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The Next GenCast

Episode 47: Backstage with Prof Sir Steve Powis, National Medical Director

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In this landmark episode of the Next GenCast, Dr. Nish Manek sits down with Professor Sir Steve Powis, just weeks before he steps down as National Medical Director of the NHS in England after more than seven years in the role.


This is not just an interview — it's an unfiltered, powerful reflection on leadership under pressure, told by the man who stood at the helm of the NHS during one of its most turbulent chapters: the COVID-19 pandemic.


In a conversation recorded live at NHS Confed Expo in June 2025, Sir Steve opens up in a way few senior leaders ever do.


He talks honestly about the terror of those early pandemic days, what it really felt like to stand at the podium during Downing Street press conferences, and the emotional toll of knowing the NHS could collapse under his watch.


But this episode is about far more than crisis leadership. It’s a deeply personal insight into what makes a great leader — from the power of relationships and kindness to handling imposter syndrome at the very top. Sir Steve also shares the most important lessons he’s learned, what he hopes for the next generation of clinical leaders, and how he wants to be remembered.


**Highlights

  • 03:00 – "I didn’t set out to be a leader"
  • 06:00 – “I caught the bug” – enjoying policy and strategy
  • 08:00 – Early mentors, first impressions, and learning to manage a unit
  • 11:00 – Becoming a Medical Director and then National Medical Director
  • 14:00 – The Simon Stevens sofa interview
  • 16:00 – Imposter syndrome, confidence, and doubt
  • 21:00 – Pandemic prep and the moment it became real
  • 26:00 – Behind the scenes at Downing Street press briefings
  • 30:00 – Media gaffe: “I didn’t hear the question…”
  • 32:00 – Communicating in a crisis: “You’re never speaking to just one audience”
  • 37:00 – The emotional toll and the moment that broke him
  • 43:00 – Watching The Repair Shop in tears
  • 48:00 – Working with politicians: “See the world through their eyes”
  • 52:00 – Legacy and pride: Royal Free, North Middlesex, and the NHS model
  • 59:00 – Quickfire round: cartography, Springsteen, and shoemaking
  • 1:03:00 – Final leadership advice: “Kindness. Patience. Relationship


**Links and resources:

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