An opportunity for renewal
Clinical Director describes working through the pandemic and what the future might hold
feel both hopeful and nervous,” said Professor Jason Leitch, Scotland’s National Clinical Director and, arguably, the public face of Scotland’s efforts to combat COVID-19.
While First Minister Nicola Surgeon is preeminent – the one, along with her fellow ministers, making policy – Professor Leitch has been, from the early days of lockdown, the person that the Scottish public regard as the voice of authority. Their guiding voice in briefings, on televised public health announcements, and during live question and answer sessions with viewers.
He has gone from 12,000 followers on Twitter before the pandemic – “a relatively tight group of global [public health] safety and quality people who all knew each other” – to more than 62,000 today. His profile increased significantly after the resignation of Scotland’s Chief Medical Officer, Dr Catherine Calderwood (for flouting government advice on staying home).
There is nothing good about a pandemic, but the past months have taught us that it is imperative that some priorities will have to change
The dental profession had its own moment with this key figure, midway through last month, when Clive Schmulian interviewed him live for the last in the Lockdown 2020 webinar series (see News, p13). Discussion ranged over his responsibility for the quality and safety of the healthcare system, to when dentists might return to practice, funding for dentistry, and how he switches off (three meals a day, eight hours sleep and a run “very slowly” in a circle around his house).
Then, on 29 May – the day after Sturgeon had outlined the nation’s ‘route map’ out of COVID-19 restrictions – came an opportunity for reflection. “Hopeful,” he explained to Scottish Dental magazine, “because it’s the first day of the lockdown release and it’s a wonderful thing to be able to tell people that they can meet one other household outdoors. With physical distancing of course.
“But I’m also nervous, because there are still 800 people in hospital and 40 in intensive care with coronavirus and I worry about the future of this viral pandemic.”
Like most weeks since lockdown began, it had been a busy, emotionally charged time. “[It] has been intense, purposeful, varied and full of uplifting stories of service and courage. I spoke to the leaders of Scotland’s main sporting bodies and to the leaders of some of our island communities. I had a number of media appearances including taking questions live on television and radio. And I have also spent some time with senior politicians discussing the pandemic.”
Leitch qualified as a dentist in 1991 and was a consultant oral surgeon in Glasgow before becoming a Quality Improvement Fellow at the Institute for Healthcare Improvement in Boston and, in 2007, joining the Scottish Government. “I had the unique experience of over a year in the US, where I was formally educated in public health and learned about system change and improvement at the Institute,” he recalled.
“I then had an opportunity to join the Scottish Government part-time, to focus on one of the biggest challenges of our time; the safety of patients in the healthcare system. That seemed like too good an opportunity to miss; to have an influence on a national level on such an important problem.” He was appointed Clinical Director in 2012.
From his days in Glasgow as an oral surgeon, he misses the connections, “the patient and families and the surgical teams”. During the early days working in government, he also missed the ability to “fix a problem quickly.” The pace with which results are achieved now has, necessarily, changed: “Pre-pandemic work felt very distant from instant results, whilst during the pandemic some of what we do has had faster results.”
As National Clinical Director, he is partly responsible for quality in the health and social care system in Scotland, including patient safety and person-centred care, NHS planning, and implementing quality improvement methods across the Government and the broader public sector. Tom Ferris, the country’s Chief Dental Officer, is the policy lead for oral health and the leader of the profession in Scotland.
“I try to support him in any way I can in advocating for oral health and the quality and safety of dentistry,” said Leitch. Did his time in Boston prepare him for the current crisis? “[It] gave me a much deeper knowledge of epidemiology, statistics, and public health. Informally, it taught me a great deal about leadership, systems improvement and surrounding yourself with high performing team players.” What about dealing with social media trolls and Piers Morgan? “I am, of course, very happy to be questioned and held accountable, but I expect this to be done in a spirit of kind enquiry,” he said. “The direct name-calling that I receive genuinely doesn’t trouble me. The comments that get under my skin are the ones that question my motives and my integrity.”
With practices closed since 23 March, the burden of maintaining the oral health of the population has fallen to the Urgent Dental Care Centres (UDCCs) that were established in response. Initial figures suggest varying results (see News, p12).
“Those figures quoted were for the very early days of operation of the UDCCs and no longer reflect activity in [health board areas],” he said. “The CDO and his team are in regular contact with boards to discuss issues which can affect the UDCCs.
“As the Government moves forward with its plans to remobilise dentistry, increasing amounts of urgent dental care activity will return to the practice setting and the UDCCs will primarily be focused on delivering treatments that require aerosol generating procedures (AGPs). The UDCCs have generally been effective at meeting the needs of the population who were in need of urgent care.
“However, we recognise that there are patients who don’t meet the criteria for urgent care but who have a genuine concern with their oral care that needs to be addressed and this is where we are moving towards within the remobilisation plan in phase two.”
As practices reopen, an immediate concern is the supply of personal protective equipment (PPE).
“We are working closely with the NHS Scotland procurement teams to ensure a robust and sustainable supply of PPE is made available to NHS dental practices in the recovery phase. The CDO and his team are in regular contact with NHS NSS regarding the PPE supply chain and its sustainability and will take this into account in their planning.”
Leitch has been working with colleagues to develop the overarching strategy towards remobilising health services “and dentistry is a key part of this plan,” he said. “Tom Ferris ensures that NHS dentistry has a high profile within these plans as they are taken forward.”
He added: “I hope the financial support measures put in place by the Scottish Government for NHS practices will mean that they are in a good place to prepare to return to delivering care for their patients. The impact of COVID-19 will mean that many health services will operate differently in the ‘new normal’ and dentistry is likely to be in a similar position.”
Did he think that there will be the same number of dental practices operating in Scotland next year as there was last year? “The Government has taken the action that it has taken towards financially supporting NHS dental practices and dental practitioners with the intention of maintaining NHS dental service capacity in the long term,” he said.
In his interview with Clive Schmulian, Leitch was asked about the long-term funding model for dentistry. “I think this present position, however long it lasts for us, is an opportunity – once we can lift our heads – to think about how we want the health and social care system to be designed,” he said.
“And I think that goes all the way from who owns the social care homes and how we pay for staff in those homes … all the way through to how we manage primary care teams and to dentistry, optometry and other parts of traditional high street healthcare. I think that is an opportunity for renewal, if that’s not too hyperbolic, about what that might look like.
“I think for a while coronavirus is going to slow us down in dentistry – no question – because you’re just literally not going to be able to go as fast as you have previously. So, something is going to have to give in that process. Is that about payments? Is that about design?
Is it about teams? It’s about all of these things.”
In the last edition of Scottish Dental, we explored the work that was under way on a ‘new model of care’ for adult NHS patients. Did Leitch think that the pandemic had strengthened the need for reform? “I think it is fair to say that the excellent work undertaken by the CDO and his team in relation to the new model of care will not be lost as the Government moves through with the remobilisation of the NHS dental services and into a longer-term steady state.
“For example, the move towards preventive care identified within the new model of care seeks to reduce the need overall for restorative dental interventions, which will reduce the need for AGPs in the longer term.
“The funding arrangements for NHS dental services going forward will be clearly linked towards the delivery of the new model of care and planning for this will be taken forward with care and engagement with stakeholders, including the public. It is also vital to continue the progress we have made in the improvement of the oral health of the younger population and maintain these improvements into the adult population. Dental practices will be key to this improvement.”
As the profession looks, apprehensively, to the future does he also think about what he might be doing? “In an ideal world, I would like to be involved in the redesign of health and social care across Scotland,” he said. “There is nothing good about a pandemic, but the past months have taught us that it is imperative that some priorities will have to change. It would be great to be involved in how that shift in priorities looks for the people of Scotland. And perhaps have some input globally, addressing a renewed focus on the quality and person-centred nature of health and social care delivery.”