This is an interview with Grantly by Derek Hockaday at his home in Curtaining Cottington,
and it's about his memories of the Oxford Medical School grants.
You came in 1956, Torchwood? Oh, I think so, yes.
Yeah. And what did you what made you come really?
Well, the situation was that I've always wanted to be a GP.
I mean, I don't know what made you want to go into medicine, but I remember when I first went up to be interviewed at Thomas's where I trained,
uh, the called Bill, Bill, big bill that we certainly have not.
But he'd been a government servant in Ghana in the Empire.
And I said, why do you want to be a medical student? I said, I've always wanted to heal people, so don't be so stupid.
He said, What do you mean [INAUDIBLE] keep. Tuesday was a deep sense of vacation, really, I mean, why do people want to do anything?
It's something you from deep down you could explain anyway, in those days you could train very quickly because war was just started.
So you're in and out of medical school and you learn by dugouts like I am now, because all the rest have gone into the services.
And then you were then in a tank regiment or something in the final bits in the warfare
where you learnt an awful lot about my experience because there was nobody else to do it.
There was a search initially, initially, and then last in, last out.
So I then went to the Middle East and was in the Sudan when the partition was going on still.
And then down in Suez, the DMO, the age of 23, I suppose, looking after 600 bed and hospital and medical divisions.
And so you had an enormous amount of experience and you learnt on the job.
Yes. And you came back and the Pacers swarming with people.
Court time expired registrars because there's no work for us and all the general practises were full.
Mm. So then what did you do. And I learnt that Thomas is a very special thing.
There was a guy there called John Richardson. He became Sajani.
He was a very charming man. And his sister his wife was was, I think, silly.
Abuzer, she was a woman. She was a mother daughter.
So this tremendous collection of Thomases through the brothers who came down, you know, all of that and so forth.
And I learnt from him.
He said, if you become a consultant physician, you are actually the servant of the general practitioners.
So the general practitioners will still be you because you are a servant to them.
You're not the consultant telling the generations what to do that employ you to help them.
An ethos and I think really needs to come back. Yes. And so that's how it happened.
And then the only way you could get on was if you're going to have to go into medicine outside your apprenticeship doors.
Because my cousin was a GP in the holidays as his assistant, and Tony DAUn House is a great friend of Richardo, actually was Thomas's.
And he was in the thing called the medical unit, and he knew everything.
And the only other place he could go to was Hammersmith. So I went and trained under MacMichael and Andrew.
What Michael has done here, not the time, but unfortunately Andrew is a spitting image of his father and I just learnt so much from that man.
And one of his his colleagues was Peter Schaffer, who'd been at University College and had trained with, you know, who I mean, Lewis Lewis.
So he was part of the British Lewisite. Yes. And the rest of London was all stiff collar consultants who are British, actually.
So, yes. And so there was Peter Schaffer went back to Thomas's and you had to get a
job in your teaching hospital if you were to get on as a consultant anywhere. So he invited me back to work for him.
And then he trained growing up under Lewis with, uh, George Pickering.
Mm hmm. And then George Pickering had been asked to come down here and I had now become pretty expert in investigative cardiology.
I know Michael Schaefer. So I was asked by George to come down here really as his bugle boy to set up a cardiac lab.
When you were first assistant at Thomas's, were you there?
No, no. I was called a time expired. Registration was the answer.
Yeah. And so I was a I think I was called a lecturer on the Petersham.
But Peter Schaffer, I learnt a [INAUDIBLE] of a lot from them.
Guy One thing I learnt from him was that if you did anything new and you wrote a paper about it,
you had to hone it down to every word meant anything to a paper that's five, five or ten pages long.
I ended up on two sides of a piece of A4, which is just amazing.
What good language could do is now when you came to Oxford, it was a sort of promotion.
But were you intrigued by Pickering? I thought it was marvellous. Yes, well, it's worse than that.
But because what happened was that he he needed a first assistant, as he called it, to come to him.
Anybody else would have had a reader named.
It was the same status, I thought, as a reader, but Peter Schaffer said to me, look, you must you must be very careful of tinkering with it.
He said he's very charming. Don't think you can run him because he can always run.
You watch this figuring asked me down to Chaffetz and Giles where I was living, and he asked Pamela as well, sensibly for the weekend.
Yes. And so the timing and what his wife could talk and so forth.
And she was an absolute dear friend. Yes.
And Tom took after her son and he then said what he wanted to do and what he wanted me to do to come down and be a condition
for him because he had to do all these other things so he could always feel secure because he wanted his his firm to be,
although it was going to be the medical unit was going to be just like any other film so that the parks people,
the scientists in the parks and sort of clinical school was no good because they were all GPS got pompous since the war came needed.
They were no good. And everybody have got to go to London. So our job was to make the parks.
People realise it was pretty good medicine in Oxford as well.
And then I came back and I just was a bit I just didn't I didn't feel comfortable with the guy.
Hmm. And Pamela said to me, what on earth are you doing?
She said, your time expired. Senior registrar, you're now nudging thirty or whatever it was, and you've got no long term prospects.
You can't get into general practise. You're too highly qualified. And and and you turn a man down like that because you're not quite sure about it.
You're just mad. So she took the job, right.
So then I came and when I got here, lo and behold,
I was slightly right because he hadn't told me that he'd gone to had his bets by asking somebody else to be the first assistant.
Well, there were two of us were Bill Cranston. No. Joni Mitchell.
No,
it was it was Brown Bronte Stuart who started the whole business of liquid understanding is this marvellous guy and a South Africa and a lovely wife.
And we were tremendous friends straight away because George had a gift of picking people.
Yes, I think he did. And he really did. And so he was great in many ways.
But you have to watch the quality of force.
And when you came to Oxford, how did you find Oxford compared with Thomas's and what were you sort of feeling?
Terrifying things. You were bad. No, I was terrified.
Yeah, you were terrified. But what did you think of the practise of what was going on, the nursing, etc., in Oxford compared to Thomas's?
I thought it was I thought a slipshod frankly, it's no truer.
There wasn't that Tomatis. I had a I don't know if it's still the same.
I doubt if it is actually had this situation where the the nursing school,
the Florence Nightingale School of Nursing, was more important than the medical staff and the consultants.
They were all people in Harlow Street and so forth. It was a voluntary hospital.
They came in and gave the time as well, the hospitals and the senior staff.
Brasilia's worked with them. But you were really apprenticed to the nurses and so forth.
And in fact, when you went on the wards, there was a clinical student.
You spent your first week to a fortnight working with the nurses to learn how to behave yourself.
Right. And I don't think that's a bad practise at all, actually.
I think to walk into the clinical school and then spend your part of your assignments would be just working as a nurse assistant with a coat on the.
Learn how to, you know. But so that's how it started.
And so it was and it varied enormously. Yes.
And then you bring up good discipline.
You were building up cardiology, but how much general medicine were you doing?
Oh, a lot.
I mean, I was a cute general physician, so rather than being a cardiologist, I didn't know a clinical cardiologist, the clinical cardiologist.
I've been investigating experimental cardiologists with Michael.
If you ask the patient if you could run catheters all over their body that, you know, you had to have their permission.
But in fact, they were assisting you, finding out how the normal body went wrong.
Mm hmm. So making a clinical diagnosis of heart disease, particularly paediatric heart disease, is a nightmare.
And I just say to people like Victoria, small fish, I've never learnt on the job.
I am learning all the time. But she still was a great help.
Yes, because there's nobody else to go to, actually. So you would be doing angiograms for angiograms and total heart angiograms?
Yes, yes. Yes. And was there anything special with the pressure we made our own catheter, the pressure gauges on things because you had no ultrasound?
No, no. I mean, what what what went on to do a subsequent generations was to do parallel studies using
non-invasive techniques so you could make do these things without those techniques.
That's the great joy of modern advances in non-invasive cardiology.
Yes. And what sort of you had a university contract or in any case, I was paid well, didn't worry.
And they said, no, it wasn't proper for me to ask. No. What I did know is that I wasn't a university, so I had no more.
Right. It was George Pickering and his department, his first assistant, then the man, The Apprentice boiler house.
But in my state, it's in practise. How much time did you have for research?
Well, how do I find nowadays research is spelt.
It's called research is the whole of medicine is search research.
So, in fact, what was required was to have a way that we could make formal diagnoses which are sufficiently
accurate without cutting the person open to know if they needed open heart surgeries,
which was developing then in London and so forth.
And the idea was that it had to develop in Oxford to run getting all the patients going up there because it was not you know, we needed more centres.
So the whole business was right on the edge of of finding out everything when when the chest was opened by a cardiologist,
he didn't codecs and he didn't read it in those days. Know what are going to find anyway.
So you had to ask permission. Permission, please. May I cut you open to find out if I can do anything?
Is there was an enormous requirement of trust between the patients and the doctor and the surgeon in particular.
So roughly, when did you begin to work with this?
McGrath Right from the beginning, yeah. So that must have been your research topic, really.
One did that as a hobby. Yes. Night. Yeah, right.
But you didn't do it in working hours. I mean, do you feel that your working hours were totally taken up with clinical care,
including the investigative cardiology and a certain amount of negotiation?
You see, the real problem was that when you can retire, they couldn't find a replacement of that kind to come.
And they also had a situation where they were beginning to realise that they had to clean up and the cardiology or part time GP surgeons,
really very good ones and so forth.
And they wanted to put that on the map in the same way academic surgeries as a new profession.
And they couldn't find anybody and nobody would come on ultimately.
And they also really would back somebody would get on some cardiac surgery.
And so they asked Philip Anderson, who was a very, very successful general thoracic surgeon up in Leeds,
to come, and he said, yes, he'd come and start open heart surgery, but he'd never done anything.
Right. So what do you think he did? He took the job and then went off to Briber Hammon's in Cambridge to learn how to operate on dogs.
Yes, I think could two years and his first assistant called Alf Gunning came down and started doing.
A chaotic, simple cardiac surgery like Michael Stenness, mitral stenosis and stuff.
Well, it was our previous experience where he'd worked as a junior up in Leeds for Filiba very much under his role.
Now, Gunning, you know perfectly well who he was because F was one of these strange people who had trained.
He was a South African as bright as a button. A very, very good surgeon.
And he had trained as a general surgeon and then become an EMT surgeon, if you please.
And then quite a number of his generation and I got a nominal dysphagia at this age when I get excited, I can't remember anybody's name.
But there were three of them. There was Afghan who was one of them.
The other one was the chap who operated on the first transplant surgeon who I mean, Chris Epona in South Africa, Chris Bowen.
And I got to know because he came over quite often because my brother was a super chap, but Chris Barnard was something slightly different than his.
And then there was a man called who went to London, who is the other great chap who funded him, who they were all contemporaries together.
And so Alf came down as his job and then he did the cardiac surgery like mitral cynicism.
And there was the beginning of cooling people down there to invent from wholesaler's so we could cool people down and open them up.
And so it was supposed to fix that kind of thing. But Philip Anderson was an individualist.
He didn't want to work with anybody except himself.
So he demanded from the universe that he wouldn't come unless they built his own operating theatres.
And they gave me and made his own cardiac lab so he could do the investigations himself.
And he brought youngsters down and got any experience of that kind of thing at all.
And Pickering hadn't got the plant for me to start it.
So I had to ingratiate myself somehow or another to work in for businesses when there were no I had no authority over.
It was very difficult indeed.
So the only thing you could do is to get to know the people in the lab so well that they came to you rather than him, actually.
Yes. Yes.
And then things got to a stage where it really was very difficult because everything, you know, you couldn't do the job properly and they couldn't.
So I built up a waiting list of four or five hundred cases,
patients who needed cardiac catheterisation and couldn't get them and then went to the border guard.
I never got on the board of governors. I was much too difficult to help anyone who didn't want me there.
So I went to the board of Governors and I had to close the waiting list down because it was not morally right.
Is all these patients who go to London is.
And by that time they couldn't cranio subvention to the university has been cut down to triennial and then down to annual.
And Lord Franks had just been appointed as the chairman of the Board of Governors.
Marvellous man. Yes, upright, tall, upright man in body and in mind.
And so and this happened.
And so the way Franks came and said, look, you said there's a whole lot of money unspent from previous years.
Could you have another cardiac department? So I said, yes, there's a courtyard between the X-ray department and not next door.
I'll fill in the courtyard and we'll build the lab and have our own cardiogram.
Right. And so the money was there. We did it.
I started. That's about sixty three. Sixty four. I would have to look it up.
Yeah, sure, sure. It was when Frank had been there for about a year.
Yes. And who were the technicians really helping you.
They were dreadful. They were all people who had no Tenere.
They were, they were undisciplined. They're not trained.
And it was an absolute nightmare.
But and it was helped a lot in a funny way, coincidentally, by Alf Gunning doing most of the major surgery because filibusterer was quite, very good.
But he was also very political, very busy.
And he had a dining club, pretty bederson all the big surgeons around the world and Liley High and DeBakey and all these sort of things turned up.
And there was a gallery above the operating theatre and another Department of surgery.
And Alf Gunning teamed up with a chap called a.
In Barraclough, who has worked in the engineering department, and his father was a technical chap, and there they were making artificial nails, but.
And before that, the sister, junior sister in the operating theatre said, I'm not working here anymore, OK?
Once in my contract. So then I had a sister was so good.
Now central to London to train as a technician. And she ran the technician. Right.
Right. So that's how it was done. Yeah, it was. So, you know, that's how the place worked.
I mean, it was very hard, but it was small enough to do this when you don't know when it's systematised,
you have intrigue and a massive scale with a place as big as it is now.
Heaven help the place. So how are you getting on with this work?
Well, I had a big grant for that. Yes. And the reason for that was that when I was at, uh, before I was it.
When I was in Hammersmith, oh, no, I know when I first came back to Thomas's, you couldn't do it, and that was in 1953.
Jaspers can't remember what happened on the dates.
You couldn't do anything in Britain in academic medicine without working in your teaching hospital and
getting your knees brown in real research in the United States long before Europe was got anything with it.
And so you had to have been to America to get ready.
And in my I had the wit to see that you must go for something in cardiology that nobody else could go into.
The person who'd done that to perfection in another field has been what's it got to back today?
What subject? Tropical medicine started in World War.
He picked something that nobody else would lose interest in and has gone on forever because nobody's in that in that penumbra area.
Yeah. And so I thought, well,
there are a whole lot of people who especially physicians who are just physicians making diagnoses of chest disease when it's heart disease,
particularly with fluid on the lungs and so forth, and cardiologists making diagnoses of cardiac disease when it's lung disease.
So I'm going to specialise in micro circulation of the lung. And Schafer did all I could to help him do that.
And so you went in and you found that there was something very strange in the lung circulation because the pulmonary artery pressure,
if it gets above 20 centimetres of water,
the whole thing leaks because the capillaries so thin that there's something not doing, keeping it down, regulating it.
And so you have to then look at the physics and read enough about physics to know about compliance and all that sort of stuff.
You had to do something to find out what the transmission line was doing in those physical terms.
So you have to have a way of measuring the you could measure the signal output, the fly,
but because by this time making little catheters, it was the pressure gauges on the air.
So you could tell the pressure in the pulmonary artery. But Valve and you had to get and you could measure the flow with the fluid that you got on the
that these cases we made in the department more so with the help of the engineering school here.
So, uh, um, I, I learnt that before that.
Pickering, um, about Schaffer's.
Well, if you want to go and look at this long so you better go to work with this man called Julius Cobbora.
Unfilial everybody. If you went to work for Julius Gomera, you, you, you learnt everything.
Yes. He was a pharmacologist. So it wasn't only about four or five years old.
That was, I suppose, at the time. And he looked about a hundred. And so if you worked for Julius, it was tremendous.
And so I went to do this Komarow for six months, I think it was.
And he employed us English people because he paid us so little. We worked all the time.
And, uh, there there was a man called Arthur Dubois who worked with Ron Otis and Fynn from Rochester.
And Arthur Dubois was Rennie Dubois, his son, the metabolic person.
You know, what about him? And Arthur was an incredible guy, very quiet.
And he asked me what I was doing. And I said, I have this idea that there's something preventing them leaking, keeping the pressure down.
And I've come to learn about this here. And he said, well, we have to look at the ten quick that he was a professor.
And he said, uh, Krog used to use a spirometer for measuring cardiac output with nitrous oxide.
And I've got a system, a graph here for studying the mechanics of the lung, which do discoverability.
Fire came from Richardson, the great big thing, like a steel box for going down into a submarine,
you know, jump in the box and here's a bag of nitrous oxide.
And, uh, and we'll measure the pressure in the box and see what happens.
And he put NCG on me, uh, and, uh, that very afternoon, I took a nitrous oxide and EKG to see when the heart was the ventricle was pumping,
uh, you know, and lo and behold, there was a trace in the box, a lot of pressure.
And it lost in a funny sort of way. It looked like when you plotted it that it had a wave pattern to it.
So it. Blood flow in the capillaries right in one day is, you know, that doesn't happen very often.
How was it how easy was it to get a book built in Oxford Pickering?
Well, the first. But then when a when a train passed in Philadelphia, the box resonated with a much bigger signal.
So you had to get rid of all the noise. So brilliant.
And I said, well, why don't we put a fourth wall down the middle. Yes.
And we'll put a differential manometer in the box measuring the side without a person in.
And we'll and we'll use a subtraction. So he was just a wonderful technician, this guy.
So he tried it all out. And then I came back to Oxford. And Camilo's a wonderful creature because we used to go in at night into it.
So I made a box. I knew it had to be rigid, so I made a box.
It would fit on top of the catheter table, which was really but of course, the teeth of the table was fat sided.
So it's just like one side of that box in Philadelphia.
And so, George, George Pickering's labs, we all had our own level way down the corridor is still there and the pump for the off.
And I had a lab on first one on the left and he came in and it had a concrete was designed for animal work, so it had a concrete terrazzo floor.
So I decided and then Frank started with a man who was working for Bordelon and done that, Jemmy Savile.
Chaplin got so badly he he'd worked with Bob Dylan.
And Frank Stark was a brilliant inventor, is a very charming man to work with, such as Never Got Anything Done.
But he was the guy that helped the developing oxygen breathing equipment for Hillary and people.
Uh, and the unit had shut down when Bob Dylan retired.
And so Pickering had made a home for Frank Stott.
And so, Frank, start with an emergency employee on this business.
And he came in and he designed the hoisting equipment and so forth, and a new way of measuring the instantaneous pressure flow, which was so clever.
It was unbelievable that we had to do it on the floor because it was rigid and thick concrete, the feminised to come in with Frank at night.
And she'd be a subject insider on the book. And then a man called.
Oh, Lord. David, David, David, David.
From from it'll come from the network is very great now we all tiny, we all knew each other internationally, like, you know, people do still sense.
And he invited me to to Buffalo. And I got very fond of him.
And he came over here and he was the kind of guy that was such an experimentalist.
He used to get his colleague to do kestrels on him.
So he had a catheter, a cardiac catheter done at night on the floor so we could measure pressure and flow at the same time.
And then we had the situation of not wanting to try and do it, and disease of people with pulmonary hypertension, all the rest of it.
And we had patients who came in who needed heart disease investigations.
And we talked to them and said, look,
there are things that we could do that would help us enormously at the expense of prolonging a catheterisation for some time longer,
perhaps half an hour longer.
And it means coming down the corridor and coming into my lab and going on the floor and having these measurements and going back again.
And I said there is risk because it's not necessary. And it's an astonishing that people you got to know them so well.
They said, cut my head off. You like Doctor, you know, I trust you.
And so within.
So what I used to do is then get a colleague, Jeff Brown, criminal, turned up by this time to go with them and say, look, this is really in it is.
And then finally give him a piece of paper to sign. Yes. And they still did it.
So there were one or two studies done like that on the floor. Mm hmm.
So he then got one or two measurements, which were quite enough then to say this is why it was working if you didn't need to do anymore.
And out of that came a strange thing, because as we got more and more expert and things got tougher and I mean by tougher,
the diseases got less and less available because we were studying diseases as perturbations of normal physiology.
I understand. Yes. But as the diseases got better treated are disappearing.
Yes. So we couldn't go on with finding out the pathophysiology because they weren't there.
And we had to do experiments on animals is to look at that.
And I found that much more difficult because animals don't have a choice of saying, I don't want that done.
Yes, I do this. I do. There's another moral dilemma for you.
So. Well, this was going on. I mean,
the other big change as it happened probably before Brown came was the cocain malum retard and the whole firm system in medicine was shaken up.
Where did that fit in? That would have happened while you were building up the graph of.
Well, it did it it it was it didn't hurt at the same time.
They did virtually. Yeah. Within months. Well, the point was that Judge Pickering was very good at getting people and that is where oh lord.
I got this Faizabad today. Tony Mitchell. No, no, no.
I'm letting them do is so. So John Ledingham came down as a second physician on John Pickering's farm were.
No, I think he came as a second on a new firm within the first year.
Well, he came down, yes. But let's say he came down having been recruited by George Ray.
Yeah, absolutely. And that's where that was one of the replacements came.
Yeah. Yeah. And I can't remember who the other one was because before that,
presumably you'd been working on the end er on the Regis professor's firm doing your job hunt.
Yes. And how much on take medicine were you doing that before you got the firm with Joan.
Oh I think we were on take. Well there were four physicians we don't take every fourth day.
Yes that's right, yes. I mean you are the main Ontake. Oh George.
Yes. Yeah, that's what I thought. Yes.
And just enormously I mean that the time in the army with the Sunnis and in in the Sudan and and initially with all sorts of diseases,
I mean, we not even seen one of the few people in the world have a smallpox epidemic, for instance.
I mean, you had an enormous, expensive medicine of all kinds, but you'd be into digital dating with bill grants and interdimensional.
They were just on the phone. Right. Okay. So they were under me, in a sense.
Yes. And then you started up on one of five firms with John Ledingham because I was with John and so John and I.
And John was a wonderful person because he was good at coming to work, he very you know, he knew how to talk to people nicely and he and I.
So he got much better at the community. And we thought so like we didn't have to ask each other.
Like, we knew we trusted each other completely. And so I could keep out of the lab.
And one thing and another, if you're going to do any research on John, was not a research work.
He was a clinical research worker. But he could do that at the bedside in a sentence, you understand?
Yes, I do. So then it could be a full time doctor. Ready.
But I was I was I was the new generation of people that had to be a clinician and a scientist and
not so subspecialties in clinical work that you only know a tiny bit of the body you used to do,
which is what's gone wrong now. It's gone completely too far.
But then John was not so fond of, but involved very heavily with the renal dialysis business within a few months.
But he was a clinician because there was Desmond Oliver and he was the boss there.
I mean, John had no say in how the dialysis was done. The Desmond wrote, there was a lot of no nonsense there.
Yes. Then it was accepted. Yes.
As a supplier of patients, that is the relationship is now don't get this wrong.
But the places where graft didn't yield what you hoped it would yield.
Absolutely. In terms of knowing, I mean, I still have enormous confidence in differential diagnosis of what's now being looked at with perplexity.
There's all sorts of disease research being done and molecular genetics being thought about when it's nothing to do with it.
Yes, I mean, the management of cardiopulmonary lung disease is still incredibly badly done because it's been so subspecialists.
It's worse than it ever was when there was general cardiologists and general physicians.
Do you understand me? So why isn't there a body seismograph in every hospital, as it were necessary?
Because you can do so much with non-invasive method. Right. Okay.
Because we then got to a stage where we're with the new methods coming along, you could do with ultrasound and stuff, most extraordinary things.
You can work out the pressure fluid dynamics very well. But there was the ultrasound that really took over.
What? Yes, everything that we did, we had to be done as to turn taxonomy into applied physiology to be sure about it,
and then somehow correlate that with with more and more sophisticated non invasive methods.
Yeah, yeah. And you only use the invasive methods. Now, flow methods is not used any more.
Now the pressure, but sometimes I do understand is and now within NMR stuff is getting even more sophisticated.
So Bozman and Bhishma Rajagopalan worked with you and a Frith first Firth.
Colin Firth. Yes. And, uh, and what's in there?
Bernie Gurche, who went to the Mayo Clinic in South Africa, and he's now chief editor of the European Heart Journal.
Good. Because Biche is still in Oxford, of course, and ambitious and extraordinary.
Man, I have very fond opinion.
Uh, he was, um, he wasn't me, really, in the fact that he's one of the the most superb general diagnostic technicians I know.
And he's an enormously creative scientist. I mean, the stuff he did on with, um, NMR is magnificent.
Well, but he was one of the he was one of these people that could never.
Uh, somehow couldn't imposes authority.
Mm hmm. And I think the reason for that is that she's a very devout Brahmin man and he has an enormous sense of humility and deep humility is.
This was being led a dance when he was making a lot of the creative decisions down
there and I went to saw David Weatherall because he needed a new first assistant,
Mérida, because John had gone missing. And so the visuals approached.
But David very sensibly didn't make him a main reader.
He made him a first assistant to do the work of a mind reader and organising the clinical teaching and stuff, you know,
and which made an absolute mess of it because you had a nurse or he couldn't get people to toe the line, right?
Yeah. And this has gone on like that.
And he's been made use of all his life. And yet he's the one who missed an enormous creativity.
That man. I'm very fond of him. Then how happy were you about the evolution of your general medical duties, the firm duties with John Ledingham?
I mean. Well, they were beautiful. Yeah, I know. But the general sort of hospital set up and the Ontake arrangements and all that sort of thing.
Well, it was sufficiently intimate that it didn't work immensely.
Well, I mean, when we went up the hill, John and David,
whether or not there was a situation that there was really very tight senior continuity every day and night.
There was no business of working time directive and going or, you know, for a half day week and you decide to go to go sailing that weekend.
But then gradually patients tended to be scattered around the hospital.
And that's a real problem then, was that the the the the disaster was never a transfer because you went up the hill and the business
of opening the to the contractive coincided with more and more stringent imposition of budget.
That meant we were now not just a district general hospital had evolved out of the war looking after local areas specialities.
We were now an area speciality for an increasingly urban population, but we were now that then a regional speciality, subregional speciality.
Then we became a regional speciality there and became a national speciality in that.
But in every discipline you can think of and an international speciality,
Midway's and we had the same number of beds as we needed for our local population.
Yes, that was the problem. Yes. And so we then in a situation where we were hunting around and going to any bed you could find.
And so there were five or six firms so-called going into the same ward and the nursing sisters being driven, frantic.
In fact, they couldn't these doctors coming in all the time. If they went round to the doctor all the time, they had never done the nursing.
And so the result was there was a them and us growing up with the nurses and doctors and got on with their end
and and corporate understanding and management suffered by default through sheer overtaxation to understand.
I do. Yes. And I think that's a very good and it's one of the real problems about Oxford.
And we now have it. And and it's got to such an extent now that the main wards for the people over 65
are in the home that you are now sitting in because they have to get them out.
Yes. Yes. And so there's a situation where if you go in for any thing that is that is acute, which takes time in the elderly.
You are blocking a bed. Yeah. And so that comes back to the whole business of the relationship with general practitioners in the hospital.
If the general practitioners are only there to to decide where the patients go for their things, when things go wrong,
when the whole business of designing the health service and the Beveridge and they've been in the
van was a GP's had a per capita stipend where they knew their patients intimately when they joined,
and they are therefore then saw to it that they picked up the slightest thing that went wrong very early.
Mm. So they didn't. So they knew that when patients did go to hospital it was dateable with and so the turnover.
But nowadays that same nurturing and understanding of what the patient's health, deteriorating health where there is is not there.
So the patient is then sent in to be sorted out at a time when things have gone beyond the point of return, as I understand it.
Yes. No, indeed. That is what's happened. Yes. Yes. And it's a real problem because the main wards now for people over 65 have to be.
In home, there's not room in the hospital or institutions, did you think the organisation of nursing nursing training was changing for the better?
Well, that's just another political situation, because, quite frankly, the nursing training that that worked right up until someone came along,
which was again in the era of the Thatcher era that started abusing her name because I can't remember the year but say, 60 right now.
Two things happened there, which I think is part of one,
was that there was a thing called the University Grants Committee, which provided for the teaching hospitals.
It couldn't continue grant to the universities for their units, so-called in the teaching hospitals.
All right. And these provided for the staffing for research and teaching purposes, as well as clinical leadership in the specialities,
the growing specialities with their colleagues and calling in exchange for plant and services.
All right. Mm hmm. So they weren't paid by the NHS, but they were paid by the university in exchange for a level for not having to pay a
university and having to find the money for the plant and services to understand. Mm hmm.
And then with Margaret Thatcher, she to tidy it up.
She did it. She and money was getting tight. She said, well, the easiest thing to do is to make it the university funding committee.
Mm hmm. So it's separated. And then at once they had no plant you.
Yeah. And that's where the trouble started. Yes. All right.
Now, one of those things was that they were then siphoned off and it was then university funding for teaching and research.
And at the same time, the expertise and the nursing was now getting to the stage of being fraught.
And at the same time, the previous health had been national health and social service was all in one so
that the consequences of looking after the care of people was not just for nursing,
but also for the plant and services which required occupational therapists and all these sort of people social and the accoutrements that go with it.
Right. Yeah. And one of her colleagues, which is Keith Joseph, separated social services from national health.
So then there was another fiefdom and then and tensions of professionalism grew.
And then the nurses found that the doctors were behaving badly, which they were,
and talking down to the nurses so that the the Royal College of Nursing said they should should be a university training scheme for nurses.
Yes. And so then there was another fiefdom where the nurses had to go to university.
And and it was in particular the problem was that the university was another university and not a non-profit.
So there was a competition of interest. And then the royal colleges then started having been genetic colleges of Royal
College of Surgery and all kinds of medicine and alternatives to obstetrics.
All right. Mm. They then became subspecialists.
You had the Royal College of P p o the Royal College of General Practise and so and the Royal College of Psychiatrists.
Every kind of sounds better. And then all in developed fiefdoms and Chinese walls of excellence is.
So the whole thing then became a competition of excellence, which was so rather like the fiefdom of of of unions that they are a form of union.
Mm. Uh, in many ways the same as the BMA.
Mm. And the teaching unions.
And so there's enormous competition of personal interests where the patient is a product that can be defended and traded between each.
You know, from your days in the PM, you then became one of the teaching.
I mean one of the main firms of the NHS. You would have kept up your links with the PM after 66.
And then did you move the graph down to the cardiac unit?
But it still happens. What happened when when we went up to the dawn of the days of the would?
No, no, that's fine. I understand that it went yes. So now when you're up at the Dome Reactive Work Universe attach.
Used to have.
Looking at your time in the Radclyffe, John Radcliffe, do you think things developed well or poorly or should they have gone down the route?
I think it was almost inevitable from outside circumstances that things that happen
like this and what's happened is that the the society has changed from one of noble
endeavour amongst the caring professions and the teaching professions and the and
the legal profession and the political professions where there's a situation that.
Them, where they think entirely about the material goods, the particular requirements, so it's very much a utilitarian functional.
Uh, humanistic, utilitarian philosophy, which doesn't have a place deep down in the quietness of the mind for the nature of the intuitive,
which in the kind of fields that we're moving in into sounds and and natural philosophy,
which medicine is where the condition of the nonmaterial domain of consciousness is not just something that is part of a construct of a machine,
uh, but comes from something which is totally mysterious and worshipful.
So there's the sense of that kind of a duty to some higher, higher principle than just material to to understand it's doing it very well.
No, no. That is what's going on.
And so if you look at anything that's going on, including the new arrangements of the National Health Service and the professions,
it's all about how we can tinker with the means when we haven't defined the philosophy of what that means for you to do.
And there is a fundamental difference between the whole way that the material world is thinking compared with what you find in something like,
uh, and it applies to the religions as well.
Uh. To surprise me, the defence area and the police,
and so where are the situation where going and being more and more sophisticated about
how you prevent something happening which ultimately leads to massive conflict?
Yes. Yeah, no, indeed. The wrong way around.
So we have to come back to a situation where we don't tinker with more and more clever ways of monitoring each other.
Just imagine the current situation with the community care groups.
We now have a thing called Monitor that's a name for you with the government is to monitor how the monitoring has been done.
So everybody is watching everybody else. There is a sense of deep, deep mistrust.
Yes. Yes. Uh, and the openness.
However, you can't have openness without trust, and that is so serious.
It has to be it has to change and it won't change from the top down.
And it comes back to how places like great medical schools like Oxford occur.
And I take the view ultimately, if you go around the wards now and here,
those clinical students in there who are all problem solvers and know exactly where they're going,
they come in and then be marched about in groups, being told what what's going on by juniors and even the seniors.
And I've even heard senior people in the medical school who they are to lead them talking about the kids when they're in their twenties and thirties.
Mm hmm. Mm hmm. There's an arrogance of knowing best when we should be a place of corporate learning together.
Yes. Yeah. So I think ultimately it'll have to change from the way the newer generations coming in have the guts to do.
What's happening by analogy in Turkey at this moment when people know what's right.
And so the children, the kids come in and they say, this isn't how we're going to be taught.
We are we are coming to learn to solve problems with you as your genes take a long, long time to change.
Yes. To that, partly as an answer to what I was thinking.
What would you do if you were the Gauleiter of health over the next five years?
But you feel it's a much longer problem. You're one of the people that I would like to go and talk to quietly is the current Gauleiter.
His name is What's your name? I forget some of it was Donaldson, but.
No, no, no. I mean the politician. Oh, right. Yeah, the new one's just moved.
I think the guy's got right out. He could have it.
He's got it. Yes, but it ends with an eight. He going there were you know, can't understand.
Now that chap I, that chap I just never met him.
But I can take a look. I mean he but he can't do it from the top down.
No, no. He's got all these fiefdoms I've talked about. We know what to do.
You have to do with the Royal College of Physicians. And what did you think.
Yes. You were on a committee or do I know I wasn't?
I was, uh, I think I've never been on any committee or anything.
And, uh, I've got to know people up there.
Um, my view is that if the committee seemed to actually get hubristic so that ultimately they only know each other on themselves,
I've taken the view that I will find out who the secretaries of the committees are.
Mm mm. And the same way that I used to know intimately every every gay porter in Oxford.
Mm hmm. So you could park your car is in the same way that I still more or less know the telephone operator.
They know who I am when I talk to them. Yes, but but, uh.
So you need to know the functionaries very well. Hmm. But but I have a great admiration for people who are sufficiently public, so, I mean,
the public servants that I'd like to see in college much more are the people who are in their 60s who give up,
who don't want to go on, but people going in to do things on the college in their 40s and so forth.
And so to the exclusion of what they ought to be doing makes me very, very worried indeed.
And you will find that now with electronic voting, the college is now very dangerous because it's all done electronically on the first you know,
the people who go and the only people who are going to people who are grim grooming
themselves for high office and then doing their work properly is a very worrying situation.
Yes. What did you think about the administration in Oxford, Ben?
Well, I learnt a lot about how wrong I was about it. I mean, the one thing I mean, when you're simple directive, we all rather laughed at John Barrow.
We thought he was sycophantic one week run by his wife, actually.
But when you came to find out what was going on in that tiny organisation,
John Barrow was one of the most devoted civil servants has ever been in health.
Yes. And you didn't find out until he wrote that book. And that book wouldn't have been written if we hadn't had a thing called McKinsey.
Right. Because George Pickering, no monkey talk to another millionaire monkey called Kouda and Talor then went and got something
organised when he went to the King's Fund or whatever it was set up this enquiry into Oxford,
much of which came to Coquille. Mm hmm. And the guy who did that was a man called Maximalism.
I've never actually talked about that, but actually everything went on this place.
But McKinsey works by making some major discovery of efficiency and so some here.
So he was employed by McKinsey. And he's a good, nice, honest, good man.
Well, he's a lovely chap, but some head had to fall and that head was.
Yes. And he was fat. Mm hmm. Mm hmm. And then he wrote this wonderful book.
What a gentle, discerning Christian man that was.
He wrote a book and he knew it backwards. And he was his old guard, civil servant.
And now the government of getting rid of those known and the civil servants are
a very vulnerable brood breed now because they are they should be above party,
but they are now being big party hacks.
But to come back to burrow, he is a limitation of degrees of freedom, prevented him from doing the things he wanted to do.
Yes. Yes. So we were very blessed.
Now we have administration. I admire the current chief executive enormously, but then his office.
But what worries me is that they never come out of their office. The chief medical officer has never seen them.
He is meant to be a paediatric physician and he probably does half a day.
But I mean, he knows nothing about what's going on. And we had a good clinician who was David Wells, Rita, whatever it was.
Mm hmm. Whose name I got to say this. I can't remember, but you know who I mean.
And he went to become the chief of the bunch and he became a guy with a clipboard.
Yeah, that's as bad as anybody else is. Crispen, you.
No, there's no sense of corporate leadership that I learnt about in the Army.
Yeah, yeah, yeah. You know, you can't get people to go in all different ranks and so forth pulling on the same boat when if you if you don't get on.
So they all feel part of the show together when one of them was going to get killed, you know, now you don't get killed.
No, that's the problem. Yeah. Yeah. There isn't the corporate responsibility.
And we now have a situation which is beyond all of them a sense because the place is so big,
the old model that you and I know about before, even when they went up the hill first nice.
It was level. They were in place if were told about that. So it wasn't very much bigger, had more people in it.
But it's now got to a size efficient mass where it's so big nobody can communicate.
Yeah, no, I think that comes into it.
And I know the long corridor, the old reactive, very different from the lifts and the general active for meeting people, just for meeting people.
I mean, the experiment, they did try hard to try and make people do it together, but everybody takes sandwiches and they never meet either.
They send emails to. Never send an email to talk to the person first about anything important that never happens.
Now we've covered a lot, but is there anything you'd like to be talking about that I haven't done?
I think really what I would like over lunch, we talked about, I think what you're doing when it goes to the to the Bodleian,
one of the things that is happening now, we have so much information that it never gets out.
It's never syntheses, because I think basically if there's so much information that there's there's no information.
And so the result is that all the same mistakes will be made again. Mm hmm.
And there is something that requires a state of affairs.
And I don't think it's anything to do with changing the way is the young doctors are trained or the responsibilities or the after hours.
But that requires us that all the after hours it takes and giving people time off and so forth, that was done in our day.
But there was a situation where together we we realised that we could provide that full hand, but we didn't have to be legislated for it.
So we have to get back to a corporate sense of vocation or duty to start with and organise ourselves and not have to have new systems put into place.
But more importantly, I don't think that business is going to be done until the next generation or
two or three generations of young men and women coming into medicine come in
with their eyes shining like that for young men going in and saying he wants to
wants to do good and good and was ridiculed because that's what's happened.
The people I meet have that sense of what I've just met a medical student, a one such person aged 17,
whereas somewhere he doesn't think he's going to get into a medical school because he doesn't think he's going to get enough high grades.
Right. When he's when he has a deep sense of purpose.
Yes. Yes. That there is a requirement for a very much more particular generation to come along and that'll take time.
Well, that's been a splendid interview, closing down this interview.
That's all that makes.