Paul Simpson on fighting cancer, leaving Bristol City, Carlisle United - and returning to football

Simpson, the former Carlisle United manager, is five months on from an operation to remove cancer from his body. "As I sit here now, I feel physically really well,” he says. “I’ve no idea what’s going on inside of me, but I’ve got one kidney left that seems to be doing the job properly.”  

Early in our conversation the 55-year-old says he regards his as a "positive" cancer story – one where the process was clear, the treatment exceptional, the recovery quick and the prognosis good – rather than a “sad” one. He returned to work a matter of weeks after surgery and, having left Bristol City in October, is now eager to get back into football. 

A life in the game such as Simpson’s, which included a fine playing career with clubs such as Manchester City and Derby County followed by varied managerial and coaching achievements, offers few chances to pause and take stock. He says the first time he truly reflected on the last few months was the day he cleared his things from Bristol City and headed back home to Derbyshire.

“When I was driving that day it suddenly dawned on me," he says. "It was the first time I thought, ‘Wow, that’s quite a tough couple of months you’ve been through’.” 

Even then, Simpson says, he was not gloomy about the fact he had had cancer. The main theme, as he describes the detail of what happened, is one of clear-minded and optimistic progress through the serious challenge of renal cell carcinoma. 

“Back in February of 2020," he recalls, "whilst I was working at the FA [as England Under-20s head coach], I went across to Italy to watch a Copa Italia Under-19s semi-final. I’d also met with a couple of Chinese people in Tenerife, where I was with my wife on holiday, to talk about a job over in China.

“I suddenly picked up this cough, which stuck with me for about 18 months. I had loads of tests but couldn’t get to the bottom of it. So I knew something wasn’t quite right, which probably forced me to go and have a health assessment [through the League Managers’ Association].  

“The doctor, Dr Sally Harris, said there were a couple of things which were a little bit alarming, so I had a CT scan. They called me up a couple of days later and said, ‘We’re really sorry, we can’t find anything wrong with your chest and lungs, but you’ve got a tumour on your kidney'."

Simpson says a diagnosis of cancer was a “massive shock” given his lack of other symptoms and, while he says the reassurances from doctors helped ease his mind from the outset, there was the unavoidably difficult job of breaking the news to his family.  

“I was in the car with Jacqui [his wife] at the time and she got really upset with it, but I was driving so had to hold it together. Telling my boys [sons Joe, Jake and Dominic] and telling my mum and dad [Ken and Olive] was really difficult. 

“I think probably telling the boys was the only time I got emotional about it. Two of them were at our house, and me and Jacqui had just done our shopping. We’d rung the boys and asked if they could be on the driveway to get the bags and put things away, because me and mum were going back over to Wilmslow.  

Paul Simpson said the hardest part of his cancer diagnosis was telling sons (left to right) Dom, Jake and Joe about his condition (photos: PA / Barbara Abbott)

“At that point they knew something was wrong. They both came out, we handed the bags over and I told them then. Then I had to ring our eldest, Joe, who wasn’t with us, and then I rung my mum and dad." 

"I don’t know,” he continues, “…it’s one of those things where you just get on with it. Whenever I’ve had things to deal with in football we’ve always been of the view as a family, ‘This is fine, we’ll just deal with it’. When I’ve been sacked, or even the time when I left Carlisle for a positive reason for me [to join Preston in 2006], and the boys were getting threats at school, we were always, ‘Look, we just deal with it together’. Maybe having thick skin, if that’s the right term, helped us get through this.”  

Simpson is known as a meticulous organiser – “almost OCD”, he says – and being able to plan his way through the various stages of treatment helped. “The surgeon was absolutely top class and was so positive about the prognosis. I would be having my kidney out in three or four weeks in Christie’s Hospital. It would be done by a robot, and I was told the success rate was incredible. He said, ‘Looking at you, you’re a dream patient – you’re fit, well, I’ll get the kidney out, you’ll be back at work in six weeks’.  

“I know there’s millions of really sad cancer cases, but I was, ‘No…this is gonna be a good story, this one. This is gonna be fine’.”

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Simpson says that, having had no symptoms, several came at once at the start of his two-week isolation period before surgery – severe pains, passing blood in urine – but was reassured that this was normal as he awaited the procedure. 

There was, he says, only one spell when anxiety built. “At no point did I think, ‘This is the end’,” he says. “But there’s the three-week period when you’re waiting for lymph node tests, when you go… ‘What if it has spread? What do I do then?’ 

“Not literally, but I gave myself a slap – ‘Right, calm down, just relax, you’re gonna be ok – you’d know if there was anything bad’. If it did happen [thinking more darkly], it was a passing thought that I managed to shake myself out of." 

Paul Simpson, left, pictured with Nigel Pearson and Keith Downing, temporarily stepped back from his assistant head coach job at Bristol City as he underwent surgery to remove a kidney (photo: PA)

Simpson had started pre-season training in his assistant head coach role at Bristol City before stepping back for treatment. He says the support of his friends was immeasurable, while “their wives were baking cakes for me while I was wasting away”. 

When Bristol City announced why he had temporarily withdrawn from his job, messages from across football, including from supporters of his many clubs such as Carlisle, gave him further strength. 

“It does help," he says. "There’s no denying it. It’s quite a low place when you’re isolating and you’ve got your head full of broken biscuits wondering, ‘What if this happens, what if that happens...’ It gives you a real lift to know people do actually care.”  

Simpson says players at Bristol City took turns to call him while he was at home after surgery, while his family kept him aware of kind messages on social media (he does not use the platforms himself). A week and a half after his kidney was removed – he also stresses his good fortune that he was able to afford private healthcare – he was well enough to contribute remotely to the football club: watching games and filmed training sessions, doing one-to-one Zoom calls with players. 

In his garage, he worked on a cross-trainer and lifted weights to build his strength back up, having overcome the initial post-surgery discomfort. “I didn’t expect to be in the pain I was in over the first seven to ten days,” he admits. “I was probably a little bit naïve. I rang the surgeon to say I was struggling, and he said, ‘You do know what I’ve done to you? I’ve literally removed your kidney and moved all your major organs to do that…so you’re gonna be sore’.  

“Since then, though, I’ve been ok. I never thought for one minute I’d ever have to cope with a cancer. But you just get on with it. When I think about my mum…nearly 15 years ago, she had a brain haemorrhage. She’s still fighting fit and going strong now. You don’t know what you can cope with until you’re put into that situation."  

“My cancer has been a really successful one," he adds. "People say, ‘When you were ill…’ I think, ‘No, I wasn’t ill’. Jacqui – who has been absolutely brilliant through all this – always says, ‘You had cancer, you were ill!” But I don’t feel as though I was ill. 

“The way I think of it is this: if I had to choose a cancer, then I’d choose one on a major organ I’ve got two of and only need one of, and with the cards in my favour as they were here. Whether that’s being stupid I don’t know, and whether down the line it’s going to hit me like a baseball bat I don’t know. But that’s the way I’ve dealt with it. I just think I’m really fortunate and I’m hoping that’s the end of it.”  

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Simpson, who must have a scan every six months, had the operation in early July and was back on the training ground at the end of August. Less than two months later and he had left Bristol City. This was not health-related, he says, but a case of things having altered in the coaching set-up at Ashton Gate.  

“I think, if I’m honest, I felt a little bit out of it because Nigel [Pearson, the manager] had brought Curtis Fleming in, so there was another member of staff Nigel was confiding in more than he was with me and the other [assistant], Keith Downing. There was a little bit of a shift I could sense. 

“It didn’t come as a surprise to me when the decision was made to leave. I was just of the view, ‘Oh well, so be it, that’s life.’ There were a few other things, like my job title changing, and we came up with an agreement to terminate my contract. We didn’t have a fall-out, but it was probably the best thing for all parties.” 

Simpson says that, rather than sit wondering about what comes next, he decided to take courses with the LMA and FA, aimed at his personal development. “I’m doing one tonight: ‘Stepping into the Boardroom’, which is around the sporting director and director of football roles, which interest me,” he says. “I’m just doing everything I can to make myself better.”  

The day it was announced Simpson was leaving Bristol, his name surged to the top of the betting for the Carlisle United job, the Blues having fired Chris Beech. The idea of ‘Simmo’ returning to his home city to revive the club he led to successive promotions in 2005-6 appealed to many supporters. There was contact, he says, but it was never a realistic prospect.  

“I left Bristol on Thursday, and John Nixon [one of United’s owners] called me on the Saturday. Although I knew I’d left Bristol, it wasn’t all sorted and agreed, and I didn’t know how long that was gonna take. I just said to John, ‘I’m not in a position to do anything. It’s too early’.

Paul Simpson says United co-owner John Nixon, right (pictured in 2006) called him to ask if he was interested in joining the selection process when Carlisle were seeking a new manager, but the ex-United boss says it wasn't the right time (photo: Jonathan Becker)

“He said, ‘Well, we’re having a meeting and we’re down to three [candidates]. Would you like to make it four?' I said I can’t. He rung me again on the Monday and asked if I was still of the same view, and I said yes. We then had a chat for 20 minutes about what was happening. 

“There was never a point where he said, ‘Will you become the manager?’ It was, ‘Would you be interested?’ I couldn’t have done it and it wasn’t the right time to do it either.”  

Would the idea ever appeal in the future? “I don’t know. It’s really hard to say. The club was in a different position when I went in [in 2003]. Initially I wasn’t even thinking about management; Roddy Collins asked me to come up and be a player, and I really fancied finishing my career having one year playing for my home team. I then had the enjoyable chaos of John Courtenay [the owner who made Simpson manager]. But the turning point for me at Carlisle was Fred Story [Courtenay's successor]. He was absolutely fantastic for me. Without a Fred Story-type person, Carlisle’s gonna be a really difficult job.  

“As much as I love Carlisle United, because it’s my home team and a team I supported when I was a kid, I’m probably only gonna get one chance at a management job again. I don’t know the politics that are going on there, but Carlisle isn’t in a position where I would be the right person for it, in my opinion.”  

Simpson says that in Keith Millen, his former club have appointed a well-respected person with vast experience, and he wishes the club well. He last watched the Blues in the 2020/21 season and confesses he has seen Hartlepool more often this campaign, since Jake is strength and conditioning coach there.  

In management, Simpson led Rochdale, Carlisle, Preston, Shrewsbury and Stockport before assistant roles at Derby and Newcastle, and then a successful time with England, whose Under-19s he guided to the World Cup in 2017. He is open-minded about what his next role might entail.  

“It’s probably not doing myself any favours at the moment because I’m really open about whatever I do,” he says. “I don’t know if I’m hedging my bets. Being an assistant is an absolute doddle in comparison to being a manager, but I think I’ve got a lot of experience and I can help people, particularly if it’s a younger coach.  

“I really want another shot at being a manager. But I also think I could do that director of football role as well, dealing with all the rubbish that a young manager doesn’t want to deal with. I don't think I'm being arrogant when I say I believe I've experienced a lot in the game and could put that into practice.

Simpson managed England's Under-20s to the World Cup in 2017 before returning to the club game three years later with Bristol City (photo: PA)

“When I left Carlisle in July 1982 I would never have dreamed I would still be involved in football aged 55.  For whatever reason, whether I’ve got some ability or been really lucky – I don’t know what it is and don’t really care – I’ve loved the ride I’ve been on. If I don’t get another job in football, so be it and I think I’ve got enough life skills to be able to do something else. But I’d like another opportunity at it.” 

Simpson’s last experience of club management was a rotten experience at Stockport, where he says promises were broken. “After that I definitely needed to take a period of my life away from being a manager. But there was no way I was going to allow that short period of time at Stockport to totally sour my thoughts on management. I needed to go away and educate myself a little bit better. The next place I go into needs to be somewhere I feel I’ve got a fighting chance.”  

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Simpson had such a chance at Carlisle in 2003, because Courtenay had ousted Michael Knighton after the toxic latter years of his ownership, and there was an opportunity to build. Having joined as a player for a last hurrah with his home-city club, he was appointed manager when Roddy Collins was sacked. The team was bereft, but Simpson made a string of inspired signings and, after relegation to the Conference in 2004, the team rebounded with a spring. 

We reminisce about the period in 2003 when the Blues had a company voluntary arrangement lifted and Simpson, assisted by Dennis Booth, could bring in players to transform the team. 

“I went from a situation as manager where I had to go in the dressing room to say ‘Morning’ to everybody to work out who’d been drinking and then send them home, to a dressing room where the likes of Andy Preece, Kev Gray and Tom Cowan, as well as Chris Billy and Peter Murphy who were already there, would sort things out – ‘Oi, we don’t do that here, the gaffer wouldn’t like that’. It made such a difference when we got good pros in there.”  

The 2005/6 League Two team remains the last title or promotion-winning side at United: the team of Gray, Billy, Murphy, Karl Hawley, Keiren Westwood, Chris Lumsdon, Paul Arnison, Derek Holmes, Simon Hackney, Zigor Aranalde, Danny Livesey, Adam Murray, Michael Bridges and the rest. Simpson insists that subsequent years, when the club sustained itself in League One under Neil McDonald, John Ward and Greg Abbott, deserve to be remembered just as positively. He also admits, a little regretfully, that he did not bask in the glory of 2006’s title as much as others did.

Simpson, under Fred Story's ownership, led Carlisle United to what are still their most recent promotions in 2005 and 2006 (photo: Jonathan Becker)  

“After the last game at Stockport [which secured the championship], on the Monday I was releasing players who I didn’t feel were going to be right for League One,” he says. “You don’t get the time or the chance to enjoy it. After I got the sack at Preston, which was my first sacking, I thought, ‘Right, what’s gone on over the last few years…?’ And you think, ‘Wow, that was really good’. 

"That was the first time I gave myself the opportunity to enjoy what we’d achieved at Carlisle, which is a little bit sad, really.”  

Simpson can enjoy the fruits of that and other successes when he walks into his study and sees his medals on display, while his England World Cup medal is in the dining room. If other accolades come along, it will not, he says, be a result of pursuing positions in an undignified way. 

“What I’ve realised is, if you’re chasing the job, they’re probably not interested in you,” he says. “The job comes and finds you. One of the lecturers on the LMA diploma said if you’re out of work, you should go to games in the directors’ box if you know the manager’s struggling. I disagreed, and was told, 'Well, if you don’t, others will'.  

“But I sit here today and can tell you I have never been to a game because I think a manager’s struggling. If I get to that point, I’m gonna be in a bit of a desperate situation. I don’t want to resort to that.”  

At Carlisle, Simpson refused to fill his diary more than six weeks ahead because he knew how volatile and short-term management could be. He says that is still the case, to the point that he found it unusual to open the diary at home and see that Jacqui had written in all Hartlepool’s fixtures. “She’s planned Jake’s season,” he smiles. “Whether or not an S&C coach is a bit more secure than a manager…you like to think so. But I don’t plan any further. Just no point. Makes a mess of your diary.”  

I ask if the last year has further underlined an instinct to live each day on its merits. Simpson shakes his head and returns to the notion of beating cancer with focus, not philosophy. “I’d rather I hadn’t got it, but I’ve got no regrets about having cancer, because it’s been dealt with,” he says. “I move on and I’m in a position where I can really enjoy my life again.  

“I think people all over the country have shown unbelievable resilience over the last 18 months [with Covid], and this year has taught us as a family we can cope with a lot. Let’s get on and enjoy it, and hopefully 2022 is a good one for us.”