Ciarán Devane sits back and considers the link between his current role as chief executive of Macmillan Cancer Support and the post he moves to in January: chief executive of the British Council. The view from his office will certainly be poorer. His magnificent vista of the Houses of Parliament, from the 13th floor of the building known as charity towers on the banks of the Thames (also home to Marie Curie and Comic Relief), will be replaced by a back alley near Trafalgar Square.
But the link, he decides, is the power of relationships. "To give you a Macmillan example," he says, his Irish accent little dimmed by 30 years in the UK, "we cannot tell anybody what to do in the NHS. But we can help them to do what we believe is right through influence, relationships and evidence. Similarly, in a global environment where there are multiple relationships between vast numbers of people, whether it's Britain and India, or China, or anywhere else, it relies more on soft power – and relationships are key to that."
His motivation, however, will be very different. Devane's wife Katy died of cancer in 2003. She was diagnosed five years before, barely three months after their wedding. During her last three years he became her full-time carer. His successful career as a highly paid management consultant was put on hold and never reignited. Instead, he took the helm of a cancer charity.
His desire wasn't simply to ensure no one should have to suffer in the same way. Rather, his experience of cancer support, including from Macmillan, had been so positive that he wanted to extend it to everyone in the same predicament. He sought to drive the charity to become bigger and better, broadening its base of beneficiaries.
Seven years on, he can leave in the knowledge of having done just that. It has moved from being a warm and cosy charity that your grandma supports to one that works on the cutting edge of social media campaigning. This summer's ice bucket challenge (Devane took part, and shivers in recollection) was a cultural phenomenon, let alone a fundraising one. About 1.3 million people tipped buckets of ice over their heads and, in so doing, raised £4.5m for Macmillan.
He admits it will be a challenge to replicate that sort of success, but says his team has done so before. "We've always been a much-loved charity and the propensity to give to Macmillan has always been quite high. But when I joined, we weren't necessarily growing at the rate that that would suggest. When I started, the conversation about our coffee mornings was along the lines of 'we'll get to £7.5m if we're really lucky'." In 2013, Macmillan's coffee mornings made £20.3m.
Inside this great organisation is another one trying to get out
The charity's total income in 2009 was £123.4m, with £17.7m from fundraising events. By 2013, total income was £186.9m, with events attracting £37.2m. Surprisingly for a numbers man, an engineer by training and a consultant who presided over large pharmaceutical mergers, these aren't the indicators he points to. "I'm not sure I can claim much credit for them, quite frankly," Devane says. "But I can probably claim some cultural alignment. I remember at the very beginning saying to somebody: 'Macmillan is a great organisation, but inside this great organisation is another one trying to get out.' If I was writing the history of my tenure here, I would say that I allowed that other Macmillan to come out."
He likens the philosophy he brought to the team to that of British Cycling's Dave Brailsford and Chris Boardman, who sought to "do a thousand things 1 per cent better". This meant "attention to detail and shutting down the things that didn't work – not tomorrow or next week, or after a review meeting and a report in three months' time, but today. Have the confidence to try new things, plus a quality improvement attitude, plus a bit of innovation. Then good things will happen."
'A club that plays nicely together'
Devane is also a great believer in collaboration. Cancer charities are "a club that plays nicely together", he says – each one knows its distinct role. If you want to find the cure, then it's Cancer Research UK; hospice care, Marie Curie; the "cancer journey in the middle" is Macmillan, he says.
But when he took up the post in 2007 "there was nobody in the United Kingdom who could answer the question 'how many people in the UK have a cancer diagnosis?'," he says. "If Macmillan is trying to improve the lives of people with cancer, and you don't know how many there are, how do you do that? We found out that the number was two million, but also that it was growing and would be four million by 2030. Macmillan's strategy is now based on those two things: we've got to look after the two million people who have got cancer now; and we have got to shape the world so it can cope when it's four million people by 2030."
That's quite a task in times of austerity: cancer patients now have the uncertainty of Personal Impact Assessments, and will lose up to £191 a year by 2015 because welfare payments are rising more slowly than living costs, according to Macmillan research.
As a trustee of the National Council for Voluntary Organisations, Devane meets many "very small charities doing amazing things in difficult circumstances". But he doesn't think Macmillan is necessarily overstretched by filling in gaps left by a retreating state. "In an odd way, we get more done", he says. The landscape created by the Health and Social Care Act 2012 means, he says, "if you are sufficiently strategic and can genuinely demonstrate impact, it's almost easier to have that million-pound funding conversation now than it would have been a few years ago. But it's more difficult to have the £100,000 conversation."
Devane has a more direct line to the NHS than most. He's a non-executive director of NHS England, which presents him with a tricky balancing act between being critical friend, lobbyist and insider. "I would hate to think I would say different things in a Macmillan room, an NCVO room and an NHS England room", he says. Indeed, his recent public statement that UK cancer survival rates were "a national shame" suggests that he doesn't do that. "The big advantage Macmillan has is that we don't take statutory money," he says. "We are not commissioned to do anything. That means we don't feel we have to mind our Ps and Qs."
In other respects, however, Macmillan has been accused of getting too involved in the health system. It has been advising four NHS GP-led clinical commissioning groups in Staffordshire about a £689m, 10-year contract and a separate £535m contract to provide end-of-life care. Virgin, Care UK and Ramsay Health, among other private health groups, have expressed their interest, causing cries about back-door privatisation. Christina McAnea, head of health at the union Unison, called it "a dangerous experiment", and the satirical magazine Private Eye damned Macmillan for entering the political minefield of NHS privatisation.
Devane is calm and clear in his defence. "First, there are 61 contracts a year for cancer and end-of-life in Staffordshire, so that's 610 contracts over the 10 years. Rather than manage 610 contracts and hope they all join up, what the four CCGs want to do is agree with the existing provider base – the same providers tomorrow as today – to work together to maximise the outcomes they can achieve from the existing pot of money."
Staffordshire's CCGs are in the middle third nationally in terms of performance, he says. If they can be raised to the top third, "between 1,700 and 2,400 people will be alive one year after a cancer diagnosis who would otherwise not be", says Devane. "So the reason we are interested as Macmillan is that we know coordinated care delivers higher quality, saves more lives and delivers more value."
He offers an example in Manchester where Macmillan looked at the costs of helping people with breast cancer over four years. "There was one group of people, who'd been diagnosed early, who didn't spend very much time in hospital," he says, "a middle group and a group who spent a lot of time in hospital. People in the last group were, presumably, more ill, but that was only true for half of them. The other half were like the group in the middle, but were spending 10 additional days in hospital not because they needed to be there but because there was no one to put the care coordination in place, to make the phone calls.
"We could optimise those hospitals for evermore, but those people would still spend those 10 nights in hospital. So Staffordshire is about saying we can save more lives and deliver more quality if the providers collaborate or coordinate with each other."
For Devane, far from contributing to the dismantling of the NHS, this is about ensuring its future. "There is no way on earth that the taxpayer at the moment will be able to cope with four million people who have cancer," he says. "The same amount of money spread over more people is not sustainable. What we want to do is to help the NHS to learn how to provide higher survival through better coordination. If we can do that in Staffordshire, the rest of the NHS can learn how to do it too. Then we have a fighting chance of having an NHS in future."
Irishman promoting 'Britishness'
Perhaps this foray into political minefields sets Devane up nicely for the British Council. Because a quarter of its funding comes from government, it is far closer to the Foreign Office than Macmillan is to the Department of Health. Mandated by Royal Charter to promote British language, education and culture abroad, it has 7,000 staff based in more than 100 countries. Part charity, part quango, part private education provider, its underlying purpose is one of promoting Britishness. Which begs the question, why is a southern Irishman, and one whose first language was in fact Irish, interested in doing so?
"My family see the irony in it," he laughs, saying he is prepared for some stick on return visits home. But after 30 years in the UK, he has lived longer here than anywhere else. More importantly, after his wife died he went to study a master's degree in international policy and practice in Washington. That was to be his sector change. He was preparing his CV for the likes of the World Bank when the Macmillan position popped up and cancer came back into his life. Now it is his time to move on.
"When you talk about cancer, there is a little bit of you that remembers back," he says. In a poignant video on the Macmillan carers website, he describes his wife's last days. He says giving his wife "permission to go", as suggested by the nurse, was the hardest thing he's ever had to do. He has not remarried.
"It will be nice not to be talking about cancer for a while," he says now. "I'm looking forward to that. In a funny way, this is going back to where I intended to be, having done this odd, fantastic diversion through Macmillan."
Devane's proudest achievement at Macmillan was, he says, playing a part in the Nine Outcomes – a piece of research from 2010 into what cancer patients really wanted the NHS to do for them, resulting in nine simple statements such as "those around me are well supported" and "I am treated with dignity and respect". Everything Macmillan does is now lined up against the nine outcomes, offering a clarity of purpose that he believes has been fundamental to the charity's success.
"It was a lightbulb moment," he says. "Some of them we could have predicted, but one or two were a surprise. The biggest one was cancer patients saying they wanted to give something back; that they didn't want to be part of this club, but now that they were, they wanted to ensure the next member had an experience that was at least as good, if not better, than theirs." He is, of course, talking about cancer patients. But they are also fitting parting words for the man himself.