Mike, this is a very, very intriguing man, Tom Ridge, thirty first of January 90 to run for Mike.
Very kind of you to give an interview and we're very grateful.
Can I first ask you the title of the job you came down to in Oxford and what it all meant really?
Well, I came in 1994 and the official title from the university whose appointment it
was primarily was director of postgraduate medical education and training.
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.
And so my point was a little unusual. It was primarily university with honorary contract with the regional health authority.
Was most of the postgraduate deans in other reasons were the other way around.
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?
I certainly made it as soon as I arrived, although I knew many colleagues here.
In fact, I'm just remembering that the day I arrived and somebody met me and I knew at the front door said,
you do realise my full of 300 personalities and type personalities in Oxford.
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,
which were the four countries of Bux Bonks Oxfordshire and Northamptonshire,
and also, of course, all the speciality advisers and the different specialities, mainly based in Oxford, but also in hospitals.
And so it was an integral job.
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.
The general practise side was very well looked after by John has learnt his colleagues,
and really I let him continue to and he was the director of general practise training.
But I had to cover all those specialities. And I had the background in diabetes and technology.
And so I knew and had met in all the hospitals. I'd let people with different specialities.
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.
So that was good background for for the purpose.
And I would say I would spend in one week, at least one day in London, Department of Health or both teams meeting.
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.
You mentioned the physicians you knew, but how much your time was involved with surgery, say?
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,
but rather got to know well and admired many of the colleagues and all the specialists
responsible for training of about 1500 postgraduate doctors across the region.
And I was very keen to enhance the training programmes.
When I came to Oxford, I think I was a bit surprised to find it was a divided medical school,
which is unusual in this country at that time because of the complete sort of separate psychological,
if not physical, but it was physically from the school.
And that's not true anymore. And it's, well, truly integrated now. But I was a bit surprised.
And there was also, I have to say, an attitude within Oxford, which is a little bit uncomfortable, was to say, you know,
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.
And there's a conceit in that which I don't like, didn't like.
And I was determined not well to make sure that the people in the region who resented
that would come to realise the strengths of being in elite training programmes.
And so this was the culmination. He was the chief medical officer keen to get rid of the old senior registrar.
Great. Much of the chagrin of the old school, but then create this unified specialist registrar.
Great. So that was an important element and enabled me to to talk to the regions and make sure we had in every
speciality a good programme which let the specialist registrars rotate because most of them are going to end up.
And it's so important they have some experience of that, not purely an academic centre.
On the other hand, I was keen to support academics and this became the era when to create new posts that government gave the
postgraduate deans 50 percent of the salary and they had to find the other half from somewhere else.
And early in my days, the university was going to get rid of intellectuals and create for technical tutors with the money consulting.
Right. And I was alarmed by that and said, well, if you've got AP'TIN collectors across different specialities,
I suppose you take half those salaries to go for consulting tutors, leaves the other half an hour.
Matchett So I kept this sort of by integrating my approach academically as well.
So we kept those temperatures. And I report important sweetcorn for future would be academic doctors.
And I think also we have well funded more or more research fellows around.
When the integrated SBL Jobs came along, I think 90 percent of them have done a clinical job already.
So they were eligible for allocated. No, but others had.
Compete in open competition for such training programmes as we had created, but then if they're in research,
could take off the next day with that number secure in the knowledge that when they come back.
So I tried very much with my background in both medicine as an academic and as a clinician to make sure that both parties,
NHS and university worked collaboratively. And I think we could be reasonably smooth transition.
And the programmes became very popular nationally, even in the least popular specialities.
So I think it sounds a bit boastful. I don't mean that, but we made that transfer relatively smoothly.
You said you'd match the salaries of half the salaries.
When was your budget? Was that you? No, no. The only bit of the investment was my salary and the secretary.
So how did you get her the NHS from the Council of Health?
It's all in this in this era that that proportion of of the NHS budget of topsides for education
was handled from the point of view of the medical training to the postgraduate deans.
So there was about 50 million that I was responsible for.
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,
which is sort of I could play with a bit more flexible and I would use that in sort of some innovative ways.
And I was keen to support flexible training. That's another thing.
I mean, that's also had a good name for it. What do you mean?
Well, people who take part time, maybe mostly women, because of natural biological reasons, but not only women and proportion,
we actually have the highest proportion of frigatebirds, highest 10 percent at any one time.
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.
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.
And if I had what we overspent and I was going to be sacked, I said, may I have the last word?
And I would say, you're going to fire me because I've spent some overspend on training, flexible trainees and particularly women.
And I think they wouldn't pull the trigger. I didn't get shot.
Was that the error shift? I mean, did you get your hands on, if not directly?
It was it's an error when where the money went and where where it should be were very obscure and
very obscure that the teaching hospitals got some money and then it was part of that great budget.
And so timing it and identify. But it was mainly for undergraduate teaching or for preclinical, not preclinical or clinical teaching in the hospital.
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,
which is the where the NDIS was like. I didn't think it was for undergraduate teaching.
I thought it was to compensate the hospital for the fact that they did undergraduate.
Yeah, well, I mean, yes, that's true. But it was an allocation for the time so spent.
I mean, however, getting it disentangling it from the rest of the budget was extremely difficult.
But I wasn't responding. I had to separate from that. It was not swift.
Yeah. Now they revert to sort of modern jargon.
Line manager, did you in any sense have a line manager, either NHS or university?
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.
But I would say I had to be answerable to the chief executive of the regional health authority,
essentially to the to the NHS and to that to the Department of Health,
although in the common era can send you promoted the post gravy deans collectively to be a cohort of his number two A's.
If I put it that way, if the chief if the permanent secretaries are one and the deputy chief medical officers are two,
there was a bit of a bit of resentment amongst the senior civil servants and
there was a bit of a tension as to whether we were civil servants or we weren't. We weren't.
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.
And so they had to agree if I misbehaved because I had to be disciplined for it didn't come to that.
But that was my sort of line management on the NHS side and the university side.
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,
but it wasn't like that administratively, that he was the senior research fellow, put it that way.
But, of course, I respected talk to David Weber, who I love, because in subsequent structures,
the head of division is not necessarily the religious professor medicine.
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.
But essentially I have to answer through the division. And then when appraisals and assessments came in, of course,
I would have a joint appraisal with with David whether the regents and the deputy from what was region.
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,
which you would know when we when we became angry in Oxford, when we met John,
because the Banana Republic, as it was called Oxford, we met at Milton Keynes halfway.
That lasted about two years. And then it was just reorganised again.
And we became southeast London, that is southeast England.
So which is the sort of bottom caller outside London and that took you from
our past north of Parkes was catching up to the Isle of Wight to Dungeness.
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.
And then it really organised again as get it right to get Thames Valley.
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.
And I think of the time spent by the NHS on reorganising that time and again and the amount of
effort from money spent wasted in my work in these organisations was just before I retired.
I saw this one coming and I thought, I don't need to be in the middle of that one again.
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.
And you're an ancient civil servant because I was interested. I spent a day a week in London on average.
Yes. I was talking about well basically I think in the common era.
And he was CMO for 94 to about 98.
And Liam Donaldson followed him. He was very keen on improving medical education and training from his background as a surgeon,
then as a oncologists then as opposed to Dean and then as a chief medical officer.
So he had a very good grasp. I liked him.
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.
Subsequently, Liam Donaldson wasn't so emphatic about that.
And I think the roles or the authority of was gradually eroded or diminished,
particularly to the extent that a medical education at the postgraduate level didn't become so important in the eyes of the NHS.
They had a lot of things to deal with. Who is really driving these reorganisations and where is the initiative coming from?
Oh, I think government ultimately you have to say whatever and not be dependent on any government changes.
I mean, in the last four years, as you know, I there's another reorganisation coming on.
I'm not going to get involved in the pros and cons of any of these things.
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.
And I think you do have to change,
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.
And later, what would you say of the novelty improvements that came in and which you were probably involved?
Well, I certainly believe in the unification of the registrar Cinderella story, which was a very important education.
I was sympathetic that not all my colleagues were, because even prior to that,
the bottleneck for would be hospital appointments was not until you failed to get
the senior registrar because the senior jobs were no privileged consumption.
So you could get to 33, 34, and especially having spent, you know, eight years training and then be thrown on the scrap heap.
And I thought that that decision shouldn't happen that late.
If you're not going to make it, then really I was in favour of the decision making time being between I said,
John Registrar so you can find the registrar it was that took three or four years smoothly.
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.
It was a huge expansion. Also in certain specialities of the unified grade,
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.
I was less keen on that because I think part of the management,
many people differentiate and find their speciality later rather than early in their careers.
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,
yes, they knew what direction they wanted to go, brought in medical or surgical or general practise.
And at the end of the house, jobs, you asked them again and two thirds again knew where they were going,
but different to the group and said people didn't need time and time to experience on the subject.
And so because they were very much traditional just medicine, surgery.
And one of the things I helped to do was create new hospitals in some of the other specialities,
including general practise and psychiatry, for example. So people could perhaps have three or four month modules.
And this was in that one year, which is now called foundation.
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.
So I was in the early stages of moving in that direction and then I lost track of my own thoughts.
What was your first question? Well, the question really was what would the novelty improvement?
Well, I think so. That was the education registrar, the creation of new hospital jobs, because as a university responsibility,
I was responsible for the Oxford graduates wherever they were working.
I had to sign them off at the end of last year, even if they were working outside.
So I had to know whether we can get reports from whoever was supervising it and I had to then sign them off.
So changing the traditional format of the house one year was I was involved in that.
So that's a novel in that sense. Yeah. Um, I've mentioned flexible training.
I think that is important that we continue to do that.
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.
I was very keen that the academics could continue to get special training.
But now these new specialities, the new scientific developments were essentially not necessarily what I called target or specialities.
If you think of a portcullis in the vertical lines, our hearts, lungs, got an old neurology, whatever you can say.
But the new disciplines of genetics might make molecular biology what I was trying to say.
Therapeutics cut across all those people training in the academic world where you could you could go to my
speciality meetings and hear the same sciences that we hear in the gastroenterology meetings or in the other.
And I was keen that these academic people should also get good technical training in general medicine,
for example, because by and large, the emphasis is different on different specialities.
And the physicians are much more interested in the academic side than most of the other specialities.
But essentially so I, I created it and it was unique at the time.
The acute general medical training programme was three years so they could get a ticket as a completed trained specialist and gentleman
internal medicine whilst doing their science and become available to the teams in the hospital and take part in the acute takes competency.
What did you think of the influence of the membership exam in British Medicine?
CBS and I always thought it was a mistake that a future academic researcher, medical,
but basically doing laboratory work linked to a particular speciality had to be competent at membership level across the board.
He thought they should just be competent in their own speciality. Well, I think it is.
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,
by and large, have moved in the direction of having, if you like, an entry exam as well.
Most deals have an exit exam, and that's another issue.
But actually and I got involved in European medicine as a representative of the UK in the speciality in the closet.
And and they like to be present at one stage. And together, my Irish colleagues,
we argued in favour of having this two year general training after graduation rather than going down the street and
especially which is what the rest of the world largely does in Europe and in America and Japan and places like this.
They go straight into the speciality. They become very competent.
They're trained specialists, not questioning that, but they don't have the breadth that we require of our trainees, medical or surgical at.
And that matters ultimately oh, and I think it's a weakness of our and paradoxically, as we become more and more specialised,
the people who can deal with the acute taste and see the patient as a whole,
I'm talking about mental as well as physical beyond their own narrow speciality, a few.
And that's really a weakness now because people aren't just systems that I'm really
impressed with the huge advances in the field of all sorts of specialities.
But still, in trend terms, I value the strength and I don't therefore not on that base in camp.
But I do think it's important whenever it is appropriate that people can take time out to do
their research and be and we supported people going up to three years out of the programme.
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.
It comes right. And I said to them, well, you know,
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.
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.
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.
The third is the founder of Doctors Net.
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.
He got a lot of other talents and he continued to practise part time.
But in essence, that's probably the single most beneficial, innovative tool of the whole my decade.
And I will give credit to him entirely for you. Earlier, I think when we were chatting, you mentioned type personalities.
And so when you were with this anglicised up with Oxford and Cambridge, did that work?
Oh, well, I have friends in both camps and I'm in Cambridge, so I'm accepted.
But there wasn't really any conflict. But but it also didn't work out.
They respected each other. Both halves of this strange banana republic.
I got on with a typical Oxford. I got on with their own things.
There wasn't much collaboration in the practical sense. It wasn't a merger of each.
Each rival institution, capital Cambridge, were developing clinical school.
But I mean, they'd already done it. But they were still developing. Yes.
And using places like Ipswich coaches for training more than Oxford written or not.
Well, I don't think this is personal.
In the early seventies, I went for John McCain as a consultant really too soon in my career and I wasn't appointed.
But I really blew it because I said to Cambridge, people who are in the preliminary visit,
what are you doing about integrating clinical training with all the other hospitals around the East Anglia?
And their attitude was, we're a scientific institution of world renowned.
We're not meant to talk about that. And there were blinkers about that.
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.
Yeah. Which was quite strong.
And I think they were also and there was resentment from outside, but more particularly Oxford as a small city, it's 150000.
OK, you've got some splendid centres and so on.
But you've got of 950 students who wind up from 250 was going to need.
And I was supportive of that. But still a small school in the UK.
But we did train a much bigger catchment area for the purpose of training students.
And so I was keen again that, well, the students did go out to some of the hospitals.
But when it came to those jobs, I mean, Northampton was excellent and very popular.
Unfortunately, Northamptonshire was removed from our geographic patch of subsequently.
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,
postgraduate students trained as well as teachers. And so I deliberately try and break down those walls so that there wasn't a
barrier between us and them in the sense that the academic centre of excellence,
which Oxford is, was also part of an integrated region.
The sort of room for somebody like me not knowing what was going on with Northhampton was an excellent place,
progressive, and Redding was a bit stuck in the mud or looking to London.
Well, I think historically that is true.
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.
But interesting enough, I mean, one, I was very fortunate in my nature.
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,
you know, I'd like to put a new post in here in this speciality as part of this programme.
And one or two of the senators didn't want that, which was a bit of a disappointment, I have to say.
So I didn't mean what Michael, you mentioned that there was a huge expansion in the consultant grade while you were in office.
Was that a good thing? And what was driving it? The short answer is, I think we had a right.
We have had a very pyramidal structure that people expected more consultant provided service, not just consultant led.
So there's a move to do that. The specialities all expanded in a single they were singlehanded practitioners anymore in their speciality.
They were just like in general practise. The group that was recognised, of course,
that the NHS would not have survived without at least one third of its staff who come from the Commonwealth countries largely.
And we weren't producing enough doctors. So the medical school numbers expanded from about 4000 to about 7000 over that decade.
I'm talking about mid 90s to 2000,
and that has a momentum which goes into the higher grades and the diversification I referred to at the interval between OSHA and registrar.
So I think all sorts of pressures. And now we do produce mainly our own graduates.
There's concern about unemployment, but of course it's competition. We still have free competition.
We still believe as doctors that we can choose to go wherever we like to do whatever speciality we like.
We do not need 10000 cardiac surgeons. We need a few good ones.
I mean, in a sense, competition that introduces Europe because you're on this committee in Europe.
And what did you feel your aim was on that committee?
Well, is there's an organisation which is for all the member states and with an every in the in the health division,
there's there's there's one for every subject.
And so just happens to be the endocrinologist. You've covered this as well.
And the the aim was essentially to it was to do the 1976 77 act of freedom of movement.
It's nothing to do with doctors as such.
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.
And so it was to do with the standardisation or recognition of qualifications.
Origi. And, of course, the different traditions of trading in different European countries are different.
I mean, I think I'm trying to remember who was the commissioner at the time, became a head coach.
His name was just going out. He had had the doctors wrangling about this for years.
He said, right as of the date. And Germany, you didn't recognise your file court, your final qualifications, period.
And that became European law. Yes. Now, there is a difference in that.
We talked about it earlier about how the benefits of having a broader trading system.
So that was the background against which we had similarly in the different specialities,
tried to make sure that the specialist qualifications required to be recognised,
say the courts were recognised by other European countries professionally.
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.
The influence with the commission level is political and that is another matter altogether.
But the politics were driven by integration with eventually, which has to do with the freedom of movement of people.
Yes, originally. But it professionally became and it was a very agreeable group.
And we've got remarkable agreement within the speciality group and then with the representatives also.
So within the broad division of the medical specialities were amazing unanimity in the
how people should be trained up to the level of becoming independent practitioners,
different in different countries, but not not in principle, apart from the fact you touched on earlier,
that we believe in a bit of general training, first to come back to Oxford.
What were your relationships? How do you integrate with the regional hospital board?
Well, it was it wasn't quite the board that you remember.
I mean, it was the board. I think there was still an integrated board.
We used to meet on Saturday mornings with the university and some of the presenters.
That was I mean, the representatives of both the region and the University of.
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.
Mm hmm. So that's within the chain of. So who would you be dealing with then?
Well, I mentioned earlier I think I would be dealing with a tremendous patriot was that was in the end the region.
She was the public health doctor there.
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,
but really quite a shock to me. I mean, it's interesting to deal with the profession as a whole.
I put it this way.
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.
It gives me a bigger headache, the bottom one percent of our profession of the top.
So you start to had a laugh and we went down and we could deal with.
But but I didn't come across the bottom one percent of our profession.
Now, in the course of my 20 years in Newcastle one time and before I worked in a good hospital,
200 consultants, probably with a really good ethos, same sort of quality sources we have in Oxford.
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.
So I wasn't very particularly experienced but the difficult side of our profession.
But I have to say the dean and the trainees more than the consultants, every specialist got his bottom.
One percent of my cumulative experience over a decade is more than I would have wished to have acquired.
And that's including theft and dishonesty and incompetence.
And so no one's immune to that. And we're not very good at disciplining ourselves as a profession.
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.
And so you interview the right one before damage is done to patients in the profession being very good at that.
Who is responsible for that? I mean, were you in any sense or was it the individual hospital should be doing?
Well, it's the employer and technically. But things would come to light like falsification, CVS.
And we would, you know, because you get 300 tickets for each year.
But it's something like bring it to light, in which case it would be reported to the employer.
Hospital will have a proper enquiry for language, if it was confirmed, they would,
the person would be dismissed and then reported the Medical Council that that was due process would have to be had some.
And what was your relationship to your college? How did you enjoy that?
Which is the one where I felt it's really been a privilege to be a friend of one.
And OK, I would make every effort to go to the two or three governing bodies term and I would go into the guest,
distinguished medical guests, usually to the guest nights, twice it.
When you say you made every effort, did you get there? Oh, I got to governing bodies.
Conscientious, right. And if they were to if they were to guess not dinners and to parties, not in.
My wife and I brought a whole series over the decade of very distinguished medical guests, not only medical personnel.
And what would the privileged, well, privileged courses after after a whole week, which I enjoyed the stimulus and the challenge of my colleagues,
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.
And I was only being one of them is a super college that's really unstuffy and friendly and welcoming right from day one.
So I thought it would also feel a bit more part of the university in the medical world,
as you know, help most of your colleagues have done to understand what you're doing.
I would never be able to go to college for lunch because I was too busy somewhere around the region also.
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.
Now the is coming down and about. How did you integrate with that?
Well, I, I made sure that one of the representatives of the dean accompanied every college visit, especially.
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.
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.
And in the interregnum before the death of my predecessor, Yareli and Malcolm go for that.
And he went with John and I did one hospital and now they're at school.
And they put in a pretty damning report that said things had to change.
So the new boy come in autumn of 94. Nothing's been done.
So I said to him, I get three months of these changes, which you may not have to be affected.
I would move the house jobs. Well, it didn't make a change, so I removed him.
And not for the Boston people. You know, there's no need for these jobs.
Are not households to change jobs. If you could only see the consulting.
But when they go to theatre once a week to see them and say you need staff, great jobs, people to do the jobs.
And I took the person away, but then put them into Wixom, which hadn't got enough House offices to do a proper rota.
So the actual transfer to that collective trust didn't damage them, but it took them out of places where there was no training.
Will that make people sit up and take notice? And I take the Churchill.
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.
It was completely different. Oh, no, I will. When I first came,
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,
leaving me to be chair and the BMA junior doctor was Evan Harris.
Right. And through letters, you know. Yeah. And and he he had his heart in the right place and he certainly was a terrier
in terms of trying to get conditions right for doctors around the region.
Got under the skin of most of my senior colleagues and I spent a lot of time pouring oil on troubled waters.
But there was a valid issue and it was not unique to this particular hospital into that great and hospital.
I've talked to several managers about this.
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.
And in military terms of power, I said, you know, you're poor.
You're providing facilities for lunch, breakfast, lunch and tea.
If you're not early supper for those who are working between eight and eight and
then you expect the rest of it twelve hours overnight without providing anything.
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
provision that my term had been that there was a because they wouldn't keep a staff open on a restaurant,
but there was had to be some facilities in the junior officers mess for cooking and.
Providing the basic ingredients, so it was it was a condition of getting a job,
Haastrup recognised by the proof of the hospital as best we could, it wasn't adequate, but that was how we did.
It did come within my province. It was more headaches than probably the most difficult question because things are changing with time.
How would you compare Newcastle and Oxford? What was good?
What was bad? Well, firstly, professionally, I mean, as a physician, I found no difference.
That might seem strange. Look, you know, it wasn't because in both places a good relationship between academic and NHS jobs.
There's a conscientiousness which, you know, I was part of my own upbringing and my studies and and the patient came first.
And that ethos, I'm sad to say, even for what one reason, probably domain is been lost in some places not here,
but we're not you know, we're not immune from criticism in that respect.
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.
And this is much in nursing as a medical problem. And I.
You know, the profession opposed the abolition of the states and rodenas because they were the salt of the Earth,
often mature women who had families grew up and had a property training,
and they were, by and large, pretty loyal and hardworking and properly trained.
And I understood the question, wishing to become a good year institution.
And we needed tons of nurses. And there's some real talent amongst some.
On the other hand, they made a big mistake and getting rid of that grade, which was the basic backbone of good nursing.
So I answered your question, when you have responsibilities professionally in terms of teaching,
Newcastle was was in the forefront of really integrated teaching, both clinical and preclinical, which in Oxford is a long way behind that.
I'm not saying there's a ethos.
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.
And Newcastle funding was all what was here.
Of course, you've got a three year proper science training and then three years clinical and there's horses for courses.
So if you like the was more emphasis on the academic side, I think in Oxford, and that has a good reputation.
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.
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,
which is so paramount and people being evaluated and that was generally true of all academic institutions.
The pressure research is such that because the teaching doesn't have the funding with it and the way that research does,
there's a real danger of the teaching being devalued.
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.
And I did that. I mean, I arranged every meeting with all the regional boards and all the students in the hospital.
Most of them haven't.
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.
And I lots. That's good. And that was appreciated, I think, because they got to know each other.
And I also brought up those things like I've got the chief medical officer to come and talk to them.
So we had a very serious, distinguished, not just for college presidents, but more sort of senior people still.
Now, you weren't responsible for general practitioners.
Well, I was I overall overall, I'm responsible for training in clean dentistry, although I'm a dental.
We had so I was a director of general practise training. I mentioned John Haslet, followed by John Toby, followed by Neil Johnson,
who went on to become a dean and then subsequent professor of general practise in Warwick,
followed by Derek Galán, who also went on to become Dean and then is now going to be Dean in Wales.
So they're very able group and they had a very organised training much they were ahead of the rest of the specialities.
And so I was content to let them carry on with nudger in there.
And I was involved in the appointments, but so I was them overall chiefly responsible.
So if something went wrong somewhere, whatever it was, general practise or whatever, dentistry,
interesting because we have no dental school and therefore the region's shortage dentists, because we don't train them locally and.
And he we have a good, good relationship in terms of developing the postgraduate training for dentists,
and he had his own group of people, but we were very supportive of that.
Now, you were always doing some clinical work. I did.
I said, well, I can I couldn't go on doing medicine because I couldn't continue day on a daily, daily basis.
But I said I would like to do a diabetic clinic in an American clinic.
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.
So I did. I did the diabetic clinic throughout my life that I had to reduce to one of them a week.
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.
Would you say there is a difference contrast between the general practitioners in Newcastle and Oxford?
I can't answer that. There were good general practitioners in both, uh, and there was a good postgraduate set up in in Newcastle.
And of course, Donald Irwin, who was a GP, became president of the GMC, John Walton to be president of the GMC,
and indeed one of my contemporaries having left Newcastle, I think six of them became presidents of their respective colleges.
So Newcastle had a fantastically good era and I could name them all.
And it was a privilege to be amongst them.
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.
And I can remember I mentioned John Walton, who is known, John Evans, the surgeon, Professor Gerontology, Joe's iconic microbiologist.
And the first names just come on my head. But Dr Bird was sadly died of a brain tumour.
He was immunology. Adrian Harris, I'm guessing, and Michael Tunbridge, Judy,
they all came from Newcastle General Hospital because Adrian trained in Liverpool, but he was working here.
We appointed him. I was on the Finance Committee. Oh, I was involved in some of the committee, perhaps a lot.
But when Adrian was appointed professor at Newcastle at the age of 31, we knew we wouldn't be there.
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,
the three hospitals to the traditional teaching hospital and the general hospital,
despite his name, had the specialist unit because in fact, Rowbottom had come to me.
I set up the neurosurgery that was radiotherapy, neurology, MRC and it but he was a general hospital.
Yeah. And serve the poor in the Newcastle. So that's you asking and comparing off Newcastle.
So when the treatment, of course the specialist went there.
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.
And of course, the same I guess everybody defending the profession spends an awful lot of time defending the status quo,
is that recognising change is going to come. You might be better spent, time might be better spent adapting to the new requirements.
And it quite rightly, the decision had to be made to close the of family.
But after many years of resistance from, understandably, people who are loyal to their own traditions and a fantastic history,
and the same is true of Newcastle, what would be happening in Newcastle say happened?
Well, with the. Well, it was, you know, some of the most beautiful country.
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.
But in terms of health care, they would have primary primary care there.
There's a I mean, there was a hospital in Hexham which is comparable to, say, was a hospital in Banbury, which is now,
of course, an integrated part of the set up and as you know, was resisted being demolished over 25, 40 years.
And it's one of the problems with the town that's that size 25, 30000 or whatever.
It was not bigger is how what is the options?
We're providing health care and you can't do all singing and dancing in there.
And also so the present arrangement,
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,
everything because it gets swamped.
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.
They need to delay is not finding a bag because grandma's still there and hasn't got a home to go to Northwest.
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.
I'm getting a bit of traffic. No, no, no.
You said you got out here early, early by age, partly because there was another reorganisation coming.
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.
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.
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.
So he's gone through two or three other organised organisations and the structure by which the postgraduate deans answer to the centre.
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.
And I think that the relationship now with level five, that's a real well, I think is a real change.
I think that's one change the other.
And it's perfectly because it is that health provision of health care is true of of of universities, not just to the NHS.
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.
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.
And that's the way of the world. And it's happened within our own speciality diabetes.
Look at diabetes. You know, UK compared with the British Diabetic Association, which was purely the dog's diabetes.
UK now raises all the versions of ourselves.
And this is probably it's the way things have moved.
On the other hand, in terms of postgraduate medical education, instead of asking to the chief medical officer,
you are saying to the somebody in the region, regions called now it's got another name.
So it will be part of what do we se the south with roughly half of this.
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.
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.
Right. And then I don't know that he what how that relates to the department.
So he would have something to do with Oxford Brookes. Did you ever have anything to do with it?
And not directly, because, of course, the training of most of the nonmedical people have donnybrooks.
And I have have have meetings with people in Brooks and my wife's habituated for them, for their handicapped students and so on.
And and I certainly know the set up there.
But as in my area, we would deal with medicine and not the other specialist.
I don't know how far my successor has links with books or not money.
That's been extremely interesting. Now, what would you like to say that I haven't asked you about?
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.
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.
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.
So I was not to the point you gave. So what was the upside? What was the downside?
Well, the upside was was really being an environment which is stimulating and challenging and and hopefully constructive to the downside,
I think was dealing with the bottom one percent of our profession caused me a few sleepless nights and the frustration of actually my
relationship with the Department of Health because I wasn't afraid to say what I thought would never have been probably not tactful.
But to blunt was my Yorkshire coming up, um, and come back from lunch a bit like the boy said,
the emperor's got no clothes when I felt a sense of going in the wrong direction and said so.
But the civil servants didn't like to pass that on to their masters. Yeah.
So I got a bit of frustration. I didn't yeah. There were, there were other positive things.
I did help set up an electric scheme for people to take three months for the services because they're short of dogs.
And I argued. So it's Territorians. No, no, no, no.
This is people doing NHS training who might be interested. I thought they could learn a lot the minute you were keen to recruit.
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,
being allowed to take three months out of their training programme because of biological.
Or whatever, without detriment to the chain. So I said if women make millions of women, the president could do that.
So anybody could take three months off for valid reasons, without detriment to the training.
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,
Navy, Air Force, with approval set up an agreement, they would be paid by the service.
So we had some money to pay for Lukan. But more importantly, I persuaded the powers that be to recognise that this was possible.
And so it was approved. And I think that was something I used to achieve.
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.
I think that led to very interesting trips that I made, including went to Bosnia and Burwick Ashram.
What was the legacy of John Potter and Ralph Johnson?
Oh, well, John was still around when I came much loved from a bachelor area in the days when suddenly,
although he said that he used to spend his time sitting in the town of the winds writing letters, the Times.
But he was a benevolent, humorous, kind person.
And I can't judge what he done.
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.
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.
Shocking and tragic death. And so I don't know what changes he made.
Can I leave it at that? Anything else you'd like to say?
Well, I've enjoyed our company. I probably talk too much.
And I think I do want to generalise. I think it's fair to say how am I went?
But I wasn't frightened to to take tough decisions and to lead and large I think Quantico's kindness.
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.
There was quite a lot of resentment to the changes that came about.
And I am pleased that I was able to do that and remain friends with most of my colleagues across all the specialities.
Mike, thank you very much. It was a lovely interview. I really enjoyed it.