Leading Questions

In this episode of Leading Questions Dame Una O’Brien, who was permanent secretary of the UK Department of Health between 2010 and 2016, joins podcast host Siobhan Benita for a chat about her unconventional route into the civil service, and what she learned along the way.

Having been appointed health department permanent secretary just as a coalition government was formed, and responsible for implementing sweeping and controversial healthcare reforms, Una was right in the thick of it – being scrutinised before a parliamentary committee no less than 28 times.

It was a “bumpy” ride, she admits, but one she was absolutely ready for – not least because a breadth of experience acquired outside the civil service in her 20s stood her in good stead for the challenges to come.

The daughter of Irish immigrants who were “firm believers in giving back”, with a love of history and having received teaching on the British Constitution, Una decided to pursue a career in either politics or the civil service.

She soon realised she wasn’t cut out for the misogynistic political environment in the UK at the time – “I wasn’t prepared to fight that fight”, she says, acknowledging that other women had “much more moral courage than I did”.

So, when viral meningitis struck leading to months in hospital, Una re-evaluated her career path, and after 10 years in politics and parliamentary and academic research, moved into the health sector and later the civil service Fast Stream, landing first in the Department of Health.

Though she went on spend time at the Cabinet Office and transport department, she always returned to health. As she describes, the experience prior to joining the civil service that had “the most profound effect on me” in the decades afterwards, was the three years she spent working to set up a hospice and care centre for people with AIDS and HIV “right in the white heat of the controversy about that disease, as it started to really hit communities in London in the late 1980s”.

She saw first-hand the people who were on the receiving end of poor care and discrimination and who felt excluded from public services – something that “gave health a centrepiece in my inner world” and spurred her on in subsequent work.

She shares the part she played in the Bristol/Kennedy Inquiry into the deaths of babies after heart surgery at the Bristol Royal Infirmary and an inquiry into poor care at a hospital in Staffordshire. The latter led her to the “deeply hurtful” realisation that her department’s responses to letters from patients’ families lacked empathy and that troubling patterns of substandard care had been missed – leading to reform of the department’s handling of letters from the public.

Having risen up the ranks – Una spent time as the health department’s director general of policy and strategy – she was appointed permanent secretary exactly 20 years to the day since she joined the civil service. She describes vividly the vision she had while waiting to go into the interview room of all the women who had supported her in the past standing behind her, willing her to succeed, and thinking “I can’t let you down”.

Also touching on her current work as a career and leadership coach, insights into working with ministers, and the skills needed in this new world of hybrid work, this is an episode packed with personal reflections from a leader whose motivations never wavered.