Smash hit

Doing things differently can, however, throw up new problems. Since the advent of the European Working Time Directive, for instance, there are fewer exhausted, error-prone junior housemen staggering through hospital corridors but the danger is that they reach the end of their training less experienced than previous generations. And what of nurses, I ask? Hasn’t their quality fallen because capable young women prefer to go to university than be bullied by Hattie Jaques? He says he has not found that. “Most people who go in for the caring professions — whether doctors or nurses — are people-orientated and get rewards from helping others. I know it seems corny, but these are the things that motivate them.”

Even the economic migrants who largely fill the NHS’s ancillary jobs? “I don’t know. That’s not something I’ve studied. Some people think that generational attitudes are shifting. The so-called Generation X, as compared to the baby-boom generation, is much more interested in work-life balance than going the extra mile. But in health care, although people maybe don’t want to spend all their time working, their core motivation is still one of compassion.”

It was clearly Sir Liam’s too. With a little surgery, I extract the information that although he was born in Middlesbrough he left the city at nine months and spent most of his childhood in Rotherham in South Yorkshire. His father was the town hall’s medical officer of health. Slightly bizarrely, therefore, Liam would take to his mother letters from school signed by her husband informing her it was inoculation time again.

“I hated that, but it was very formative. I went to grammar school and I was one of only three children of professional backgrounds in the class. The rest were sons of steel workers or miners. And that was very, very formative for me. I felt that I had both understood and also had great insight into the lives of people working in those sorts of occupations, with those sorts of family backgrounds, very much less privileged than my own.”

Their fathers would retire from the mines and steel mills and die young? “They did. In the school holidays I did a couple of stints at Steel, Peach and Tozer and it was very, very hard work, in incredible heat.”

But now that everyone works in call centres, Rotherham should be getting healthier? “Well, the country is getting much healthier. But the gap between the best off and the least well off hasn’t changed a great deal. And that’s what I would like to change.”

He trained as am surgeon in Birmingham but he decided that accepting a post at Leicester University might be the better way, long term, to narrow the health gap. “I always was interested in what made people ill. It was the detective stories in epidemiology and medicine that inspired me. I’d read the Doll-Hill [1954] discovery of the link between lung cancer and smoking and then heart disease and smoking, and it fascinated me.”

He emerged from academia to take regional public health and management posts, ending up with responsibility for seven million people in the North East. It was the time of the Cleveland Child Abuse crisis, but also the period when waiting lists began to lengthen, paint peeled from hospital walls and the NHS ceased to be a source of national pride and became a political football.

“Over time, I think the infrastructure of the NHS was not invested in and ran down. Nobody did it deliberately. I think it was due to a very simple flaw in the way the NHS is run, which is that it never seriously invested in high-quality information. It’s one thing to try and do things more efficiently, get better value for money if you can see the outcome, but not when you’re just saving money and you’ve got no measure of whether things are working well.

“When I was a doctor in training and I went on the ward at night there’d be two or three nurses looking after 30 patients. But at times in the Seventies and Eighties, you would see one inexperienced nurse covering that whole ward. To make the money go further, people had cut back on the infrastructure and reassured themselves that it wasn’t affecting the quality of care. And it was.”

Yet the money is there now and doesn’t Britain still lag behind most other developed nations in the outcomes for all major diseases except the blood cancers? “Well, we are getting a lot better and closing the gap on things such as cancer survival and a lot of that has been due to the improvements in infrastructure.”

Are things better than 30 years ago when he started out? “I do feel it’s better. I think the staffing, the equipment, the infrastructure, but also the attitudes. There still isn’t as much customer focus as I would like to see, but there’s a lot more than there would have been even five years ago. Attitudes are changing.”

And are ours over what we eat? “The thing is that most of the health advice is taken up pretty readily by professional people but for people living in disadvantaged circles it’s much more difficult for them to follow those healthy options. A single mother without access to a shop with fresh fruit and veg or where her child’s got nowhere to go out and play, no green space, it’s much more difficult.”

I hope to catch him out over his own diet but he insists that he breakfasts on wholemeal bread and fruit, brings in a home-made sandwich for lunch and, although he often attends official dinners, observes the fiveportions-of-fruit-and-veg-a-day rule. As for vitamin and mineral supplements, the target of some bellicose EU edicts last week, he doesn’t bother with them.

So what, I ask, about these long days and weeks? Has he got his work-life balance right? “Probably not. I love work so much it is probably a bit of an addiction.”

One that will kill him? “I hope not,” he says. So do I. Even after six and a half years of kindly-meant nagging, Sir Liam’s work watching over us has hardly begun.