Dr Sir Peter Simpson: The Royal College & European Societies

Closely involved with several medical societies, Dr Simpson is a Past President of the Royal College of Anaesthetists and was the first President of the European Society of Anaesthesiology. He was knighted in 2006 for services to the NHS and initiated the first European-wide qualification in anaesthetics. In this interview he discusses his training and the role of the government and colleges in current medical education, and the role he played in establishing the European Society. The full transcript is available here.

Medical School and Marriage

Both my parents were doctors. No one before that in the family was a doctor at all. My father came from the north of England, northeast and basically came south before the war on scholarships because my grandfather, who I never knew, worked in the shipyards, and had no money. So my father came, went to Leeds and then came south, and met my mother who lived in Ealing actually and she was a doctor, she was one of the first lady doctors… at the Royal Free. And they married in the war… and I was born just at the end of it.

My father was a chest physician, and my mother did all sorts of things really, even some anaesthetics. She actually anaesthetised for an eye surgeon in London and would bicycle around giving open ether for eye surgery. Sir Henry Stallard she anaesthetised for, but she didn’t end up as an anaesthetist, she ended up actually in schools medicine, schools general practice really, and in the end wasn’t really valued and so she went off and did teaching after that.

I think probably once I ceased to have ambitions to be an engine driver, because my father and mother were doctors it was sort of assumed I would be really, and actually what I enjoyed at school was science so it wasn’t a very difficult choice I think probably. I sort of drifted into it and I wasn’t ever diverted from that.

It was the days when you said, ‘I’d like to come’ and you’d phone up the Dean and he said, ‘Why don’t you pop up for an interview, dear boy.’

I remember my medical school interview, they interviewed me and it was all very, very chatty and nice and then they said to me, ‘And how’s Tom?’ My father was Tom, so I said, ‘Fine, thank you very much.’ They said, ‘That’s jolly good.’ And afterwards I asked them why it was that they were so interested in sons or daughters of doctors, and they said, ‘Well, to be honest because you know what you’re going in for and the dropout rate is far smaller.’ It was the days when you said, ‘I’d like to come’ and you’d phone up the Dean and he said, ‘Why don’t you pop up for an interview, dear boy.’ And you did. And then they said, ‘Well just go away and get some ‘A’ levels’. I remember it very well!

I lived at home for the first two years because it was easier and because I didn’t have a grant, well I had a minimum grant, which I think was the princely sum of £80 a year if I remember rightly, and it was easier to live at home and travel in every day. And I found that difficult to get into the social side of it, because you were always going off home, so after that then I joined up with a whole lot of others and we had a flat and it was great after that.

I got through the exams alright actually. I’m the sort of person that once you set me down and say, ‘That’s what the target is’, I’ll go and do it. What happened was I got married when I was a student. That was very unusual in those days.

I was a third-year student when I got married, but first or second year when I got engaged, and my father thought it was all…I was far too young to do that sort of thing, though he was very fond of my now wife, and basically he said to me, ‘Look, as far as I’m concerned I will carry on supporting you as though you’re single, but it’s one go at finals. You fail anything, that’s your problem.’ And that was fair enough I thought actually, ‘cause he was actually supporting me completely really, so that was a big stimulus to get through, and yeah, I got through.

“‘It’s one go at finals. You fail anything, that’s your problem.’”

Her parents were on the staff of Bryanston School. She wasn’t quite might house-master’s daughter but she wasn’t far away… and she was to go to Great Ormond Street as a nurse, but she wasn’t then 18 so she couldn’t start, so she went off to France, to Grenoble University for a year, and when she came back her father said, ‘Simpson,’ he said, ‘You’ve got to find someone to play tennis with my daughter!’ And we were having a mixed tournament. And… in the end I played with her. We were the only two of course who took it seriously! But actually we weren’t an item really at school …well a bit, but I mean then we went apart while she went to GOS and I went to Barts, and met again two or three years later.

I was organising a big party and I went through my address book and thought, just invite all the people you can, and blow me down, she said she’d come! I was with another girl at the time and that wasn’t terribly successful, that bit of it, but the rest of it was very successful!

So we got married in ’69. Well, in my third year, and she was by then a staff nurse at the Middlesex.

“The Patient’s Going Blue…”

I did [one] house job at Chase Farm… surgery with a guy called Bill Richardson. And then I went across to Barnet General and worked for a chap called Gordon Royston as a medical houseman. Loved them, loved both jobs, terrific! Both of them with Australian registrars who were just terrific! They didn’t mess about, they just let you get on with it but by jingo they were hard task masters.

Basically I did house jobs, then I did A&E at Barnet ‘cause it was quite a busy A&E and it seemed to be quite good, ‘cause I thought that’ll be thing that teaches you how to do all the things you should be able to do as a doctor, and… I applied at Barts and the others… to do anaesthetics. And I did it only because I thought this looks like quite a nice thing to do, I’ll have a go at this. I had no preconception of doing it. My mother, who had had a tiny bit of it, was in no way influential. It was just I thought it would be a nice thing to do. It seemed to me to be an exciting and growing speciality.

“‘Mr Ellis, the patient’s going blue’ and he’d say, ‘How blue?’ And you’d say, ‘Very blue!’”

We had a great time as students doing [anaesthetics]… and the person I remember best was … George Ellis, who a lot of people know, who was basically Grimsdyke in the Dr in the House books and George Ellis wasn’t married, he lived in the RAC Club, and when we were students we were sent to theatre with George and he would let you … he used closed circuit halothane and he’d say, ‘Well off you go dear boy.’ Everybody was called ‘dear boy’. ‘Go on, dear boy’ he’d say, ‘just you do it. I’ll be in the anaesthetic room reading Motorsport,’ which is what he always did. And if you were in the theatre with a patient and he was in there, you sent a message in saying, ‘Mr Ellis …’ ‘cause we always called him Mr Ellis, he insisted on that, ‘Mr Ellis, the patient’s going blue’ and he’d say, ‘How blue?’ And you’d say, ‘Very blue!’ I think you realised how hairy it was as a student there, you were allowed to do a lot.

I certainly didn’t want to do general practice, I wanted to do an acute hospital specialty, that’s what attracted me, and what attracted me as well was being able to do the sort of hands-on things that people expect you to be able to do, and that’s why anaesthetists and, as it became, intensive care, was appealing really.

“I think you realised how hairy it was as a student there, you were allowed to do a lot.”

I did enjoy my first anaesthetic job, I did. I felt that I learnt a lot from a lot of different people, I modelled myself on one anaesthetist, a lovely man called Brian Gillet, who has since died, but he was just wonderful. He gave the most immaculate repetitive anaesthetics, and down to how many times he would brush his hand across… after he’d put the spirit swab on, to dry it. He always did it three times. And he was meticulous like that, and I could imitate Brian’s anaesthetic down to a tee. And that was good training because I had a really safe technique.

Barts, at the time I was there, had three very formative occurrences which really cemented… we had the Moorgate train disaster, we had the Tower bomb and we had the Old Bailey bomb, and the effects of those on you wanting to be able to treat people was massive. I think once I’d seen those, that was it, I was gonna do anaesthetics and intensive care without a doubt.

“Barts… had three very formative occurrences… the Moorgate train disaster, the Tower bomb and the Old Bailey bomb… the effects of those on you wanting to be able to treat people was massive.”

We did have triaging, I remember it quite well, the triaging, and that was very well sorted out, but it was quite an alarming experience. I came in on the train and there was a lot of congestion at Farringdon Station where I got off for the hospital, and I said, ‘What’s going on?’ They said, ‘Some idiot’s run into the buffers at Moorgate!’ That’s what we were told. And so you went to hospital and … most of the day it was a normal day and then suddenly, about lunchtime and then into the afternoon, suddenly people started trickling in. It was horrendous.

Academia

I was there as an SHO and then a registrar, and then I started getting interested a little more in research and that sort of thing and Peter Cole was at Barts and ran a research laboratory there where he encouraged us to do projects and then, every now and again, if he thought somebody was really interested, he’d encourage you a bit more, and I decided I was gonna spend more time with him, so I got a lecturer’s post there.

He was researching hypotensive anaesthesia and particularly sodium nitroprusside, and he had a biochemist there who had developed an assay for nitroprusside, and I was encouraged, that was basically, Peter Cole said, ‘Look, I’ve got the opportunity for somebody to do an MD working with Cyril’. And because I’m not the sort of person who says no to very much I said, ‘Oh, fine, I’ll do that’ and suddenly I went home and thought, ‘What on earth have I agreed to?’ ‘cause nitroprusside was, in those days, death in a bottle really, wasn’t it? I mean you didn’t know … hypotensive anaesthesia was quite a hairy occupation. He was a most amusing man really. Moderately chaotic I think is probably how one would describe him, but an absolute delight and an enthusiast. He was very supportive, very supportive.

“‘I’ve got the opportunity for somebody to do an MD.

Oh, fine, I’ll do that’… and suddenly I went home and thought, ‘What on earth have I agreed to?’”

The MD was called The Metabolism and Toxicity of Sodium Nitroprusside and I wrote it up when I was in Oxford, by then I’d gone to Oxford, but it was perfectly well received and passed and all that sort of thing, and I was very pleased I’d done it really. It told me an awful lot about research method. Peter was very good at that and also he was a great one for saying, ‘You need to finish this…’ There were other people who’d worked with him who basically had their MD thesis still written on the sleeve of a white coat, and it never quite got through. he was one person but the other person who said to me, who influenced me about finishing it was Cedric Prys-Roberts, but probably more of that later.

I was an SR, because I’d been a lecturer and I wanted to have my clinical credibility, I didn’t want the idea of just being regarded as an academic, because I didn’t know whether I wanted to be an academic for ever and so I decided that I’d done my two years as a lecturer and then I did two-and-a-half as an SR, a non-rotating SR in Oxford. My interests were largely clinical and intensive care… all at the Radcliffe. But of course I did quite a lot of research things along the way because people kept giving you things to do and there was also the MD to finish off and so on.

Alex Crampton Smith encouraged me in the sense that I went to apply for a job in Oxford initially, it was one that rotated with Reading and the impression you got was … ‘it’s all fine, you’re coming from a good lectureship, that’s all great.’ Anyway, I didn’t get it and nothing was said but I was a bit … ‘what’s gone on here?’ So anyway, I went off with my tail between my legs and I came back a bit later and there was a non-rotating job… and I was appointed to that, and afterwards Alex came up to me and said, ‘We thought you’d be better with a non-rotating job’ and nothing was said, it was a great example of nothing was said in those days, and I could have never applied again and would never have known any different, but that was the way it worked. They left it to your initiative, but they were very supportive… I was very grateful for that.

“We said, ‘Whatever you do, because it was not soluble in water, don’t put Propofol in Cremophor.’ So they did. And so in the early days… there were several anaphylactic reactions.”

I went to Bristol because I’d finished my thing, can’t remember whether we called it accreditation or what it was then, but I think it was called that, and I was wondering what to do and for two pins … I mean Oxford I thought was great, if there’d been a job in Oxford I would have applied… I thought it was wonderful, but then Cedric came along and he’d just moved down to Bristol and he was looking for a senior lecturer, would I be interested? And I said, ‘yes I would be.’ I knew nothing about Bristol at all. So he said, ‘Well there’s only one condition, because you must have that MD degree, not just you say you’ve finished it, it’s got to be done.’ So that was a big stimulus to get that knocked off and I did. And then so I went down, I was appointed in Bristol as a Senior Lecturer to succeed John Powell, who was a lovely man who then went back into the NHS.

I changed tack a bit then because… John Powell was interested in the early stages in the immunology and basically in how anaesthetics affected growth and the immune system and so on, and he had a wonderful technician there called Sheila Radford who basically then became my technician. I had a laboratory and everything. So we… got into anaesthetic immunology and in particular into the immunology related to intravenous anaesthetic agents. Althesin was the big one which we spent a lot of time doing, and trying to look at the predisposing factors to anaphylaxis to Althesin. We did a lot of work with women and with pregnancy and so on, ‘cause it was quite obvious there was a link there. And then we got into the issues around Cremophor, which was a preservative, and at that point then they introduced what is now Propofol, but it was ICI 35868 in those days, and they’d just got the initial trials, they’d done some animal studies, and they were just gonna start the human things, and they said that they were gonna produce it and we said, ‘Whatever you do, because it was not soluble in water, whatever you do, don’t put it in Cremophor.’ So they did. And so in the early days of propofol there were several anaphylactic reactions to it. But once they took out the Cremophor, it was fine. So we then had this new drug, this was first human patient studies, not volunteers, patient studies, and this lady said to me, ‘Yes, I’d have that’. And I said, ‘What made you say yes?’ And she said, ‘Because I know you’ll watch me like a hawk!’ And of course she was fine.

“I think the secret in those days was our training meant that we did a vastly greater number of cases… there is no doubt, to my mind, that volume is something that gives you confidence.”

I was a Senior Lecturer for about four years and at that point I wasn’t sure whether I wanted to go on and be an academic or not, and Cedric had made it quite plain  to me that a senior lectureship was not for life. He said, ‘You either go on in academia for a chair, or you perhaps move towards the NHS.’ At that time, my senior lectureship was based at Southmead and the Infirmary, and there was also Frenchay Hospital in Bristol, and at that time Ronnie Greenbaum moved up to London, he came from there to London, so there was a vacancy and I applied for that and got it, and actually so I moved into a totally, purely clinical environment which was predominantly neuroanaesthesia, thoracic anaesthesia and intensive care. And I stayed there for the rest of my career until I retired from clinical work in 2007.

I think nowadays patients expect, in terms of quality and safety… within surgery or anaesthesia, they expect somebody to be an expert. I think the secret in those days was our training meant that we did a vastly greater number of cases so that actually … I mean when I was in Oxford I did a solid three months’ thoracic anaesthesia, nothing else, and I probably did four or five months neuroanaesthesia, and that’s in addition to the intensive care, and you did do long days and see a lot of cases and I felt … because I hadn’t done it for about four years, when I first went to Frenchay I did want to just proceed cautiously, but to be honest, after two or three weeks I was fine. And we did, because we did a lot of things, my thoracic list on a Monday was four thoracotomies, which were lung resections and so on, and there was no time to sit down really, and neuro was pretty similar. And I think there is no doubt, to my mind, that volume is something that gives you confidence.

The Royal College of Anaesthetists

Actually I don’t see myself as getting involved in medical politics… it’s amazing how serendipity works, I went to Bristol ‘cause Cedric suggested it, I went to Frenchay because that’s what I wanted to do. When I was at Frenchay we had a very dynamic department, we had John Zorab, we had Peter Baskett, Ronnie Greenbaum had left but we had a number of others, and Robin Weller of course was a close colleague of mine really. There was a general feeling that ‘What are you going to do’… And so after a few years, they said, ‘Have you thought about doing something at the College? Why don’t you think about applying for College Council?’ So I applied and I didn’t get appointed because I was an NHS consultant in effectively a DGH, and you don’t know lots of people at that stage. I applied once to get onto the Association Council and didn’t get onto the Association Council either. And John Zorab said, ‘Whatever you do, don’t despair. If you want to do it, do it! The only way you won’t get appointed is by not applying. Do it.’ And the thing to remember is that basically as long as your share of the vote is going up, keep at it. If it starts falling off, that’s a different matter. So I didn’t apply again for the Association but I applied twice more for the College. I think on the third time I was appointed but it was certainly going to be the last one, but I got on. And it was really due to the encouragement of Peter and John that I did it, and I was eternally grateful to them.

The situation at Frenchay was always the department was left to its own devices really by the hospital. So basically as long as the work was done, how it was done didn’t really matter. Well that’s rather strong but I mean basically what I meant was John Zorab and Peter Baskett were away a lot and the VSRs just covered them and initially when I went away I would try and balance it so I’d try and make it like a bit of annual leave or a bit of study leave or whatever, and certainly when we went examining and that sort of thing.

It was only after I’d been an examiner at the College that I then applied to go onto Council. That was ’97… before we had, or the time we got a royal charter… I did enjoy it. I pursued an interest in exams, I was never Chairman of Exams but I was on the Exams Committee and I got into the education and training really. That was the bit that interested me. And if I look at all the things I did, that was the thread through it all really.

‘Whatever you do, don’t despair. If you want to do it, do it! The only way you won’t get appointed is by not applying. Do it.’”

I became Deputy Medical Director and then Medical Director at the Frenchay. And that was… again it was John Zorab you see, he was the Medical Director and he looked and he needed somebody to carry on, and what you did in those days was look around for people, didn’t you? And sort of say, ‘Have you thought about this.’ That was what he always said, ‘Have you thought about this?’ And I hadn’t really. But actually because I was an organiser and… I like to think fairly upfront and straight, and fair, it just sort of appealed to me, so I did. And we had a wonderful Chief Executive called Ann Lloyd, who became Director of Health for Wales, and she was terrific to work with, absolutely wonderful. She was very fair, very straight, you knew where you were, and yes, I was quite happy. It was at the time when we were starting to negotiate over producing a North Bristol NHS Trust and subsequently a new hospital, and by the time that was really going I’d finished my time as Medical Director.

The next major step, of course, was Vice President… at the College it’s very much a matter of taking your hat out of the ring if you definitely don’t want to do it, rather than putting it in, but it was not an unreasonable thing. I didn’t think it was me at all really. But then that’s for others to judge.

I was surprised when I became Vice President, and I was just as surprised when I became President, but of course the field was narrow and the difficulty with that was that there were really at that time I think probably two of us in the frame. We were very good friends and one of us was going to get it and one wasn’t. He is a good friend of mine, he’s a really nice guy, and it was going to be one or other of us I think. I don’t think it ever got to the stage of forgiving, but maybe he would tell you completely different!

State vs College

I think we were at a very difficult time with the European Working Time Directive for junior doctors, and junior doctors’ hours and the big influence that that had over training. I mean we alluded earlier to the idea of how much time did you have to train and how much opportunity did you have to actually do sufficient numbers of cases, and we were having to tackle very much the idea that working time directive reduced the availability of clinical material for people, and how do we avoid that elongating training?

So the European Working Time Directive was one, and then we got into the whole issue of PMETB, The Postgraduate Medical Education and Training Board. When I started as Vice President or President we had what we called the Specialist Training Authority, and the Specialist Training Authority effectively devolved the training of a certain specialty to the Royal College, and the Royal Colleges were therefore the final arbiter in the amount of training you did, how long your training was for, where you could do it, where you couldn’t do it, what was fit for training and so on. And there was no doubt that a number of politicians… did not like the power that the Royal Colleges had. [They] felt, and in a way I can see where he was coming from… the job of government in funding medical education and training is to train doctors to work in today’s NHS… And that is very different from what we did, which was training doctors to work in a specialty, but it wasn’t NHS focussed.

“There was no doubt that a number of politicians… did not like the power that the Royal Colleges had.”

Alan Milburn wanted to follow the model, as far as I can see, which is pursued in a number of other countries, whereby they say, ‘We train this many doctors, we need that many anaesthetists, that many orthopaedic surgeons, that many pathologists and we need this number in Hull and this number in the Southwest.’ And he wanted to be able to say that therefore they were training them appropriately for what was available. And there was a big faceoff with this in the sense that he was going, if he could, to put the colleges on a back foot effectively and say, ‘No, the state’s gonna control this. You colleges can do what we want you to do or what we tell you to do.’ So the Postgraduate Medical Education and Training Board was set up and it was chaired by a lay chairman. And it had representatives on it from the various colleges and from all sorts of other establishments as well and Peter Hutton was the President of our college at the time and… we agreed… ‘Somebody needs to be on this.’ My job. ‘Off you go and sit on PMETB.’ Or as you had to then, apply to sit on PMETB. And it wasn’t a foregone conclusion at all but anyway, I was appointed to PMETB and it worked OK, but there was an awful lot of treading on eggshells everywhere ‘cause the colleges were pretty opposed to it, and they saw it as training being imposed on them or standards being imposed on them. And it was struggling a bit, and then the people on PMETB said, ‘… we’ve gotta have a Vice Chairman… because what happens if anybody decides they don’t wanna carry on?’ So anyway, who became Vice Chairman?… and that was it, ‘cause I say yes to things. And then within about three months the Chairman had resigned because he felt he couldn’t work with everybody. So suddenly I was catapulted as Chairman of PMETB, and at that point I said to them quite clearly, ‘Look, I am a College President’ ‘cause by that time I was, ‘and I’m quite happy to do the two things, but I’m not happy to take off my President’s hat so basically my view is that PMETB needs to be working with the colleges, not telling them what to do.’ And this was a pretty big sea change. I was only the acting Chairman.

I think the critical shortfall in anaesthetists was anticipated a long time back. I think we saw it coming without a doubt…”

As I say I was acting Chairman, and I acted for about a year or more, and then they decided they were going to advertise the job permanently, did I want to apply?… you’ll have to stop being College President.’ I said, ‘I’m not prepared to do that. I was elected to do that and that’s what I want to do. You can have me in that knowledge.’ And I applied and Peter Rubin applied and Peter Rubin, quite rightly I think, got the job, so he took over from me, but by that time I like to think we’d actually steered it a lot more in a sort of complicit way and a collaborative way towards working with the colleges, and that’s certainly what Peter pursued. This was 2005 I should think, about that.

I think the critical shortfall in anaesthetists was anticipated a long time back. I think we saw it coming without a doubt, and that’s why we wanted to the colleges to be able to say that to accredit somebody you needed… There were many other things, but the PMETB and all the ideas behind that were much more in, because of course then it moved into accreditation of training and… became very much a sort of tick-box exercise, and so if it was an epidural, PMETB would say you need to do 30 and as soon as you’d done 30 you ticked the box, whereas our view before that was that actually it didn’t matter how many you did, as long as you were competent! Obviously you had to do a minimum number but after that you were much better able to be seen to be competent by those who were training you. They would sign you up in a much more sensible way.

It was a difficult time… at that time I think a lot of the colleges… felt under threat. Because they’re back now I think, the specialty looks to them to be run by them.”

It was a difficult time. I mean at that time I think a lot of the colleges… felt under threat. Because they’re back now I think, the specialty looks to them to be run by them and everybody acknowledges that’s how it’s done, but at one stage there was very much the belief that actually government could take it over and we would just be a sort of … I don’t know how we’d work with the Association but we’d be just a professional body really.

Europe

My European involvement goes back, again, to John Zorab. John Zorab was a member of the European Academy, and they decided they thought they might run an exam, so John came to me and he said, ‘You’re into examining, aren’t you? Can you help me? It won’t be very much. Can you just help me set up a multiple choice exam that we could use in Europe? Use some of the basis that you’ve got in England.’ And that was the start of 25 years of developing the European Diploma in Anaesthesiology and Intensive Care, which is still going today. It’s the only multilingual medical exam in Europe. It’s run in probably about eight languages now including English, but when we started we had a nucleus of lovely people from Europe, professors. So we ran it originally in English, French, German, Italian and Spanish. And the secret, of course, was to get a translation which was accurate in all the languages and so on, and we managed to do that and it became… it’s now a big exam. It was designed, I think really, to answer the question which still gets posed today, which is when an anaesthetist from a European country comes and applies for a job in the UK, how do you know they’re any good?

“Can you help me? It won’t be very much… just a multiple choice exam that we could use in Europe?”

And that was the start of 25 years of developing the European Diploma in Anaesthesiology and Intensive Care…”

I think the raison d’être was to give countries which did not run a qualification the opportunity to show that they could do one and did do one, and then it became that because it became associated with the freedom of movement of clinicians, and I became very passionately involved with that and ran it as I say until … I stopped after about 20 years I think.

What happened was that I was running this exam and at the time there was a decision that, we had the European Academy and we had the European Society and we also had CENSA, the Confederation of European National Societies of Anaesthesia and a lot of people thought that it didn’t really work having effectively three organisations in Europe, and people were prepared to put their differences aside, I think, to a good degree, to try and look at whether we could amalgamate these organisations.

“I am really proud that we managed to do it!… I think anaesthesiology in Europe is undoubtedly better for it.”

I got involved because basically each organisation brought different things and the academy, which was what I was involved with ‘cause of the exam, was bringing the exam, the journal, and hospital visiting programme and all the sort of things … similar to what the College did in the UK. And before long the exam became a key thing, a key bargaining chip, call it what you will, in the thing, and the question was how we were going to assimilate the exam and before I knew where I was I became a sort of figure trying to mould the new organisation, incorporating these things. Why, I dunno. Perhaps because it’s an English trait, I don’t know. But anyway, I did get involved with a lot of that. And there were some fairly vested interest in various places… but at the end of the day I am really proud that we managed to do it! And I think the success is the envy of a lot of others that couldn’t do it and I think a number of people gave up their aspirations perhaps to presidential roles within the various societies, and I think anaesthesiology in Europe is undoubtedly better for it, without a shadow of a doubt actually. Sorry!

I feel very strongly because basically if we’re not members of the European Union, no longer will our people be considered as eligible to sit the examination, ‘cause to sit the exam you have to be born and you have to have your primary medical qualification in an European member state. We’re no longer a European member state. The consequences are significant. There might be a way [around it], but I am sad because I regard myself as a European and I have many great professional European friends.

NCEPOD & Triservice

The National Confidential Inquiry into what was originally Perioperative Death and then became Patient Outcome and Death. I was a member of that. Again representing the College, and then I became its Chairman, and I loved it actually. I think we did a lot of good work there. It still carries on now. It has a lot of influence, when an NCEPOD Inquiry comes out hospitals have NCEPOD committees to deal with the recommendations of the inquiry and there’s no  doubt that the methodology of NCEPOD was used to look at the cardiac surgical results of individual cardiac surgeons, and is at the basis of a lot of, currently of accreditation.

It was all about getting people’s confidence that you were actually doing something which was designed to improve the quality and safety of patient care, not to pillory individual people or whatever.

“We had an SR with us and one day on the secretary’s typewriter was a message saying, ‘Gone away, don’t know when I’ll be back.’ And of course he was off to the Falklands.”

I enjoyed being President of the Triservice Society. That was by invitation because I have no connection with the armed forces at all, and because of my association with the College and because the armed forces, the military branch… we organise their training in the same way as we organise civilian training. And I enjoyed it very much actually. They were very, very welcoming. We had some very interesting meetings. It’s an opportunity, I think, for us to realise how difficult it is for them to complete their training while they’re on deployment or the deployment interrupting it and so on. I remember years back when I was at Frenchay we used to have forces anaesthetists there, and we had… an SR with us there and one day on the secretary’s typewriter was a message saying, ‘Gone away, don’t know when I’ll be back.’ And of course he was off to the Falklands.

Achievements and Regrets

I was knighted in 2006… that was a massive, massive surprise. I mean I was thrilled … for the speciality of anaesthesia it’s terrific. I was the lucky recipient of it. But it did come as a big surprise, yes. I mean I had an inkling that there was a submission going in, but when I came home and opened an envelope … the word knighthood written on it, I thought now that is really strange! But actually … it is good for anaesthesia. And I do my best now to try and promote others in whatever way we can really.

“I was knighted in 2006… that was a massive, massive surprise.”

We’re a very close family… we had a different arrangement from nowadays because of course Jane, my wife, was at home for 16 years while the children were growing up, and so they got the continuity there, but maybe … I wasn’t that much of an absent father I don’t think, well I was I suppose. I worked all the days and of the nights of course we did many more nights than these days. Working weekends as well and I used to travel to London a lot. I used to have a season ticket up on the train. And Bristol’s sort of doable in a day but if you want to get up for an early morning meeting, it’s a bit difficult.

My son became an anaesthetist after I’d finished. We were deliberate in avoiding any association and in fact people at Exeter didn’t know we were related at all, ‘cause it’s quite a common name. But he got into intensive care first and then wanted again to do the practical things which anaesthetists do.

“I say about 95% of my career I enjoyed, 5% was tough… I had a wonderful time.”

Do you know I don’t think there’s anything I wish I hadn’t done. I don’t have any regrets. I think I enjoyed, I say about 95% of my career I enjoyed, 5% was tough. Probably the toughest bit was being a medical director actually. I thought that was tough because so much of it is dealing with personnel who are actually your colleagues. And that was quite difficult. Yes, I think that was probably the toughest, but overall I’ve very little regrets. I had a wonderful time.

I think [the biggest achievement] it’s the European Diploma actually, because it had such massive ramifications. We started off running it from a bedroom at home, as you do with these things, and you end up with an international qualification… And it was because we persevered with it, ‘cause it wasn’t all plain sailing and we had to do a lot of persuading of various governments… For example you go to a country like Poland and they have their own way of training people and they don’t want you interfering with that, and the question is how can you graft something onto their training to allow their trainees and their accredited people to move around? It was that sort of diplomacy I enjoyed a lot. But I could never have done it if I didn’t have the background in the UK. Being a College person, and then being President of the College, was massive advantage because you could actually carry that credibility through. ‘cause at one stage I was President of the College and either President of the European Society or about to be, and it was a very big advantage doing both, very big. So it’s difficult to say just one thing but possibly.

I think people need to be aware of the potential interference of government with professional training…[it] is a very risky thing to do”

I think the bit I think people need to be aware of is the potential interference of government with professional training. I said it earlier and I’d say it again really, that I can understand the logic that says if they pay for it, they ought to be able to have an influence; but the idea of trying to take it over I think is a very risky thing to do. It doesn’t work, it’s like any profession. Yes, you can, I suppose, try and influence the way training goes, and it will happen again, I’m sure it will happen again, but thinking back on what these various things and PMETB was something which I think could have absolutely gone terrible really. So that’s the message I think.