pandemic. He and the First Minister, who he regularly accompanied on her daily televised briefings, have an envied level of communication that has been lauded across these isles.

He even gave Piers Morgan a run for his money when appearing on Good Morning Britain back in March 2020, when Scotland had just 153 cases of COVID.

When the two men clashed over the rules around mass gatherings, Leitch retorted: “I’m not sure where you got your masters in public health from, Piers.”

But even good things can become tiresome and in February of this year, almost 12 months on from the first lockdown, and with thousands of television appearances, including various public health adverts, a regular spot on the Saturday BBC radio show Off the Ball, and countless media interviews, one social media wag suggested that the public health expert was perhaps enjoying being in the spotlight a little too much.

 “Why do @scotgov continue to thrust @jasonleitch down our throats?” he typed.
 “This new advert with him drivelling on is just a step too far. 
“Definitely making the most of time in the limelight. Can’t wait till this is over and we won’t see or hear this fame-hungry wee man again.”

With typical Leitch chutzpah, and with a finger on the pulse of the nation’s mood, the professor tweeted back: “You and me both Alan... I can’t wait until it’s over too.”

And with the end-game seemingly in sight, Leitch and I meet on the day that Scotland comes out of level zero. We start by talking about time and how the last 18 months have merged into a blur and how life has all been a little surreal. I ask him how he has kept track.

“I think that professional bit for me and my close involvement in this, means I can remember accurately the big decision days, the three-week rhythm of reviewing where we were at, making announcements, the lockdowns, the data, Delta emerging… but what’s missing is the same as for everyone else, that personal stuff.  

“For instance, my mum and dad both turned 80 in December and March, and we didn’t do a thing that we had planned. So, for the first one we had a Zoom afternoon tea for my mum’s 80th, which isn’t exactly the end of the world compared to some of the things other people have missed out on, but it’s not great, is it?

“We’re a very close family and we would normally have gone away somewhere and have all been together for a big celebration. And then my dad’s in March, I think we managed a small barbecue at the back of my sister’s house. 

“So, some of those personal things are gone, missing, we can’t get back. And for some people, they’re gone forever because they have tragically lost family and friends to this disease. And so, yes, I am the guy who stood at the podium and cancelled Christmas but I’m not taking all the blame – but okay, I’ll take some of the blame. 

I’m a dentist who then became a surgeon who then did public health as a hobby so I genuinely do feel a bit of a fraud in that environment

“I’ve had people ask me what it feels like to be that person. The person that is seen to be stopping you doing things you want to do and, fortunately, in the moment, and remember you’re one of a group of people, including three clinicians, who are in the, let’s call it the big room, but there’s also the chief economist and the chief social policy adviser and we are all trying to help the politicians make those choices, it’s a team. Macron has a room like that, and Merkel has a room like that, and so on. So, I didn’t feel alone in this.

“The really difficult seat [is the one the First Minister is in] and this isn’t for me or for you to feel sorry for her, or to feel sorry for the deputy first minister, or anybody, but that’s the hard seat.

“We give the best advice we can from our expertise along with our judgements which are not always absolutely cut and dry, and it is up to the political leaders to make the call. Every country has had to struggle with that but that is also their job.

“It’s given me a deeper appreciation for the seat they sit in and for them as individuals and their values and their character. But also, to be honest with you, I have seen up close the liaison with the UK government and the other two devolved administrations and I’ve been on many more calls than I ever thought I’d be on, both with the four country clinicians, but also with the four country health ministers.

“For example, with Jeane Freeman previously and now with the new cabinet secretary, and while some people will refuse to believe this, they’ve been honestly very constructive, very constructive. On occasion they’ve even be light-hearted. 

“And look, I know that there is a game [politics] in there that I don’t fully understand and it’s not my job, of course, to understand, but when we’re talking about what we’re going to do about Pfizer vaccine, how many freezers have we got, and what is your plan for the Western Isles, what’s your plan for the northwest of England, those conversations have been really good. 

“I think I’ve got a much greater appreciation for cabinet decision-making that I hadn’t fully had before. I mean, why would I even be at cabinet or helping cabinet decide things previously? I would occasionally, pre-pandemic, give advice or context about patient safety or about quality of healthcare delivery or something, but it was a special event.

“Now it’s kind of a bit dull, part of everyday life, because we are talking about these things all the time. So, I think I’ve appreciated the level of decision-making they have to make, and I also think that I understand more fully that they really feel that burden and they feel it heavily.”

Leitch originally trained as a dentist, working for a year in general practice in Wishaw and then as an oral surgeon, or “surgery from the neck up” as he describes it – “I didn’t do fillings, I hated it. My mother still hates the idea that she can’t come to me for her dentistry!” Once qualified, he worked in the west of Scotland with patients who had experienced trauma to the face until, he admits, he “got a bit bored”.

“I wanted new challenges. I went to America to the Institute for Healthcare Improvement, which is in Boston. It is probably the global leader in healthcare improvement, and when I say healthcare improvement, I mean improvement of the delivery system, I don’t mean smoking and alcohol. Actually making the delivery system better.”

There he met and worked with Don Berwick – an inspirational figure who assisted President Obama with his healthcare reforms and was later appointed by the then prime minister, David Cameron, to advise on the UK’s NHS. Leitch says Berwick became “a bit of a hero” to him.

Leitch learned transformation techniques through a fellowship at the IHI and took a degree in public health at the Harvard School of Public Health.

“I became an odd combination of a surgeon with a public health degree, which is very unusual. [Former chief medical officer, Sir] Harry Burns is just about the only other one you’ll ever meet, actually! It gives you a unique insight into the day-to-day operational management.”

He returned to the UK and to the dental hospital but admits that that didn’t work out due to his energy and appetite for new challenges.

“I had always had this slightly extrovert personality but now I had a new skill and they didn’t know what to do with it. So I left and I came to work for the Scottish Government.”

Since then, he has applied what he learnt about transformational change into practice within the NHS. He says his day job is about ensuring patient safety, and that patients and their families are treated with compassion and care.

As the civil servant responsible for preventing patient harm, this pandemic has seen him pushed to the fore of public health messaging and how to protect a population. What prepared him for this?

“There’s no folder on the wall to tell you how to do this, Mandy, but you try and answer the exam question you’re asked. And we’ve tried to do it through a framework called the four-harms framework, which is a bit dry, but I think helpful.

“So, COVID harm, then other health harms – cancer waiting times, mental health issues etc, social harms - loneliness, education, stopping kids going to school, working from home, and then the economic harms - losing your job, losing your hospitality business, etc. So through those four harms, public health is not just about harm one, it’s all four.

“But I feel a bit of a fraud in this because I’ve got a masters in public health but I’m sure the public health professionals, the likes of Professor Linda Bauld, wouldn’t call me a public health professional.

Leitch on a hospital visit alongside health secretary Humza Yousaf  | Picture: Alamy

“After all, I’m a dentist who then became a surgeon who then did public health as a hobby so I genuinely do feel a bit of a fraud in that environment, which is why we’ve got a public health leader at Public Health Scotland, who’s the clinical lead for that bit.

“All the public health leaders in the country also come together, and we’ve got a national group too. I just happen to have become like one of the familiar faces of that public health response.

“But I’m not stupid, I understand where my limits are, but I think it is the moment for public health to give the best advice it can and if I can be part of that in communicating those messages effectively, then all to the good.

“I may feel like a fraud but the only thing worse than a pandemic for me would be having this job in a pandemic with no purpose. Without a role in this, I would have struggled, if I hadn’t had something that allowed me to use what limited skill set I have around, perhaps communication, and perhaps the ability to take the advice and put it into some form that people can understand, that would have been hard for me. I wouldn’t have liked to have been on the sidelines.

“Are we on our road out of this? Yes, as a country we are. As a world, we are still accelerating, 440,000 people caught this virus yesterday, 27,000 people died yesterday, so the global pandemic isn’t over. The vaccines will get us out of the global pandemic as long as we can keep up with variations and I’m sure that Delta is not the last one, there are 24 letters in the Greek alphabet. I am hoping we don’t get them all, but we will get more. 

“Our vaccine is not going to suddenly stop being effective. It is not binary - it is not, vaccine will work, vaccine won’t work, but we will probably get another variant somewhere in the world. It could be from here, it could be from somewhere else, I don’t know.

“Has this been the big one, nobody knows. The top of the risk registers globally was a flu pandemic [and] lo and behold the top of the risk registers globally is still a flu pandemic. It is still what is the most likely infectious agent to give us a global pandemic, although nobody can predict. I think we have learnt a lot about response, I think the world will be more ready. The WHO, I think, has done really well, and countries have responded as well as they can. So, I don’t know if we will see another one in our lifetime. I hope not.”

But for now, Leitch knows that this is not the end. COVID is still with us albeit with the miracle of a vaccine now in the armoury, and questions are now turning to what lessons can be learned and, more importantly for some, what went wrong. He faces various inquiries and I ask him how he is approaching that prospect.

“When I was a little boy - I am not sure if this is imagined or actually happened - my mum told me, at times of crises, revert to the truth. And that is what I have tried to do on the podium, it is what I have tried to do on Off the Ball when Frank phones in about whether he can go to the Dundee United game, honestly, and whether Frank can have the wedding that he has postponed four times. Just tell the truth as you know it that day.

“Now I am getting used to interviews being played back, I never thought that would happen to me, never thought I would do enough interviews to play them back so that kind of ‘gotcha’ version of events is already happening.

“And there will be a bit of that, I am sure, and it won’t just be a single public inquiry, it will be a parliamentary inquiry, rightly, it will be a UK parliamentary inquiry, and then there will be public inquiries, and then there will scientific inquiries. The WHO will do massive debriefs for the world about what we should and shouldn’t learn. Public Health Scotland will do it as well.

Leitch says it has "been a privilege" to be at the centre of the pandemic response    |    Photo: Anna Moffat

“And I think I should fully engage in all of that. I hope they don’t do it to find reasons to blame people, in that way of, ‘on the fourth of the month at 11 o’clock in the morning you said this’. I honestly hope we don’t have to play that game, because that would make us behave in a certain way as well and we will end up just exchanging lines.

“I hope we do it to learn from what we have experienced and make it better for the future and to give people who feel like they haven’t had answers during this pandemic, the answers that they seek. But I can tell them now that the clinical teams have made the best decisions that they can with the information they had at the time.”

Returning to the point that angry Alan on Twitter made about loving the limelight, what happens when suddenly it all gets turned off and @JasonLeitchOnTV is no longer on the telly, no longer the centre of attention? How will he cope with going back to the day job, back into a less visible public role?

“Wow, I don’t know. I think it will be a transition rather than a sudden moment, but it does feel weird because I think I have done something like 600 media interviews in 18 months. It is preposterous. I honestly don’t know how it will feel. I probably need advice from you and others about what that looks like. 

“Is it a Desert Island Discs moment and then you disappear into the ether? I mean I had a fantastic job before this. I spoke globally on quality improvement and patient safety, I was in an international network of people so I knew the Swedish health system would come and ask for my help as well as the Scottish one, so that doesn’t seem so bad if you go back to some of that.

“But is there something about the access to the decision-making that we have had in Scotland that will disappear because it won’t be about public health anymore?

“And then there is something about the comms and the media that isn’t all bad. I have quite enjoyed elements of that, it is very challenging, I quite like the cut and thrust of a Martin Geissler interview, I don’t mind that. You’re right, that will disappear, so what do I do with that? Do I get relegated to a spot on What the Papers Say at 10 o’clock on Sky News? Will people pass me in the street saying that’s that man that used to be Jason Leitch… I hope not.

“What I am going to say sounds a bit partly privileged and partly complex. But it has genuinely been a privilege to be at the heart of a country’s response at a time of crisis. Genuinely it has.

“But it’s also overwhelming at times. And it’s a bit like your question earlier about whether I have had dark times - that doesn’t really resonate with me, but overwhelming moments like ‘flipping heck, really Delta, here’s another one’, yes, there have been those moments, when we get told the science say, the Indian variant has an R number twice the Alpha, when you think, ‘no, don’t give us that today because I now have to phone the First Minister and tell her that’.

“So, there are moments where you think can this really get worse, and it does, and you keep going because you can’t be overwhelmed or stop. There’s that complexity, but what would I do, would I rather be in that and do my best to help in some small way or would I rather be invisible and not have any problems? I think you know the answer to that.”