Welcome to Transformational Thinking for Health Leaders. I'm Dr Fiona Day, Master Practitioner Coach and Chartered Coaching Psychologist. This is a podcast that will help you meet your most complex leadership challenges and transform your perspectives, helping you to become a more effective and creative leader with a deeper understanding of yourself and your own world of work.

Andrew Furber has been the regional Director of Public Health North West for the Office of Health Improvement and Disparities at the UK Department for Health and Social Care, which is a function which was previously part of Public Health England and also part of NHS England since May 2020 and he's also Honorary Professor of Public Health Practice at the University of Manchester. Andrew's many previous roles include Centre Director for Public Health England in Yorkshire and Humber and is a Director of Public Health for over a decade. He's past President of the UK Association of Directors of Public Health and originally trained as a general practitioner and worked for seven years in Nepal at all levels of the health system and has also taken short-term assignments in several other countries.

His current portfolio includes public health workforce development nationally and Andrew was awarded an OBE for services to public health in the Jubilee Birthday Honours List in 2022. So welcome to Transformational Thinking for Health Leaders, Andrew. Thank you.

So it's great to have you here and we've known each other for quite a long time since I was a new registrar and you were the senior registrar in the place where we were both based back in the early 2000s. So Andrew, tell us, if you would, about your career to date. Thank you. 

Well, you've summed it up very well in the introduction, but I went to medical school back in the 1980s really without any clear idea as to why I was going or what I wanted to do having qualified and I remember distinctly a professor of genetics who taught us and explaining his career trajectory that he had a very keen interest in genetics as a student, did placements on genetics once he qualified, got rotations on genetics, worked in the US on genetics and ended up as a professor of genetics. A very linear career course. Mine has been anything but that.

I kind of got to the end of medical school not really knowing what I wanted to do, but kind of enjoying everything. So I ended up training in general practice, which I loved and really enjoyed very much, but then had a hankering to go and work overseas and an opportunity came up to do that short term initially for six months in the east of Nepal. Having been to Nepal once, you get to hear of some of the opportunities.

So ended up coming back, finish off GP training, went back out to Nepal in a community health and development role where my eyes were really open to the social determinants of health and the importance of those as well as clinical work. Having done that for a few years, decided that I needed to kind of get a formal qualification in public health. So I came back to the UK to do a master's in public health, went back out to Nepal after that to work on HIV and TB control programmes, which I very much enjoyed.

But that came to a natural conclusion, so I came back to the UK to do the higher specialist training in public health, went on to be a consultant in public health in Yorkshire, a director of public health, and then worked for Public Health England and now, as you say, working for the Office for Health Improvement and Disparities and NHS England. So it's not been a linear career path at all, but I draw in my current role from every role that I've done before. So in terms of people listening to this podcast, I wouldn't worry at all if you don't have a clear career plan.

And the advice I give to people who are thinking about their next move is to listen to their heart as much as they listen to their head and go for what really you feel passionate about and you feel excited about and you probably won't go far wrong. Yeah, that's wonderful. Thank you for sharing that.

And it's a great example of a kind of career based on serial mastery where you keep building on your skills and taking it in a slightly different direction. And in terms of what I call career epidemiology, the kind of the trends in modern careers, we definitely see that that is happening in terms of that kind of traditional three stage process of education, employment and pretty much the same role for 30, 40 years and then kind of retirement. That's absolutely kind of falling by the wayside.

But it is the kind of the model that has gone there before us. But, you know, you've kind of described really beautifully that the way that you've kind of woven your own path here based upon opportunities and what was kind of interesting to you. And I guess kind of taking quite a lot of risks at the same time in terms of working abroad and coming back and forwards that you were describing there.

So, yeah, thank you for sharing that. And I'm curious, Andrew, what was it like then, you know, after seven years in Nepal, returning to the UK to do public health training? How was that transition for you? It was an interesting transition because when I came back to the UK, I was struck that how many things were actually very the same. The principles were the same in the way that I was practicing in Nepal, the things that we were looking at there, the principles that we used as part of our work, the importance of those social determinants of health, the importance of working with government agencies, exactly the same in the UK.

It was just the context that was different. And some things actually from working internationally, I found to be stronger than the practice that I entered when I returned to the UK, which at the time public health was still in the NHS and evaluation was one. So when we applied for funding for the work that we were doing overseas to the donor agencies, usually they had a requirement that 10% of our budget was dedicated to evaluation because they wanted to know whether or not the investment that they were making was working.

And if we couldn't demonstrate that it was working, they wouldn't be giving us any more funding. I was astonished to come back to the UK to find out that that wasn't the norm at all and that evaluation was often an afterthought, that people were setting up pilot work left, right and centre and never really knowing whether or not it worked, but somehow it got continued. So that was one of the things that I've tried to be more rigorous about in terms of the UK practice, but I've brought such a huge amount.

I've benefited so much from my work overseas in terms of cultural competence, working in challenging situations, my own personal resilience. So I think it's a wonderful thing to have been able to do and I feel very privileged for the time I spent in Nepal. It sounds like a really interesting experience and a really interesting opportunity to reflect on the differences because I remember when I moved from Scotland where I'd been an SHO in public health to Yorkshire and Humber to the training programme when I first met you and being really struck by the differences in health policy because it was not that long after the evolution in Scotland and just like just even within the UK just how different things are, but also that where there are similarities as well, but really interesting observation I guess around that rigor of evaluation and then how you were able to take that insight and kind of weave it into your work going forward in terms of good practice.

So yeah, thank you for sharing that and I suppose I'm curious, you know when we first met you were very much at the end of training and doing your part two and finishing that and then applying for your first consultant post and I remember learning a lot from you at that period of time and I teach the transition to consultant course for public health senior registrars and do some interview skills training with them and I often think about your experience of that first consultant post application. So would you tell us a little bit about that experience and kind of what that was like for you please? Sure, well I think everybody gets to the end of specialty training whether in public health or any other specialty for that matter and starts to panic a little bit that we won't get into consultant jobs and I was no different, you know, I was remember being anxious at the time thinking, crikey my training is coming to an end and I need a consultant job and the public health system goes through cycles of feast and famine and at the time it was a time of famine where budgets were exceptionally difficult sounds a bit like now doesn't it but budgets were exceptionally difficult and posts were few and far between. I was put in touch with somebody by then regional director of public health who knew that there was a consultant job coming up in a particular part of Yorkshire so I went along had a chat, they seemed very keen, it sounded a good job.

I was all set up for the interview and the night before the interview I had a phone call from one of the directors of the organisation saying that they'd just had a board meeting that day, they'd realised the parlous state of the budget and they'd put an immediate freeze on all recruitment so having readied myself for an interview the next day I ended up not having one so that kind of threw me into a bit of disarray. But then I heard about another consultant job coming up in Sheffield, South East Sheffield PCT as it was at the time and long story short went along there, was interviewed for the job, was appointed to the job and it turned out I think in many ways to be the sort of making of me in terms of my senior public health career. It was a terrific job, really enjoyed it, I had a great boss at the time, it was a nice organisation to work for, working in Sheffield was really good.

The council had some forward thinking ideas, sexual health and teenage conceptions was one of the areas I was leading on. Sheffield at the time had really high teenage conception rates and to work with the council in quite creative and innovative ways around addressing that and reversing that trend, as I say was foundational I think to my kind of senior public health practice going forward. So I think anybody that is coming towards the end of training and as I did those years ago panicking a bit about whether you'll get a job, I always kind of reassure people there will be something out there that's right for you and even if you get into a post and do it for a year or two and find out it's not quite right or something better comes along, that's fine, you're then on the ladder and can progress up and get into whatever the post is that ultimately you want to end up in.

But it is a big step up from going from the training scheme to being a consultant and I think that's something that people just need to recognise and to prepare for and I always told trainees just recognise it will be a step up, make sure that you have kind of support in place. I was part of a learning set at the time which I found invaluable because the things that I was experiencing and going through turned out not to be unique to me, that everybody else making that similar transition in their first senior role were experiencing similar things and just to talk that through with your peers and with your colleagues was immensely helpful and immensely supportive. Yeah, great, thank you for sharing that experience and like you say very much that kind of feast or famine but I do really remember how the rug had really been pulled from under your feet and it was a really great learning experience for me in terms of understanding how the world worked and the realities of challenges around funding.

So yeah, thank you for sharing that and also the kind of the tips for people who are on the cusp of CCT and transitioning to consultant post. And I remember, Andrew, that you became Director of Public Health quite soon and I remember as well that you said specifically it was because you wanted to do things your way and I've reflected on that a lot over the decades and I guess I'm kind of curious about what that was, doing things your way and what it was like then being a Director of Public Health for you. Yeah, well I guess I came into public health training having been in leadership roles in Nepal, being sort of relatively senior in the organizations that I was working in and in terms of my age I was sort of getting towards my 40s as I recall at the time which now seems very young but at the time seemed quite old in career terms.

So a DPH job came up in Bradford as it happens and I'd not long since got my consultant job and come off the training scheme and it really did feel too early for me. But I spoke to the Regional Director about that and said, you know, it just looks a fantastic job. It's the sort of population I'd love to work with, the sort of ethnic mix that Bradford has, the degree of deprivation, some of the exciting things that were happening there.

So his advice was, which was good advice I think, again if your heart tells you that you feel excited about it, then, you know, go for it and the worst that will happen is you don't get the job and you'll move on to something else. So I took his advice and I applied and I didn't get the job but I got some really good feedback and the feedback that was that, you know, I had what it took to be a Director of Public Health and that kind of gave me great encouragement really and when an opportunity came up to do an interim DPH role to cover a role that somebody was vacating, I jumped at the chance and thought, well, you know, this is a chance to do it for a period of time in an interim capacity. If it doesn't work out for the employer or for me, you know, we can each walk away without any damage being done.

And for me it's a way of just getting some DPH experience so that when a substantive post comes up, I shall apply and have that experience. I did that job and absolutely loved it and loved just being able to, as you say, do things the way that I wanted to do them, to put my mark on things, to identify some priorities and see some real progress. The particular focus I remember from that first role was around tobacco control.

We had very high smoking rates and particularly high rates of smoking at the time of delivery, smoking amongst pregnant women at the time and an opportunity to turn that around, which we did, which, you know, I still feel really proud of that work. So that was great and they seemed to like what I was doing. I enjoyed working there so they advertised the job.

I applied and was appointed substantively. But again, it was a big transition from being a consultant to being a DPH. So once again, I made sure I had a mentor at the time of an established director of public health in a nearby area who was immensely helpful in supporting me through that time.

But a learning set as well with, again, another very experienced and very wise director of public health who helped me in those early days at that more senior level. Yeah, and I suppose I really hear the value of those mentors in supporting you around your career transitions. And you were very much that person for me during the course of my career.

So thank you very much for that. And I guess it's great that you had the opportunity to kind of try it on and see what it's like and kind of ease yourself into it as well. But also, I think there's something really important about applying for roles, even if you don't, even if you're not the successful candidate, because then you do know that you are appointable at that level.

And then that, like you say, does give you the confidence to kind of carry on and keep looking for other opportunities as well. So, yeah, thank you for sharing that. And I know that you're interested in personal and team resilience and well-being and also public health workforce.

We'll come on to that in a moment. But in terms of the personal and team resilience and well-being, what's interesting to you around this and what are you involved in? Is there anything you'd like to share around that, please? Yeah, I think this is just so important. And if I didn't know it before the COVID pandemic, I certainly knew about it during the COVID pandemic, which, as you will understand, was a very, very intense period of work, not only for me, but for my team as well.

I mean, even before that time, but certainly during and subsequent to the COVID pandemic, you know, I've made sure that I've looked after my personal resilience. You know, each day I try and be physically active. I, you know, make sure that I get downtime at the weekend.

I try and draw barriers around my work and don't let it, as far as possible, eat into, you know, evenings and weekends and holiday periods. I kind of make sure that I schedule holiday periods regularly through the year so that, you know, I know after, you know, two or three months I'm ready for a break. So I need to have something scheduled in the diary to make sure that I can get that downtime.

So I think, you know, as leaders, looking after yourself is just so important. And over the years, I've learned the importance of doing that and take that very, very seriously now. So looking after yourself, really important, but looking after your team as well, I feel is a key part of leadership.

When I look at the very best leaders, they appoint really good people around them and they look after them really well. And that's what I've tried to do. In terms of my own staff, I have sort of four areas that I always think about in terms of ensuring that their well-being is maximized.

And that's purpose, making sure that everybody's clear about what they're there to do and understands the importance of that purpose. It's about recognition. It's about acknowledging the successes, even if they're just small successes, taking that time to celebrate and recognize what people have done is so important.

Fulfillment. This is about people feeling that what they're doing is worthwhile and that they're progressing in their own career or they're seeing a difference for the work that they're doing. And then the final one is belonging.

And I think for me, EDI has been in the news a lot recently in terms of what's happening in the United States. But for me, it kind of boils down to belonging, that everybody, whatever their background, whatever their characteristics, should feel that they belong as part of the team. And so I take these things really seriously.

I take our staff surveys really seriously and encourage people to complete them. And we do get pretty high response rates for those surveys. And, you know, I take the results of them really, I see them as being really important and focus on those four things in terms of trying to improve the well-being and resilience of my own teams.

Great to hear that. And also, you know, very much an evidence-based, psychologically informed, you know, set of four kind of checks that you're consciously putting in place there. So, yeah, great to hear that. 

Thank you. And I guess there's something about, you know, that staff surveys can seem to be something that aren't, are kind of like corporate and not really adding value. So great to hear that, you know, that you really encourage participation and then kind of really take the results seriously too.

Because it's data, isn't it? It's a form of needs assessment. So thank you for sharing that. And your kind of wider interest and kind of national responsibilities around public health workforce, leading the Public Health Workforce Collaborative for England, I suppose I'm curious about who is the public health workforce these days? How are they, how is it changing? What emerging roles are there? And also, I suppose I'm just curious about AI and the role of AI in public health and whether we might all have an Alexa-style personal health coach in 10 years or so.

Yeah, what's happening around public health workforce? Yeah, thank you for the question. I co-chair now the Public Health Workforce Collaborative for England, which is the, as it says on the tin, the collaborative of the public health agencies in England that have an interest in this. So this is the Faculty of Public Health, Royal Society of Public Health, UK Public Health Register and so on, as well as ourselves in the Department of Health and Social Care, NHS England.

We have had a number of conversations about what is the public health workforce and it is an important question. We have a particular focus on the more specialist end of the workforce, so specialists, but then also practitioners, but there's obviously also allied health professionals, colleagues with a nursing background, other health-related professions who have a really important public health role. But then, of course, there's a wider workforce and the Royal Society of Public Health have been doing some excellent work in terms of what the potential is of that wider workforce of people who might be hairdressers, for example, who might be able to have those conversations with their clients about health issues.

But it's the more specialist end, I guess, that we focus on in terms of the public health workforce collaborative. I think it's going to be a really exciting year in terms of public health workforce because we have the 10-year plan for the NHS coming out in the summer. The government has its health mission and I know as part of that there's going to be a real focus on prevention.

So as these things come out during the year, we're going to be asking, well, what's the public health workforce requirement to deliver on these ambitions that the government has? So that's the thinking we're going to be doing during the year. And I think it's going to be quite interesting to think about public health careers in the context of that new emphasis on prevention across the system. So the NHS, as you know, is seeing the opportunities that they have, particularly around secondary prevention and the importance of public health capacity to enable them to fulfil that potential.

Local government's got a really important role in terms of the work that they do around public health, national government, UK health security agencies. So the opportunities for public health careers are going to grow, I think, over the coming years. And it's important that we have an approach to workforce that helps meet that demand.

In terms of AI, that's a really interesting area as well. So when I went to medical school in 1984 and you went to the library, there were no computers. And if you wanted to find an article, you had to go to something called Index Medicus and look up the article through the keywords or whatever and then go off and find the paper copy of the article, either photocopy it or summarise the information that you needed.

And I remember towards the end of my time there, which was sort of 1989, they got the first two computer terminals and I remember there being a queue of people trying to use these computer terminals to find the information that they need. Now, you know, we couldn't imagine doing our jobs without computers. And I think, you know, in 10, 15, 20 years' time, we will not be able to imagine practising public health without artificial intelligence.

I see it as a really transformative technology. Now, I don't know exactly what it will do. I suspect a lot of the routine work that we've been used to doing around needs assessments, for example, we will just ask Alexa or whatever the version is that we have at the time to produce a needs assessment on a particular topic and that will, you know, do the grunt work of collating the data and public health specialists will be more around the interpretation, quality assurance, putting in some of the sort of qualitative dimensions to needs assessment.

But I suspect there'll be lots of ways in which artificial intelligence does transform the practice of public health over the next 10, 15, 20 years. And I think, you know, that's for somebody starting out on a public health career now, I think that's very exciting and something that I would definitely get into. Yeah, things have really changed, haven't they? When I did my psychology intercalated degree back in 1993, I did a module on human-computer interaction and, you know, it's still the same learning from that now, but the scale of and the pace of change is kind of unimaginable, isn't it? But yeah, I guess it's really interesting, it's a provocative challenge to think about what that future could be like and, you know, how technology can be used in a transformational way.

Because public health problems, you know, they are complex, aren't they? And there are very few simple solutions in this environment and very much needing sort of a transdisciplinary response. And I think, as you may know, I'm involved in progressing work across the boundaries between public health and psychology. And I'm kind of curious, Andrew, you know, just to conclude how you think that public health will become even more transdisciplinary going forward and, you know, pharmaceutical public health, psychological public health, these are kind of emerging transdisciplinary approaches.

Do you have any kind of perspective around that that you'd like to share? Yeah, absolutely. You're absolutely right. And the thing I love about public health is that you're working alongside people from many different backgrounds, professional backgrounds.

So, you know, I think within my team now I've got somebody that's actually started out as a journalist, you know, I've got people who've got nursing backgrounds, health visitor, people who were academics, did geography, you know, all sorts of different things. And this, I think, adds value, adds interest, firstly, as being a part of a team of such people with varied backgrounds and bringing different skills to the problems that we're facing. But also it's just so important, given the complexity of public health, to have that breadth of thinking.

So I think that's only going to grow and it's interesting that the joint training that's now available so that you can get your accreditation in both general practice and public health that the Faculty of Public Health and the Royal College of GPs have put on has proved to be very, very popular. And that doesn't surprise me at all. And I suspect that that might be the beginning of more joint training between public health and different disciplines, psychiatry is another one, but you could imagine it across a number of specialties.

So that's, I think, very important and going to be very useful going forwards. Because I think having technical capability is a really important part of what we do. And we spoke in the previous question about AI and what AI will be able to do.

But I think having that technical competence across a number of disciplines, understanding how they relate to one another, how to draw value out of the other disciplines that we need to work alongside, is important now and is going to grow in importance going forwards. So I think it's a really important area. Yeah, so it's kind of not just important, but I guess what I also hear is that it kind of, it makes life interesting as well.

Like, you know, you were saying that kind of, you know, having a team with such diverse range of backgrounds is kind of exciting and stimulating, I guess, as well. So yeah, thank you, Andrew, for sharing all of your kind of wisdom and expertise and your kind of career journey with us. I'm sure, you know, everybody's going to really enjoy hearing and learning more from you around this.

So thank you ever so much for taking the time to talk with us today. You're welcome. It's been great to talk to you.

Thank you. And I look forward to seeing you again soon. If you've enjoyed this podcast and would like to find out more, head over to www.fionadayconsulting.co.uk and you'll receive three hours of free CPD, the Health Career Success Programme, when you sign up to my newsletter.

And there's loads of other resources to support you as a medical or public health leader on my website too. Thanks for listening.