1
00:00:08,080 --> 00:00:16,170
Mike, this is a very, very intriguing man, Tom Ridge, thirty first of January 90 to run for Mike.

2
00:00:16,170 --> 00:00:20,230
Very kind of you to give an interview and we're very grateful.

3
00:00:20,230 --> 00:00:27,010
Can I first ask you the title of the job you came down to in Oxford and what it all meant really?

4
00:00:27,010 --> 00:00:31,930
Well, I came in 1994 and the official title from the university whose appointment it

5
00:00:31,930 --> 00:00:37,300
was primarily was director of postgraduate medical education and training.

6
00:00:37,300 --> 00:00:50,650
But a shorthand would be postgraduate dean, which I was one, and all the health reasons in England and in Scotland, one in Wales, one man.

7
00:00:50,650 --> 00:00:57,310
And so my point was a little unusual. It was primarily university with honorary contract with the regional health authority.

8
00:00:57,310 --> 00:01:02,750
Was most of the postgraduate deans in other reasons were the other way around.

9
00:01:02,750 --> 00:01:13,610
Health authority and honorary titles in the university. So how much of your time was spent really in Oxford and how much in the region outside Oxford?

10
00:01:13,610 --> 00:01:20,300
I certainly made it as soon as I arrived, although I knew many colleagues here.

11
00:01:20,300 --> 00:01:26,300
In fact, I'm just remembering that the day I arrived and somebody met me and I knew at the front door said,

12
00:01:26,300 --> 00:01:31,880
you do realise my full of 300 personalities and type personalities in Oxford.

13
00:01:31,880 --> 00:01:42,860
And I said Tufts is not 300 million. And that either way, I made a purposeful visit around the whole of the region in all the hospitals in the region,

14
00:01:42,860 --> 00:01:47,930
which were the four countries of Bux Bonks Oxfordshire and Northamptonshire,

15
00:01:47,930 --> 00:02:00,390
and also, of course, all the speciality advisers and the different specialities, mainly based in Oxford, but also in hospitals.

16
00:02:00,390 --> 00:02:04,880
And so it was an integral job.

17
00:02:04,880 --> 00:02:12,500
And I would I wouldn't be able to formally apportion my time, but I was very keen to support proper training programmes in all specialities.

18
00:02:12,500 --> 00:02:16,430
The general practise side was very well looked after by John has learnt his colleagues,

19
00:02:16,430 --> 00:02:20,480
and really I let him continue to and he was the director of general practise training.

20
00:02:20,480 --> 00:02:27,800
But I had to cover all those specialities. And I had the background in diabetes and technology.

21
00:02:27,800 --> 00:02:32,480
And so I knew and had met in all the hospitals. I'd let people with different specialities.

22
00:02:32,480 --> 00:02:40,310
And I think, as you would know, being a diver told us to self that you get into this whole world in his wife, of course, all hospital.

23
00:02:40,310 --> 00:02:42,950
So that was good background for for the purpose.

24
00:02:42,950 --> 00:02:54,560
And I would say I would spend in one week, at least one day in London, Department of Health or both teams meeting.

25
00:02:54,560 --> 00:03:06,290
And I would be at least one day a week in the region somewhere and in and out of all departments, both, of course, and in Oxford itself.

26
00:03:06,290 --> 00:03:11,180
You mentioned the physicians you knew, but how much your time was involved with surgery, say?

27
00:03:11,180 --> 00:03:19,760
Oh, well, as much time as I did, I was very particularly careful as a physician not to be purely biased by my background as a physician,

28
00:03:19,760 --> 00:03:24,740
but rather got to know well and admired many of the colleagues and all the specialists

29
00:03:24,740 --> 00:03:29,150
responsible for training of about 1500 postgraduate doctors across the region.

30
00:03:29,150 --> 00:03:34,430
And I was very keen to enhance the training programmes.

31
00:03:34,430 --> 00:03:38,600
When I came to Oxford, I think I was a bit surprised to find it was a divided medical school,

32
00:03:38,600 --> 00:03:44,450
which is unusual in this country at that time because of the complete sort of separate psychological,

33
00:03:44,450 --> 00:03:48,020
if not physical, but it was physically from the school.

34
00:03:48,020 --> 00:03:53,540
And that's not true anymore. And it's, well, truly integrated now. But I was a bit surprised.

35
00:03:53,540 --> 00:04:01,970
And there was also, I have to say, an attitude within Oxford, which is a little bit uncomfortable, was to say, you know,

36
00:04:01,970 --> 00:04:08,830
we're Oxford, we're know with the great Oxford, and then we beyond the city walls was was beyond the pale a little bit.

37
00:04:08,830 --> 00:04:12,740
And there's a conceit in that which I don't like, didn't like.

38
00:04:12,740 --> 00:04:17,300
And I was determined not well to make sure that the people in the region who resented

39
00:04:17,300 --> 00:04:23,270
that would come to realise the strengths of being in elite training programmes.

40
00:04:23,270 --> 00:04:29,540
And so this was the culmination. He was the chief medical officer keen to get rid of the old senior registrar.

41
00:04:29,540 --> 00:04:35,660
Great. Much of the chagrin of the old school, but then create this unified specialist registrar.

42
00:04:35,660 --> 00:04:42,260
Great. So that was an important element and enabled me to to talk to the regions and make sure we had in every

43
00:04:42,260 --> 00:04:48,290
speciality a good programme which let the specialist registrars rotate because most of them are going to end up.

44
00:04:48,290 --> 00:04:52,820
And it's so important they have some experience of that, not purely an academic centre.

45
00:04:52,820 --> 00:05:01,040
On the other hand, I was keen to support academics and this became the era when to create new posts that government gave the

46
00:05:01,040 --> 00:05:05,960
postgraduate deans 50 percent of the salary and they had to find the other half from somewhere else.

47
00:05:05,960 --> 00:05:16,670
And early in my days, the university was going to get rid of intellectuals and create for technical tutors with the money consulting.

48
00:05:16,670 --> 00:05:25,280
Right. And I was alarmed by that and said, well, if you've got AP'TIN collectors across different specialities,

49
00:05:25,280 --> 00:05:32,330
I suppose you take half those salaries to go for consulting tutors, leaves the other half an hour.

50
00:05:32,330 --> 00:05:38,600
Matchett So I kept this sort of by integrating my approach academically as well.

51
00:05:38,600 --> 00:05:43,940
So we kept those temperatures. And I report important sweetcorn for future would be academic doctors.

52
00:05:43,940 --> 00:05:51,800
And I think also we have well funded more or more research fellows around.

53
00:05:51,800 --> 00:05:58,340
When the integrated SBL Jobs came along, I think 90 percent of them have done a clinical job already.

54
00:05:58,340 --> 00:06:02,360
So they were eligible for allocated. No, but others had.

55
00:06:02,360 --> 00:06:09,260
Compete in open competition for such training programmes as we had created, but then if they're in research,

56
00:06:09,260 --> 00:06:15,230
could take off the next day with that number secure in the knowledge that when they come back.

57
00:06:15,230 --> 00:06:24,350
So I tried very much with my background in both medicine as an academic and as a clinician to make sure that both parties,

58
00:06:24,350 --> 00:06:30,920
NHS and university worked collaboratively. And I think we could be reasonably smooth transition.

59
00:06:30,920 --> 00:06:36,290
And the programmes became very popular nationally, even in the least popular specialities.

60
00:06:36,290 --> 00:06:44,630
So I think it sounds a bit boastful. I don't mean that, but we made that transfer relatively smoothly.

61
00:06:44,630 --> 00:06:48,470
You said you'd match the salaries of half the salaries.

62
00:06:48,470 --> 00:06:54,680
When was your budget? Was that you? No, no. The only bit of the investment was my salary and the secretary.

63
00:06:54,680 --> 00:06:58,610
So how did you get her the NHS from the Council of Health?

64
00:06:58,610 --> 00:07:07,550
It's all in this in this era that that proportion of of the NHS budget of topsides for education

65
00:07:07,550 --> 00:07:13,250
was handled from the point of view of the medical training to the postgraduate deans.

66
00:07:13,250 --> 00:07:16,580
So there was about 50 million that I was responsible for.

67
00:07:16,580 --> 00:07:25,070
But most of that, of course, is getting the salaries of the trainees actually within the sort of I had within that's about 100000,

68
00:07:25,070 --> 00:07:33,050
which is sort of I could play with a bit more flexible and I would use that in sort of some innovative ways.

69
00:07:33,050 --> 00:07:36,600
And I was keen to support flexible training. That's another thing.

70
00:07:36,600 --> 00:07:40,070
I mean, that's also had a good name for it. What do you mean?

71
00:07:40,070 --> 00:07:49,140
Well, people who take part time, maybe mostly women, because of natural biological reasons, but not only women and proportion,

72
00:07:49,140 --> 00:07:54,350
we actually have the highest proportion of frigatebirds, highest 10 percent at any one time.

73
00:07:54,350 --> 00:08:03,020
But in most of the other regions, the the way it was handled was there was a cap for the amount of money that flexible treatments could have.

74
00:08:03,020 --> 00:08:13,010
One of the problems of being, of course, that the timing of the choice of place, which was not always predetermined and I said I would not cap it.

75
00:08:13,010 --> 00:08:19,190
And if I had what we overspent and I was going to be sacked, I said, may I have the last word?

76
00:08:19,190 --> 00:08:27,380
And I would say, you're going to fire me because I've spent some overspend on training, flexible trainees and particularly women.

77
00:08:27,380 --> 00:08:33,050
And I think they wouldn't pull the trigger. I didn't get shot.

78
00:08:33,050 --> 00:08:38,150
Was that the error shift? I mean, did you get your hands on, if not directly?

79
00:08:38,150 --> 00:08:49,190
It was it's an error when where the money went and where where it should be were very obscure and

80
00:08:49,190 --> 00:08:55,160
very obscure that the teaching hospitals got some money and then it was part of that great budget.

81
00:08:55,160 --> 00:09:03,530
And so timing it and identify. But it was mainly for undergraduate teaching or for preclinical, not preclinical or clinical teaching in the hospital.

82
00:09:03,530 --> 00:09:10,610
So for the clinical students teaching as well as I'm speaking to you and but it sort of got lost in the pool of the budget,

83
00:09:10,610 --> 00:09:15,830
which is the where the NDIS was like. I didn't think it was for undergraduate teaching.

84
00:09:15,830 --> 00:09:20,190
I thought it was to compensate the hospital for the fact that they did undergraduate.

85
00:09:20,190 --> 00:09:25,400
Yeah, well, I mean, yes, that's true. But it was an allocation for the time so spent.

86
00:09:25,400 --> 00:09:30,980
I mean, however, getting it disentangling it from the rest of the budget was extremely difficult.

87
00:09:30,980 --> 00:09:34,910
But I wasn't responding. I had to separate from that. It was not swift.

88
00:09:34,910 --> 00:09:38,660
Yeah. Now they revert to sort of modern jargon.

89
00:09:38,660 --> 00:09:46,760
Line manager, did you in any sense have a line manager, either NHS or university?

90
00:09:46,760 --> 00:09:55,430
I felt sometimes that I was writing a troika, you know, but in The Highness's there was a a racehorse and a donkey cart horse.

91
00:09:55,430 --> 00:10:05,390
But I would say I had to be answerable to the chief executive of the regional health authority,

92
00:10:05,390 --> 00:10:11,990
essentially to the to the NHS and to that to the Department of Health,

93
00:10:11,990 --> 00:10:21,440
although in the common era can send you promoted the post gravy deans collectively to be a cohort of his number two A's.

94
00:10:21,440 --> 00:10:29,150
If I put it that way, if the chief if the permanent secretaries are one and the deputy chief medical officers are two,

95
00:10:29,150 --> 00:10:33,800
there was a bit of a bit of resentment amongst the senior civil servants and

96
00:10:33,800 --> 00:10:38,900
there was a bit of a tension as to whether we were civil servants or we weren't. We weren't.

97
00:10:38,900 --> 00:10:45,560
I had to have a special contract because I was a university partner then. So it was my contract was between the university and secretary of state.

98
00:10:45,560 --> 00:10:53,180
And so they had to agree if I misbehaved because I had to be disciplined for it didn't come to that.

99
00:10:53,180 --> 00:10:58,250
But that was my sort of line management on the NHS side and the university side.

100
00:10:58,250 --> 00:11:06,260
There was nothing like as formal as that. And I felt. This time, you see, I thought the religious professor was the head of the medical school,

101
00:11:06,260 --> 00:11:13,220
but it wasn't like that administratively, that he was the senior research fellow, put it that way.

102
00:11:13,220 --> 00:11:19,850
But, of course, I respected talk to David Weber, who I love, because in subsequent structures,

103
00:11:19,850 --> 00:11:24,110
the head of division is not necessarily the religious professor medicine.

104
00:11:24,110 --> 00:11:30,740
There are not by now. No, no. Well, it wasn't that out of the way so that I sort of lineman's went that way.

105
00:11:30,740 --> 00:11:35,570
But essentially I have to answer through the division. And then when appraisals and assessments came in, of course,

106
00:11:35,570 --> 00:11:44,200
I would have a joint appraisal with with David whether the regents and the deputy from what was region.

107
00:11:44,200 --> 00:11:52,550
It was then because we moved in 10 years that I was going to be had for this reorganisation from a benign Oxford Regional Health Society,

108
00:11:52,550 --> 00:11:57,980
which you would know when we when we became angry in Oxford, when we met John,

109
00:11:57,980 --> 00:12:03,080
because the Banana Republic, as it was called Oxford, we met at Milton Keynes halfway.

110
00:12:03,080 --> 00:12:07,730
That lasted about two years. And then it was just reorganised again.

111
00:12:07,730 --> 00:12:13,230
And we became southeast London, that is southeast England.

112
00:12:13,230 --> 00:12:19,010
So which is the sort of bottom caller outside London and that took you from

113
00:12:19,010 --> 00:12:25,170
our past north of Parkes was catching up to the Isle of Wight to Dungeness.

114
00:12:25,170 --> 00:12:32,030
Bizarre. It was because I was trying to it didn't it didn't match any of the natural flows of railways, roads or people.

115
00:12:32,030 --> 00:12:37,550
And then it really organised again as get it right to get Thames Valley.

116
00:12:37,550 --> 00:12:46,760
I think it became in the same the chief executive remained the same throughout these reorganisations, although we didn't have to go to Panopto moment.

117
00:12:46,760 --> 00:12:54,620
And I think of the time spent by the NHS on reorganising that time and again and the amount of

118
00:12:54,620 --> 00:13:02,870
effort from money spent wasted in my work in these organisations was just before I retired.

119
00:13:02,870 --> 00:13:07,150
I saw this one coming and I thought, I don't need to be in the middle of that one again.

120
00:13:07,150 --> 00:13:14,520
And I so I actually stopped the year earlier than I needed to do. Yeah, but I'd done ten years and that was long enough, sort of, you know.

121
00:13:14,520 --> 00:13:20,510
And you're an ancient civil servant because I was interested. I spent a day a week in London on average.

122
00:13:20,510 --> 00:13:25,790
Yes. I was talking about well basically I think in the common era.

123
00:13:25,790 --> 00:13:30,410
And he was CMO for 94 to about 98.

124
00:13:30,410 --> 00:13:37,620
And Liam Donaldson followed him. He was very keen on improving medical education and training from his background as a surgeon,

125
00:13:37,620 --> 00:13:42,080
then as a oncologists then as opposed to Dean and then as a chief medical officer.

126
00:13:42,080 --> 00:13:45,530
So he had a very good grasp. I liked him.

127
00:13:45,530 --> 00:13:57,710
And and so in his era, we would be perhaps once a month with him to to discuss how to effect changes in the medical education world.

128
00:13:57,710 --> 00:14:03,860
Subsequently, Liam Donaldson wasn't so emphatic about that.

129
00:14:03,860 --> 00:14:09,380
And I think the roles or the authority of was gradually eroded or diminished,

130
00:14:09,380 --> 00:14:18,530
particularly to the extent that a medical education at the postgraduate level didn't become so important in the eyes of the NHS.

131
00:14:18,530 --> 00:14:27,470
They had a lot of things to deal with. Who is really driving these reorganisations and where is the initiative coming from?

132
00:14:27,470 --> 00:14:33,020
Oh, I think government ultimately you have to say whatever and not be dependent on any government changes.

133
00:14:33,020 --> 00:14:37,790
I mean, in the last four years, as you know, I there's another reorganisation coming on.

134
00:14:37,790 --> 00:14:40,610
I'm not going to get involved in the pros and cons of any of these things.

135
00:14:40,610 --> 00:14:48,930
I'm just concerned that the amount of time and effort put into it and there was a time when the sort of philosophy was changed.

136
00:14:48,930 --> 00:14:50,900
And I think you do have to change,

137
00:14:50,900 --> 00:14:58,790
but you have to know the direction in which you're going to change for purpose and not just a change for its own sake and accommodate camera.

138
00:14:58,790 --> 00:15:06,020
And later, what would you say of the novelty improvements that came in and which you were probably involved?

139
00:15:06,020 --> 00:15:11,780
Well, I certainly believe in the unification of the registrar Cinderella story, which was a very important education.

140
00:15:11,780 --> 00:15:16,010
I was sympathetic that not all my colleagues were, because even prior to that,

141
00:15:16,010 --> 00:15:21,800
the bottleneck for would be hospital appointments was not until you failed to get

142
00:15:21,800 --> 00:15:26,060
the senior registrar because the senior jobs were no privileged consumption.

143
00:15:26,060 --> 00:15:33,200
So you could get to 33, 34, and especially having spent, you know, eight years training and then be thrown on the scrap heap.

144
00:15:33,200 --> 00:15:36,500
And I thought that that decision shouldn't happen that late.

145
00:15:36,500 --> 00:15:43,820
If you're not going to make it, then really I was in favour of the decision making time being between I said,

146
00:15:43,820 --> 00:15:50,370
John Registrar so you can find the registrar it was that took three or four years smoothly.

147
00:15:50,370 --> 00:16:00,930
It was important. And I think the numbers are always difficult because the numbers never get right, for there was a huge expansion of consulting jobs.

148
00:16:00,930 --> 00:16:07,430
It was a huge expansion. Also in certain specialities of the unified grade,

149
00:16:07,430 --> 00:16:16,970
so that was one thing I think Tom was keen to integrate the NHL as well as the restructuring that may have happened more subsequently after I retired.

150
00:16:16,970 --> 00:16:21,650
I was less keen on that because I think part of the management,

151
00:16:21,650 --> 00:16:28,040
many people differentiate and find their speciality later rather than early in their careers.

152
00:16:28,040 --> 00:16:36,830
And I was always amused because I used to tease in the final year to ask if they knew what they wanted to do and two thirds would say,

153
00:16:36,830 --> 00:16:41,210
yes, they knew what direction they wanted to go, brought in medical or surgical or general practise.

154
00:16:41,210 --> 00:16:45,860
And at the end of the house, jobs, you asked them again and two thirds again knew where they were going,

155
00:16:45,860 --> 00:16:55,460
but different to the group and said people didn't need time and time to experience on the subject.

156
00:16:55,460 --> 00:16:58,490
And so because they were very much traditional just medicine, surgery.

157
00:16:58,490 --> 00:17:04,490
And one of the things I helped to do was create new hospitals in some of the other specialities,

158
00:17:04,490 --> 00:17:10,850
including general practise and psychiatry, for example. So people could perhaps have three or four month modules.

159
00:17:10,850 --> 00:17:15,680
And this was in that one year, which is now called foundation.

160
00:17:15,680 --> 00:17:24,320
Now, obviously, they were two, but most foundation is one. And you now have about six speciality subjects to get through, including those other ones.

161
00:17:24,320 --> 00:17:33,320
So I was in the early stages of moving in that direction and then I lost track of my own thoughts.

162
00:17:33,320 --> 00:17:37,520
What was your first question? Well, the question really was what would the novelty improvement?

163
00:17:37,520 --> 00:17:49,130
Well, I think so. That was the education registrar, the creation of new hospital jobs, because as a university responsibility,

164
00:17:49,130 --> 00:17:51,740
I was responsible for the Oxford graduates wherever they were working.

165
00:17:51,740 --> 00:17:56,240
I had to sign them off at the end of last year, even if they were working outside.

166
00:17:56,240 --> 00:18:02,240
So I had to know whether we can get reports from whoever was supervising it and I had to then sign them off.

167
00:18:02,240 --> 00:18:08,300
So changing the traditional format of the house one year was I was involved in that.

168
00:18:08,300 --> 00:18:12,950
So that's a novel in that sense. Yeah. Um, I've mentioned flexible training.

169
00:18:12,950 --> 00:18:15,800
I think that is important that we continue to do that.

170
00:18:15,800 --> 00:18:24,590
Well, I think also they weren't so much novel, but I think we got into the era of integrating the academic and the clinical training.

171
00:18:24,590 --> 00:18:31,410
I was very keen that the academics could continue to get special training.

172
00:18:31,410 --> 00:18:40,700
But now these new specialities, the new scientific developments were essentially not necessarily what I called target or specialities.

173
00:18:40,700 --> 00:18:47,420
If you think of a portcullis in the vertical lines, our hearts, lungs, got an old neurology, whatever you can say.

174
00:18:47,420 --> 00:18:53,870
But the new disciplines of genetics might make molecular biology what I was trying to say.

175
00:18:53,870 --> 00:19:00,200
Therapeutics cut across all those people training in the academic world where you could you could go to my

176
00:19:00,200 --> 00:19:05,390
speciality meetings and hear the same sciences that we hear in the gastroenterology meetings or in the other.

177
00:19:05,390 --> 00:19:13,580
And I was keen that these academic people should also get good technical training in general medicine,

178
00:19:13,580 --> 00:19:18,320
for example, because by and large, the emphasis is different on different specialities.

179
00:19:18,320 --> 00:19:22,970
And the physicians are much more interested in the academic side than most of the other specialities.

180
00:19:22,970 --> 00:19:27,050
But essentially so I, I created it and it was unique at the time.

181
00:19:27,050 --> 00:19:33,890
The acute general medical training programme was three years so they could get a ticket as a completed trained specialist and gentleman

182
00:19:33,890 --> 00:19:45,140
internal medicine whilst doing their science and become available to the teams in the hospital and take part in the acute takes competency.

183
00:19:45,140 --> 00:19:49,370
What did you think of the influence of the membership exam in British Medicine?

184
00:19:49,370 --> 00:19:56,600
CBS and I always thought it was a mistake that a future academic researcher, medical,

185
00:19:56,600 --> 00:20:04,520
but basically doing laboratory work linked to a particular speciality had to be competent at membership level across the board.

186
00:20:04,520 --> 00:20:08,480
He thought they should just be competent in their own speciality. Well, I think it is.

187
00:20:08,480 --> 00:20:15,740
I personally think it's a unique feature of British medicine. I suppose we're talking about physicians in Britain because but the other speciality is,

188
00:20:15,740 --> 00:20:20,960
by and large, have moved in the direction of having, if you like, an entry exam as well.

189
00:20:20,960 --> 00:20:23,690
Most deals have an exit exam, and that's another issue.

190
00:20:23,690 --> 00:20:31,190
But actually and I got involved in European medicine as a representative of the UK in the speciality in the closet.

191
00:20:31,190 --> 00:20:36,710
And and they like to be present at one stage. And together, my Irish colleagues,

192
00:20:36,710 --> 00:20:43,290
we argued in favour of having this two year general training after graduation rather than going down the street and

193
00:20:43,290 --> 00:20:49,880
especially which is what the rest of the world largely does in Europe and in America and Japan and places like this.

194
00:20:49,880 --> 00:20:53,600
They go straight into the speciality. They become very competent.

195
00:20:53,600 --> 00:21:02,280
They're trained specialists, not questioning that, but they don't have the breadth that we require of our trainees, medical or surgical at.

196
00:21:02,280 --> 00:21:12,210
And that matters ultimately oh, and I think it's a weakness of our and paradoxically, as we become more and more specialised,

197
00:21:12,210 --> 00:21:17,550
the people who can deal with the acute taste and see the patient as a whole,

198
00:21:17,550 --> 00:21:23,520
I'm talking about mental as well as physical beyond their own narrow speciality, a few.

199
00:21:23,520 --> 00:21:31,020
And that's really a weakness now because people aren't just systems that I'm really

200
00:21:31,020 --> 00:21:36,630
impressed with the huge advances in the field of all sorts of specialities.

201
00:21:36,630 --> 00:21:42,850
But still, in trend terms, I value the strength and I don't therefore not on that base in camp.

202
00:21:42,850 --> 00:21:47,610
But I do think it's important whenever it is appropriate that people can take time out to do

203
00:21:47,610 --> 00:21:54,150
their research and be and we supported people going up to three years out of the programme.

204
00:21:54,150 --> 00:22:05,160
Also, I think importantly, people might want to go a programme for other valid reasons why three people wanted to go out and set up.

205
00:22:05,160 --> 00:22:08,910
It comes right. And I said to them, well, you know,

206
00:22:08,910 --> 00:22:14,850
we do let people go out for because you've got to find yourself some money because we'll use the money to replace you with a locum.

207
00:22:14,850 --> 00:22:21,090
So come back and talk to me in a year because, yeah, you can go and tell me the end of the year whether you think it's viable to do a second year.

208
00:22:21,090 --> 00:22:29,100
But the maximum is three. Well, one after you came back and decided that he wasn't the second I went in the commercial world.

209
00:22:29,100 --> 00:22:34,470
The third is the founder of Doctors Net.

210
00:22:34,470 --> 00:22:46,630
Right. And I take all credit and it's a fantastic achievement, which he did was he took time out and they became so successful.

211
00:22:46,630 --> 00:22:51,180
He got a lot of other talents and he continued to practise part time.

212
00:22:51,180 --> 00:22:58,230
But in essence, that's probably the single most beneficial, innovative tool of the whole my decade.

213
00:22:58,230 --> 00:23:04,680
And I will give credit to him entirely for you. Earlier, I think when we were chatting, you mentioned type personalities.

214
00:23:04,680 --> 00:23:11,100
And so when you were with this anglicised up with Oxford and Cambridge, did that work?

215
00:23:11,100 --> 00:23:15,840
Oh, well, I have friends in both camps and I'm in Cambridge, so I'm accepted.

216
00:23:15,840 --> 00:23:21,690
But there wasn't really any conflict. But but it also didn't work out.

217
00:23:21,690 --> 00:23:26,680
They respected each other. Both halves of this strange banana republic.

218
00:23:26,680 --> 00:23:31,330
I got on with a typical Oxford. I got on with their own things.

219
00:23:31,330 --> 00:23:36,980
There wasn't much collaboration in the practical sense. It wasn't a merger of each.

220
00:23:36,980 --> 00:23:42,090
Each rival institution, capital Cambridge, were developing clinical school.

221
00:23:42,090 --> 00:23:45,150
But I mean, they'd already done it. But they were still developing. Yes.

222
00:23:45,150 --> 00:23:50,910
And using places like Ipswich coaches for training more than Oxford written or not.

223
00:23:50,910 --> 00:23:53,910
Well, I don't think this is personal.

224
00:23:53,910 --> 00:24:07,740
In the early seventies, I went for John McCain as a consultant really too soon in my career and I wasn't appointed.

225
00:24:07,740 --> 00:24:13,200
But I really blew it because I said to Cambridge, people who are in the preliminary visit,

226
00:24:13,200 --> 00:24:19,320
what are you doing about integrating clinical training with all the other hospitals around the East Anglia?

227
00:24:19,320 --> 00:24:23,160
And their attitude was, we're a scientific institution of world renowned.

228
00:24:23,160 --> 00:24:27,930
We're not meant to talk about that. And there were blinkers about that.

229
00:24:27,930 --> 00:24:37,890
And and, of course, you know what? In East Anglia Medical School, but not now, it wasn't as rigid, but Oxford had an element of that.

230
00:24:37,890 --> 00:24:39,600
Yeah. Which was quite strong.

231
00:24:39,600 --> 00:24:47,250
And I think they were also and there was resentment from outside, but more particularly Oxford as a small city, it's 150000.

232
00:24:47,250 --> 00:24:50,490
OK, you've got some splendid centres and so on.

233
00:24:50,490 --> 00:24:55,380
But you've got of 950 students who wind up from 250 was going to need.

234
00:24:55,380 --> 00:24:59,640
And I was supportive of that. But still a small school in the UK.

235
00:24:59,640 --> 00:25:04,230
But we did train a much bigger catchment area for the purpose of training students.

236
00:25:04,230 --> 00:25:10,590
And so I was keen again that, well, the students did go out to some of the hospitals.

237
00:25:10,590 --> 00:25:16,230
But when it came to those jobs, I mean, Northampton was excellent and very popular.

238
00:25:16,230 --> 00:25:20,820
Unfortunately, Northamptonshire was removed from our geographic patch of subsequently.

239
00:25:20,820 --> 00:25:30,600
That's nothing to do with us. But it goes back to my philosophy of trying to make sure that the good teachers and the teachers had students,

240
00:25:30,600 --> 00:25:39,000
postgraduate students trained as well as teachers. And so I deliberately try and break down those walls so that there wasn't a

241
00:25:39,000 --> 00:25:45,780
barrier between us and them in the sense that the academic centre of excellence,

242
00:25:45,780 --> 00:25:53,820
which Oxford is, was also part of an integrated region.

243
00:25:53,820 --> 00:26:00,120
The sort of room for somebody like me not knowing what was going on with Northhampton was an excellent place,

244
00:26:00,120 --> 00:26:05,670
progressive, and Redding was a bit stuck in the mud or looking to London.

245
00:26:05,670 --> 00:26:07,290
Well, I think historically that is true.

246
00:26:07,290 --> 00:26:15,090
One St. Mary's in London had links in Redding, and when I was a young doc, Redding had a very good name for training people.

247
00:26:15,090 --> 00:26:19,830
But interesting enough, I mean, one, I was very fortunate in my nature.

248
00:26:19,830 --> 00:26:31,500
We were talking about an expansionist era in terms of numbers of training, and I was in trying to create training programmes would go to you and say,

249
00:26:31,500 --> 00:26:36,600
you know, I'd like to put a new post in here in this speciality as part of this programme.

250
00:26:36,600 --> 00:26:43,620
And one or two of the senators didn't want that, which was a bit of a disappointment, I have to say.

251
00:26:43,620 --> 00:26:52,940
So I didn't mean what Michael, you mentioned that there was a huge expansion in the consultant grade while you were in office.

252
00:26:52,940 --> 00:27:00,840
Was that a good thing? And what was driving it? The short answer is, I think we had a right.

253
00:27:00,840 --> 00:27:09,660
We have had a very pyramidal structure that people expected more consultant provided service, not just consultant led.

254
00:27:09,660 --> 00:27:19,380
So there's a move to do that. The specialities all expanded in a single they were singlehanded practitioners anymore in their speciality.

255
00:27:19,380 --> 00:27:24,450
They were just like in general practise. The group that was recognised, of course,

256
00:27:24,450 --> 00:27:30,870
that the NHS would not have survived without at least one third of its staff who come from the Commonwealth countries largely.

257
00:27:30,870 --> 00:27:39,600
And we weren't producing enough doctors. So the medical school numbers expanded from about 4000 to about 7000 over that decade.

258
00:27:39,600 --> 00:27:42,120
I'm talking about mid 90s to 2000,

259
00:27:42,120 --> 00:27:54,060
and that has a momentum which goes into the higher grades and the diversification I referred to at the interval between OSHA and registrar.

260
00:27:54,060 --> 00:28:00,120
So I think all sorts of pressures. And now we do produce mainly our own graduates.

261
00:28:00,120 --> 00:28:03,930
There's concern about unemployment, but of course it's competition. We still have free competition.

262
00:28:03,930 --> 00:28:08,610
We still believe as doctors that we can choose to go wherever we like to do whatever speciality we like.

263
00:28:08,610 --> 00:28:16,200
We do not need 10000 cardiac surgeons. We need a few good ones.

264
00:28:16,200 --> 00:28:20,970
I mean, in a sense, competition that introduces Europe because you're on this committee in Europe.

265
00:28:20,970 --> 00:28:24,150
And what did you feel your aim was on that committee?

266
00:28:24,150 --> 00:28:33,580
Well, is there's an organisation which is for all the member states and with an every in the in the health division,

267
00:28:33,580 --> 00:28:38,520
there's there's there's one for every subject.

268
00:28:38,520 --> 00:28:43,170
And so just happens to be the endocrinologist. You've covered this as well.

269
00:28:43,170 --> 00:28:51,990
And the the aim was essentially to it was to do the 1976 77 act of freedom of movement.

270
00:28:51,990 --> 00:28:53,940
It's nothing to do with doctors as such.

271
00:28:53,940 --> 00:29:01,740
But, you know, if you're part of the European Union, you have the right to go and practise your work in any of the European countries.

272
00:29:01,740 --> 00:29:06,120
And so it was to do with the standardisation or recognition of qualifications.

273
00:29:06,120 --> 00:29:11,290
Origi. And, of course, the different traditions of trading in different European countries are different.

274
00:29:11,290 --> 00:29:18,650
I mean, I think I'm trying to remember who was the commissioner at the time, became a head coach.

275
00:29:18,650 --> 00:29:23,300
His name was just going out. He had had the doctors wrangling about this for years.

276
00:29:23,300 --> 00:29:31,100
He said, right as of the date. And Germany, you didn't recognise your file court, your final qualifications, period.

277
00:29:31,100 --> 00:29:34,610
And that became European law. Yes. Now, there is a difference in that.

278
00:29:34,610 --> 00:29:40,100
We talked about it earlier about how the benefits of having a broader trading system.

279
00:29:40,100 --> 00:29:43,700
So that was the background against which we had similarly in the different specialities,

280
00:29:43,700 --> 00:29:47,690
tried to make sure that the specialist qualifications required to be recognised,

281
00:29:47,690 --> 00:29:54,470
say the courts were recognised by other European countries professionally.

282
00:29:54,470 --> 00:30:03,230
And we got a remarkable degree of agreement about that. But the real problem is at the summit level we are in, the European bureaucracy is getting in.

283
00:30:03,230 --> 00:30:10,610
The influence with the commission level is political and that is another matter altogether.

284
00:30:10,610 --> 00:30:16,890
But the politics were driven by integration with eventually, which has to do with the freedom of movement of people.

285
00:30:16,890 --> 00:30:24,350
Yes, originally. But it professionally became and it was a very agreeable group.

286
00:30:24,350 --> 00:30:32,660
And we've got remarkable agreement within the speciality group and then with the representatives also.

287
00:30:32,660 --> 00:30:37,370
So within the broad division of the medical specialities were amazing unanimity in the

288
00:30:37,370 --> 00:30:41,690
how people should be trained up to the level of becoming independent practitioners,

289
00:30:41,690 --> 00:30:46,400
different in different countries, but not not in principle, apart from the fact you touched on earlier,

290
00:30:46,400 --> 00:30:51,380
that we believe in a bit of general training, first to come back to Oxford.

291
00:30:51,380 --> 00:30:56,600
What were your relationships? How do you integrate with the regional hospital board?

292
00:30:56,600 --> 00:31:01,460
Well, it was it wasn't quite the board that you remember.

293
00:31:01,460 --> 00:31:05,450
I mean, it was the board. I think there was still an integrated board.

294
00:31:05,450 --> 00:31:09,590
We used to meet on Saturday mornings with the university and some of the presenters.

295
00:31:09,590 --> 00:31:15,350
That was I mean, the representatives of both the region and the University of.

296
00:31:15,350 --> 00:31:24,770
But that was actually abolished when the Oxford Regional disappeared. And so I didn't have any dealings with that board as such after that.

297
00:31:24,770 --> 00:31:32,360
Mm hmm. So that's within the chain of. So who would you be dealing with then?

298
00:31:32,360 --> 00:31:38,900
Well, I mentioned earlier I think I would be dealing with a tremendous patriot was that was in the end the region.

299
00:31:38,900 --> 00:31:42,830
She was the public health doctor there.

300
00:31:42,830 --> 00:31:53,450
And then with overstocking occasionally when she saw so and then I always had covered one or two things which wouldn't go on anywhere,

301
00:31:53,450 --> 00:32:01,380
but really quite a shock to me. I mean, it's interesting to deal with the profession as a whole.

302
00:32:01,380 --> 00:32:03,260
I put it this way.

303
00:32:03,260 --> 00:32:16,700
I remember one of my colleagues coming to see me and Short-circuiting harvestable, and I looked at him and I said, you know, I don't know.

304
00:32:16,700 --> 00:32:20,890
It gives me a bigger headache, the bottom one percent of our profession of the top.

305
00:32:20,890 --> 00:32:26,210
So you start to had a laugh and we went down and we could deal with.

306
00:32:26,210 --> 00:32:29,120
But but I didn't come across the bottom one percent of our profession.

307
00:32:29,120 --> 00:32:34,790
Now, in the course of my 20 years in Newcastle one time and before I worked in a good hospital,

308
00:32:34,790 --> 00:32:40,790
200 consultants, probably with a really good ethos, same sort of quality sources we have in Oxford.

309
00:32:40,790 --> 00:32:53,840
But as a people, I only came across one or two and in my 200 staff at the time, I was 15 years of saying, know one of the mental health problems.

310
00:32:53,840 --> 00:32:57,740
So I wasn't very particularly experienced but the difficult side of our profession.

311
00:32:57,740 --> 00:33:06,140
But I have to say the dean and the trainees more than the consultants, every specialist got his bottom.

312
00:33:06,140 --> 00:33:13,670
One percent of my cumulative experience over a decade is more than I would have wished to have acquired.

313
00:33:13,670 --> 00:33:19,760
And that's including theft and dishonesty and incompetence.

314
00:33:19,760 --> 00:33:27,200
And so no one's immune to that. And we're not very good at disciplining ourselves as a profession.

315
00:33:27,200 --> 00:33:35,990
And so often things when when they do come to life, there's a chain of things which have been noticed but not acted upon.

316
00:33:35,990 --> 00:33:44,630
And so you interview the right one before damage is done to patients in the profession being very good at that.

317
00:33:44,630 --> 00:33:49,970
Who is responsible for that? I mean, were you in any sense or was it the individual hospital should be doing?

318
00:33:49,970 --> 00:33:57,200
Well, it's the employer and technically. But things would come to light like falsification, CVS.

319
00:33:57,200 --> 00:34:02,750
And we would, you know, because you get 300 tickets for each year.

320
00:34:02,750 --> 00:34:07,240
But it's something like bring it to light, in which case it would be reported to the employer.

321
00:34:07,240 --> 00:34:11,840
Hospital will have a proper enquiry for language, if it was confirmed, they would,

322
00:34:11,840 --> 00:34:20,120
the person would be dismissed and then reported the Medical Council that that was due process would have to be had some.

323
00:34:20,120 --> 00:34:24,290
And what was your relationship to your college? How did you enjoy that?

324
00:34:24,290 --> 00:34:29,840
Which is the one where I felt it's really been a privilege to be a friend of one.

325
00:34:29,840 --> 00:34:40,040
And OK, I would make every effort to go to the two or three governing bodies term and I would go into the guest,

326
00:34:40,040 --> 00:34:45,170
distinguished medical guests, usually to the guest nights, twice it.

327
00:34:45,170 --> 00:34:49,340
When you say you made every effort, did you get there? Oh, I got to governing bodies.

328
00:34:49,340 --> 00:34:57,590
Conscientious, right. And if they were to if they were to guess not dinners and to parties, not in.

329
00:34:57,590 --> 00:35:05,810
My wife and I brought a whole series over the decade of very distinguished medical guests, not only medical personnel.

330
00:35:05,810 --> 00:35:13,550
And what would the privileged, well, privileged courses after after a whole week, which I enjoyed the stimulus and the challenge of my colleagues,

331
00:35:13,550 --> 00:35:20,810
see the opportunity to go to college on a Friday night and sit with people who had nothing to do with medicine was a refreshing change.

332
00:35:20,810 --> 00:35:26,820
And I was only being one of them is a super college that's really unstuffy and friendly and welcoming right from day one.

333
00:35:26,820 --> 00:35:30,950
So I thought it would also feel a bit more part of the university in the medical world,

334
00:35:30,950 --> 00:35:36,470
as you know, help most of your colleagues have done to understand what you're doing.

335
00:35:36,470 --> 00:35:42,890
I would never be able to go to college for lunch because I was too busy somewhere around the region also.

336
00:35:42,890 --> 00:35:50,720
I was it was a privilege and not the kind of maybe it matters as well when I was very knowledgeable on the various inspection's businesses.

337
00:35:50,720 --> 00:35:54,760
Now the is coming down and about. How did you integrate with that?

338
00:35:54,760 --> 00:36:01,850
Well, I, I made sure that one of the representatives of the dean accompanied every college visit, especially.

339
00:36:01,850 --> 00:36:11,960
It would always be me personally, but it was all done at the time they came to inspect the registrar level jobs rather than junior ones.

340
00:36:11,960 --> 00:36:20,480
But, um, and the husband were my responsibility. I mean, one of the things I did when I came was to go to every hospital to look at housetops.

341
00:36:20,480 --> 00:36:27,540
And in the interregnum before the death of my predecessor, Yareli and Malcolm go for that.

342
00:36:27,540 --> 00:36:32,120
And he went with John and I did one hospital and now they're at school.

343
00:36:32,120 --> 00:36:36,680
And they put in a pretty damning report that said things had to change.

344
00:36:36,680 --> 00:36:42,320
So the new boy come in autumn of 94. Nothing's been done.

345
00:36:42,320 --> 00:36:46,670
So I said to him, I get three months of these changes, which you may not have to be affected.

346
00:36:46,670 --> 00:36:51,370
I would move the house jobs. Well, it didn't make a change, so I removed him.

347
00:36:51,370 --> 00:36:56,030
And not for the Boston people. You know, there's no need for these jobs.

348
00:36:56,030 --> 00:36:59,350
Are not households to change jobs. If you could only see the consulting.

349
00:36:59,350 --> 00:37:06,200
But when they go to theatre once a week to see them and say you need staff, great jobs, people to do the jobs.

350
00:37:06,200 --> 00:37:13,340
And I took the person away, but then put them into Wixom, which hadn't got enough House offices to do a proper rota.

351
00:37:13,340 --> 00:37:20,510
So the actual transfer to that collective trust didn't damage them, but it took them out of places where there was no training.

352
00:37:20,510 --> 00:37:25,070
Will that make people sit up and take notice? And I take the Churchill.

353
00:37:25,070 --> 00:37:33,800
Yeah, they didn't feed the doctors, the young doctors when they were on duty in the middle of the night and would have anything to do with you.

354
00:37:33,800 --> 00:37:39,500
It was completely different. Oh, no, I will. When I first came,

355
00:37:39,500 --> 00:37:55,250
I found that at the post in the vice chair of the Junior Doctors BMA committee for the doctors concerns and cleverly Mulgrave left the committee,

356
00:37:55,250 --> 00:38:00,380
leaving me to be chair and the BMA junior doctor was Evan Harris.

357
00:38:00,380 --> 00:38:07,040
Right. And through letters, you know. Yeah. And and he he had his heart in the right place and he certainly was a terrier

358
00:38:07,040 --> 00:38:10,910
in terms of trying to get conditions right for doctors around the region.

359
00:38:10,910 --> 00:38:15,500
Got under the skin of most of my senior colleagues and I spent a lot of time pouring oil on troubled waters.

360
00:38:15,500 --> 00:38:21,740
But there was a valid issue and it was not unique to this particular hospital into that great and hospital.

361
00:38:21,740 --> 00:38:23,750
I've talked to several managers about this.

362
00:38:23,750 --> 00:38:31,640
I said, you know, if you were in the Army and you sent your troops out and didn't provide them with food, they'd shoot you in the back.

363
00:38:31,640 --> 00:38:35,750
And in military terms of power, I said, you know, you're poor.

364
00:38:35,750 --> 00:38:40,790
You're providing facilities for lunch, breakfast, lunch and tea.

365
00:38:40,790 --> 00:38:45,590
If you're not early supper for those who are working between eight and eight and

366
00:38:45,590 --> 00:38:49,400
then you expect the rest of it twelve hours overnight without providing anything.

367
00:38:49,400 --> 00:38:56,600
And so we did try and battle on behalf. And and that was one of the conditions of recognising how jobs good to make sure that there was some

368
00:38:56,600 --> 00:39:02,120
provision that my term had been that there was a because they wouldn't keep a staff open on a restaurant,

369
00:39:02,120 --> 00:39:07,800
but there was had to be some facilities in the junior officers mess for cooking and.

370
00:39:07,800 --> 00:39:12,030
Providing the basic ingredients, so it was it was a condition of getting a job,

371
00:39:12,030 --> 00:39:19,200
Haastrup recognised by the proof of the hospital as best we could, it wasn't adequate, but that was how we did.

372
00:39:19,200 --> 00:39:27,630
It did come within my province. It was more headaches than probably the most difficult question because things are changing with time.

373
00:39:27,630 --> 00:39:31,530
How would you compare Newcastle and Oxford? What was good?

374
00:39:31,530 --> 00:39:38,880
What was bad? Well, firstly, professionally, I mean, as a physician, I found no difference.

375
00:39:38,880 --> 00:39:47,910
That might seem strange. Look, you know, it wasn't because in both places a good relationship between academic and NHS jobs.

376
00:39:47,910 --> 00:39:57,180
There's a conscientiousness which, you know, I was part of my own upbringing and my studies and and the patient came first.

377
00:39:57,180 --> 00:40:06,090
And that ethos, I'm sad to say, even for what one reason, probably domain is been lost in some places not here,

378
00:40:06,090 --> 00:40:10,290
but we're not you know, we're not immune from criticism in that respect.

379
00:40:10,290 --> 00:40:18,300
And I think there is there's a change of emphasis, which I think is is to the detriment, but that is to do with caring for people.

380
00:40:18,300 --> 00:40:25,370
And this is much in nursing as a medical problem. And I.

381
00:40:25,370 --> 00:40:31,640
You know, the profession opposed the abolition of the states and rodenas because they were the salt of the Earth,

382
00:40:31,640 --> 00:40:37,160
often mature women who had families grew up and had a property training,

383
00:40:37,160 --> 00:40:42,140
and they were, by and large, pretty loyal and hardworking and properly trained.

384
00:40:42,140 --> 00:40:47,780
And I understood the question, wishing to become a good year institution.

385
00:40:47,780 --> 00:40:52,310
And we needed tons of nurses. And there's some real talent amongst some.

386
00:40:52,310 --> 00:41:06,220
On the other hand, they made a big mistake and getting rid of that grade, which was the basic backbone of good nursing.

387
00:41:06,220 --> 00:41:15,400
So I answered your question, when you have responsibilities professionally in terms of teaching,

388
00:41:15,400 --> 00:41:23,990
Newcastle was was in the forefront of really integrated teaching, both clinical and preclinical, which in Oxford is a long way behind that.

389
00:41:23,990 --> 00:41:26,650
I'm not saying there's a ethos.

390
00:41:26,650 --> 00:41:36,160
I mean, probably only 20 percent of the I'm not now talking about 20 years ago, 10 to 20 percent would do integrated natural medical sciences.

391
00:41:36,160 --> 00:41:40,180
And Newcastle funding was all what was here.

392
00:41:40,180 --> 00:41:47,050
Of course, you've got a three year proper science training and then three years clinical and there's horses for courses.

393
00:41:47,050 --> 00:41:52,870
So if you like the was more emphasis on the academic side, I think in Oxford, and that has a good reputation.

394
00:41:52,870 --> 00:42:01,630
And I had when I was a physician in Newcastle and it's to terms with because the prosecutors came and joined the Newcastle, I think.

395
00:42:01,630 --> 00:42:11,150
So the ethos is the same. There was a commitment to teaching, which is, I think a bit patchy to say, because the pressures on research,

396
00:42:11,150 --> 00:42:19,090
which is so paramount and people being evaluated and that was generally true of all academic institutions.

397
00:42:19,090 --> 00:42:26,710
The pressure research is such that because the teaching doesn't have the funding with it and the way that research does,

398
00:42:26,710 --> 00:42:30,940
there's a real danger of the teaching being devalued.

399
00:42:30,940 --> 00:42:43,240
And and I think that's where I personally felt I could make some contribution to making sure that teaching standards were maintained, but also valued.

400
00:42:43,240 --> 00:42:50,050
And I did that. I mean, I arranged every meeting with all the regional boards and all the students in the hospital.

401
00:42:50,050 --> 00:42:50,980
Most of them haven't.

402
00:42:50,980 --> 00:42:59,290
When I started this happened, I hosted a dinner at one of the more so because the region people got together, never met each other, most of them.

403
00:42:59,290 --> 00:43:03,880
And I lots. That's good. And that was appreciated, I think, because they got to know each other.

404
00:43:03,880 --> 00:43:10,960
And I also brought up those things like I've got the chief medical officer to come and talk to them.

405
00:43:10,960 --> 00:43:17,230
So we had a very serious, distinguished, not just for college presidents, but more sort of senior people still.

406
00:43:17,230 --> 00:43:20,260
Now, you weren't responsible for general practitioners.

407
00:43:20,260 --> 00:43:25,900
Well, I was I overall overall, I'm responsible for training in clean dentistry, although I'm a dental.

408
00:43:25,900 --> 00:43:32,650
We had so I was a director of general practise training. I mentioned John Haslet, followed by John Toby, followed by Neil Johnson,

409
00:43:32,650 --> 00:43:37,510
who went on to become a dean and then subsequent professor of general practise in Warwick,

410
00:43:37,510 --> 00:43:45,760
followed by Derek Galán, who also went on to become Dean and then is now going to be Dean in Wales.

411
00:43:45,760 --> 00:43:51,280
So they're very able group and they had a very organised training much they were ahead of the rest of the specialities.

412
00:43:51,280 --> 00:43:56,090
And so I was content to let them carry on with nudger in there.

413
00:43:56,090 --> 00:44:02,260
And I was involved in the appointments, but so I was them overall chiefly responsible.

414
00:44:02,260 --> 00:44:07,150
So if something went wrong somewhere, whatever it was, general practise or whatever, dentistry,

415
00:44:07,150 --> 00:44:31,870
interesting because we have no dental school and therefore the region's shortage dentists, because we don't train them locally and.

416
00:44:31,870 --> 00:44:37,670
And he we have a good, good relationship in terms of developing the postgraduate training for dentists,

417
00:44:37,670 --> 00:44:42,610
and he had his own group of people, but we were very supportive of that.

418
00:44:42,610 --> 00:44:45,520
Now, you were always doing some clinical work. I did.

419
00:44:45,520 --> 00:44:52,720
I said, well, I can I couldn't go on doing medicine because I couldn't continue day on a daily, daily basis.

420
00:44:52,720 --> 00:44:56,530
But I said I would like to do a diabetic clinic in an American clinic.

421
00:44:56,530 --> 00:45:03,520
And I volunteered my services. And since I came for free, I was welcomed by my colleagues because I didn't ask for the salary.

422
00:45:03,520 --> 00:45:11,680
So I did. I did the diabetic clinic throughout my life that I had to reduce to one of them a week.

423
00:45:11,680 --> 00:45:20,980
And then when I stopped, I went off doing both for 18 months after I retired from my full time job till I hit 65 and stopped altogether.

424
00:45:20,980 --> 00:45:29,260
Would you say there is a difference contrast between the general practitioners in Newcastle and Oxford?

425
00:45:29,260 --> 00:45:37,870
I can't answer that. There were good general practitioners in both, uh, and there was a good postgraduate set up in in Newcastle.

426
00:45:37,870 --> 00:45:46,090
And of course, Donald Irwin, who was a GP, became president of the GMC, John Walton to be president of the GMC,

427
00:45:46,090 --> 00:45:52,870
and indeed one of my contemporaries having left Newcastle, I think six of them became presidents of their respective colleges.

428
00:45:52,870 --> 00:46:00,190
So Newcastle had a fantastically good era and I could name them all.

429
00:46:00,190 --> 00:46:03,610
And it was a privilege to be amongst them.

430
00:46:03,610 --> 00:46:13,960
On the other hand, it was quite interesting because there's quite a tradition of movement of Newcastle staff to Oxford, um, over the years.

431
00:46:13,960 --> 00:46:27,760
And I can remember I mentioned John Walton, who is known, John Evans, the surgeon, Professor Gerontology, Joe's iconic microbiologist.

432
00:46:27,760 --> 00:46:34,480
And the first names just come on my head. But Dr Bird was sadly died of a brain tumour.

433
00:46:34,480 --> 00:46:42,490
He was immunology. Adrian Harris, I'm guessing, and Michael Tunbridge, Judy,

434
00:46:42,490 --> 00:46:47,710
they all came from Newcastle General Hospital because Adrian trained in Liverpool, but he was working here.

435
00:46:47,710 --> 00:46:52,900
We appointed him. I was on the Finance Committee. Oh, I was involved in some of the committee, perhaps a lot.

436
00:46:52,900 --> 00:47:00,730
But when Adrian was appointed professor at Newcastle at the age of 31, we knew we wouldn't be there.

437
00:47:00,730 --> 00:47:08,470
But he came here before. I forget the batting order and the the interesting and all those people worked at Newcastle General Hospital in Newcastle,

438
00:47:08,470 --> 00:47:12,610
the three hospitals to the traditional teaching hospital and the general hospital,

439
00:47:12,610 --> 00:47:17,810
despite his name, had the specialist unit because in fact, Rowbottom had come to me.

440
00:47:17,810 --> 00:47:25,960
I set up the neurosurgery that was radiotherapy, neurology, MRC and it but he was a general hospital.

441
00:47:25,960 --> 00:47:34,510
Yeah. And serve the poor in the Newcastle. So that's you asking and comparing off Newcastle.

442
00:47:34,510 --> 00:47:37,270
So when the treatment, of course the specialist went there.

443
00:47:37,270 --> 00:47:46,810
So it was there was a similarity in sort of all that because of the biggest city in the in the organisation of health care in Newcastle and here.

444
00:47:46,810 --> 00:47:52,190
And of course, the same I guess everybody defending the profession spends an awful lot of time defending the status quo,

445
00:47:52,190 --> 00:47:59,710
is that recognising change is going to come. You might be better spent, time might be better spent adapting to the new requirements.

446
00:47:59,710 --> 00:48:03,490
And it quite rightly, the decision had to be made to close the of family.

447
00:48:03,490 --> 00:48:11,710
But after many years of resistance from, understandably, people who are loyal to their own traditions and a fantastic history,

448
00:48:11,710 --> 00:48:16,450
and the same is true of Newcastle, what would be happening in Newcastle say happened?

449
00:48:16,450 --> 00:48:21,250
Well, with the. Well, it was, you know, some of the most beautiful country.

450
00:48:21,250 --> 00:48:28,690
Well, because it's about getting about you're not far from the border and it's a lovely place to walk in the summer.

451
00:48:28,690 --> 00:48:32,470
But in terms of health care, they would have primary primary care there.

452
00:48:32,470 --> 00:48:39,310
There's a I mean, there was a hospital in Hexham which is comparable to, say, was a hospital in Banbury, which is now,

453
00:48:39,310 --> 00:48:49,510
of course, an integrated part of the set up and as you know, was resisted being demolished over 25, 40 years.

454
00:48:49,510 --> 00:48:54,250
And it's one of the problems with the town that's that size 25, 30000 or whatever.

455
00:48:54,250 --> 00:48:57,940
It was not bigger is how what is the options?

456
00:48:57,940 --> 00:49:02,620
We're providing health care and you can't do all singing and dancing in there.

457
00:49:02,620 --> 00:49:06,280
And also so the present arrangement,

458
00:49:06,280 --> 00:49:16,150
I'm not sure how well it's working now is you have to integrate and what provide centrally and you can't put everything in the centre,

459
00:49:16,150 --> 00:49:19,570
everything because it gets swamped.

460
00:49:19,570 --> 00:49:31,700
And there is a real problem, I think, to integrating health services and social services because they took the patient journey from events at home.

461
00:49:31,700 --> 00:49:39,080
They need to delay is not finding a bag because grandma's still there and hasn't got a home to go to Northwest.

462
00:49:39,080 --> 00:49:47,390
If someone's got to take a overall view, it's no good just complaining about one section of this because it's all together part of the same problem.

463
00:49:47,390 --> 00:49:52,430
I'm getting a bit of traffic. No, no, no.

464
00:49:52,430 --> 00:50:11,510
You said you got out here early, early by age, partly because there was another reorganisation coming.

465
00:50:11,510 --> 00:50:19,260
Sarah, has the job change for your successor? I can't answer that because I've stayed out of his way in one sense and I've deliberately kept.

466
00:50:19,260 --> 00:50:32,300
Yeah, but nominally the job is James. I suspect in in terms of the NHS, I didn't need to talk to him in the changing structures of the NHS.

467
00:50:32,300 --> 00:50:40,400
I think he is like me sometimes. Glad to know that he had the university problem because he wouldn't didn't have to reapply for.

468
00:50:40,400 --> 00:50:48,470
So he's gone through two or three other organised organisations and the structure by which the postgraduate deans answer to the centre.

469
00:50:48,470 --> 00:50:57,560
When we started with this one to one almost relationship with the chief medical officer, it's way, way I think there are there are layers.

470
00:50:57,560 --> 00:51:04,620
And I think that the relationship now with level five, that's a real well, I think is a real change.

471
00:51:04,620 --> 00:51:06,170
I think that's one change the other.

472
00:51:06,170 --> 00:51:15,500
And it's perfectly because it is that health provision of health care is true of of of universities, not just to the NHS.

473
00:51:15,500 --> 00:51:22,910
It's no longer just medicine. You've got medicine, nursing and all the other health professions and you'll find it medical's in universities.

474
00:51:22,910 --> 00:51:35,240
Now, that might be ideal medicine, but he is under a director of of health, not house of health, but whatever you call it, all the health specialists.

475
00:51:35,240 --> 00:51:39,860
And that's the way of the world. And it's happened within our own speciality diabetes.

476
00:51:39,860 --> 00:51:45,830
Look at diabetes. You know, UK compared with the British Diabetic Association, which was purely the dog's diabetes.

477
00:51:45,830 --> 00:51:49,370
UK now raises all the versions of ourselves.

478
00:51:49,370 --> 00:51:53,120
And this is probably it's the way things have moved.

479
00:51:53,120 --> 00:51:58,380
On the other hand, in terms of postgraduate medical education, instead of asking to the chief medical officer,

480
00:51:58,380 --> 00:52:02,690
you are saying to the somebody in the region, regions called now it's got another name.

481
00:52:02,690 --> 00:52:08,840
So it will be part of what do we se the south with roughly half of this.

482
00:52:08,840 --> 00:52:16,130
So that change is different. And locally, I don't know, there's a new acronym which I've not even learnt, but I don't think there is.

483
00:52:16,130 --> 00:52:26,130
Which means that my successor has to answer to somebody in the new region who is deemed to be responsible education across all the health fields.

484
00:52:26,130 --> 00:52:32,240
Right. And then I don't know that he what how that relates to the department.

485
00:52:32,240 --> 00:52:36,200
So he would have something to do with Oxford Brookes. Did you ever have anything to do with it?

486
00:52:36,200 --> 00:52:42,020
And not directly, because, of course, the training of most of the nonmedical people have donnybrooks.

487
00:52:42,020 --> 00:52:52,070
And I have have have meetings with people in Brooks and my wife's habituated for them, for their handicapped students and so on.

488
00:52:52,070 --> 00:52:55,940
And and I certainly know the set up there.

489
00:52:55,940 --> 00:53:01,040
But as in my area, we would deal with medicine and not the other specialist.

490
00:53:01,040 --> 00:53:05,940
I don't know how far my successor has links with books or not money.

491
00:53:05,940 --> 00:53:10,820
That's been extremely interesting. Now, what would you like to say that I haven't asked you about?

492
00:53:10,820 --> 00:53:20,570
Oh, I see. Well, I think you've also asked me a lot. Ah, I because you are sitting thinking, well how much did I achieved.

493
00:53:20,570 --> 00:53:32,450
I do not. But what I do is for others to say I think I enjoyed the job, I did enjoy the stimulus and challenge of my colleagues.

494
00:53:32,450 --> 00:53:46,130
I hope that they might save me. Well I was fair and firm, fair and I can give you an example but I didn't think I should.

495
00:53:46,130 --> 00:53:49,370
So I was not to the point you gave. So what was the upside? What was the downside?

496
00:53:49,370 --> 00:54:02,450
Well, the upside was was really being an environment which is stimulating and challenging and and hopefully constructive to the downside,

497
00:54:02,450 --> 00:54:12,140
I think was dealing with the bottom one percent of our profession caused me a few sleepless nights and the frustration of actually my

498
00:54:12,140 --> 00:54:19,190
relationship with the Department of Health because I wasn't afraid to say what I thought would never have been probably not tactful.

499
00:54:19,190 --> 00:54:27,480
But to blunt was my Yorkshire coming up, um, and come back from lunch a bit like the boy said,

500
00:54:27,480 --> 00:54:33,170
the emperor's got no clothes when I felt a sense of going in the wrong direction and said so.

501
00:54:33,170 --> 00:54:37,460
But the civil servants didn't like to pass that on to their masters. Yeah.

502
00:54:37,460 --> 00:54:41,870
So I got a bit of frustration. I didn't yeah. There were, there were other positive things.

503
00:54:41,870 --> 00:54:47,780
I did help set up an electric scheme for people to take three months for the services because they're short of dogs.

504
00:54:47,780 --> 00:54:51,440
And I argued. So it's Territorians. No, no, no, no.

505
00:54:51,440 --> 00:54:58,940
This is people doing NHS training who might be interested. I thought they could learn a lot the minute you were keen to recruit.

506
00:54:58,940 --> 00:55:06,920
I didn't have any problems with that. But also I said and I I used my argument with the flexible trainees being a women,

507
00:55:06,920 --> 00:55:11,220
being allowed to take three months out of their training programme because of biological.

508
00:55:11,220 --> 00:55:17,490
Or whatever, without detriment to the chain. So I said if women make millions of women, the president could do that.

509
00:55:17,490 --> 00:55:22,060
So anybody could take three months off for valid reasons, without detriment to the training.

510
00:55:22,060 --> 00:55:29,340
So I then set up a scheme with the blessing of encouragement with the military so that anybody who wants to spend three months with Army,

511
00:55:29,340 --> 00:55:36,050
Navy, Air Force, with approval set up an agreement, they would be paid by the service.

512
00:55:36,050 --> 00:55:43,800
So we had some money to pay for Lukan. But more importantly, I persuaded the powers that be to recognise that this was possible.

513
00:55:43,800 --> 00:55:48,240
And so it was approved. And I think that was something I used to achieve.

514
00:55:48,240 --> 00:55:54,270
But I don't think many people took it up because people were really interested in. So it was already and it was, but it was quite fun.

515
00:55:54,270 --> 00:55:59,850
I think that led to very interesting trips that I made, including went to Bosnia and Burwick Ashram.

516
00:55:59,850 --> 00:56:02,740
What was the legacy of John Potter and Ralph Johnson?

517
00:56:02,740 --> 00:56:12,690
Oh, well, John was still around when I came much loved from a bachelor area in the days when suddenly,

518
00:56:12,690 --> 00:56:18,960
although he said that he used to spend his time sitting in the town of the winds writing letters, the Times.

519
00:56:18,960 --> 00:56:24,240
But he was a benevolent, humorous, kind person.

520
00:56:24,240 --> 00:56:26,610
And I can't judge what he done.

521
00:56:26,610 --> 00:56:37,170
But he was he was much loved and and I was privileged to know him and his lovely wife, who is still alive in the mid 90s.

522
00:56:37,170 --> 00:56:49,650
And Ralph Johnson came after him. And I can't judge what impact he made because when I came up, he'd been dead for a year.

523
00:56:49,650 --> 00:56:59,580
Shocking and tragic death. And so I don't know what changes he made.

524
00:56:59,580 --> 00:57:04,950
Can I leave it at that? Anything else you'd like to say?

525
00:57:04,950 --> 00:57:10,530
Well, I've enjoyed our company. I probably talk too much.

526
00:57:10,530 --> 00:57:18,360
And I think I do want to generalise. I think it's fair to say how am I went?

527
00:57:18,360 --> 00:57:26,130
But I wasn't frightened to to take tough decisions and to lead and large I think Quantico's kindness.

528
00:57:26,130 --> 00:57:35,280
And afterwards that did feel I was on their side. I didn't say I wasn't on liberty side, but but I was, I think, able to carry things with me.

529
00:57:35,280 --> 00:57:38,400
There was quite a lot of resentment to the changes that came about.

530
00:57:38,400 --> 00:57:45,030
And I am pleased that I was able to do that and remain friends with most of my colleagues across all the specialities.

531
00:57:45,030 --> 00:57:48,410
Mike, thank you very much. It was a lovely interview. I really enjoyed it.