Dr Sheila Willatts: Full Transcript

I:             We really like to start at the beginning and look at a little bit about your background and your family. Would you like to tell us where you come from and who your parents were?

P:           I was born on 6th June 1943 so I was one year old on D Day and I always remembered that, or subsequently remembered that. Born to a farm worker and his wife who worked for the local farmer in a very small village called Wendy, which is about 13 miles from Cambridge. Went to primary school in a village called Bassingbourn where I have occasion to be very grateful to the headmaster. Basically we were very poor and, as a result of that, my parents knew that if I passed the Eleven Plus I would go to school in Cambridge and they couldn’t afford that. But the headmaster must have thought that I was reasonably bright because he encouraged them to let me take the Eleven Plus because I would get a free bus pass and I would fall into the category of having free school meals and you could get a grant for the uniform so they let me take it. And so I then went to Cambridgeshire County High School for Girls and there I stayed until I left to go to medical school.

I:             Do you have any brothers and sisters?

P:           A younger sister, nearly two years younger than me.

I:             Did she go into medicine?

P:           She didn’t go into medicine; she went to work at Addenbrookes though, in the accounting department, so she had her finger on the pulse of things that were happening.

I:             And after you left school, where did you go to university?

P:           Then I went to University College and then subsequently the medical school.

I:             Was that a particular choice that you wanted to go to?

P:           Well I didn’t want to be too far away from home. I’ve no idea why I thought that but London was very easy to get to and I think I may have been recommended this by the headmistress who said that they took more women than some of the other medical schools at the time. And indeed they had about one fifth of women entrants.

I:             When were you first interested in doing medicine?

P:           I think I remember talking to the headmistress when I was head girl because you had to entertain the headmistress for a few minutes each time, that I might like to be a nurse and she said well I could probably aspire to being a doctor if I wanted to. And I think it came about because in the year of the Queen’s coronation, my father had an industrial accident. He worked for the local farmer and, you may not remember these old binders which went on the back of tractors before the days of combine harvesters, and the blades would turn round and it got stuck, and he knew what the problem was, he saw the piece of string along the spindle, so he put his hand in to pull the string out, and the arm was left in the field. And there followed about a month of being in hospital. And one does dwell on these things and I think that may have influenced my decision. But I also belonged to the British Red Cross as a junior cadet.

I:             What did you do in the Red Cross?

P:           Well you went and you learnt. You learnt first aid and home nursing and a few other survival things. And you used to go in for competitions and things like that.

I:             It’s something that was quite popular just after the war, isn’t it?

P:           It was, it was.

I:             Whereas nowadays it’s much more low key.

P:           Yes. It’s more low key except in its work overseas. You remember these things and one of the organisations I still support is the Red Cross.

I:             When you got to university did you enjoy your time there? Is there anything special that stands out?

P:           I did. I think I was home sick for the first month and then I wondered what I was going to do with myself when I went home for Christmas at the end of the first term. I liked going to the outside places in London, I remember them as very happy times and associating with people doing the same stuff as you. A kind of camaraderie I guess.

I:             Are there any particular things that you remember as highlights in your undergraduate training?

P:           I was thinking about that and there is not a highlight, truthfully. It was all seemed to be going in the right direction and enjoying it.

I:             Which was your first job after you graduated?

P:           It was very difficult getting house jobs because, unlike now when there is a large-ish area within the Deanery, in those days if you didn’t get a job at your hospital belonging to your medical school then you had to find yourself one. And it took quite a while to get my first house job.

I:             Which was where?

P:           That was at the Bolingbroke Hospital.

I:             And that was medicine or surgery?

P:           The first one was medicine and then the second was surgery, and that was really good because the Guy’s surgeons would come to the Bolingbroke and they were quite high profile people.

I:             So you did both jobs in the same hospital?

P:           In the same hospital, yeah.

I:             And when was your first inkling of an interest in anaesthesia?

P:           It was because I wanted to be able to do practical things. It’s no good prescribing when you’ve got a calamity on your hands. You’ve got to be able to do stuff. So I think I thought that that was also a good thing for a married person to do and bring up children, general practice would be even better. So I went into general practice and then that’s when first daughter was born. And then I went back into anaesthesia after that, partly because I was known in the local hospital, St. Helier, and it was an easy step back into something I enjoyed doing.

I:             Did you enjoy general practice?

P:           I didn’t dislike it. I was called the ‘dolly doctor’ on account of there were not many women GPs around. It was in Reigate in Surrey and lots of women would come to see you just to have a little chat, because their husbands went to London on the train, they had nothing better to do. If there was anything even faintly like an emergency, like delivering, with forceps, a child in the local cottage hospital, you got into trouble for leaving the laryngoscope open and the bulb went flat rather than congratulated for saving the baby’s life. And so I didn’t dislike but it wasn’t my favourite thing to do.

I:             So you went back into anaesthetics?

P:           Went back to anaesthetics.

I:             And where did you work after that?

P:           That was back to St. Helier and then on the Kings circuit to Bromley in Farnborough.

I:             Obviously you had a family at this time; did you have any other outside interests that were particularly involved in?

P:           We did like the garden; both of us liked the garden.

I:             And you had three children, is that right?

P:           Three children.

I:             Boys? I can’t remember.

P:           It’s a boy sandwich, yes. So elder daughter, younger daughter, and son in the middle.

I:             How did your career develop, do you think, over the next year or two?

P:           I think it was an issue then of juggling family with training. And that is much more difficult to do than you ever think, even with help, even with resident help. It is difficult because you have to apportion your time appropriately. And then came the decision about where to look for a consultant job and to move to Bristol was a big step. Away from the then father, because of divorce. So you’re taking the children quite a long way away. But I was immensely lucky to go to Frenchay where John Zorab and Peter Baskett, they were both immensely supportive. They did look a bit worried about having a single parent with three children appointed, but they had always been very good at pointing me at opportunities, for which I was very grateful, very grateful.

I:             Can you remember any particular colleagues during your training that had a big influence apart from people you just mentioned?

P:           I think Shorty Mason, who was a at Kings, who was very good at looking out for where his trainees were going to be going, asking them how they thought they would fit in their personal life with their consultant life and being very encouraging. And actually that was borne out because there were a huge number of his ex-trainees at his funeral. I think we remembered him very affectionately. And also [10:27 Dougie Days] at Kings, less so because Shorty was always pioneering.

I:             What started your interest in intensive care?

P:           I think that was while still at Kings when it became obvious that there was a big difference between the technology of ventilating people and maybe having them on inotropes and looking after the whole patient who had a diagnosis and an illness. And anaesthetists were not trained for that. So there was multidisciplinary input from surgeon’s physicians and others, but actually gathering the whole thing together to get the patient better wasn’t really a concept that we were taught then. But it was definitely at Kings, and I remember Dennis Potter who was running that unit, we were much in awe of Dennis, I have to say, but he hadn’t grasped that idea either.

I:             You must have been involved in some of the quite early intensive care units, were you not?

P:           Well Kings was already going because of the usual things like cardiac surgery, and of course it had the liver unit with Roger Williams. Out in Bristol, Frenchay was very much the neurosurgical centre, head injuries, so that had a significant focus on that aspect. But again there was some resistance to this concept of looking after the whole patient and all their illnesses.

I:             What was your first big step forward in intensive care? What do you think was your first major contribution?

P:           I think it probably was getting a bit of a feel for what was happening across the country, joining the Intensive Care Society, and then standing for their Council. So that, we’re getting mid-eighties and I went to Bristol in ’78. So I think that was what started it all off.

I:             I can’t remember, who was involved in the Intensive Care Society at its beginning?

P:           Well I think the very first president was Alan Gilston. So he basically started with a cardiac surgery background, he was very dynamic. And then it moved on to people like Mike Telfer, Iain Ledingham, and then the younger whippersnappers like I came along and I did time as chairman. It wasn’t called president in those days, just chairman. And then we got to talk with other European countries and I think the biggest eye opener was seeing, from World Congresses, how the Australians did it. And they laughed at us and our backward approach.

I:             Why did they think we were so backward?

P:           Well outspoken people like Malcolm Fisher, who you will have met I guess, they had a training plan and they were charge. You would call it a closed unit rather than an open unit when all of the consultants and physicians were in charge of their patients and you were just helping them out. We had no formal training programme. I think they laughed at our rather traditional ways. But it did make me think about the differences.

I:             You went out to Australia and New Zealand, didn’t you?

P:           Yeah, a couple of times. The first was in ’89 and that was a guy called Geoff Dobb who trained with Margaret Branthwaite here and worked in Perth, and he was quite high profile in the Australia and New Zealand Intensive Care Society and invited me over to their equivalent of the Association postgraduate study day, and that was in ’89. I had then met Michael, who was to be my second husband, and he heard that I was going to Australia and he hadn’t been, so he thought it might be nice to come. So maybe after all we could use it as a honeymoon and perhaps we’ll get married. So that was a working honeymoon.

I:             You’re husband’s not in medicine, is he?

P:           No, he’s an electrical engineer and he did his PhD in radar, but he’s very good with computers and stuff which is enormously helpful.

I:             What’s your particular research interest in intensive care?

P:           I think everyone comes to this at the end. It’s how you cure sepsis, because this is the big killer. We were focusing on all kinds of … Tinkering at the edges really in those days, finding a way to cure endotoxemia we were focused on, and there were some agents that could potentially be useful. The complexity of sepsis had really escaped us at the time and the agent that I was researching didn’t improve outcomes. Now, in retrospect, I’m not in the slightest bit surprised. But then we were very evangelical, it was definitely going to work.

I:             You did quite a lot of work with maternal cases as well, didn’t you?

P:           Not with maternal cases. I did have to review all the maternal deaths. That was when … In the olden days when the Chief Medical Officer had advisors in all of the specialities, I was the one for anaesthesia. And that was put together with pain and intensive care and so I had  a look at all of the stuff that came from all of the regions and I’m just trying to remember what that group was called before it’s called what it is now. Confidential inquiry into maternal deaths was its longer title. It’s changed a bit now.

I:             How did you become a confidential advisor?

P:           I think it probably was because of the Association of Anaesthetists because their advice was sought on someone who had a reasonable overview of what was going on. And I think it was probably people like John Zorab and Peter Baskett who were sitting round this Association of Anaesthetists Council table and tossing names into the system and they included mine, which was obviously from personal contacts but knowing that I was quite keen on this intensive care business. So I guess I had a wide knowledge of stuff.

I:             Did you have any other major research interests other than sepsis?

P:           We looked at selective decontamination of the gastrointestinal tract which was a bit related and I had a couple of research fellows looking at those aspects, but also we looked at isoflurane for sedation in intensive care and the x-ray department and that was a different research person. It worked awfully well but it was very impractical.

I:             Why was it impractical?

P:           Well it’s the scavenging. And about that time we were quite taken by the ill effects of pollutants and, OK it’s fine scavenging in a single operating theatre, but from eight intensive care beds it might not be quite so straight forward and poking it out and into the atmosphere. And we were not geared for that. And neither were we really geared with the right vaporisers for the intensive care environment. So it did work awfully well.

I:             Have you got any particular colleagues that you remember specifically from those particular years

P:           I think Iain Ledingham because he was far sighted and he wasn’t an anaesthetist, so he wasn’t coming from the same place.

I:             But he was particularly interested in intensive care, was he?

P:           Yes, he was. He was a surgeon who did the shock team in Glasgow and then he went off to the Gulf, I’m not quite sure where, and interestingly he and Judith Hulf and I were the first honorary fellows of the Faculty of Intensive Care Medicine, which was 2012 I think. So he’s definitely considered the father of intensive care.

I:             You’ve published a great deal, is there any particular publication that you’re very proud of?

P:           I think it would be not the research kind of stuff, that’s not ground breaking in any way, but it’s the sticking your neck out with an editorial in Intensive Care Medicine. And it was about training. I think, if I remember this rightly, started with, ‘A prophet is not without honour, save in his own country and in his own time’. Everywhere else in Europe, Australia and the States had got training underway and working, and we were really lagging behind. And it was to try and get this message across.

I:             And that’s where you became particularly interested in training in intensive care?

P:           Yeah.

I:             Can you tell me a bit more about that? How it developed and who you had to deal with?

P:           Well clearly the service was largely delivered by anaesthetists, like 80% of practicing consultants in intensive care were anaesthetists. So starting there and I think it would be true to say that Cedric Prys-Roberts was very supportive of this concept of needing specific training separate from anaesthesia and the idea that all the colleges needed to be involved. So he was instrumental, with the other presidents, in helping to set up a group. It had various titles over its time like, ‘interfaculty’, ‘intercollegiate group on training’, so we developed a training programme and the concept and the content actually of a diploma in intensive care medicine and in the later committees we even looked at the concept of a faculty. But this was well before it was going to be accepted elsewhere. In fact I think it was emergency medicine that was setting up a faculty and so we got their Dean to come and talk about it. So there were people who were very clear about where things should go, but there were also those in anaesthesia who were rather reluctant to see that move forward.

I:             They didn’t want to let go?

P:           They didn’t want to let go of intensive care and they were lobbied by those anaesthetists who preferred a fairly gentle life at the head of the table, and I might unkindly call them, ‘those who worked to live’ rather than ‘those who live to work’. But they didn’t want to go beyond that immediate perioperative period into looking after the sick ones longer term. Or even those who were not surgical at all. So there was a reluctance, a very considerable reluctance.

I:             How do you think that was broken down, that reluctance?

P:           I think it probably was those people who were actually involved in the intensive care environment and knew their training could be better who were beginning to say, ‘Hang on, can’t we do better than this? Other countries are doing better than this.’ And quite interesting, I think it was but without referring to the CV I can’t be sure, Charles Hinds and Ken Hillman and myself did a survey because we talked to John Nunn who was the Dean of the Faculty in those days. John was very supportive of multidisciplinary training. We did a survey and it transpired that only about 16% of trainees had any training whatsoever in the wider field of intensive care medicine. So, with a bit of data there, John Nunn support, other colleges wanting to be involved, and people doing intensive care, young consultants, realising and writing to say, ‘Actually we really do support this’, then there was a groundswell of positivity rather than the negative, ‘I’ll sit at this table until the end of my list and then I’ll go to recovery and then I’ll go home.’ So I think that’s how it really came about.

I:             How do you think things are going to progress over the next couple of years from where they are now?

P:           It’s very interesting. Yesterday evening I was talking to Peter McNaughton, he’s on the Board of Faculty. And the numbers of fellows are going up as they get their exam and I think that will continue. And now that the College has adopted this perioperative role, that I think is another big wave not unlike the development of intensive care medicine, I think the Faculty will move from strength to strength and be a wise voice listened to because older, sicker people, we hear it all the time and we know we’re getting older and sicker, but we all make much greater demands on the health service and you have to be a very peripatetic doctor to be able to cope with that. Now the second wave that we were hearing about yesterday, and Rose McDonald asking this question of manpower for perioperative medicine I think these things will move forward possibly to the detriment of your everyday anaesthetist, if such still exists. I did retire in 2002 so I don’t know if such still does exist. I think it does in the smaller hospitals.

I:             I’ve heard a claim that anaesthesia, as such, is taking over the whole hospital.

P:           It’s not anaesthesia.

I:             No, it’s not. But you can see where that claim is coming from. A lot of the other specialties are feeling somewhat threatened by what they feel is intrusion into some of their area. Any comment on that?

P:           I think numerically we are the single biggest hospital specialty. I don’t know if it’s one in seven now, is it? They’re not anaesthetists, in the true sense of the word and how we used to be when we first became consultants, which was very much we were technocrats and we did the job and didn’t look at the wider picture. So it may be that there’ll be some re-naming.

I:             So there might be a breakup of the speciality as such into different sub-specialties?

P:           I think there might.

I:             You’ve chaired various organisations and been heavily involved in them. Is there any particular one that we haven’t mentioned so far that you’re proud of?

P:           I think probably it would be right back to the Intensive Care Society because these were such early days and the numbers of people who belonged to the society were very small, so we were very much feeling our way and very much perhaps behind other countries. So those were pioneering times and they were exciting times. And introducing things that the Association will probably think very simple like prizes for posters and things like that. It was quite innovative at the time.

I:             Can you talk a little bit more about your connections with the Association?

P:           I was never on the Council of the Association except as a co-opted person because of being CMO’s advisor. And it was immensely useful being there to take back stuff that was going to be relevant. You have to remember that CMO used to see his advisors in great lumps, but he would listen quite hard to stuff that was going on and things that were of concern, largely to working practices hence the Association had a far more useful voice and input into that than, say, the College. That’s not being detrimental in any way to the work that the College was doing but it was a good network that. It’s sort of fizzled out.

I:             Who was your CMO when you were …

P:           It was Kenneth Calman, who was …

I:             A very influential man.

P:           Oh yes. He went off to Durham, didn’t he? But also my husband, Michael, he was very keen on clocks <chuckles> and so they would have some good conversations about such matters which I knew nothing about. No, he was very influential because he did the Calman report on training, which was important to the Association but perhaps not so important as it was to the College. So, yes sitting on Association Council meetings as a co-opted person was very useful in picking up all of the issues that related to working practices for anaesthetists.

I:             I know you’ve also done a lot of work for the College and you’ve been an examiner for the College. Would you like to tell us a bit more about that?

P:           It was a bit daunting, being an examiner. And in the early stages, because I only examined for the then part two not the primary, the pass rate was quite low and it was of some concern that people would pitch up, often rather unprepared. So I think that fed into improvements in training. I mean you have just mentioned some of the ways that training have changed, but the unpreparedness of those who pitched up and, in those days, there was a clinical exam and it was quite salutary how some of the candidates had not got a clue what to do with a patient. And people could fail part two, they’d passed the primary and they’re onto part two, and they could fail that up to 10 times. It shows there’s something wrong with the system.

I:             What do you think the reason was for that? It’s quite a daunting thought.

P:           I think the candidates underestimated the standard that was required. But we did change things to have people sitting in on the exam, College tutors, I think all the regional advisors were processed, but that made a great deal of difference and that was reflected back. And I think the pass rate has improved.

I:             You think those people sitting in went back and fed back to their departments or their areas what needed to be done?

P:           I think so. That was the concept. At the end of the day it is up to the individual to get the facts and the skills into their heads and hands but I think largely the candidates underestimated the standard, not because there wasn’t material available, because the MCQs, short questions, were at there … Neville Goodman in particular produced a number of books.

I:             Was there some particular area of the clinical that you felt that they were particularly bad at?

P:           I don’t think so, although you could possibly make the case that in the olden days when the examining halls were in Queens Square, many of the patients used to come from the National Hospital for Nervous Diseases with all kinds of bizarre diseases that you would not necessarily expect those who were going for a career in anaesthesia to be about. So that may have been a factor.

I:             You think that was perhaps an area that should have been played down a bit, made broader based?

P:           I don’t think you should play down the importance of the clinical exam. But it may have been that the examiners could have found a better source of patients.

I:             How long were you an examiner for?

P:           I think I was an examiner for 12 years.

I:             So you saw quite a lot of trainees in that time?

P:           Some of who pop up now and again and say, ‘Do you remember me?’ And I think who the hell …  And it was that I examined them, and then you think, ‘Did I pass them?’ because that was quite important! And the most recent example, which you can cut out if you want, of a trainee popping up, I think I told you we’ve had a house in North Devon on the market for three years. In July, a second couple were coming on the same Saturday afternoon as the estate agent was walking one couple around, and please would Michael and I show them round. So we said, ‘Yes’, and emerged from the rose bed to see them when they came, introduced ourselves, and the man looked at me. And I’m thinking, ‘I wonder if he’s famous?’ I could not recognise this person. And I looked again and I’m thinking, ‘This is very embarrassing.’ And finally he said, ‘It’s Sheila Willatts, isn’t it?’ and I said, ‘Yes’ and nearly fell through a hole in the ground. He was a trainee in Bristol who had left in 1981. So they do pop up all over the place, which is very nice if it’s for the right reason, like if you pass them, if they buy your house.

I:             You’ve given quite a lot of prestigious lectures over the years, is there one or two that you’re particularly proud of?

P:           The one which was a bit scary was talking about futility and it was at a meeting at the College and it was about trying to keep alive those persons in an intensive care environment when the chances of recovery were very, very small. Now, yesterday evening I went to a meeting on mediation sponsored by the Faculty of Intensive Care Medicine and the Intensive Care Society. They don’t use the word futility anymore; everyone is kept alive, largely because the family insists. And things have changed enormously, and the guy who was chairing it was Justice Hayden, and he put this down to the rise in patient autonomy. All these patients in the intensive care environment that you’re talking about lack capacity. So it’s a bit of brave thing to talk about futility but it wasn’t seen to be that at the time. And one or two people came up afterwards and said they thought that was very interesting, slightly brave. In those days we felt we could go there. So is it a form of rationing if you can treat 100 patients for something acute in hospital rather than …

I:             What are your own personal views of that?

P:           Well I would like us to go back to being able to have a sensible discussion where the intensivist is seen as someone who knows a little bit more about prognosis than the patient’s family, is trusted, perceived as knowledgeable, not riding roughshod over the family but coming to an agreement that it is useless, futile, dare I use the word, to persist. We’ve moved a long way from that. And one of the speakers last night actually was the paediatric intensivist from Southampton who was all over the media when the child with the brain tumour was taken for proton beam therapy out of the country.

I:             Do you think the internet has had some influence on that?

P:           I think it has because you dial what you want to see where you can get it. I don’t think it means that the internet is wrong but there was that very interesting quotation from John Crowhurst in yesterday’s lecture, ‘If you want information, the internet is brilliant. If you want knowledge …’ Pause. It’s unevaluated information, isn’t it.

I:             But that’s what the patient’s relatives can get.

P:           Yeah, it is. Does that make them as knowledgeable and wise as a good clinician?

I:             This is a slightly odd question, but do you think the fact that families are much more scattered than they ever used to be has made life more difficult?

P:           I think it has because when you consider the number of single parent families, you need twice as many houses. Why do we need all these new houses? Because mother and father are not living together anymore. So you need double the number of houses. That’s an exaggeration, obviously. But the experience of trying to talk to a family around organ donation in brain stem death, the families are not a cohesive whole. They’re very often fighting. One really stroppy individual who is completely against transplantation or at least organ removal from their family member, will sway 16 sensible individuals. That can’t be right. But it is, I think, because you don’t have three generations living in the same house hardly anymore.

I:             And they’re perhaps unaware of the deterioration of the person who might have been involved coming towards the end of their life. Is there any way that we can improve that conversation that we have to have, or we used to have to have?

P:           I think it is interesting. I think there are now so many people involved in the care of one critically ill person that the continuity is lost. And with working time directives and other issues that limit the period of time that people can work, then patients and their families don’t develop the right close relationship with, ideally, the team leader, so that they will be trusted. I think that’s a way around it. And I’ll always remember one guy who we had sorted out from about his fourth admission to an intensive care environment with chronic obstructive airways disease and ventilated, had bad emphysema, and the nurse who was looking after him says, ‘He wants to have a word with you at the end of the ward round.’ And so I went to have a word with him, and he said, ‘I don’t want to be exposed to this again. I don’t want you to admit me again.’ And I think that kind of an exchange is really rare but you could only really have it if the whole unit has great confidence in the person who’s running it because otherwise someone will say, ‘Do you know she went in and talked to that man and said he won’t be ventilated again. What do you think of that?’ so you have to be immensely trusted. Those kinds of things would be great but I don’t think we’re going there. We share the responsibility with too many others. But that is a personal view. I don’t know if you would agree.

I:             I would agree strongly and I suspect a lot of other people would but whether they would admit it or not is probably a little bit different. It’s a modern phenomenon rather than something that people have been brought up to consider. You’ve done guest lectures abroad, haven’t you? Are they particularly stand out in your memory?

P:           A long time ago, ’89 in Perth when we had the ANZACs meeting, and talking about … We’d recently introduced the  APACHE II system here and we had Kathy Rowan at Oxford reviewing 23 units [corr. 26 units] and we were looking at severity scoring generally and how to use it for risk adjustment and evaluating outcomes. And so giving an overview there, the Americans were already well ahead of the game and they had Bergner, he developed the APACHE system. But giving that overview was really very useful to me but the input from the Australians about how we should be going about it because there were various other systems that were in use at the time and just that overview, the input, so you make a contribution you get at least as much back again in terms of discussion. That, I enjoyed. Two way.

I:             Did you come home with strong ideas of how you thought things should change?

P:           I think with reinforcement, it feels as though the Australians had got it right, and we must press on trying to get better training. Now bear in mind that was in ’89, it took until 2012 for the faculty of Intensive Care Medicine to be developed here. That was quite a long project to get to where we were going.

I:             Do you think there are areas that are still not being addressed properly in training?

P:           I think it’s quite difficult. I’ve been retired for too long. I think now, my perception is trainees must have done this, this and this. Skills based assessment in the workplace and so today we will pass an endotracheal tube in a difficult airway. Tick in box. That is not the same as the apprentice style that you and I grew up with, when we would listen to  the consultant say, ‘Well there’s this and this way to do it, what do you think we should do?’ You gained a great deal more from this apprenticeship than I think the trainees do these days.

I:             Do I take it what your meaning is that if you go into a planned session where you are going to pass a tube on a difficult airway, it’s very different from you anaesthetising somebody that you have on a routine list and unexpectedly find a difficult airway?

P:           Yeah or you look at the problem with the consultant and you discuss all the ways of dealing with it. You learn a lot more from that.

I:             What you appear to suggest is it’s easy to go too far along the formal training and lose some of the benefits of what was now looked at as on old fashioned way of training?

P:           Yeah.

I:             Do you think we’ll reverse that at some point?

P:           I think it’s unlikely because the bits that I have picked up more recently suggest that we are likely to shorten training. If the government gets its way they want trainees to be working longer hours as normal working then I think it’s unlikely.

I:             To change the subject completely, you worked with the General Medical Council for a while?

P:           I did.

I:             Have you any particular strong memories of that that you’d like to share?

P:           It was a good learning experience in how tedious lawyers can be and how long it takes them to cross examine and explore problems. Also the inherent difficulties with expert witnesses. Now, I did medical legal stuff before I worked with the General Medical Council and I was stunned. In your part of the world there was a professor of anaesthesia who was an expert witness and he used to say the most extraordinary things that you could not possibly believe in the witness box. Expert witnesses are a real mixed bag.

I:             How do they find these so called expert witnesses?

P:           It’s a very good question. I think some of them bubble to the top and volunteer. Firms, say like Hempsons with Bertie Leigh, who I think is an honorary fellow here as well, they will keep a list of those people who can be helpful. But to answer your question, I really don’t know. But very much was by word of mouth. One of the most difficult ones came to me via Margaret Branthwaite. I had been asked, this was when she was in chambers, I had been asked to find someone to just take a look at this excessive number of deaths in an A and E department and there was a rogue healthcare professional there who liked to brandish neuromuscular blocking drugs and people would have arrests. ‘It’ll only take you a little while’, said she and nothing came for an awfully long time and then a Fed Ex man arrived with a bundle of files about this big. Alan Aitkenhead had done a big report which I didn’t see initially because it would have been inappropriate. But what I said in an abbreviated form was virtually identical. It was astonishing, quite astonishing. But the amount of time that it took to do that. I had to say, ‘It’s going to take me … And it’s going to cost you.’ But there, I think, you had to go through every page as an expert witness, to come up with what you wanted. But sometimes expert witnesses don’t come up with the facts, they come up with opinion. But anyway I’m not quite sure how we got there.

But I quite enjoyed some of it and I think making the right decisions on a fitness practice panel which was what it was called then, was a difficult job but a worthwhile job. And the one memory that always sticks out is a very, very sad case of a surgical, I think he was not a consultant, who had done a couple of things that didn’t turn out very well and his case was due to be heard in three days, it was not completed, it was adjourned, and started again and we spent 56 days in all over that case. The chairman had two birthdays during the course of that because it was spread out over 13 months. He was found to require re-training conditions put on his practice, and a month later he died of ischemic heart disease. He’d been swilling the Gaviscon throughout, which we all thought was stress and peptic ulceration.

I:             They stick in your memory a bit, don’t they?         

P:           They do. Especially when it goes on for so long.

I:             Looking at other things, you served on regional awards committee? Different!

P:           I did, yes. Different. Very interesting.

I:             How do you think that worked? Do you think it was successful?

P:           It’s a very, very good question. I think it worked as well as it could within the constraints of how the system was set up. A lot of people did not complete their CVQs very well, they didn’t highlight the best of their practice. I know the associational anaesthetist here has always tried to be helpful and has always looked at the proportion of awards that came to anaesthetists. And part of it is our own fault and I always remember being taken aside by someone when I first completed a form. She said, ‘What about this? You can make it look better than that.’ It’s not an objective exercise. There will be some unfairness that creeps in. in the main I think the awards went to the best people but again it’s a huge task to be involved in that because you’ve got stacks and stacks of paper, and with the best will in the world, you can’t do it for more than a couple of hours at once and then come back. So to do a thorough job was very difficult.

I:             How long did you serve for?

P:           Probably about six or seven years but that would need checking [corr. four years]. I remember being medical vice chair for about the last two years.

I:             With a lay chairman?

P:           With a lay chairman who I accidently knew because she was married to an anaesthetist. She was called Jane Barry and she was from Taunton. She was a barrister but she ended up working, in the olden days, on the strategic health authority. We got along very well but the task of actually going through the stuff was monumental.

I:             Do you think the biggest problem was that the wrong people got it or that not enough of the right people got it?

P:           I’ll be loath to say that we gave an award to the wrong people. You had to have your final visit to review the names that the region had chosen with [52:12 Surneta]. He would make a case sometimes for us having neglected somebody, but it would only be in about a very few percent that we changed our draft list. So there were some cases where we looked at awards nationally and shook our heads about some persons who we knew had been given an A or better award for political activity. I don’t think it really happened in the Southwest, these were more the national things.

I:             You have a FRCP? When was that given to you?

P:           Well that was 1998. I was very chuffed about that because I had my MRCP thinking that if you’re going to look after patients on an intensive care unit you need to know quite a lot of medicine. But then if you made a contribution to medical care and people noticed that you were actually doing it then you could be proposed for an FRCP by the RCP regional advisor. That was how I was suggested.

I:             You must have been very pleased about that.

P:           I was very chuffed, very, very pleased. But actually they award an awful lot of FRCPs. So when you go, it’s an annual exercise, and you sit in the library of the College of Physicians, you’re surrounded by probably 300 others. But still, no I was pleased.

I:             I noticed that you’ve also been on medical advisory committees. What sort of experience was that?

P:           As in did I think I did a good job or did I think it was a useful exercise?

I:             I was thinking more of medical devices that came up.

P:           Oh yeah. No, that was good. It was in the olden days whilst it still existed, because then drugs and devices all went together. But there was a lady there called Sue Ludgate, did you ever come across her? She was very hard-working, pitched up about 7 o’clock in the morning, went home about 7 o’clock at night and dealt with everything to do with regulation of medical devices. And in the olden days they used to issue those warnings that you would see and you think, ‘Oh not another one.’ But it was good two way traffic and when we had a most interesting event where a patient fulfilled all the criteria for brain stem death but if you attach them to the ventilator it looked as though they were breathing, how could this come about? Well there is a perfectly logical explanation of how this came about which is not to do with patient’s breathing at all, it’s to do with changes in intrathoracic pressure during the ventilatory cycle when stroke volume goes up and down. Won’t bore you with the technicalities, but she researched that on our behalf because it was a very important issue and was immensely helpful. So that was good. When medicines and devices were all joined up together it then became a very large exercise and I was no longer involved. So beyond that I can’t really say.

I:             Are there any other official appointment type things that we haven’t mentioned that you’re happy and were proud to do?

P:           I don’t think so. I enjoyed my time as a school governor.

I:             Is this a secondary school or a junior school?

P:           No it’s a primary school. Three schools in North Devon as part of a federation. Very low population, very small numbers. But I ended up chairing the governors, started in September of 2011 and nine days later on September 20th the phone rang in Bristol at 7 o’clock in the morning, ‘Parracombe school is on fire. Don’t worry too much, the fire engines are there because the man next door saw the flames, photographed it and called them.’ And so I leapt into the car and did various things that I thought I ought to. It was quite spectacular but afterwards we had to make a very good case for getting that school rebuilt and it involved being assertive, I think is the right word, by going along to the local Devon County Council and making the case for rebuilding it. It’s actually in Exmoor National Park so you had to go along to the park authority. They were very nice and very supportive. And it was rebuilt and it was …

I:             Was it an accidental fire or arson?

P:           Well it was suspected that it might be arson. We actually think it probably was an electrical device in the school office which overheated and went, ‘woof’. But I don’t think we’ll ever know. The relevant investigations were all done. That was exciting. But to get the school rebuilt was good. To identify one or two ways in which the government of the school could be rebuilt was also good. So it was a different environment altogether, very satisfying, and I quite enjoyed it.

I:             Are there any other areas outside medicine that you’ve been involved in?

P:           Only very low key things in Devon, parochial church council and playing the organ and things like that.

I:             Why more in Devon than in Bristol?

P:           Because there’s no one in Devon who can do these things. That sounds terrible but if you come from a professional background you know a little bit about how things work. Michael used to be a church warden so he knows quite a lot of the ways of working of the local churches and he was church warden in Bristol so he became treasurer down there. We were both on the parochial church council. We knew how to do things and use the computer and stuff like that and there’s no one around, there aren’t many people who can play a keyboard at all. So the quite bad person is quite welcomed.

I:             This is your playing the organ?

P:           This is playing the organ, yes.

I:             Are you particularly interested in music?

P:           Very low key. I was taught the piano when I was young and you kind of remember a bit.

I:             You had a very varied career. Is there anything that we’ve missed out that you think we ought to talk about?

P:           I don’t think so.

I:             Any particular colleagues that you’d like to particularly mention that you haven’t already?

P:           I think, when you start to look at the people you’re grateful to, it’s the headmaster at the primary school, Peter Baskett, John Zorab, Iain Ledingham, Alan Gilston for encouragement, and Margaret Branthwaite has been a great friend. A retiring lady, now, she was my real role model I would say.

I:             None of your children have gone into medicine?

P:           No.

I:             Do you know why?

P:           One wonders. And I keep saying to myself when people ask me what I’m doing now, I say, ‘Well we have eight grandchildren, so it’s payback time.’ So you think to yourself, ‘Were you so busy with your career and not around enough? And is it that, that they would have to be too committed?’ I don’t know.

I:             Are they local to you so you see them?

P:           Five are in Hertfordshire. It’s not too far away except five of them will be down in Devon this weekend over three days. Two are in Bristol, one’s in Canada, and five are in Hertfordshire.

I:             Do you think we’ve left anything out that, with hindsight, you’d like to talk about?

P:           I don’t think so. And I’ll try not to think of it afterwards.

I:             Thank you very much, it’s been very interesting.

<Interview ends>