“I want to create teams and environments where people are judged on their abilities and their talents”
Professor Sir Aziz Sheikh OBE is Nuffield Professor of Primary Care Health Sciences and Head of the Nuffield Department of Primary Care Health Sciences at the University of Oxford. He is Professorial Fellow at Harris Manchester College, University of Oxford and Honorary Consultant with the UK Health Security Agency and Public Health Scotland.
Aziz was previously Chair of Primary Care Research and Development, Director of the Usher Institute and Dean of Data at the University of Edinburgh. He has played important advisory roles to a number of governments, inter-governmental bodies, including the World Bank, World Health Organization and the World Innovation Summit for Health, and leading scientific bodies including the Academy of Medical Sciences and the Royal Society.
Aziz has worked for over 20 years on digitising health systems, securely linking health and cross-sectoral data and then using these data to inform and influence health policy, improve the safety and quality of care, and develop personalised risk assessments. He is a fellow of 10 learned societies and he has been awarded numerous UK and international awards for his work.
Aziz was made an Officer of the Order of the British Empire for ‘Services to Medicine and Health Care’ in 2014 and a Knight Bachelor in 2022 for ‘Services to COVID-19 Research and Policy’.
Chris Salisbury is Emeritus Professor of Primary Health Care at the University of Bristol. He describes himself as having had three overlapping careers: as a full time GP for more than 10 years, then as an academic doing research and teaching alongside general practice, and finally as a leader and manager. His academic work has focused on how to ‘do family practice better’
“… if you can draw on a range of talents and equally, have key people in those decision-making circles, people who will challenge coming from different worlds, you will probably make better decisions.”
Hello, I’m Chris Salisbury and today I’m talking to Aziz Sheikh, who was appointed last year as professor and head of department at the Nuffield Department of Primary Healthcare Sciences at the University of Oxford. Welcome Aziz
Aziz Sheikh: Thanks, Chris. Great to be with you.
CS: We’ll discuss various aspects of your academic life shortly, but I wonder if we could start by talking a bit about your background and how you came to study medicine.
AZ: I grew up in the East End of London. I was born in Karachi, Pakistan, but we moved to London when I was one. And I guess, as with many Asian families, the expectation was that the eldest child would read medicine. The honest answer is that I was duly obedient and that’s what I did.
CS: I watched the video of your inaugural lecture and I have to say I found it really quite moving when you talk about your experience growing up and your experience of racism and exclusion. How do you think that influenced your career and the way your career has gone?
AS: It probably has influenced me in a number of ways but I think the most important lesson I take from that, and all those experiences, is I want to create teams and environments where people are judged on their abilities and their talents. And also, recognizing that we’re all kind of starting from different places, there may well be the need to create additional opportunities. I think the way I process those experiences is that I want to be really sure that I’m not propagating those kinds of experiences where people are being marginalized, and by creating inclusive environments where people are treated with respect and supported when they need to be. I guess this is complicated. It’s always work in progress. There are so many dimensions but that’s certainly the intent with the kind of work I try and do.
CS: Do you think it’s influenced any of your research themes?
AS: Absolutely. Certainly initially, there’s been a lot of work around inequalities. Many of us care about that passionately but I think there are additional dimensions that, because of my kind of experiences, my background, I’ve been able to bring to the mix. So, for example, ethnic or racial disparities are quite well known but there’s probably less work happening in terms of thinking about the interface between religion and health. That’s some of the early work that I’ve done.
I think what it also does give you, is a very good appreciation of the way marginalization or discrimination operates through an intersectional lens. I have no definitive direct understanding of what it means to be marginalized on the basis of gender or disability. But there is that kind of innate connection there. There are kind of parallels. There are variations, absolutely, but I think the core is trying to create more inclusive environments, and research that can foster that. Ultimately, what we’re trying to do is to deliver equitable health care across the NHS and beyond. And that’s been a pervasive theme in my work.
“There was very little awareness of allergy. It wasn’t part of our undergraduate curriculum and actually wasn’t part of the curriculum in any way really, in the UK. It was one of the Cinderella specialties, because it transcends organ systems.”
CS: Your work has covered an enormous number of themes and, in retrospect, we can trace the story. Your work, for example, on patient safety and then you had to link data sets, and that grew into some of your big data work. At least that’s how it seems to me from the outside.
But you’ve written books about caring for people from different religious backgrounds. You’ve got a big reputation in allergy and asthma and respiratory disease. I hadn’t realized how much you’ve done on tele-monitoring and tele-care for people with long term conditions. And then more recently, with your work on Covid. If you had to characterize your career, how would you describe what you’ve done?
AS: It’s not particularly linear. Like most of us in general practice or academic primary care, we’ve got lots of interests. And I think that’s reflected in my career. Initially it was around these existentialist kind of questions. I think, from childhood, I was always drawn towards the academic side of things. I was very fortunate to land one of the one year London Academic Training Scheme Fellowships at Imperial College. That was a brilliant taster and I thoroughly enjoyed the experience. I remember George Freeman interviewing me for the post at St George’s. We’ve recently reconnected and I look forward to meeting up with him. To me, that confirmed that this was something that I was interested in. But there wasn’t a follow-on opportunity, so I applied to the BMJ as an editorial registrar and the task they set, prior to the interview, was to draft an editorial on patient safety, which I did. Imperial subsequently did extend my post, so I withdrew the BMJ application. But that was, for me, completely eye opening. We’ve all made medical errors in our lives but that was the first time I’d ever seen an open discussion with a view to promoting learning. Even though I pulled out of the BMJ experience I got very interested in that piece of work.
It was the start of the patient safety movement which largely originated in the US. The Harvard malpractice study centred on hospitals so I thought there were dimensions in Primary Care particularly in the UK where there was much more volume of work. I was able to engage with all the leaders and eventually ended up working very closely with Sir Liam Donaldson who has been the WHO envoy for patient safety, and I continue to work with Liam.
My work in allergy and respiratory, again, wasn’t particularly planned. Sangeeta and I had our first child who turned out to have anaphylaxis triggered by milk and egg allergy. We didn’t have a clue how to manage it, despite the fact that we were both GPs. There was very little awareness of allergy. It wasn’t part of our undergraduate curriculum and actually wasn’t part of the curriculum in any way really, in the UK. It was one of the Cinderella specialties, because it transcends organ systems. So that led to work with the Royal College of Physicians, with the House of Lords, various select committees to try and develop capacity, because the experiences that we had were being replicated all across the UK and perhaps beyond. So that was an important strand of work.
I did a Master’s degree in epidemiology at the London School of Hygiene and Tropical Medicine, which I loved. It was fantastic experience, but I was hearing anecdotally from patient groups that anaphylaxis was increasing in incidence. But, if you’ve got a condition which affects, perhaps one in around 1000 of the population, you can’t do your standard epidemiology using questionnaires of the kind that we’re doing at the time. So, I thought there may be opportunity to look into this using some of the large data sets that were beginning to become available. We did some time-trend analysis using hospital episode statistics, looking at the incidence of anaphylaxis presenting to hospitals, showing a very clear time trend. And the lesson that I took from that was that these systems become incredibly powerful with all the data available.
The last bit of the narrative in summary is that I moved to Scotland, into John Howie’s department, recruited by John Savill and David Weller. The tender came out to lead the evaluation for the national program for IT, or the headline deliverable of the NHS Care Record Service. I was very fortunate to win that tender with a UK wide team. So we did an ‘of the moment’ piece of policy relevant work. It was quite a hot potato to handle at the time, but it was part of this journey to the digitization of health systems. The UK was quite different from the US because the US began in hospitals and we began in primary care. The focus of Tony Blair’s modernization strategy was to digitize hospitals, so I got involved in the health IT health policy side of things. Eventually I decided I was involved in so many policy related deliberations that I needed to study health policy. And so I did a Harkness Health Policy fellowship, and I did that under the mentorship of David Bates, a fantastic primary care academic based at Brigham and Women’s Hospital, Harvard, who was probably the world’s leading authority in health IT. I knew that IT was going to be important to support systems or the decision support systems that we now take for granted. But the most valuable bit of this was going to be the data coming out the back end. None of it is particularly planned, none of it particularly linear, but it’s been a lot of fun along the way, and I’ve worked with some brilliant colleagues.
“…once you link up non-core health care data assets, for example, educational data, pollution, meteorological data, welfare data, taxation data, etc. is that the range of questions that you can begin to answer are only limited by your imagination.”
CS: If we look at this in ten years’ time, which of them do you think will have the biggest impact, and what do you think you’ll be most associated with?
AS: I think the health data science work because my vision for this, particularly once you link up non-core health care data assets, for example, educational data, pollution, meteorological data, welfare data, taxation data, etc. is that the range of questions that you can begin to answer are only limited by your imagination. But I think the way we need to be thinking about this is for these data to be deployed to support informed policy making and to evaluate policy because policy, at the end of the day, is a bit of a punt. It needs iteration, it needs evaluation. There are macro level questions which, at the moment, nobody’s really looking at, or we’re looking retrospectively many years down the course. In terms of organizational efficiency, safety, quality, that work is progressing. We’re doing that in primary care and it’s happening in hospitals. But I think there is also a massive change coming down the track as we’re moving into this era of the Internet of Things. We’re generating data, a digital footprint, all the time. How can we begin to use those data, particularly to support, in real time, people living with long term conditions?
This involves work aligning with people’s lives, with people’s workflows. It’s not just a simple panacea, it’s not a plug and play. I think there’s a lot of work, but I think we can move to a next generation health system that is supported by data at macro, meso and a micro level.
CS: You’ve gone for these different fields for a variety of reasons, sometimes for personal reasons, like your child having an allergy, sometimes from your personal interest, and sometimes because of opportunities because of where you were at a particular time.
If you had a young academic in training now that you are supervising, would you encourage them to follow their curiosity in lots of different directions or would you say, find a niche and stick to one furrow and become a real expert?
AS: I do have the privilege of supervising many fantastic bright young colleagues from across the world, and some not so young, which is a lot of fun. I thoroughly enjoy it. I guess the kind of model that’s traditional in UK healthcare, and in many other health systems, is a T-shaped model where you generate depth in a really focused area and then you diversify as appropriate. That mastery may take 10, 15, 20 years before you diversify. That approach may suit a lot of people. It’s clearly not what I’ve done. I think the other approach is that you really work out what your value set is, what is it that you enjoy doing, what piques your curiosity. And then find some outstanding mentors to help you along that journey. Maybe 20 years ago, I would have thought my career would be very linear. It’s been anything but that. But it’s been a lot of fun along the way. The most important thing is that I’ve been able to work with absolutely fabulous colleagues. Not all of it is going to have an impact on people. I hope at least some of it does.
CS: It is interesting. We often give people advice to find an area of expertise and stay within your lane. A lot of very successful people actually don’t do that. They follow the things that really matter to them, that they’re interested in, and often that goes in different directions.
And also the breadth of your publications. What’s really notable is just the volume. You’ve been an author of several books, 1100 papers and, in the last five years, you’ve been author on over 400 papers, which works out at about one every four and a half days. At the same time, you were leading the Usher Institute in Edinburgh, you are editor in chief of a journal, you’re director of the Asthma UK centre, you’re leading the EAVE II surveillance platform, you’re advising government. These are just some of the things that I know about. How on earth do you do it?
AS: If you enjoy it, it’s not really work anymore. Also, having large networks of collaborators and, for those to be meaningful, it has to be reciprocal, reciprocally beneficial. I work with brilliant colleagues all over the world, and that helps. And then it’s finding the synergies. In my head I can find those relatively easily, but I don’t think they always make sense to the external world, or even to my wife. But I can find those intersections. Maybe it’s just the way I’m configured. Yes, it’s busy, but fun as well.
“…that responsibility is not to disrupt, but rather to kind of support and develop capacity across the UK. If we were just to suck in the talent from across the UK, and in the process help implode other department, that would be the wrong answer as far as I’m concerned.”
CS: Some people get a lot done by not focusing on detail, is that you?
AS: That’s definitely not me. I definitely like the big picture stuff. But, as anybody who’s worked with me, where I’m correcting grammar and I’ve got my bugbears around abbreviations and all that kind of stuff. So, I’m a detail person as well.
CS: What would your advice be to all those academics who have a paper that they’ve been meaning to get around to finish writing that has sat on their desk for months. Meanwhile you’ve written about 15 in the same time scale.
AS: I don’t think this is really about volume. This is really not a volume game. It’s a quality pursuit. And fundamentally it’s trying to work out, is the work that we are doing (and there will be different answers for different papers), is this confirmatory or is it incremental, in which case then, getting a paper that is good enough and putting it into a non-competitive journal makes a lot of sense. Because you could go around the houses and spend a lot of time trying to get it published. You have to work out which of the publications that you’re involved with are actually likely to be transformative and those will typically involve 10 or 15 different iterations before you put them to one of the bigger journals. It’s in part working out what kind of a contribution are they. They’ve all got value but where do you particularly invest your time and effort.
CS: Last year, you became head of the Department of Primary Health Care Sciences in Oxford, which is almost certainly the leading centre for academic primary care in the world, with over 600 staff. That’s an enormous responsibility; how does it make you feel?
AS: I think it’s an incredible privilege, in so many ways. It’s a fantastic department and I’m very grateful to those who have built it up. There are the leaders, Godfrey Fowler, David Mant, Richard Hobbs. I think they’ve done a phenomenal job. They haven’t done it themselves as they have a whole leadership structure underneath. That said, I’ve come from leading a department in Edinburgh, which was ahead of Oxford out of the blocks in terms of developing academic public health and primary care capacity, with a similar size, and similar kind of footprint. So at one level, it is a sideways move. But Oxford has got far more convening power. So it is a privilege to work with a fantastic leadership team. I’ve just appointed four deputy heads of departments as I believe in a distributed leadership model. We’ve got a fantastic team of leaders there in Chris Butler, Chris Griffiths, Cathy Pope, and Sophie Park as deputy heads, and brilliant administrative or professional services colleagues. So this is a team play but what I’m very keen to do is to use the convening power or the critical mass of this department to strengthen primary care across the UK and globally. We’ve got some brilliant departments in the UK; we’ve got other fledgling departments. We had a piece recently in the BJGP on this, discussed with the medical schools council. And globally, in many parts of the world this is just beginning. I’ve just come back from Pakistan, for example, where academic primary care is just taking its first initial steps. So this department is in a privileged position but with this comes responsibility. And that responsibility is not to disrupt, but rather to kind of support and develop capacity across the UK. If we were just to suck in the talent from across the UK, and in the process help implode other department, that would be the wrong answer as far as I’m concerned. And certainly as I move from the Usher Institute, I’ve tried to leave that intact because it’s a brilliant place. Cathy Sudlow, who has come into position, will hopefully make it even better. We need strong applied translational departments and many more of those across the UK and globally.
“There are always people who are doing absolutely brilliant jobs that I aspire to emulate, whether chairing a meeting or public speaking, or the quality of the research that they do, or the way they look after their juniors and their mentees. There’s always a lot to learn.”
CS: Alongside your stellar career, you were awarded an OBE in 2014 and then a Knighthood in 2022. And you talked in your inaugural lecture about how your parents, though they were graduates, worked in factories and in a market stall, and that you helped with the market stall. They really prioritized education. How must they feel now seeing you being head of department in Oxford? They must be incredibly proud of you.
AS: Yes, and I think they are very proud. And I think some of what I do they don’t really quite get anymore. And, part of the reason I’ve come to Oxford, and I’ve been very open about this in various contexts, was that both my wife and I had elderly parents in and around London, who needed so much more input. It was very difficult doing that in Edinburgh. Sadly, my father-in-law died four months ago, and my own dad died three weeks ago, but we were able to be there a lot more because we were in closer geographical proximity. So, it was the right move for those reasons as well.
CS: So what are you interested in outside medicine?
AS: Family matters a lot to me. The faith dimension matters a lot to me. I do enjoy playing sports, particularly racket sports; tennis, badminton, squash. I enjoy watching cricket, although supporting Pakistan is one heck of a heartache! I enjoy watching football as well. I would love to find a bit more time to play sport. I enjoy sport and I think it has a lot of parallels with elite academia.
CS: It’s been really interesting talking to you now and watching your inaugural lecture. You come across to me as someone who is very modest, despite all the things you’ve done. You’ve talked about family, you’ve talked about the importance of values. And, you have also described yourself as an introvert. These are not characteristics that we usually associate with very high-profile leaders. Do you think this has affected how you lead?
AS: To my mind, we as individuals and as teams or departments, are always a work in progress. There are always people who are doing absolutely brilliant jobs that I aspire to emulate, whether chairing a meeting or public speaking, or the quality of the research that they do, or the way they look after their juniors and their mentees. There’s always a lot to learn. I just inherently believe in the team-based approach and if you can draw on a range of talents and equally, have key people in those decision-making circles, people who will challenge coming from different worlds, you will probably make better decisions. You get so much further together. Has it affected the way I kind of do things? I prefer not to be the centre of attention. I’d much rather that we celebrate the talent that is coming through, and we are phenomenally blessed with the talent that is coming through across our institutions. The more time we can give them, and help them establish the careers, the better as far as I’m concerned. That’s what we try and do. Maybe we could do better. But that certainly is the hope.
CS: Those are really great lessons. Aziz – you’re starting a new and exciting chapter in Oxford, and we look forward to seeing what goes on there. Thank you so much.
