Dr Charley Johnston: Full Transcript

I:             Good morning, my name’s Barbara Thornley and the date is the 17 of July 2014. We’re at the Association of Anaesthetists and I’m here to talk to Charley Johnston about his life and career, particularly his experience in the Navy. Thank you very much for coming. Can we start at the beginning and ask you where you come from, when you were born, a little bit about your family?

P:           I’m Charley Johnston, I’m an Irishman by ancestry but was born in Egypt and brought up mostly in East Africa and the Seychelles, was sent to boarding school in Belfast, Methody, Methodist College Belfast, and I went to university across the road. I could do that because of my parents not living in Northern Ireland, I wasn’t living at home and could go there.

I:             So why were you in such faraway places, your parents must have been involved in something?

P:           My father had been a missionary teacher with the Church Mission to Jews in Cairo and they came back to England, or the UK, and something happened where he was teaching in UK, decided that money was just too tight, applied for some overseas jobs where the pay was a little bit better, got the job in Kenya, stayed in Kenya for quite a long time, but moved over to other things, staying with education, colonial service, going through various bits, the political change from it no longer being a colony.

I:             So I presume your first years at school were abroad?

P:           My first years at school, I went to a primary school in Kenya, a nursery school and primary school in Kenya, then with independence coming and a lot of uncertainty as to what was happening, I was sent back to boarding school, which meant that I –

I:             How old were you when you were sent back?

P:           I was sent back when I was almost 10, travelled home every holiday out to East Africa and when dad was in the Seychelles, that was real fun, because as a young teenager at 13, 14, nobody dreamed of putting an airport in the Seychelles, so you flew to Nairobi, overnight train through the game parks to Mombasa and four days by sea out to the Seychelles, and I called that the trip home. Even now 99 people out of 100 people would call that the holiday of a lifetime!

I:             Do you have any special memories about your time out in East Africa and the Seychelles?

P:           It was an idyllic place to be brought up, absolutely idyllic, the sort of thing you dream about. I’ll just give you examples, Alan Root who used to do wildlife films for Anglia Television, he had what had been a farm building on the shores of Lake Naivasha and he said he could see more, birds sitting in a deck chair with a gin and tonic beside him on Lake Naivasha than he could in a year tramping round Europe, bits like that. It was great, part of which is the rose-tinted spectacles, why I don’t want to go back, because a combination of undoubtedly, things are not as good now as they were, and then the people aren’t there and memories are actually people more than places, and they’re almost certainly not completely accurate, because of the rose-tinted effect that you get.

I:             Did you have any brothers and sisters out there?

P:           I’ve got a sister, Amira, she followed me through Methody, although she went after independence, so she can sing the new Kenyan national anthem in Swahili, which I can’t and I can’t sing anyway, but that’s a separate issue. And then she went on to be… she also crossed the road to Queen’s, but as a pharmacist and she’s now a pharmacist in New Zealand.

I:             A much travelled family?

P:           Yes. I did a count and in some cases stretching the definition slightly, but across my lifetime I’ve lived and/or worked and that’s including just visiting for work, in 82 different countries in my life, which was one of the reasons why whenever I retired, we’d also hire canal boats. I’m not English, England is a beautiful country to live in and we moved onto a canal boat to explore England very slowly.

I:             How nice. When you left school, what did you do after that?

P:           I went to Queen’s to do medicine –

I:             Queen’s Belfast?

P:           Queen’s Belfast. I’m left with the impression that we did more anaesthetics as medical students there than most places. I’d also done my first anaesthetic as a medical student in Northern Kenya, so I was slightly interested in anaesthetics.

I:             You mentioned earlier an interest in engineering, what made you choose one or the other?

P:           Well I’d fancied joining the Navy as an engineer for a long time, as any of my contemporaries in the military anaesthetics, the standard joke was, ‘There’s Charley, there’s a piece of kit, make sure there isn’t a screwdriver in sight!’ <Laughs> That was told against me with some truth but not as much truth as the story as repeated.

I:             You liked altering things, did you?

P:           I liked understanding how things worked, which has also meant with some of the things I’ve done in various places, you can fix them where there isn’t alternative fixing means. I was uncertain as to what to do, I ended up with both medicine and engineering offers and I let the ‘A’ levels decide and I was lucky enough, and I think I’ll use the words lucky enough, to get the grades to get into medicine, so did medicine, but having played with the engineers quite a bit in the Navy, I’m absolutely convinced that I would have enjoyed life as an engineer as well.

I:             You joined the Navy as a medical student?

P:           I joined the Navy as a medical student. I joined the Navy Reserves at 16 with a view as… what the Navy calls a stoker and what the rest of the world would call a diesel mechanic, with a view to spend as much time with the Navy as I could to find out what the Navy was like before I sold myself for thirty pieces of silver. Then I joined as a medical student and then got a cadetship, which was just as well, because with exchange… various bits, I would have had funding problems anyway, because dad, who was happy enough to put his contribution in, couldn’t get his money out of Kenya to pay me. So early years in a combination of the Naval Reserves and installing central heating systems, paid me for the early years and then the Navy paid me for the rest of it.

I:             Was there anything particular at medical school that made you interested in anaesthetics?

P:           John Dundee ran a very good course and experience for medical students so that everybody who did their month’s anaesthetics, I think it was a month, they’d finished having put a reasonable number of tubes down, which at that stage, I was very much left with the impression that it was fairly uncommon to come out of medical school knowing that you could use a bag rather than mask and at a month it wasn’t competent, but it meant that you weren’t totally frightened, should that arise.

I:             Did you have any particular outside interests when you were at medical school?

P:           I was in the Naval Reserve; I enjoyed doing things like that. I headed off with an AP…

I:             What did you have to do as that?

P:           For most of the time in the Reserves, even though I was still a medical student, the Navy was training me as a diesel mechanic and that was fun.

I:             So that would be in your holidays and things?

P:           That would be holidays, weekends, and it meant that I went off on the weekends with the minesweeper, which paid money.

I:             So when you came out of medical school, what were your first jobs?

P:           I did my house jobs with the Navy.

I:             Where?

P:           In Plymouth. I had debated on doing them in the Ulster Hospital, but I got some threats from the IRA and decided that actually –

I:             Were the threats because of your naval connection?

P:           Yes, or that is my presumption, I’d been there for a while, where my girlfriend’s mother, who subsequently became my mother-in-law lived, let’s just say there was green white and gold painting on the kerbstones. The people who lived around her didn’t trouble me, but the people who knew them, because Irish troubles, there’s always been a difference between the person you know and the group. How real it was, I’m not certain, but that made my mind up that I would go and do my house jobs with the Navy, rather than go and do them where I’d been thinking of in Ulster.

I:             What about your wife’s family, were they threatened?

P:           No, she’d lived on the street. That wasn’t a big thing, it was a tipping point for which will I do and they were both there and that made the choice.

I:             So which house jobs did you do?

P:           I did both medicine and surgery and orthopaedics.

I:             And what did you do after that?

P:           After that I had to go to Dartmouth for what we call the short knife and fork course.

I:             How to behave as an officer?

P:           How to behave as an officer and a gentleman, and there was a couple of months gap between end of house jobs and Dartmouth. I felt that the two areas that I knew nothing about were seeing unsorted patients, because as a house job somebody else has always seen the patients before you, and I could deal with that by getting an A&E job or significant resuscitation for which read anaesthetics. I did three months anaesthetics just as a gap filler. To my enormous surprise, enjoyed it hugely.

I:             So did you go straight on into anaesthetics?

P:           No, I disappeared off into the submarine world, because in the Navy you do some general duties where you are off doing whatever arises. For most of my lot, they were looking at either submarines or Royal Marines. The Royal Marines were doing in Northern Ireland, they took the Royal Marines off mine, so I… submarines… I had what they call the classic Naval choice, you have two possibilities, you can volunteer or you can be drafted. <Laughs>

I:             And you stayed in submarines for the rest of your career?

P:           Oh no, no. You do it for a couple of years and then you go into your professional medical training, but the Navy also trained me as a diver and I got involved in some of the diving research things and submarines where the doctor is responsible for atmosphere monitoring. A submarine is the biggest closed circuit breathing apparatus in the world, so there’s parts of this that were purely coincidentally very useful and the diving world. My view is, that passed me my part 1 physics and clinical measurements.

I:             Good practical experience?

P:           Well it wasn’t so much practical, it was back in the days. Physics and clinical measurement whenever I came round to the exam, was brand new and a lot of people were failing it. It couldn’t happen now, but I’d ended up with somebody coming up with a silly question, ‘What is white spot nitrogen?’ Now as an opening question that slightly floored me for a moment, then I remembered that I did [11:16] and I said, ‘It’s nitrogen of a very high, unknown degree of purity.’ And the next question was, ‘And what do use it for?’ Now my understanding, and here it is, the the proper anaesthetic answer was, ‘Zero calibration of oxygen electrodes,’ and so on. That’s anaesthetic research, I knew nothing about that. I’d signed for a tanker full of the stuff in Florida and so my answer was, ‘My main dealings have been in the internals of missile systems,’ which was not the textbook answer. So we then spent the rest of the viva –

I:             Talking about something that you knew about!

P:           Yes. The first one we did was the closed circuit, breathing stuff and gas measurement and so on, bread and butter for a couple of years. The next examiner made the psychologically logical, but physiologically completely illogical step from submarines to diving, and we were talking about under pressure… I’d been involved in a research dive only a month or so before, where we’d put two guys down to 710m, the inside of a nitrous oxide bottle’s only A540, so you’re talking about if you’d opened a nitrous oxide bottle the gas would have gone in, not out. We got into this, which meant I was talking in an area that was beyond the experience of the examiner, who clearly knew his pressure related stuff, but not playing up at that sort of area.

I:             You were talking about things that not a lot of people would have known an awful lot about at that time, do you think that this made it easier for you in some respects?

P:           I think it did in that particular one, because frankly, I did a physiology viva that was probably a better tutorial than it was a viva, and you weren’t given the results, but I had the distinct feeling that I might have been marginal in physiology, but I clearly knew more than the examiners as far as the physical and clinical measurement and the two probably balanced out.

I:             Other people in the past have mentioned some of their early research where they felt that they would not have got ethical agreement to it; would that have been a problem, do you think, with you?

P:           I wasn’t being pressurised, I was on the shore-side team. I didn’t go into the consent… but the people being pressurised, you can’t get people to do something like that, it was eight days to get them under pressure and a month to get them back. You can’t get people to go in for that sort of thing unless they really want to. I had nothing to do with the details of consent, I was a peripheral member of the team.

I:             Once you’d made the step into anaesthetics and you’d done your time in the submarines, what was your next step after that?

P:           The next step was heading down… I went to Haslar and started anaesthetics there.

I:             How long were you in Haslar?

P:           I was in Haslar until ’82, whenever, I then got something that would be totally unacceptable now, where I was sent out as the only anaesthetist in Gibraltar, as still SHO/Registrar. This would not be acceptable now, not even slightly, but again, it meant that I was working on my own, I had advice available and things like that, but you know –

I:             Do you have any particular memories of your time in Gibraltar?

P:           Some that sit fairly vividly. There was a horrible incident. Meningitis was very common, or seemed to me to be very common. Having a wee girl come in with fulminant meningitis, such that she had a respiratory arrest coming into hospital and incubating her and keeping her alive until she was flown back. She subsequently died. Not helped by the fact that my son was at her birthday party five or six days before.

I:             He didn’t catch meningitis?

P:           He didn’t catch it.

I:             Did anybody else at the party?

P:           No, you looked at it and they all seemed to be sporadic cases, there just seemed to be a lot of sporadic cases.

I:             Do you have any other strong memories?

P:           We got rid of the… any twins… provided the anaesthetic service for the obstetrics and it really was being able to provide the anaesthetic service that I’m sure that obstetric anaesthetist would love to be able to provide, where you saw every mum at the antenatal classes, so you could talk to them, you weren’t dependent on midwives’ prejudices and things like that.

I:             Were these Naval personnel or –

P:           Military personnel rather than Naval, included MOD, civilians as well. It wasn’t the local population, hence it was 300 deliveries a year. It meant you were on call the whole time, 24 hours a day, 7 days a week, but you were on call for a part-time job. If I was working 20 hours a week that was the outside limit of it, but you never knew –

I:             When that 20 hours would happen?

P:           Yes. <Laughs>

I:             How long were you in Gibraltar?

P             I was in Gibraltar for 15 months, something like that.

I:             And then you came back to where?

P:           Came back, then went back into anaesthetic training.

I:             In Haslar?

P:           Haslar, then got my exams, did much of my SR time in Oxford.

I:             And after you finished in Oxford where did you go?

P:           I went to my ASCAB, Armed Service Consultant Advisory Appointments Board, which was civilian people doing an interview, it was military people there, but the questioners were civilian anaesthetists, basically to make sure that you would be appointable as a consultant –

I:             Outside the military?

P:           Outside the military.

I:             And where did you get your job?

P:           I was asked, ‘Where do you think you will go?’ This was Gulf War I was just starting and I said, ‘I will be joining Argos on her way out to the Gulf next week!’ <Laughs>

I:             And that was true?

P:           That was true, yeah.

I:             So how long were you in the Gulf?

P:           I think that was six months, Gulf War I was total idleness, I did absolutely nothing or as near nothing as made no difference at all. We expected quite a lot of casualties, the casualty estimates weren’t good, the casualties that happened were non-existent.

I:             So after you finished there, where did you go next?

P:           Went back to Haslar, stayed as a consultant in Haslar, a couple of years later, went down to Plymouth to take over running the anaesthetic department there with a view to closing it and moving it up to Derriford and joining in with the civilian hospital in Derriford, because the military hospitals were due to close. Stonehouse was the first one to close, because it was closing under DCS15, which was a different defence route as a single hospital. And the rest were being planned to shut under Options for Change, which came later. And Stonehouse was a good working test, because Stonehouse worked very closely with Derriford and with Freedom Fields, it had done with Freedom Fields before Derriford was built, the two meshed in very closely together, and if the military/civilian relationship wasn’t going to work in Plymouth, it wasn’t going to work anywhere. It worked extremely well in Plymouth. It got to a much rockier start in Haslar, where the Haslar St Mary’s/Haslar QA relationship had never been close in a manner that the Stonehouse/Freedom Fields/Derriford one had been.

I:             It worked quite well down there?

P:           It worked extremely well. I did my best to help it, partly on contract things, where I wanted to make sure, because I was involved in the contract negotiations… ‘How many people will you provide?’ and I said, ‘We will guarantee to provide you with three trainees,’ and I usually provided a lot more than that. Providing extra bodies gets you friends in anaesthetic departments very quickly –

I:             Especially if they’re not having to pay for them?

P:           Not paying for it. I made it clear I would actually put an entire extra duty rota in, because of the military people, which meant they were able to cover things better and things like that.

I:             But I presume after you’d gone back to Derriford, you must then have gone to another war zone?

P:           I’ve been to other assorted war zones –

I:             Not as peaceful as the first one?

P:           Not as peaceful as the first one. Bosnia, which was –

I:             Bosnia was not good, I would have thought?

P:           It wasn’t great, but the major cause of deaths was road traffic accidents and we –

I:             But the roads aren’t very good out there –

P:           The roads aren’t very good and we should not have provided care for the local population was the theory, because you don’t want to set up a medical system that isn’t part of the local infrastructure. The snag is with where Šipovo was, what should have been the local hospital was on the other side of what, in NATO speak, the interethnic boundary line, which meant that in practical terms, the locals around Šipovo did not wish to go to the hospital that they should have done, so we did stuff, we did whatever was needed, which stopped us getting bored, provided a service that they wouldn’t otherwise have had.

I:             How long were you in Bosnia for?

P:           Those were three-month trips, two-month or three-month trips, fairly short.

I:             And after that, where did you go?

P:           Again, in all cases it was back to Haslar, I was aircraft carrier, Kosovo, Afghanistan a couple of times, Iraq both for the next Gulf War and for –

I:             Which was your worst war experience?

P:           My only personal horrible war experiences are actually quite limited, because Helmand was setting up Camp Bastion and that was where there was the really nasty casualty side of things.

I:             You were involved in setting up Camp Bastion?

P:           I was involved in setting up Camp Bastion, but I never served there, I visited it as part of the checks and balances thing, but in terms of the –

I:             It had a fantastic reputation.

P:           A fantastic reputation and justifiably so, and I was involved in setting up. To shift back to the starting in Afghanistan, we got it set up well, largely because of, courtesy of Gilligan, I was able to get anaesthetics completely re-equipped for Gulf War II, and that made a massive difference. I never actually spoke to Gilligan, but he tried to contact me and had spoken to my secretary just as I was about to go out to Afghanistan, which would have been Spring 2002. He then did a piece on The World at One and it was very cleverly done. Everybody had the impression that he’d been talking to me and that I’d been speaking out of turn, but actually when you analysed the transcript he didn’t say that at any point, but he was making the point that the anaesthetic equipment that we had in Afghanistan was third-rate.

I:             Inadequate?

P:           Inadequate. And it was the tri-service apparatus that Ivan Houghton had sorted out just before the Falklands, and it was outstanding equipment for the Falklands, but monitoring in particular hadn’t moved on and it was woefully inadequate. Now again, like David Kelly, Gilligan’s point was wrong in detail but right in the broad principle. If we were deploying solely with the equipment that we should have had with us, his point would have been totally accurate. Because it was a small scale unit and because we said there might be Russian chemical weapons, we’d actually brought the monitoring equipment for the chemical defence pack, which was a decent Datex monitor, everything you’d want for monitoring. So he was not accurate to the extent that what we had in that small field hospital was as good as anybody could ask. Hence the biggest thing that I did for the Ministry of Defence was after I came back, when it became apparent that Gulf War II was going to happen and I was running anaesthetists for the military at this point… To shift slightly, I was given the job on the 7th of September 2001 and four days later all the rules changed, or 9/11 to use the American terminology that we tend to refer to those days. It was fairly obvious in military planning that Gulf War II was going to happen. Blair and Bush were clearly determined that it would happen, so the military was planning for it although there was no political, ‘This is going to happen,’ it was contingency planning and the military does a lot of contingency planning based on what might happen.

So I got the transcript of Gilligan’s World at One piece and went round to all of the force commanders and the people rather further up the line than I was and said, ‘Look, Gilligan was wrong whenever he said that we had inadequate kit in Afghanistan, but that was because we’d done a fudge, a fudge that we couldn’t do on a large scale operation. If we go with the equipment that we are set to go… Because the anaesthetists, Ivan Houghton… led by Ivan, but all the detail done by many others, we’ve sorted out the equipment we needed, we got the list. Everything that’s needed here you are.’ So I didn’t need to devise a list; that had already been done for me. And I said, ‘If we do not go with this new list, the press are already aware that the existing kit is inadequate and what is more, I am warning you that they know and if you decide that this is not to be funded, then I am recording that you have been warned.’ And so Gilligan meant that Datex, for example, got the biggest single order for AS3 monitors that they’d ever had prior to Gulf War I. I think it was 160 of them or something like that <laughs> they had to drag them in from all over the world, but it meant that we went well equipped.

I:             This is into Gulf War II?

P:           Gulf War II –

I:             And then on to Afghanistan?

P:           Then on to building up… we were already in Afghanistan, but in a small scale, then Helmand and setting up Camp Bastion, with CT scanner and everything built into it. And I can recall being asked by the Secretary of State for Defence, I can’t now remember which one, because I met a number of them, on a deployment visit where I had been on the land in Iraq after Gulf War I, what did we need to make sure that we were running to Health Service standards? And I was able to say, ‘A significant deterioration of what we’re running at the present!’ <Laughs>

I:             Interesting that you were better equipped than the average.

P:           Yes.

I:             And we saw this in Afghanistan as well where I sorted out, when things were… For some time before they went bad, we sorted out… we had an extra anaesthetist in the hospital, so that we could put an anaesthetist in the helicopter to go out to retrieval and so if there was seriously injured people to be retrieved, you had either an anaesthetist or an A&E, usually a consultant. We did have senior trainees with us as an extra, but it was somebody experienced there, as soon after an incident as it was safe to land a helo without the helo being too major a part of the target system. And the results coming back from that were very, very impressive.

I:             What do you think was the major thing that made so much difference?

P:           I would say it was a system that worked rather than a particular thing. You had experienced people sent out… It starts with the first aid training, every serviceman is given first aid training, so that starting with the buddy care, you’re dealing with people who’ve been taught how to do the basic stuff. Then you’ve got the troop medics, they’re not full-time medics, but they’ve been given rather more stuff. Then you’ve got the people you send out in the helicopter, then you’ve got a team being back at the hospital, you know what’s coming back, you’ve often heard not from the, what I’ll call the ambulance rumour service, which to my mind, what the ambulance has been told to expect to get and what actually pulls up at the door have almost no relationship, because the anaesthetists or the consultant in the hospital would have a talking hat… He could get onto the radio system and you’d know what was coming. You would have a team waiting in A&E for them to come, because everybody was only a couple of minutes away and you’d a team that was working very closely together, so that everyone could get on with things, their bits. It was ATLS working exactly as it should do. So it was not a thing, it was an entire system and it was consultants; we’d two consultants and a senior specialist registrar out there, so it was a consultant-provided service to an extent that you couldn’t do that in the UK. You couldn’t provide that service, it would be far too expensive, but where the people were there and in between incidents, some were between under employed and unemployed, you could provide a Rolls Royce service that would be nice to provide in the NHS, but thank you, unaffordable. Are you going to put your consultants and anaesthetists into the ambulance going down the motorway, no you’re not, you can’t afford to.

I:             Are there any particular lessons that you learnt from places like Bastion that you think could be brought back to the UK NHS?

P:           I think it’s ones that the Health Service knows, it’s integrated teams, people who work together. The bit that I think the Health Service could do best with, but the nature of the structure is that it’s difficult, you have a disciplined structure in the military which contrary to the usual view is not a, ‘I am telling you what to do.’ The captain on the ship may take the final decisions, but he’s taking advice from everybody and if he’s only doing what he wants to do the system will break down very fast. It’s very, very two-way, much, much more two-way than most people believe, but when the decision is made, everybody goes for it. There is nowhere in the system in the Health Service that allows everybody to feel that their input has been taken care of.

I’ll shift off anaesthetics and take you to an aircraft carrier just as an instance, because as head of department in the aircraft carrier you’re involved in seeing this, and it was good management training as far as I was concerned. The air crew want to do their flying to make sure they’re totally up to speed in flying, which means that ideally from their point of view the carrier spends its whole time with a 30 knot wind going across the deck for take-off and landing, but the engines need maintenance, the seamen need to do their exercise, they’ve all… just like the Health Service, it’s a complex organisation with lots of conflicting priorities. The medics don’t come into it too often, but any time I came in, it was, ‘Right, everything else goes by the  board, if a casualty or things like that, everything else goes by the board,’ when you’re in peace time, to make sure that we don’t lose anybody’s life unnecessarily, following say, a nasty accident or something like that. So my priorities came up very rarely, but when they came up, they were more or less on the top of the list immediately. If we could get something similar in the Health Service, I think the system would work a lot better, but you see, a chief executive is not seen in the same manner as the captain of a ship is, he’s not recognised as that, and what’s more he doesn’t have the working advice structures, that head of department and things.

I:             In theory he should do, but they don’t.

P:           They don’t. It goes down many, many chains and the difference is not an ordering by rank, the difference is, ‘This is the way the decisions have been made, we’re all working for it,’ and you’ve asked people to do things. For a junior officer the easiest way for an experienced senior rating, senior non-commissioned officer to completely rot things up for the junior officer who’s ordering him about, is to do exactly what the junior officer says <laughs> rather than… The good officer will ask the [32:34 PUA2] who is enormously more experienced, but is ranked below him, to present him with tasks and problems, so that he can use the man’s experience to get things done. You don’t say, ‘I want you to put a three inch nail into that hole,’ you say, ‘I want that piece of wood fixed, that piece of wood needs sorting out.’ It’s a very different culture and although there are bits that the Health Service is trying to absorb from the military, too much of it is a culture and too less of it is defined situations, and it is not an, ‘I am ordering you to do things,’ culture, because if you order somebody to do it and they know better ways to do it, you can’t take advantage of that.

I:             Do you think some of the difference is that within the military you are very dependent upon the people that you’re working with?

P:           You are critically dependent –

I:             Whereas within the NHS that is not necessarily quite so true?

P:           It’s not true. In many respects if you’ve a good theatre team that’s used to working together, you’ve got exactly the same thing and if what you see on the NHS on good theatre teams could be applied further up the system, then it would help.

I:             True. Do you think that something like Camp Bastion is probably one of your proudest achievements?

P:           I would say my proudest achievement from the military side was getting the re-equipping, ‘We’ve got to have good kit,’ and then Camp Bastion was that taken on a stage further. My involvement in the planning for Bastion was limited to the anaesthetic world, but because of what we’d done with Argos on Gulf War II where we’d CT scanners and so on, we were moving things on and demonstrating that you could have decent kit fairly close to the front line.

I:             Just to change the subject slightly, you came onto the Council of the Association, when was that?

P:           That was whenever I was appointed as Defence Consultant Adviser, that’s sort of boss anaesthetist for the Armed Forces.

I:             When was that?

P:           As I say, that was 7th September 2001.

I:             And you spent how many years –

P:           Six years.

I:             And you enjoyed it, I gather?

P:           Thoroughly enjoyed it and actually one of the other bits, to go back to what was I proud of in the military: integrating the reservists totally into military anaesthesia. That worked and I was really proud of the way that worked. October 2001 the ordering council mobilising the reserves was put in, but by the time we were… The military were very, very short of anaesthetists. Whenever I took over running anaesthetics, in terms of fulfilling the number of posts that we should have had, we were running at 19% manning, 1-9, not 9-0. <Laughs> This is not good, it meant that we could do the Gulf War, but what we couldn’t do was the long-term follow-up with the continuing supply. The MOD said, ‘We will mobilise the…’ I went to check whether the Ordering Council, which had been done to mobilise TA [35:59] int-service people, whether it was specific for that or it was general, and it was general, so we could mobilise any reserves we needed. The TA were saying, ‘To get one person we will mobilise six.’ And I said, ‘If you do that it’s a one shot weapon, because if somebody ends up going who’s unhappy with it, they leave and if somebody ends up getting mobilised and not being sent, they’ll leave.’ So I then said, ‘I will talk to people and we will get names.’ And they still insisted for the first one that they mobilise three to get one and I couldn’t stop that first deployment, but I actually went up to where the first lot were being trained and talked to all of them and said, ‘There’s only one guy going to be going, awfully sorry about this,’ and so actually held onto the two who weren’t deployed. And then from then on I ran a rota whereby integrating regular army, regular Navy, regular air force, but particularly the army and the Navy, and the three reserve forces, all of which appoint separately, the different appointers do not talk to each other, hence trying to do it separately. And just by phoning up people and running a plot which within two months of the reservists being mobilised, I had a plot running out 18 months ahead, by talking to people, talking to my TA colleagues; there was no central list of them, it was all a question of talking to people who knew others and just trying to assemble it.

I:             Is there a central list now?

P:           Well I certainly left a central list. Not necessarily, because you may have a consultant anaesthetist who in military terms in the TA is, so to speak, a regimental medical officer for the Third Borsetshire Horse, because he doesn’t want to play in anaesthetics when he’s playing for his Thursday night and his weekend games. He’s quite happy to go as an anaesthetist if push comes to shove and he’s going to real life, but he doesn’t want to play in a field… there were a number who didn’t want to play in a field hospital with a TA, they wanted to play TA games and things like that, so I was able to get people like that out of the woodwork. And I would phone them up and say, ‘I’m sorting a plot,’ and they’d say, ‘Can I volunteer for this?’ And I’d say, ‘No, you’re not volunteering, I’m not having you volunteering, let’s discuss dates and then you’re going to be compulsorily mobilised, because if you volunteer you’ll only get your TA rank as opposed to if you’re compulsorily mobilised you’ll get paid to match your Health Service and private practise income’ and things like that.

I:             It must have made you quite popular, that then?

P:           I think it worked and it meant that somebody then got the mobilisation and oddly enough the dates had been in their diary often for six months or a year beforehand.

I:             So whoever was leasing them were also not surprised and …

P:           Not surprised, because they talked with them. And I didn’t have any appeals, because they talked to their trust, they were able to say, ‘I can be compulsorily mobilised,’ but, for example, I’d have somebody who was happy to go, but they were involved in the management of their trust and their trust was involved with two trusts merging. So they came back to me and said, ‘The trust’s not happy for this’ and I thought… he was the clinical director or something like that with two trusts merging and I thought, ‘OK, we don’t need to bother with an appeal, we’ll take him off now,’ we discussed other dates with him. He hadn’t actually figured that side of it out. So we didn’t have any appeals, because the trust and –

I:             You were able to keep a steady supply?

P:           Able to keep the steady supply going and not lose our reservists, because they had demonstrated that they were an integrated part of the military anaesthetics and it worked very well in anaesthesia; the other specialities it didn’t work as well is the impression that I have, but then I would say that, wouldn’t I? <Laughs>

I:             You were a member of the council until 2007 is that right?

P:           Yes.

I:             And you then began a Queen’s Physician?

P:           A Queen’s Honorary Physician, yes.

I:             Do you still hold that post?

P:           No, I don’t, because that is a while I am serving post, but that gave me the most ridiculous… a serious dose of what my daughter called, ‘Daddy’s bling!’


I:             Lots of nice things to wear you mean?

P:           I am told that the epaulettes that I had/have, which is gold wire and it is gold wire, I believe that’s about three grand’s worth.

I:             How often did you have to wear them?

P:           You put them on for anything. If you were going for a mess dinner, whenever you put the medals on and so on, you put this on, and duties in the palace, you’re putting it on for that, for garden parties and state banquets and things like that.

I:             Pleasant?

P:           Yes, or investitures, things like investiture. The way the medical cover worked for these things was that because the Queen’s Honorary Physician could be any speciality at all, he was there for the formal cover for something going on, but they always sent a senior anaesthetist trainee from whatever service the person was, so that if somebody did actually have a cardiac arrest, you had somebody who actually knew what they were doing, as opposed to a senior occupational physician or something like that. Now with a bit of luck I’d have known what I was doing, but I still took the trainee because it meant that I could enjoy what I was doing and in the unlikely event of work being needed, I’d also got somebody competent.

I:             You talked earlier about coming back to Derriford – how long were you working in Derriford for?

P:           Oh, until I stopped work altogether in 2009. Basically again this was the change that came out where the MOD stopped moving consultants around, which meant that I always came back to the same job in the UK.

I:             That must have been much better for you.

P:           Oh, enormously better!

I:             And also for the hospital?

P:           Yes. You see, where before that the military had moved consultants round place to place, which was just pointless, I made the point to people considering joining that I was the last consultant in the Navy to be moved from one Navel consultant job for another for military reasons. That’s why I was moved down to Plymouth, to take over the department with a view to integrating it, and in terms of an NHS job I never moved again and wouldn’t have wanted to. There are people who have moved subsequently, but those are moved because they have chosen to. I mean Charlie Edwards, who had been at the [43:00] I believe is now working at the QE up in Birmingham and things like that, but those were moves about like an NHS Consultant can choose to move.

I:             Did you have a special interest in Derriford?

P:           I was in the Pain Clinic for a while, but then whenever I took over the … Defence Consultant Advisor, running anaesthetics for the military, I dropped to what effectively became a part-time anaesthetists job, because there wasn’t the time to do … and so I stepped out of the Pain Clinic. I was just a jobbing gas man, working with Major GU and Major Operating GI, just because of the lists I had.

I:             You didn’t stay particularly in trauma for instance?

P:           No, I was on the On Call rota, which meant that I might be doing trauma.

I:             But not as a special interest.

P:           Not as a special interest. The acute on call was the special interest. Let’s face it, most trauma on the NHS is now done on schedule list, and most trauma is not the equivalent of a soldier getting blown up; it is granny fracturing her neck of femur, and there isn’t much military value in that. There is much more military value in doing the acute on call and the granny’s faecal peritonitis than there is in doing the trauma for granny’s hip.

I:             You finally retired in 2009.

P:           Finally retired in 2009.

I:             Having had some fairly serious family problems.

P:           2007 wasn’t a good year! Two of my trainees died, one with cancer, one with suicide.

I:             This was down in Derriford?

P:           Yeah. The suicide was in Scotland, but it was somebody who’d been in Derriford. They were both people I knew well. My father died, my older son died and my wife got a diagnosis of Alzheimer’s. We’d been suspicious of [45:03] Alzheimer’s before Corrin died.

I:             But that probably was the tipping point?

P:           Not so much … I don’t believe it tipped her Alzheimer’s, but it stripped away the coping mechanisms for dealing with a deteriorating memory.

I:             Do you have another son – is that correct?

P:           I’ve got another son and a daughter, so …

I:             And they live in the UK?

P:           They live in the UK, yes.

I:             Have any of them gone into medicine?

P:           I’m the only person in the family with anything to do with medicine. None of the others are … either military or medical, and I’ve no military or medical in the family; it just worked out for me.

I:             Is there anything that we’ve not talked about that you would like to mention or keep for memory?

P:           I’m not sure. I fell into medicine, I fell into anaesthetics.

I:             By accident, yeah.

P:           By accident. I haven’t done anything military or anything medical since the day I left. I haven’t missed either of them for a moment, but if I was to go back, if I could wind the clock back I would do the same thing again <clicks fingers> just like that. It was great.

I:             Did you get any other awards that we haven’t …

P:           No. I’m just a jobbing gas man there to do the job. <Chuckles>

I:             Thank you very much. That was very interesting.

P:           Thank you!


<Interview ends>