British Heart Foundation's James Cant on how research can save lives

James Cant became the director of the British Heart Foundation in Scotland in August last year, after a period in a similar position for the British Lung Foundation. “It’s been all I expected it to be,” he tells Holyrood.

Cant started his career in the civil service, joining the Ministry of Defence in 2000 after getting his PhD at the University of Glasgow. He describes the department as “an absolute supertanker” which proved difficult to move. 

He moved into the voluntary sector “by accident” after joining an education charity on secondment from the Scottish Government. With two children, he opted to stay in Scotland rather than return to Whitehall.

RELATED CONTENT

A balanced breakfast: Holyrood's pre-election Q&A with the party health spokespeople

Scotland's NHS needs more than political consensus on health

Targeting prevention- a roundtable discussion on public health

The experience of working for government has informed his approach since, he says.

“You become very aware of the kind of pressures, and sometimes constraints, senior officials and particularly ministers are operating under. I suppose, in a sense, that has informed my approach toward working with government, which has always been, wherever possible, to be collaborative; to act as a critical friend, both as an individual but also as an organisation.”

The journey from defence to health politics is a substantial one in itself, but Cant insists there are similarities in terms of media and public criticism while high levels of support for “the boys and girls in uniform” remain.

“There’s sympathy for those on the frontline, but then often far greater scepticism and less sympathy for the supposed grey suits. Managers, clinicians who have gone into management, who are sometimes portrayed as blockages to good service. 

“NHS Scotland is a classic example of this. What you have is hugely committed managers who are working under extreme pressures of constraint and demand. We’re actually very fortunate in the Scottish context because the amount of best practice and innovative practice that comes up through the management structure and is shared across Scotland, I don’t think we give enough credit there, often.”

Cant says the attraction of the British Heart Foundation (BHF) was the levels of scale and influence the organisation can wield. While many define the BHF by its high street presence, there is also a large research portfolio which will see around £57m invested in research over the next few years in Scotland alone.

This is not to play down the role of the retail sector. Cant pays tribute to the “efficiency, dedication and professionalism” of the charity’s army of volunteers.

But what people are perhaps less aware of is the work of the charity in policy areas. Work around prevention, community defibrillators, and the research underpinning Anne McTaggart’s member’s bill on a soft opt-out register for organ donation in recent years show a charity hard at work in politics.

Although ultimately McTaggart’s bill was defeated, the Scottish Government indicated it would look again at the proposals next parliament.

Recent events with the political party health spokespeople for the BHF run by Holyrood revealed an “underpinning consensus” on public health, Cant says, which his colleagues from elsewhere in the UK regard “with significant envy”.

The achievement shows the BHF is more than a “something must be done charity”, he says, but plays an active role in coming up with solutions.

“I think we’ve played a really significant role. I’d have to pay tribute to [Policy and Public Affairs Manager] David McColgan at this point in terms of helping to set an agenda, being a catalyst and offering that crucible, in a way, for discussion and the consensus to develop.

“So much of the progress we’ve made on tobacco has been on that consensus basis, working in close partnership. I think BHF Scotland has been integral to that,” says Cant.
Public health will be an area of broad consensus in the next parliament, not just among politicians but also within the third sector, he predicts, when economics have made third sector organisations think more carefully about how they divert their resources. 

“I’m always aware we operate as an organisation because of the people who fundraise for us, who may think their contribution is quite humble and quite modest but without which none of this can happen. We owe it to them to make sure everything we do is relevant,” he says. 

This job includes raising awareness of the scale of research the BHF supports in Scotland, and working with the Scottish Government and the NHS in Scotland to translate that research into practice, or as Cant puts it, “in with the nuts and bolts of delivery”.

Moves to install CPR kits in every fire station in Scotland are under way. Cant says it is an example of new models of investment.

“In a way that almost flips the coin, because traditionally the voluntary sector has looked at the statutory sector for resource which we then deliver. In a sense what we’re doing is the opposite, so we’re investing in and supporting statutory partners.”

Although the BHF funds research across the world, the organisation has an “understanding of how devolution works” and the way the NHS delivery models are increasingly different across the UK, according to Cant.

“If you look at it from a lay person’s perspective, they don’t care where the cure is found, whether it’s Oxford, Belfast, Cardiff or Edinburgh, or increasingly Boston or Hamburg. That’s the context. But where it gets really interesting is translating it into delivery in increasingly divergent health services.”

One example of the “unprecedented scale” of research is Familial Hypercholesterolaemia (FH), which is a genetic condition leading to exceptionally high levels of cholesterol in the blood. It leads to sudden and unpredicted heart attacks. 120,000 people are estimated to have FH in the UK, but only about 10 per cent or less have been identified. The BHF has funded research which has led to a test being produced which identifies FH. If it is found, the person is put on a low dose of statins to address the danger.

The BHF is currently working with NHS Grampian to roll it out and hopes it could be Scotland-wide in the next parliament.

“While the research requires a lot of resource, often the solutions can be relatively straightforward and inexpensive,” says Cant. “To me that captures what we have to be as an organisation. A phenomenal brains trust in our research colleagues – I feel at my least intelligent in their company, brains the size of planets and humble with it – and they’re producing things like this.”

Research is also being funded examining how the heart muscle recovers after a heart attack and looking at ways to mend it. There will be a societal impact as more and more people survive heart attacks, he concedes, which underpins the need for health and social care integration.

“710,000 are living with the impact of cardiovascular disease. That’s nearly a fifth of the population, a big social group. The pace of change only increases.”

Integration is happening at “probably the most challenging era the NHS and local authorities have ever experienced,” says Cant. “I’ve likened it to building a much-needed extension on one end of your house while the other end of your house is on fire.”

The Scottish public also have a responsibility to look after the NHS by looking after their own individual health, he adds. “In a sense, triage begins at home.”

One thing individuals have less influence over is air pollution, and research following a £7m investment by the BHF in the University of Edinburgh has revealed breathing particles PM2.5 and PM10, primarily produced by diesel vehicles, can increase the likelihood of heart attack by 13 per cent.

People may be surprised to see the BHF campaigning on an issue traditionally the realm of environmental NGOs, Cant says, but Professor David Newby’s research provides “clear and unequivocal evidence” of the public health impact. 

“Some of the impact on your body is quite horrendous. Historically, we’ve always thought about air pollution as a lung problem. Coal-fired factories, massive particles getting stuck in your lungs. Actually, these particles are a quarter the width of your hair and going straight through the lungs into the bloodstream.”

It’s not about being anti-car, he says, but requires a “modal shift” in transport policy. Planning too. But with impacts on health coming from so many policy areas, where can a third sector organisation like the BHF draw the line, in terms of its activity? 

“It provides a bit of a tightrope as an organisation and for me as an individual, because fundamentally, we are a research organisation. That’s where our roots lie, that’s the strategic focus. Research, research, research. 

“The balance I need to strike is to try and translate that research into treatment at the bedside and at the same time allow the research to form the backdrop to a narrative to what, as you say, becomes a universal conversation.”

Air pollution, he says, is a perfect example “We’re not saying save the world for your grandchildren. We’re saying people are dying now. As many as 2,000 people a year in Scotland are dying because of the causes of air pollution. We’re able to elevate that debate into an arena other charities might not be able to access, and create a platform for a consensus to occur.”

A long way from working for the MoD in Whitehall, then?

“Hand on heart, no two days are the same. There’s a sense of purpose I never had when I was working in the MoD. I was a small insignificant cog in a machine you couldn’t really turn where you thought it should go. The machine here is still huge but it’s heading in the direction I think it should be going. And you see the benefit to people’s lives. What our organisation does is save people’s lives, and it continues to do that daily.”