A health 'hack' who wants to put something back

February 20, 2004

Former BBC editor Niall Dickson was seen as a surprising choice to lead a health research think-tank. Terry Philpot looks at what he has to offer the King's Fund.

I hope you'll be kind. I've only been here four weeks," says Niall Dickson, in the middle of answering a question about his new post as chief executive of the King's Fund. He sounds cautious, but there is nothing tentative about the former BBC social affairs editor's idea of where the establishment's favourite think-tank-cum-health-policy research unit is going.

Dickson was seen as a bit of a surprising choice to head the fund. The Guardian , for example, wondered what a "hack" was going to bring to so august an institution. Those who are or have been associated with the fund, founded in 1897, tend to regard the appointment as at worst "interesting" and at best "something different". But Dickson does know what he is talking about on health and social affairs. He spent 18 years reporting on social affairs at the BBC, has been editor of Nursing Times and Therapy Weekly and has worked in voluntary organisations. Moreover, his immediate predecessor, Julia Neuberger, was on her appointment better known for being a north London rabbi and media pundit than for her knowledge of health or even of management.

Dickson will have to deal with the legacy of her reign, which includes controversy over staff cuts and reorganisation - according to one former staff member she left "a lot of blood on the floor". But some argue that the fund had become too disparate an empire and needed to be made more of a coherent whole.

And far from criticising Neuberger's streamlining approach, Dickson says there is a need for more integration of what he calls the fund's "businesses". "We need to (create) a coherent body of work so that the wider world knows what we do and how we do it," he says.

Neuberger also stands accused of sacrificing the fund's wide-ranging work across social care and health imperatives to focus on mainstream National Health Service issues. The fund's work on learning difficulties disappeared under her stewardship. On the other hand, its work on public health has increased, and it has undertaken a major inquiry into mental health.

Not surprisingly, Dickson doesn't believe that the fund has narrowed its focus. He suggests that its current management review might lead it into childcare, a field with which it has not been previously concerned. He also points out that health and social care are now so linked as to be inextricable, something the BBC acknowledged by placing him in charge of both health and social care stories.

But why jump ship from a top-flight career in the media, which has seen his analyses of the main social affairs stories broadcast into the nation's homes on an almost nightly basis? Dickson says it wasn't that he was bored of his old job, even if he did see things coming around again and again, but he wondered if it was time to move on. Mainly, like many journalists who have spent years reporting and commenting, he wanted to see if he could make something happen. Having managed 80 staff at the BBC and been a magazine editor, he also fancied managing a whole organisation, rather than a part of one.

Besides the gibes about his not having a health background, Dickson has also faced criticism that he is not sufficiently academic to lead an organisation that - despite Neuberger's pruning and the fact that other agencies and academic centres such as Leeds University's Nuffield Centre have impinged on its territory over the years - is still one of the most well resourced, high profile and wide-ranging social research bodies in the country.

While acknowledging that producing high-quality academic work is one of the fund's objectives, he says that he doesn't feel that his relative lack of academic qualifications is a disadvantage. "No one can have all the knowledge and skills demanded of somewhere like the King's Fund," he says.

"I've been involved with healthcare policy at the BBC and have a knowledge of research, as well as an understanding the topography of the subject so I'm quite able to have discussions with academics and researchers."

Many of the fund's partners are academic institutions. For example, it collaborates with King's College London to offer an MSc in health services management. Dickson is enthusiastic about this kind of "cross-fertilisation" and maintaining and expanding the fund's traditional focus on health management. But he is keen to reach out to frontline staff - nurses and social workers among them - with whom the fund has not previously been in touch. This is not just for teaching purposes. He sees the elegant and high-tech central London offices that house the fund's 105 staff as being a meeting place for the exchange of information and ideas. "A place of learning," Dickson calls it.

The library receives 5,000 visitors and 8,000 inquiries a year, and the fund is landlord to related organisations. Moreover, it also hosts one of the 19 specialist libraries of the National Electronic Library for Health in collaboration with Sheffield University's School of Health and Related Research.

Dickson is keen to emphasise that his organisation's pretty voluminous research output is peer-reviewed. The British Medical Journal , for example, published its work on chronic disease last month. This concentration on research places the fund in a very different position from campaigning charities and think-tanks such as the Institute for Public Policy Research.

But Dickson is also keen to see that research doesn't stop, where it often does, with publication. He wants to see research results being piloted and, if successful, taken on by the government, the NHS or other agencies to see if their results can be replicated nationwide. Its Enhancing the Healing Environment project, for example, which aims to improve healthcare environments with colour, light, art and design, is being carried out in 23 NHS trusts with 50 others waiting to take it up.

Dickson is also robust in standing up to criticism of the fund's relationship with the government. One former member of staff described this as "uneasy" ("not in the game and not out of it") and another thought it so cosy as to threaten the fund's independence. Dickson dismisses such notions, calling the organisation "a critical friend" in that it is committed to the NHS and supportive of health and social care but not committed to any particular political ideology. For example, it is neither for nor against markets - it has pointed out where they create problems (residential care) and where there may be evidence (from the US, at least, in the case of chronic disease) that they have a place.

He does think, however, that both the Tory and Labour governments have been sometimes "oversensitive" to criticism, which he says the fund must "manage" by not appearing to be overly negative. But he adds: "We won't shrink from saying what we think is right and, if necessary, be assertive on the evidence."

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