Putting the Mouth Back into the Body Politic | Sara Hurley

Sara Hurley, guest · [02:37]Well, let's start with how I describe myself, my lived experience. I am a person, but I'm also a patient, I'm a parent, I'm a partner. And I am a participant in life. I also happen to be a healthcare professional and a public servant. And all of those roles, every one of them has given me a deep respect for systems, for people, and for the impact that leadership has on everyday lives. But that doesn't answer your question, does it? And I think that if I look at my career and the roles, it doesn't feel like something that was carefully planned. And at the time, certainly, I know that things felt quite fragmented, and I suppose I was naturally responding to what was needed rather than following any clear pathway. I started as a clinician, and dentistry, as many people know, means that you're working with people at moments of their vulnerability, be it pain, fear, or embarrassment. And you learn really quickly that trust matters as much as technical skill. And from there, I went into the British Army, and I did that post-qualification, which added responsibility early on. I was immediately into management and then leadership under pressure. But what I did have was a very, very clear understanding that what I was doing was a practical application of service. And only in hindsight, latterly from stepping down from my national role, do I see the coherence where I have repeatedly been drawn to complexity, places where systems matter as much as individuals, and where fairness really counts. And over time, that's changed how I think about management, about leadership, because they're different, and I've recognized that it's less about career progression or status, but I have been fortunate to experience stewardship, where I've been responsible for something whilst I hold it, but I know that I was never going to hold it forever, and therefore my responsibility has been a theme of leaving things better than I found them.

Sara Hurley, guest · [09:01]So the role of the chief dental officer is to be the advocate for the patient and the advocate for value for the public purse when it's being paid for by the taxpayer. Patient first. Public next, and then an advocate for the profession in advancing really strong evidence-based care, safe care, and quality care. That means shaping policies that address inequity of access. Policies that will ensure that we are able to distribute care across communities. But increasingly, I saw my role as to bring dentistry and more importantly, oral health out of its silo and to integrate oral health into other areas of public policy. Be that, our Starting Well policy that was able to talk about doing a dental check by one for children, whether we were putting supervised toothbrushings into schools, whether we were working in care homes with, individuals of special educational needs, or at the other end of the life spectrum, supporting people with, with elderly and frail. These are areas that had been siloed. Dentistry was thought as inspect, drill, fill, repeat. My argument is that that is an outmoded, outdated, and unsatisfactory approach to oral health. And one of my Big mantras was it's time that we put the mouth back in the body. Because if you think about it, how we communicate with the world, our, our nonverbal expressions, as well as our verbal expressions, the majority of what we consume will go in through the mouth. The majority of what we drink goes in through the mouth. And if we're not looking after this oral cavity, and we don't look after that well, then there are impacts, as we know, for the rest of the body. And so by putting the mouth back into the body, and more importantly, my role as Chief Dental Officer was to put the mouth back into the body politic, to ensure that it was on a political agenda, to be the advocate, is where I started, the advocate for patients, the advocate for value. And the advocate for the profession.

Sara Hurley, guest · [27:47]And decisions in dentistry meant that whilst all of across healthcare had incomplete evidence, wherever you were, it was incomplete evidence, but you had to make decisions with the Values that you held, the evidence of doing the best. And I knew that every decision I was offering, cause obviously it's the ministers that make the decision, but they need an evidence base, they need their options, their courses of action. And you would have to give those decisions, those courses of actions with what are the second order effects? How is this going to affect people's health? How is it going to affect their livelihoods? And one of the things that I bizarrely found myself is no longer providing advice on just purely the clinical aspects, but the business aspects. And when we asked our practices to stop doing what they do really, really well, they still had staff to pay, they still had overheads. And so I was making business cases for supporting. And I remember a civil servant saying to me as I stood down in my role, Sara, You put one point four billion pounds into dentistry during COVID that kept businesses afloat, that kept staff employed, that created a seed corn for us to restart. And arguing that case was a unique. I mean, I've done budgets before, but creating those set of arguments when everything else was going on was quite hard. And, you know, as I said, guidance, guidance from Public Health England, guidance from the government, it changed almost daily. And I can remember one evening, I'm looking at a piece of evidence, and I know that I read it three days earlier, and then there was a second bit of evidence that almost put it 180 degrees the other way, and then it came back again. And I'm looking at this, and I'm knowing that whatever decision I am going to put forward as a set of proposals, it's going to upset someone. And I realize this, I think about this now that I realize that the moment then my role as a, as a clinical leader was not about certainty. It was about willing or being willing to hold uncertainty on behalf of others. I think what mattered most was my ability to say to people, look, this is what we know. This is what we don't know. This is why we're choosing this path as the preferred option. People can live with uncertainty. As I reflect back now is people struggle with opacity. So uncertainty, yes, but it was the opacity. And my job was to hold that uncertainty on behalf of others. Not always a comfortable place to be in.

Sara Hurley, guest · [33:41]there's an unspoken assumption that if you choose, if you've chosen that senior role, if you've chosen that senior role in public health or public life, you sometimes have signed up to absorbing all the weight, and you'll do that without comment. I think for many people out there, well, you know, that's the deal. You're expected to be calm. You're expected to be available 24/7. You're expected to be decisive. You're expected to be steady. And that's all regardless of what you're carrying internally. I sense in the military, the, the emotional safety was always there, the very nature of the cadre that you're working with, the nature of the team, the nature that you're, you're, you're all there on a six-month tour, you're, eating together, you're, you're, you're working together, you're, you're running around the airfield together, you all, you know, put on your body armor together when the sirens go off. You're not doing anything on your own. But COVID was, and that, that, that was an important thing. And I, I, I, I think for all of us, that ability to have a session where you could talk about the weight of holding other people's anxiety, holding other people's disappointment. And yes, I recognize for some people I was having to hold their anger and their fear, their fear of what was going to happen to their business. That weight of, of the decisions that will affect livelihoods and wellbeing, and then the expectation that you're going to show up the next day as if it hasn't taken a toll. And, and maybe that's what we don't do enough of. You know, we rarely acknowledge leaders in any part of the system have somewhere to put that weight. So COVID created an area, a team, a group of people, and, and, you know, hopefully I managed to continue that thought process. Because when you, when you're working in a complex system, like the NHS or in government, if you, if you share, if you share uncertainty upwards, you know, you might appear weak. You certainly can't share it downwards without destabilizing a system. So you, you get used to carrying it quietly. And you probably can do that when there's a nice little steady hum. But in a crisis, You need to find yourself a place where you don't have to perform, a space where, you can be reassured that you can say out loud, I'm, I'm, I'm not sure. Oh, surely that's simply being human. And, and to be human without consequence, without judgment, and to do that with your peers, that was really special. And I think all the individuals that, that were in that little group, we all share the scars of COVID, but we share them proudly.

Sara Hurley, guest · [40:46]So we are societal animals, despite what you might be seeing or feeling. And in that society, when public service erodes, the people who suffer first are those with the least power to protect themselves. I come back to my protect and serve phrase earlier on. Yes, the institutions we have are imperfect, often frustratingly so, but they do remain the mechanism through which societies express collective responsibility. I am a product of collective responsibility, was, had a great schooling. funded by the state, went to university funded by the state, career development funded by the state, a job funded by the state. That public service set of institutions have been amazing to me, and they gave me social mobility. My, my parents are proud of what I've done, and hopefully I have then created some social mobility for others. Society advances. So with health, education, justice, social care, none of those are going to function without people who are prepared, willing, willing to carry responsibility on behalf of others. And for me, when experienced leaders opt out entirely, we lose institutional memory. The ethical ballast of our communities and the ability to learn from the past mistakes goes. So public service systems are vital. They need to be more agile because they are feeling quite brittle at the moment. I understand why people back out. Burnout absolutely is real, and I agree with you mistrust is real, but public service, it matters because it's one of the few places where fairness can be designed into a system at scale. That doesn't happen in industry. That doesn't happen in a profit-making shareholder dividend organization. So public service matters because fairness can be designed into systems at scale, and that is why we need people opting in, not opting out. Thoughtful, sustainable contribution is how systems change, and a public service system Operating at scale, creating fairness, creates dividends, not just for today, not just for tomorrow, but for generations. And that's what makes me get up in the morning.

Sara Hurley, guest · [45:51]First, don't confuse confidence with certainty. Sara, don't assume you've got everything worked out early. Allow your curiosity to take you further, and it will certainly take you further than certainty ever will. So that's confidence, certainty, and curiosity. Make sure you get them in the right order. Second, and I probably did heed this unconsciously, going back to our very first question, as I, as I look back, Sara, pay attention to what unsettles you. The things that irritate or trouble you are often clues to where your contribution will lie. So don't smooth things away too quickly. And that I think has been one of my key drivers in terms of addressing the, the inequity. Many friends will probably say this is a lesson that has, I have learned, but it's taken me a long time to learn it. And it's to use your voice sooner. You don't have to wait until you feel ready or perfectly qualified. Leadership in the roles I experienced didn't begin because someone gave me permission. It began when I took responsibility. I, I sense that, you know, Sarah stepping off on an expected path, I would say to her, Don't even worry about an expected path. You'll find the work that actually matters to you if you listen to the things that unsettle you. You're prepared to take responsibility. And instead of just responding in empathy, which takes a lot of energy, use compassion and create action. And that would be the, the sort of the, the key things. I would hope that I have learned those over the years and have applied them. But at the age of 18, 19, going into Bristol University, I think the advice my 18-year-old would have asked for was, tell me about sun protection because I want my complexion to last longer. And I think I moved from an individual that wanted to protect and serve her skin to protect and serve others.