Managing a health crisis: interview with Jason Leitch

“The most important thing to say is coronavirus is nobody’s fault. Coronavirus is no respecter of ethnicity or age or boundary, you can’t shut your country down and hope it goes away. The virus is global, the virus is here, and the virus will be here for a long time,” Jason Leitch says.

The Scottish Government’s national clinical director has become the spokesperson for what to do and what not to do during the COVID-19 pandemic.

He has consistently appeared on television, and in Twitter feeds, over the past fortnight, heeding public warnings and answering difficult questions about the rapidly evolving health crisis.

Leitch has been praised for providing clear, logical messaging to the public about what steps they need to take to help “flatten the curve”. Last week, he even took on Piers Morgan, during an interview on Good Morning Britain.

Holyrood meets Leitch on an abnormally busy Thursday afternoon at his St Andrew’s House office, amidst a backdrop of public fear and anxiety as First Minister Nicola Sturgeon tells reporters in a room nearby that the COVID-19 response will move from the ‘contain’ to the ‘delay’ phase.

As I enter his office, the voices of Sturgeon and Chief Medical Officer Catherine Calderwood are blaring through his computer speakers. But Leitch is not at his desk as I take my seat. He has rushed to the bathroom, to heed his own advice to the public.

“Are we shaking hands?” I ask, as he walks back in. “I am, I just washed mine,” he replies.

After listening to the end of the press briefing, Leitch sits down, and I ask how he is getting through such an intense period in his career.

“Honestly, if you give me three meals a day and eight hours sleep, I’ll pretty much do whatever you want,” he says.

“The reality is that my job now is not the same as the people working in the emergency departments. But, hopefully, we’re giving some kind of national leadership and national guidance to that work. And the other slightly odd thing is, you train for this.

“Some days in government for a clinician are quite dull, this isn’t dull.”

How does one train for something like this? Leitch, who started his career as a dentist and then worked as an oral surgeon for many years, says moving to the United States to study public health was the moment that his career changed.

“I did a master’s in public health at Harvard, and I did a fellowship year in an organisation called the Institute for Healthcare Improvement, who are the global leaders in how you change healthcare systems,” he says.

That training included “how to communicate with the public and with the health service” in a crisis.

“You learn how to manage a crisis. At some level, it’s exciting to be involved in it, if you can try and make it better for the public,” he says. “I came back to Scotland and got a government job in charge of patient safety. So, I started doing the patient safety programme in the hospitals, leading that with other people. And now, here I am. I thought I’d last six weeks, and I’ve been here for ten years.”

The intensity of the current pandemic has meant Leitch is using every inch of his American education.

“I had no idea that, sitting in the EPI101 class at Harvard, hearing from some of the greatest brains in public health, that 15 years later I might have to scrape off some of that memory and remember what doubling time meant, but it’s real,” he says.

“So, just like learning how to take out wisdom teeth was important on that career journey, it turns out that epidemiology is also important.”

Leitch is spending most of his time communicating advice on COVID-19 to the public and the health service. Asked whether he enjoys this aspect of his job, he says: “I thought I wouldn’t, but I do, in the right setting.

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“These few weeks have been interesting because, when I normally go on the telly or the radio, it’s usually... there’s been a crisis of some kind, and I go on, and I’m held accountable for the health service. And I’m OK with that, that’s a different kind of pressure.

“But these weeks, the interviews have been very different. They’ve been about education and informing. I think it’s one of the jobs, particularly of the clinical leaders, to inform and educate the public through our public service broadcasters.

“The politicians can do some of that, the First Minister is very reassuring, and the Cabinet Secretary for Health can do some of that.

“There’s a different voice, I think, when you use the clinicians to inform the public about behaviour change. That story is changing, even today, about the instructions we’re going to give the public about large-scale events, or about staying home if they’re sick. I think that comes better probably from the clinical leaders, and I quite like it.”

When swine flu took hold more than a decade ago, Leitch wasn’t in the same role, but he remembers Sturgeon’s leadership.

“The Health Secretary at the time is now the First Minister. So, she’s had more training in epidemiology than many of the rest of us, in fact,” he recalls. “The response is relatively similar, so, the First Minister [is] taking leadership, with the Chief Medical Officer very prominent.”

However, he is careful not to compare the two viruses. “We’ve done a lot of learning both then and since then about how the country should prepare. But this virus is different. And the world is different,” he says.

“The response in China was different. What we’re seeing in Italy is different. And the high-end numbers of people being affected is worse.”

He says globalisation has been “good and bad for this virus”.

“If you compare it even to the swine flu epidemic ten years ago, travel around the world has grown exponentially, the number of cheaper airlines, the amount of people who travel for almost no money, has allowed the virus to go fast around the world.

“But, that’s the bad side of globalisation for the virus. The good side of globalisation is we share data much, much better. And the Chinese have been very open and transparent with their data.

“The more information we get about the virus, the better chance we have of intervening with the right intervention, but also at the right moment in time. The clinical worry is that this virus causes pneumonia and it causes it relatively quickly in a segment of the population, and that segment needs quite intensive treatment. That’s the vulnerable people we’re worried about.”

Another change in the last decade is social media. Leitch says while “there is a lot of nonsense on social media” he has found that people are more willing to listen to experts than previously.

“Social media allows us to myth bust, it allows us to talk directly to the population in a way we haven’t been able to, but it sometimes feels a little bit like an echo chamber. I am finding it slightly refreshing that the world appears to have gone back to listening to experts a little bit more than it has in recent months.”

Was Scotland prepared for a virus outbreak of this magnitude? “I think we’re prepared,” Leitch replies, “that doesn’t mean the health service won’t have to overcome challenges, but we’ve done desktop exercises for this for years.

“It’s been number one in the risk register for ten years across most western health systems, so, we know it’s coming, and we know that every time we get one, the nature of society is different. I think we’re ready, but the health service can’t have the capacity it requires at a pandemic time every day, so we have to change the nature of the health service for a temporary period in order for us to manage that pandemic. And that’s what we’re planning.”

As well as the public messaging, Leitch says much of his time is spent planning.

“Today, we’ve got 60 cases, when you go to print, we’ll have more than 60 cases. But we are using those days, weeks to prepare,” he explains.

“Yesterday, we spent four hours with the chief executives of the health service in full planning mode for the whole country, saying, OK, how many intensive care beds do we need, where are we going to move the trainees? The longer time we have for that, the better chance of reducing the big peak of the virus.”

That planning also extends to the NHS workforce, and his own staff at the Scottish Government. Leitch says they are adapting what they do so that some things will be less important than others, “because, physically, we need people to do different jobs”.

This includes the decision to call off NHS Scotland’s upcoming annual conference in June, “not because it’s a large gathering, we’re cancelling it because we need the 2,000 people who go to it to be on the front line”.

“And the other thing is we’re trying to stay healthy ourselves. We know we’re going to have absence rates beyond what we’re used to, so we’re moving people into different roles so that we can manage that.”

Back to the broader issues in public health. Last month, the UK and Scottish governments held drugs conferences one day apart at the SEC in Glasgow. The Scottish Government had been planning its conference for later in the year but changed tack when the UK Government announced its own conference would be held at the end of February.

Drug-related deaths are now a major policy issue, but Leitch agrees the subject has become a political football between the two governments.

“I think it has become politicised,” he says, “but if you scrape the surface, the only bit that’s really contentious is the safe injecting rooms. That’s the bit that has been blown into politics.

“If we leave that aside for a moment, most of the rest of it is pretty established, in European countries, the four UK countries agree, it needs more investment, it needs more of that community-based environment, it needs better relationships with the third sector, it needs mental health interventions at a younger age, it needs all of that.”

He adds: “But Scotland does appear to have a particular challenge in pockets around the country, and that’s why we think the safe injecting rooms should be part of the whole package”

So, is it possible to take politics out of health? “No, not in a public-funded health system, and nor should it be possible,” Leitch says.

“We’re spending £18 billion on health, a big proportion of the Scottish national budget. That should absolutely be debated by politicians and I should be held to account for what we, collectively, the executive group, do with that money.

“And we should have to go to the Public Audit Committee, as much as I maybe don’t enjoy those sessions as much as I should, I should be held to account for that, as should the health minister.”

But he makes clear that “politics in health is good, playing politics with health is bad.” Leitch says he “often” discusses with Health Secretary Jeane Freeman “her job versus my job or her job versus the CMO’s job”. “She is good at the politics, we are not, we are not elected. We give the best advice we can to her and the First Minister, and they make the choices.”

In April, the Scottish Government’s new national health body – Public Health Scotland (PHS) – will be officially launched. The body boasts it will “reset how Scotland thinks about health and wellbeing”.

Explaining how it will change the current landscape, Leitch says there will be a structural change, with PHS bringing NHS Health Scotland, Health Protection Scotland and public health analytics under one umbrella. “Public Health Scotland will become one of the bodies that reports to the cabinet secretary and the chief executive of the health and social care system, my boss, so we will have a much closer relationship with that whole thing,” he says.

For Leitch, the two key public health challenges in Scotland are “clearly, inequality and mortality, and those two things are not separate”.

“There is a gap in Scotland, between the rich and the poor, for lack of a better description,” he says.

“The health protection bit is absolutely crucial, but the medium to long-term bit is not about coronavirus, it’s about the population, the nature of the welfare payments, the way we treat pregnant women.

“And that’s where most of the value will come from things like Public Health Scotland, the reform of the infrastructure to allow us to do more of that.”