1 00:00:01,470 --> 00:00:11,310 Mike, this is an interview between Mike give him a Derek Hockaday on the twenty seventh of February one for Mike. 2 00:00:11,310 --> 00:00:15,630 Obviously you came to Oxford, but what made you want to come to Oxford at that stage? 3 00:00:15,630 --> 00:00:20,040 Because were you already a consultant at various? No, I was a lecturer. 4 00:00:20,040 --> 00:00:24,040 A senior registrar at. Right. And so you put in a consultant job. 5 00:00:24,040 --> 00:00:29,620 I applied for the job. I was working with Richard Beard, lots of marriage. 6 00:00:29,620 --> 00:00:34,110 And I'd done research leading to an M.D. with Richard, which is on diabetes. 7 00:00:34,110 --> 00:00:39,020 In pregnancy. Yes. And that was when Eric Turnbow was it. 8 00:00:39,020 --> 00:00:48,120 Eric had arrived in Oxford from the chair in Cardiff in 1973. 9 00:00:48,120 --> 00:00:54,990 He took over from Sir John stalwartly. And what was the opinion about Alec? 10 00:00:54,990 --> 00:01:01,800 And did you have a big reputation or Alec once appeared, I believe, 11 00:01:01,800 --> 00:01:10,050 in a Sunday Times kind of supplement where he was described as the obstetrician's obstetrician and he was very highly regarded. 12 00:01:10,050 --> 00:01:19,650 Yes. And, uh, he was a man of immense enthusiasm. 13 00:01:19,650 --> 00:01:22,410 Um, he was very good at getting money. 14 00:01:22,410 --> 00:01:33,860 He had several MRC programme grants and project grants at a time when there were still grants that you could get clinical work. 15 00:01:33,860 --> 00:01:40,020 The basic work was mainly obstetric clinical work. 16 00:01:40,020 --> 00:01:49,140 I'll just stop this and tests that we're doing all right. I think I think we will be bit. 17 00:01:49,140 --> 00:01:55,260 OK, let's go on then. Um, and how did you find the Oxford Department? 18 00:01:55,260 --> 00:02:07,180 I mean, you came from Paris. What was the contrast between the two? 19 00:02:07,180 --> 00:02:18,150 There wasn't a great contrast, really, from my point of view. I was moving from one academic department with a. 20 00:02:18,150 --> 00:02:23,870 Head of department who was very much my mentor. 21 00:02:23,870 --> 00:02:40,080 An inspiring man, which would be it sadly now deceased, to work with another man who was equally highly respected and very productive. 22 00:02:40,080 --> 00:02:46,890 I think there was probably a greater emphasis on basic research in Alec's department, 23 00:02:46,890 --> 00:02:51,710 and that's because he had for many years worked with the late Anderson. 24 00:02:51,710 --> 00:02:58,500 Mm hmm. And she was a basic scientist. And I think she was medically qualified as well with her. 25 00:02:58,500 --> 00:03:06,510 Her basic work was laboratory, not clinical, although Alec's interests were, I think, predominantly clinical. 26 00:03:06,510 --> 00:03:16,170 And I think that was the main difference. The other big difference was the Nuffield Department has a very large laboratory 27 00:03:16,170 --> 00:03:23,650 space and there were a number of other people there doing basic research. 28 00:03:23,650 --> 00:03:27,720 And that differed from from areas where the laboratory side was was really quite small. 29 00:03:27,720 --> 00:03:32,550 I think was the biggest difference between the two. And was that the advantage of it being. 30 00:03:32,550 --> 00:03:37,230 Well, I mean, there some guy I knew of the first people who went to the news site. 31 00:03:37,230 --> 00:03:46,500 So did you find it a good building, as it were? The maternity building is an interesting building. 32 00:03:46,500 --> 00:03:51,360 It was described as designed by Saddam, still worthy, 33 00:03:51,360 --> 00:04:03,750 and the plan was based on the fact that all women would remain in hospital for two weeks after delivery. 34 00:04:03,750 --> 00:04:09,960 And so the number of beds in the original building was quite extraordinary. 35 00:04:09,960 --> 00:04:16,170 And, of course, when it was built, it was the first hospital on that Headington site. 36 00:04:16,170 --> 00:04:21,720 Obviously, that was the field and so on, but not on that site. 37 00:04:21,720 --> 00:04:31,260 So the Headington site had to be standalone. So the hospital actually had its own kitchens and its dining room and all the rest of it. 38 00:04:31,260 --> 00:04:44,520 By the time I arrived, which was in 79, the so-called down to the main block had been completed and those facilities had gone. 39 00:04:44,520 --> 00:04:50,780 And in fact, the kitchen area and I think the dining area were converted into a medical record store, 40 00:04:50,780 --> 00:04:54,990 which I've always described the building as being a Rubik's Cube, 41 00:04:54,990 --> 00:05:08,970 because during my 30 years as a consultant, first five of which I was a clinical leader in Turnbull's department and then subsequently an NHS post, 42 00:05:08,970 --> 00:05:14,610 the number of changes that have occurred are extraordinary. 43 00:05:14,610 --> 00:05:21,180 So, for example, the area that is now the gynaecology theatres in Ward was originally medical 44 00:05:21,180 --> 00:05:29,880 secretaries offices and the medical records department in the laboratory space, 45 00:05:29,880 --> 00:05:36,510 which is on level two where the academic offices are, 46 00:05:36,510 --> 00:05:44,610 was obviously built with the future in mind because the John himself was very much a clinical individual. 47 00:05:44,610 --> 00:05:51,240 Most an embryo was one of the clinical readers. 48 00:05:51,240 --> 00:05:58,680 And it was in fact his post that I took when I was appointed or he retired and I was appointed to it. 49 00:05:58,680 --> 00:06:04,980 And most of them continued to work after his retirement. 50 00:06:04,980 --> 00:06:15,060 I met him once and asked him how he was getting on with his research, and he said in his very quiet way, it was going well. 51 00:06:15,060 --> 00:06:22,040 And I said to most and most people retire to the to their garden, this is your garden, isn't it? 52 00:06:22,040 --> 00:06:30,270 And he said, yes. So there was a sort of ethos of of laboratory work, which Marston was involved with. 53 00:06:30,270 --> 00:06:39,390 And then Chris Redman became involved with a number of people were brought in, interestingly, 54 00:06:39,390 --> 00:06:49,660 all of whom seem to have ended up as Professor Ian Sargeant being an example, because I was a professor in more recent times, Joe Polt. 55 00:06:49,660 --> 00:07:00,960 And I think I think Dunstall worthy the who's a highly controversial man, 56 00:07:00,960 --> 00:07:09,960 was very prescient in realising that it was important for the Department of 57 00:07:09,960 --> 00:07:14,250 Health and Gynaecology to have a strong laboratory based research programme. 58 00:07:14,250 --> 00:07:20,040 And I don't think that he actually personally did any work that the laboratory based. 59 00:07:20,040 --> 00:07:23,890 But he knew that that was what was required to build a department in future years. 60 00:07:23,890 --> 00:07:32,390 And he may have had the shadow shed somewhere over his shoulder because she had done basic work, as it were. 61 00:07:32,390 --> 00:07:40,710 Yeah. One of the things that I did in preparation for our discussion today, I thought, 62 00:07:40,710 --> 00:07:46,440 well, I don't know the dates of the various Nuffield professors and Chasseur, 63 00:07:46,440 --> 00:07:52,630 who I knew when he returned to Hammersmith after his retirement chasseur, 64 00:07:52,630 --> 00:08:02,220 was the first Nuffield professor Orangi, and he was appointed in 1987 and he stayed in that post in 1967. 65 00:08:02,220 --> 00:08:10,620 So he and I were actually consultants at the John Cliff or at least Oxford hospitals for exactly the same time that he is strong, 66 00:08:10,620 --> 00:08:15,180 whether he was there from 67 to 73. 67 00:08:15,180 --> 00:08:23,700 And then because as we've mentioned and there's no doubt I mean, 68 00:08:23,700 --> 00:08:30,450 Cecil Moore is famous for the Discovery documentary Mentoring, and that work was done at University College Hospital. 69 00:08:30,450 --> 00:08:40,290 So it was done before he came to Oxford. But the work that went on with a sort of utero tonic, obviously toxic substances, 70 00:08:40,290 --> 00:08:46,100 which must an embryo then embraced and did a lot of work on prostaglandins in. 71 00:08:46,100 --> 00:08:53,250 Lindsay then came in and found, I should say, when I was appointed, the other clinical leader was Gordon Stewart, 72 00:08:53,250 --> 00:09:03,690 but Gordon Brown went to a chair in Bristol and in McKensie applied for that post and was appointed as a reader. 73 00:09:03,690 --> 00:09:11,820 And he carried on Muffin's interest in prostaglandins, men with whom he had been working before, 74 00:09:11,820 --> 00:09:17,760 so that that whole process carried on an increased regimen with his interest in pre-eclampsia, 75 00:09:17,760 --> 00:09:30,190 developed the laboratory based investigation of the disease, if one can call it that, a pregnancy for which there is still no explanation. 76 00:09:30,190 --> 00:09:45,240 I mean, this is a bit of an aside, but many years ago, when I was at Queen Charlotte's as a young doctor, Professor Sir John Beasley was on Instagram. 77 00:09:45,240 --> 00:09:50,460 The Reverend Professor John Beasley used to do a talk on pre-eclampsia, 78 00:09:50,460 --> 00:10:00,660 and the last slide was a sort of Nobel peace type award or a medical award, I should say, or the Oscar. 79 00:10:00,660 --> 00:10:05,860 And he said this awaits the person who discovers the cause of pre-eclampsia, somebody still waiting to claim it. 80 00:10:05,860 --> 00:10:15,180 Then, as I understand it, I always used to think of Chris Redman as the first physician to the foetus in utero. 81 00:10:15,180 --> 00:10:19,980 I mean, is that fair? Because he before that, I mean, I'm sure other people were doing it, 82 00:10:19,980 --> 00:10:28,290 but it seemed to me that he was taking the health of the baby in utero into consideration much more than previously. 83 00:10:28,290 --> 00:10:35,880 Yes, I think that's fair. I mean, he he was an obstetric medicine consultant. 84 00:10:35,880 --> 00:10:39,840 He wasn't a foetal maternal medicine consultant, 85 00:10:39,840 --> 00:10:52,140 which is the breed that has arisen since starting in the 80s as a result of the Royal 86 00:10:52,140 --> 00:10:56,820 College of Physicians gynaecologists recognising that this was an important role. 87 00:10:56,820 --> 00:11:03,990 Chris, in many senses, was more like Michael the Sweet Queen, Charlotte's and you, 88 00:11:03,990 --> 00:11:11,820 S.H., in being interested in maternal diseases complicating pregnancy. 89 00:11:11,820 --> 00:11:25,920 I think it would be fair to mention a man called Geoffrey Robinson, who was an obstetrician who worked very closely with Chris Redman. 90 00:11:25,920 --> 00:11:37,200 And he, I think, inculcated in, Chris, a recognition of the foetal aspects of things. 91 00:11:37,200 --> 00:11:45,320 So they meshed together there. I wouldn't be able to say for certain how much each had an influence with regard to the foetal medicine side. 92 00:11:45,320 --> 00:11:55,140 Yeah, because foetal medicine was in its infancy, I. 93 00:11:55,140 --> 00:12:04,680 I did a lecture or presented a lecture to the regional obstetrician gynaecological 94 00:12:04,680 --> 00:12:13,110 group that I set up when I was chairman of the Regional Training Committee, 95 00:12:13,110 --> 00:12:21,990 and in that I was giving a history of obstetrics during my 30 is John Radcliffe. 96 00:12:21,990 --> 00:12:35,160 And one of the things that I started with and of which I had a slide was first ultrasound scanner at the time. 97 00:12:35,160 --> 00:12:44,400 So this was made by Nuclear Enterprises, a company in Glasgow, I believe, 98 00:12:44,400 --> 00:12:52,020 who in Donald had worked with Hughes, who was essentially the person who introduced medical ultrasound. 99 00:12:52,020 --> 00:12:59,350 And there is a room on level two. 100 00:12:59,350 --> 00:13:04,030 I said earlier that the government was unable to attend some level three, level two, 101 00:13:04,030 --> 00:13:09,150 which is the sort of one of the ground floor entrances adjacent to the special care baby unit, 102 00:13:09,150 --> 00:13:17,170 there was quite a large room, some 20 foot square, which contained the scanner. 103 00:13:17,170 --> 00:13:22,450 It was an enormous machine, very simple. 104 00:13:22,450 --> 00:13:28,160 And that was the totality of ultrasound in Oxford in 1979. 105 00:13:28,160 --> 00:13:31,750 I mention that in relation to what you're saying about the foetal medicine side of things, 106 00:13:31,750 --> 00:13:37,090 because up until that point, there was no way of visualising the foetus. 107 00:13:37,090 --> 00:13:46,150 There was no way of observing its normality or otherwise and its state of health or otherwise. 108 00:13:46,150 --> 00:13:57,640 If I were to say that 30 years on, you almost trip over the number of ultrasound machines and there were ultrasound, 109 00:13:57,640 --> 00:14:05,350 something like 10 in the ultrasound department and others scattered around the hospital, I used to use ultrasound in gynaecological work. 110 00:14:05,350 --> 00:14:15,040 I did when I last 10 years of my time there. So the great changes occurred and certainly foetal medicine is one of them. 111 00:14:15,040 --> 00:14:19,450 There are now, I think, three or maybe four feet of internal medicine consultants. 112 00:14:19,450 --> 00:14:27,670 I mean, that's the other big thing that's changed in the 30 years in that at the time that I was appointed, 113 00:14:27,670 --> 00:14:34,510 there was the professor, the two clinical leaders who were consultants and three NHS consultants and a total consultant. 114 00:14:34,510 --> 00:14:43,540 But it was six. I think it's close on 20 seconds with a workload that is not dissimilar. 115 00:14:43,540 --> 00:14:46,900 I mean, the total number of deliveries in the directive itself, 116 00:14:46,900 --> 00:14:56,680 as opposed to other hospitals such as the home total number of deliveries is around 6000 now, is about 5000 in 1979. 117 00:14:56,680 --> 00:14:58,810 So there's an increase in workload. 118 00:14:58,810 --> 00:15:06,490 The intensity of the work has increased in parallel with what happens in intensive care units, so A&E departments and so on. 119 00:15:06,490 --> 00:15:14,470 So you do need the additional staff when you mention workload, I mean, how did you find the workload in your first five years? 120 00:15:14,470 --> 00:15:25,080 We did you feel very busy or that you could have been doing more or. 121 00:15:25,080 --> 00:15:35,280 My time obviously was split between my research interest and I had a laboratory based diabetes programme. 122 00:15:35,280 --> 00:15:41,820 I also was involved in contraceptive research, specifically metabolic effects of oral contraceptives. 123 00:15:41,820 --> 00:15:49,800 So I had a full research programme and I had a clinical workload. 124 00:15:49,800 --> 00:16:02,850 I was reading an article by one of the former academics in Oxford who did a default with Alec Turnbull, 125 00:16:02,850 --> 00:16:11,250 and he has since in Australia and he has since become a professor in Australia. 126 00:16:11,250 --> 00:16:16,290 And I was interested to note that he said that he found it extremely difficult to do the sort of laboratory 127 00:16:16,290 --> 00:16:23,040 work that he'd done for his difficulties years ago because the clinical work was all consuming. 128 00:16:23,040 --> 00:16:24,720 And I think there's an element of truth in that. 129 00:16:24,720 --> 00:16:36,690 And I think most clinical academics do find that unless you're very strict with the amount of clinical responsibility that you're prepared to take on, 130 00:16:36,690 --> 00:16:41,010 you will have difficulty maintaining a research interest. 131 00:16:41,010 --> 00:16:48,780 The way things panned out with the 5000 deliveries that we had ultimate responsibility for somewhere in the 132 00:16:48,780 --> 00:16:55,320 regions of 2000 fell to the academic department and the remaining three thousand to the Energy Department. 133 00:16:55,320 --> 00:17:00,840 So there was not a lot of difference between the amount of work that we did, the gynaecological, 134 00:17:00,840 --> 00:17:09,960 it was probably about half of what they did in terms of numbers of clinics and operating time. 135 00:17:09,960 --> 00:17:13,680 So what did your laboratory do with the diabetes research? 136 00:17:13,680 --> 00:17:17,910 What we're measuring. I was looking at well, I did. 137 00:17:17,910 --> 00:17:30,120 I had two main programmes. One was looking at gestational diabetes or more particularly trying to establish a range of ranges of normal. 138 00:17:30,120 --> 00:17:36,480 Yeah, a subject that was controversial when I first became involved with it in the early 139 00:17:36,480 --> 00:17:44,280 70s and which I have to say was controversial when I retired in 2009 and remains so. 140 00:17:44,280 --> 00:17:49,440 And I think the problem in regard to that specific issue, 141 00:17:49,440 --> 00:17:57,550 which is what is gestational diabetes and how do you diagnose it, has become clearer in that. 142 00:17:57,550 --> 00:18:00,190 Over at least four decades, 143 00:18:00,190 --> 00:18:14,950 possibly five people mistakenly thought that they would be able to put a Cut-Off point and the work that's been done subsequently, 144 00:18:14,950 --> 00:18:24,460 in particular a large multicenter study has actually shown as probably logic and biological knowledge would 145 00:18:24,460 --> 00:18:35,470 dictate that it is essentially a continuum and therefore where you put your Cut-Off is somewhat arbitrary. 146 00:18:35,470 --> 00:18:41,810 So that was one aspect where we studied 500 women doing glucose tolerance tests and of other things. 147 00:18:41,810 --> 00:18:56,460 And that was that was published. Um, the other studies that I was involved with in my five years as an in an academic post were actually 148 00:18:56,460 --> 00:19:04,440 joint studies with Mary's is in essence a continuation of the work I've been doing for my M.D. thesis. 149 00:19:04,440 --> 00:19:18,630 And then subsequently and that was to look at women who are diabetic, insulin dependent diabetics, 150 00:19:18,630 --> 00:19:30,510 as they were called in Taiwan compared with Normal's and others who appear to have impaired the first tolerance called gestational diabetics, 151 00:19:30,510 --> 00:19:44,880 if you like. And we were looking at a variety of substrates and blood, three fatty acids and other lipids and amino acids and so on. 152 00:19:44,880 --> 00:19:52,110 And most of that work was published. The amount of acid work was never published because it didn't really show anything. 153 00:19:52,110 --> 00:20:01,860 We all said it's a continuation of some studies, which I did with a man who's now a consultant in Manchester, Nightmarish, who took my place. 154 00:20:01,860 --> 00:20:14,430 It's American. And we were doing some of the laboratory work for the studies looking at obesity and things like that and their effect on pregnancy. 155 00:20:14,430 --> 00:20:18,600 So free fatty acids where they measured their memories are in Oxford. 156 00:20:18,600 --> 00:20:23,580 They were measured in marriage. Yes, they were a cooperative study. 157 00:20:23,580 --> 00:20:30,810 We did the amount of acids and, uh, we did our own glucose estimations and so on in the laboratory on level three. 158 00:20:30,810 --> 00:20:35,670 Then you'd have been doing quite a bit of teaching, I guess. Uh, yes. 159 00:20:35,670 --> 00:20:51,900 Um, I mean, the the way in which the system worked was that each firm would have medical students attached to them. 160 00:20:51,900 --> 00:21:01,500 And I used to tutorials with students, um, on a weekly basis, sometimes twice weekly. 161 00:21:01,500 --> 00:21:11,250 Um, so I have three, four students who come to my office on level three and we choose a topic and go through it. 162 00:21:11,250 --> 00:21:20,790 And so when I when I think back on it, um, again with historical perspective in more senses and one of the, uh, 163 00:21:20,790 --> 00:21:26,730 the tutorial that they really used to like was the one where I went down to the level of the delivery suite, 164 00:21:26,730 --> 00:21:31,290 brought up a tray of instruments, which is called the destructive instrument set. 165 00:21:31,290 --> 00:21:38,400 And it's a bit like looking at sort of things you'd imagine a torturer to use. 166 00:21:38,400 --> 00:21:45,600 People are always fascinated by, um, I had quite a lot of experience of destructive operations, 167 00:21:45,600 --> 00:21:57,780 which now just don't happen because I've worked in Durban for 18 months, um, as a sort of exchange during my time in South America. 168 00:21:57,780 --> 00:22:13,530 And we had a lot of cases of women who came in having been in labour out in the bush basically for anything up to a week, usually with dead infants. 169 00:22:13,530 --> 00:22:21,030 Um. That, fortunately, did not happen, so the instruments were essentially historical, 170 00:22:21,030 --> 00:22:27,180 but we're still there and still packed and sterile and still ready for use should that need arise. 171 00:22:27,180 --> 00:22:39,400 And they used to find it fascinating. How did the medical students in Oxford compare with the ones that matter is just the same? 172 00:22:39,400 --> 00:22:49,690 I never had any problem with medical students, and that's I think because I respected their intelligence and I know that some of 173 00:22:49,690 --> 00:23:00,970 my other colleagues who tended to take a rather superior approach when lecturing, 174 00:23:00,970 --> 00:23:11,590 found to their horror that Oxford students tend to be very quick to respond to things that they don't agree with. 175 00:23:11,590 --> 00:23:18,670 And if they think the person who's teaching them is actually made a mistake or an error, they will not remain silent. 176 00:23:18,670 --> 00:23:25,000 And and if you don't respect that and acknowledge something that you may have said that is 177 00:23:25,000 --> 00:23:34,330 incorrect and you can find yourself in an adversarial situation with medical students, 178 00:23:34,330 --> 00:23:43,180 I don't think that ever really happened at the time when I noticed medical students change was when they started. 179 00:23:43,180 --> 00:23:58,080 And that really is in the last five or 10 years of my time to have mature students who have it on a short track and who had done degrees elsewhere. 180 00:23:58,080 --> 00:24:01,570 And some of those could be quite difficult. 181 00:24:01,570 --> 00:24:06,550 But by and large, now I thought Oxford students were delightful. Hmm. 182 00:24:06,550 --> 00:24:11,050 And did you get into the thought of the district and the region? 183 00:24:11,050 --> 00:24:19,000 Yes, I used to do three very different times. 184 00:24:19,000 --> 00:24:29,180 We had antenatal clinics, long established clinics at Fort Knox and on the Hilton and Chipping Norton, 185 00:24:29,180 --> 00:24:38,230 the Memorial Hospital in Chipping Norton and also in the Mushroom Road having hospital in Abingdon. 186 00:24:38,230 --> 00:24:46,790 So those are two that I did for many years and at the time that hospital contracts came in. 187 00:24:46,790 --> 00:24:53,260 We expanded that. I was actually the chairman of the. 188 00:24:53,260 --> 00:25:02,080 Department at the time and we had an additional there were other Abbington in Chipping Norton with the clinics didit, 189 00:25:02,080 --> 00:25:11,740 but there were also clinics, which my other colleagues did in Watlington and everything else now can't at the moment. 190 00:25:11,740 --> 00:25:20,590 But we increased the numbers and we went up to Farringdon and a sort of competitive approach to to Swindon. 191 00:25:20,590 --> 00:25:26,110 So, you know, we could see an incursion into some territory. 192 00:25:26,110 --> 00:25:32,830 And then the Horten, which wasn't part of the John Danforth Hospital trust at that time, moved into Kidlington. 193 00:25:32,830 --> 00:25:39,760 So a week without a clinic in Kidlington as well. So this sort of competitive process, which didn't really, I think, 194 00:25:39,760 --> 00:25:43,720 make any difference to the finances and possibly gave additional choice to patients. 195 00:25:43,720 --> 00:25:52,540 I think its main benefit and students used to come to those peripheral clinics as well. 196 00:25:52,540 --> 00:26:02,050 They were predominantly obstetric clinics, but we also had gynaecology clinics, certainly, and having the gynaecology clinic continue. 197 00:26:02,050 --> 00:26:13,350 But I believe they've all been stopped when it comes to. And was the flying squad still going on with that system? 198 00:26:13,350 --> 00:26:21,180 I have no record of being involved with the Flying Squad, which I think indicates that it probably stopped. 199 00:26:21,180 --> 00:26:27,930 It was very much just over the thing even before he was professor, you know, on his way up. 200 00:26:27,930 --> 00:26:33,240 I believe that it was the role that he was given when he first came to Oxford. 201 00:26:33,240 --> 00:26:42,270 And I believe that it was Hazama who who gave him that as a remit. 202 00:26:42,270 --> 00:26:49,770 And it was certainly needed at that time. I have an experience of the flying squad, been working in London. 203 00:26:49,770 --> 00:26:58,500 And then as a medical student when I was in Winchester, I know I went out to the Flying Squad and then. 204 00:26:58,500 --> 00:27:07,440 Yes, that creates memories of a woman who had a prolapsed cord and a midwife and an at home, obviously, 205 00:27:07,440 --> 00:27:13,620 and a general practitioner who respected the midwife who had put the woman onto all fours, 206 00:27:13,620 --> 00:27:21,600 as is appropriate to get the head of the cord and the memories of neighbours in adjacent houses, 207 00:27:21,600 --> 00:27:28,200 watching this woman on all fours being carried to the ambulance with the general practitioner doing a 208 00:27:28,200 --> 00:27:33,750 vaginal examination to keep the head above the parapet off the cord as they went to the ambulance. 209 00:27:33,750 --> 00:27:40,320 And we then followed the ambulance to the hospital and they got to live births with babies crying experience. 210 00:27:40,320 --> 00:27:48,340 Not the sort of thing that happens much these days. Although having said that, just yesterday a lady delivered in the streets of New York. 211 00:27:48,340 --> 00:27:53,520 Right. We still have births in unusual places continue. 212 00:27:53,520 --> 00:27:58,620 So we are going to have to land and do any premises, you any national committees. 213 00:27:58,620 --> 00:28:04,210 And so I was involved with the Royal College of Physicians gynaecologists. 214 00:28:04,210 --> 00:28:09,600 I was on the scientific advisory committee. 215 00:28:09,600 --> 00:28:19,290 I was involved with the membership committee or the diploma and specifically the membership committees of the ISG. 216 00:28:19,290 --> 00:28:29,940 I was a membership member examiner for the membership from about 1984 through till well after my retirement, in fact, because they took me back. 217 00:28:29,940 --> 00:28:35,250 So for 25 or more years without examining Oxford or up in London. 218 00:28:35,250 --> 00:28:38,720 And that was in London. Yes, that changed as well. 219 00:28:38,720 --> 00:28:43,380 The nature of the to examination changed. 220 00:28:43,380 --> 00:28:59,370 Originally, you had the clinical examination done in approximately 10 hospitals within travelling time from London. 221 00:28:59,370 --> 00:29:05,460 So ranging from, say, Hillingdon in the West through to Graves' in the Middle East. 222 00:29:05,460 --> 00:29:13,860 And you'd be allocated a hospital and one of the local consultants who would also be an examiner and you did the clinical exam together. 223 00:29:13,860 --> 00:29:19,590 They stopped that. I think I'm right in saying in the nineties, late nineties, 224 00:29:19,590 --> 00:29:26,790 mainly because it became increasingly difficult to find women who were prepared to subject themselves, 225 00:29:26,790 --> 00:29:33,210 particularly the kind of closer examination purely for an examination purpose. 226 00:29:33,210 --> 00:29:40,050 But then, of course, going back to the medical students, 227 00:29:40,050 --> 00:29:47,280 that has had an impact on them because there has been a reticence and understandable 228 00:29:47,280 --> 00:29:51,570 reticence on the part of women to be examined by people who are not competent, 229 00:29:51,570 --> 00:30:01,950 experienced, in other words, as part of their training, and whereas colleges like the Royal College general practitioners who in fact set the 230 00:30:01,950 --> 00:30:12,450 standard for clinical examinations that involve actors and actresses who will play the part. 231 00:30:12,450 --> 00:30:16,490 And that's the line that the Royal College of Obstetricians has gone down. 232 00:30:16,490 --> 00:30:29,430 They now have actors and actresses who will either be the patient or the partner of the patient and so on for so you can examine things 233 00:30:29,430 --> 00:30:40,590 like bereavement counselling and and dealing with people who don't necessarily agree with what you're suggesting and so on and so forth. 234 00:30:40,590 --> 00:30:47,520 The same thing has happened with women resisting the idea of being examined by medical students. 235 00:30:47,520 --> 00:31:01,350 And as a result, in the years just before my retirement, the Nuffield Department set up surrogate is probably not the right term. 236 00:31:01,350 --> 00:31:11,970 But women who are paid to come along and teach speculum examinations to students and very often both doing 237 00:31:11,970 --> 00:31:17,070 it to themselves to demonstrate what has to be done and then taking the student through being done. 238 00:31:17,070 --> 00:31:22,260 Most people would consider this to be a fairly unusual sort of job, but nonetheless, 239 00:31:22,260 --> 00:31:30,450 that is the way things have progressed and probably to the benefit of all concerned because a student 240 00:31:30,450 --> 00:31:37,680 is going to be more relaxed with somebody who knows what's happening and is actually guiding them. 241 00:31:37,680 --> 00:31:45,090 And it does mean that when the time comes to do it for real on the patient, they will have the confidence that they can do it. 242 00:31:45,090 --> 00:31:54,780 Uh, inevitably, students, when they first do particularly expected examinations, are incredibly tense. 243 00:31:54,780 --> 00:32:01,000 And when you're tense, you don't. They do your best for the person who is performing the examination. 244 00:32:01,000 --> 00:32:10,550 This show you mentioned your chairman, was that a rotating chairmanship of the place? 245 00:32:10,550 --> 00:32:14,540 The answer is yes. And I did it for a very long time. 246 00:32:14,540 --> 00:32:22,880 I'm not quite sure how many years or why I was chairman for a while and then march on. 247 00:32:22,880 --> 00:32:33,320 It took over and then I took over again from him at the time that again, 248 00:32:33,320 --> 00:32:43,010 problems with naming names now comes in our chief executive who went on to be the chief executive of NHS. 249 00:32:43,010 --> 00:32:54,500 They might come to me. I did it for many years. But I also, from the teaching point of view, this is not postgraduate teaching. 250 00:32:54,500 --> 00:32:58,610 I became chairman of the original Obstetric Gynaecological Training Committee, 251 00:32:58,610 --> 00:33:12,300 and the big change that occurred from the point of view of postgraduate education was that in the. 252 00:33:12,300 --> 00:33:22,960 Mid 90s, early to mid 90s, the new cowman process came into being with. 253 00:33:22,960 --> 00:33:30,970 Essentially, a rotational training programme within the region that had previously been a rotational training programme. 254 00:33:30,970 --> 00:33:41,110 Senior registrar level, which involved Redding, Oxford and Northampton, but at registrar level, 255 00:33:41,110 --> 00:33:45,850 an individual would be appointed to the hospital and would have usually a two year 256 00:33:45,850 --> 00:33:53,620 appointment and would work with a particular firm with the counterproposals proposals, 257 00:33:53,620 --> 00:34:06,700 training programmes set up with a total of seven years training to, etc. the registrar and rotating between all the hospitals in the region. 258 00:34:06,700 --> 00:34:18,160 And I was involved in setting that up, together with Pauline Whurley, who became the district the regional tutor, I think that title. 259 00:34:18,160 --> 00:34:22,570 Was there any difficulty persuading people to fit in with that? 260 00:34:22,570 --> 00:34:36,640 No. Well, I think that it assured some of the general hospitals who'd had difficulty getting good quality staff that they 261 00:34:36,640 --> 00:34:45,010 would have trainees of the calibre that we had for many years enjoyed the other the other big change that, 262 00:34:45,010 --> 00:34:46,270 of course, has occurred. 263 00:34:46,270 --> 00:34:58,360 Um, to some extent, integrating that process was the change in the EU regulations and the fact that when I was first appointed there, 264 00:34:58,360 --> 00:35:05,290 we had many trainees from Australia, New Zealand and South Africa did. 265 00:35:05,290 --> 00:35:11,740 And with the change in the regulations and Home Office regulations, um, 266 00:35:11,740 --> 00:35:16,060 plus I think certainly where Australia and New Zealand concerned a substantial 267 00:35:16,060 --> 00:35:24,280 increase in the quality of the service and training available in those countries, 268 00:35:24,280 --> 00:35:32,200 such that some would say in some areas it exceeds what is achievable in Britain these days. 269 00:35:32,200 --> 00:35:35,950 They cease to to come to the UK. 270 00:35:35,950 --> 00:35:38,290 And I think that was a great loss, 271 00:35:38,290 --> 00:35:45,550 not least because there were a lot of exchange programmes and so quite a few people had the opportunity to go abroad, 272 00:35:45,550 --> 00:35:52,060 as indeed I did when I was at St Mary's, as I went to Durban for 18 months, which was an invaluable experience. 273 00:35:52,060 --> 00:35:56,170 Did you ever do that from Oxford Exchange at all? I didn't know. 274 00:35:56,170 --> 00:36:07,810 I didn't actually get things done. So with Kalmen programme, one of the problems that arose and continues to be a problem, 275 00:36:07,810 --> 00:36:15,640 which I don't think anybody is adequately solved, although people are trying to address it. 276 00:36:15,640 --> 00:36:25,570 Precambrian training programme. You would spend, as I said, two years with a particular team, very often just a single consultant, 277 00:36:25,570 --> 00:36:30,130 which meant that individual got to know you very well, your abilities, et cetera, et cetera. 278 00:36:30,130 --> 00:36:41,140 And as a result, you got a lot of practical experience counts and you would often be on a six month rotation within the same unit. 279 00:36:41,140 --> 00:36:45,200 You would spend a year in one particular unit and then go to another hospital elsewhere. 280 00:36:45,200 --> 00:36:55,450 And all of this coincides with increasing litigation culture and increasing expectation that the consultant, 281 00:36:55,450 --> 00:37:02,560 if he doesn't actually do he or she doesn't do your procedure, will actually be there present when it's being done, et cetera, et cetera, 282 00:37:02,560 --> 00:37:09,310 with the net result that you now have trainees who have a shorter training period, 283 00:37:09,310 --> 00:37:14,930 who are getting less practical experience because there are more of them, 284 00:37:14,930 --> 00:37:19,840 and plus the fact that they're rotating much faster so that your knowledge 285 00:37:19,840 --> 00:37:25,240 of their abilities and qualities is less than it would have been previously. 286 00:37:25,240 --> 00:37:31,600 And I think that's one of the negative features that I was aware of during my time. 287 00:37:31,600 --> 00:37:38,510 And, um. As with most things been, 288 00:37:38,510 --> 00:37:49,910 benefits in the wastage from speciality is much less in that as I think is applied across 289 00:37:49,910 --> 00:37:59,750 all specialities during the just over four decades that I was practising medicine, 290 00:37:59,750 --> 00:38:05,150 you got into a registrar post. There were far more registrar posts and there were senior registrar posts. 291 00:38:05,150 --> 00:38:10,280 If you got a senior registrar post, you knew that you were pretty certain to get a consultant post. 292 00:38:10,280 --> 00:38:20,840 But many registrars failed and failed to get into a senior registrar post, either because of inability or because of a lack of support, 293 00:38:20,840 --> 00:38:28,730 for whatever reason, with the net result that they had to choose another speciality. 294 00:38:28,730 --> 00:38:32,270 Many went into general practise, some went abroad. 295 00:38:32,270 --> 00:38:42,230 And that's what I meant when I said the loss to the profession of sometimes very competent people who are very disgruntled as well, 296 00:38:42,230 --> 00:38:48,240 because they and I think that there has a positive side in some specialities. 297 00:38:48,240 --> 00:38:57,560 So taking your region, especially diabetes, I think if you if you were somebody who had considerable experience, that registrar grade of diabetes, 298 00:38:57,560 --> 00:39:03,500 then you actually became quite attractive in a general practise because you had a skill that was really translatable. 299 00:39:03,500 --> 00:39:07,030 And the same would be true nowadays, particularly for women. 300 00:39:07,030 --> 00:39:12,560 And I don't mean to sound sexist who've done gynaecology that makes them attractive in general practise 301 00:39:12,560 --> 00:39:21,530 where increasingly the gynaecological work is consultations that were performed by women GP's. 302 00:39:21,530 --> 00:39:28,980 But obstetrics skills have had limited attraction. 303 00:39:28,980 --> 00:39:32,630 I mean, Oxford did its part. 304 00:39:32,630 --> 00:39:44,930 I think the whole reformation of services, which the Flying Squad was one part, did develop the general practise obstetric unit within Oxford. 305 00:39:44,930 --> 00:39:50,120 And when I was appointed, it was very, very active and they were responsible for several hundred deliveries a year. 306 00:39:50,120 --> 00:39:59,890 And these were committed GPS who would come in 24/7 to look after and either be present at or indeed delivered their patients. 307 00:39:59,890 --> 00:40:08,480 My full name was the one that most people know was extremely influential in that regard, both locally and nationally. 308 00:40:08,480 --> 00:40:13,550 Uh, again, changes in contracts, particularly GPS contracts, 309 00:40:13,550 --> 00:40:21,530 and the fact that they even for their general practise duties, let alone obstetrics, do not do it out of hours. 310 00:40:21,530 --> 00:40:32,690 Work has meant that that has just ceased to cease. By the time when I retired, it had gone from being extremely active back in the 80s to nothing. 311 00:40:32,690 --> 00:40:38,600 You know, it's the end of the noughties article. You were mentioning being chairman. 312 00:40:38,600 --> 00:40:44,450 Did you start and I blue or was it after he'd retired? 313 00:40:44,450 --> 00:40:50,450 Alec became ill relatively shortly after my appointment. 314 00:40:50,450 --> 00:40:57,380 Right. Um, I think it was nine to or thereabouts. 315 00:40:57,380 --> 00:41:11,630 Ninety three, certainly at the point that Gordon Stereotactic got his appointment in Bristol and I was then the senior academic, 316 00:41:11,630 --> 00:41:24,830 as it were, under Alec. And so my first involvement with university matters was deputising for Alec on the university 317 00:41:24,830 --> 00:41:34,220 committees that he was required to attend as also a fellow green college at that time. 318 00:41:34,220 --> 00:41:41,050 And I was involved with Green College Committees I. 319 00:41:41,050 --> 00:41:50,810 Only became involved as chairman of the. 320 00:41:50,810 --> 00:42:05,480 Department, after I've been appointed as an NHS consultant, which was a post I took up in November 1984, so I just read it from November 79 to 84. 321 00:42:05,480 --> 00:42:12,520 And what did you really do as chairman in the hospital? I don't mean committees. 322 00:42:12,520 --> 00:42:19,300 Initially, it was a question of organising the service and its provision, 323 00:42:19,300 --> 00:42:36,360 which meant having knowledge of staffing both within medicine and obstetrics and gynaecology, ecocide and the midwifery side. 324 00:42:36,360 --> 00:42:49,710 I had at that time an interesting conflict with our lead midwife at that point who. 325 00:42:49,710 --> 00:43:03,370 That's the lady who. Had come from Canada, but was originally British and was very keen to establish midwifery led care. 326 00:43:03,370 --> 00:43:16,620 This caused a considerable amount of conflict, something he went on to have a chair in midwifery in London, and in fact, he left Oxford. 327 00:43:16,620 --> 00:43:27,380 I got a bit of a clown and basically. 328 00:43:27,380 --> 00:43:39,590 One of the things that I was involved in the organisation of was creating so-called team midwifery in different parts of the city, 329 00:43:39,590 --> 00:43:47,750 to some extent there was already midwifery that care or midwifery that care further afield in Chipping Norton, 330 00:43:47,750 --> 00:44:00,300 in some women were delivering in these peripheral units. But the idea was to have teams of midwives who would. 331 00:44:00,300 --> 00:44:08,430 Together, a team of five or six be responsible for a group of women who they would get to know intimately but see them for the entire network, 332 00:44:08,430 --> 00:44:13,320 usually in the general practise surgery, and then would follow them in and deliver them. 333 00:44:13,320 --> 00:44:24,390 And with a very short discharge, usually on the same day at most 24 hours, return home and continue the care while they were at home. 334 00:44:24,390 --> 00:44:39,860 So team midwifery was something that was being set up at that time in which I was indirectly involved with working with, um, the midwife. 335 00:44:39,860 --> 00:44:54,170 What subsequently happened, of course, was the whole contract process where GPS contracted to the hospital and together with the unit manager, 336 00:44:54,170 --> 00:44:59,240 I had to review contracts and signed them off and so on. 337 00:44:59,240 --> 00:45:06,260 It was from my point of view or rather fictional, and I think in truth it was fictional. 338 00:45:06,260 --> 00:45:13,730 Um, and I suppose if I were to comment following on from that, uh, 339 00:45:13,730 --> 00:45:26,480 the one thing that one saw on which I was resistant to that it is possible to resist is the expansion management aspect of the service. 340 00:45:26,480 --> 00:45:31,190 Yes. Um, and that applies throughout the hospital. 341 00:45:31,190 --> 00:45:36,960 It's not in no way unique to our department and indeed at all levels. 342 00:45:36,960 --> 00:45:44,660 And um, and in some respects it was was good. 343 00:45:44,660 --> 00:45:49,850 But in other respects, one felt, but there were more managers than required. 344 00:45:49,850 --> 00:45:58,630 Why did the doctors let that happen? You know, looking back, I often wondered in a way. 345 00:45:58,630 --> 00:46:01,150 Not all doctors were interested in becoming involved in management. 346 00:46:01,150 --> 00:46:11,890 Absolutely I was, because it seemed to me that that was the only way we were going to influence what happened. 347 00:46:11,890 --> 00:46:17,890 And I think I'm right in saying that we were able to influence what happened. 348 00:46:17,890 --> 00:46:27,460 And if you're going to have managers, then you want to have managers who are good and with whom you get on well with that combination. 349 00:46:27,460 --> 00:46:39,700 Uh, sir, the service and standards will improve for the patient, which is primary goal now. 350 00:46:39,700 --> 00:46:54,160 And I certainly was very lucky to have managers with whom I worked extremely closely like interments, obviously the first thing. 351 00:46:54,160 --> 00:47:00,000 And Richard Jones. 352 00:47:00,000 --> 00:47:21,180 There's another. The the work the way I viewed it was not only were you responsible for the clinical service provision of clinical care, 353 00:47:21,180 --> 00:47:24,930 but also for the hotel aspects of the service. 354 00:47:24,930 --> 00:47:34,450 And it always used to frustrate me that if you compare this with what you might call a benevolent industry or little retail, 355 00:47:34,450 --> 00:47:35,820 that's what I'm thinking of. 356 00:47:35,820 --> 00:47:43,650 I always think of John Lewis as being rather a good example of that, that the quality of the facility in which you do your shopping, 357 00:47:43,650 --> 00:47:52,140 John Lewis, and the quality of the toilets and all the other things are generally superb. 358 00:47:52,140 --> 00:48:00,990 And it's always sadden me that it was difficult to achieve that sort of standard of provision of service. 359 00:48:00,990 --> 00:48:05,640 And likewise, but with the hotel aspect of it, food and all the rest of it. 360 00:48:05,640 --> 00:48:10,710 So I was involved and I try to involve myself in all those things, how effectively I did. 361 00:48:10,710 --> 00:48:12,660 So I don't know. I used to do rounds particular. 362 00:48:12,660 --> 00:48:23,610 I remember doing rounds with Richard Jones, who then went to South Africa as a hospital manager on a weekly basis. 363 00:48:23,610 --> 00:48:28,200 And we would choose an area and and go through. 364 00:48:28,200 --> 00:48:34,980 I think the other thing that many people would comment on with regard to that aspect of care, 365 00:48:34,980 --> 00:48:44,550 which is the the quality of the facility that has been changed, 366 00:48:44,550 --> 00:48:52,410 by the way, the services provided in the days when I was first appointed, 367 00:48:52,410 --> 00:49:01,350 you would have a particular ward, would have its own cleaning staff, et et cetera. 368 00:49:01,350 --> 00:49:05,110 That all changed again with the contracts that were made and so on. 369 00:49:05,110 --> 00:49:15,660 And I think that meant that there was a certain loss of pride and also less control by the professionals who were providing care, 370 00:49:15,660 --> 00:49:25,540 the nurses and midwives. And they had less control over what the staff who were responsible for the cleanliness of the facility and so on. 371 00:49:25,540 --> 00:49:38,910 So when you first came to Oxford, how did the nursing care compare between Mary's and Oxford any different? 372 00:49:38,910 --> 00:49:46,900 I don't think the standards were any different at all. I think that. 373 00:49:46,900 --> 00:49:57,450 London is a much more cosmopolitan place, so one tended to see a much wider range of nations and that is then subject to change. 374 00:49:57,450 --> 00:50:09,220 Yes, but particularly with the EU, you know, both in terms of staff and and patients want to see a much broader range of nationalities. 375 00:50:09,220 --> 00:50:14,000 I've always admired the obstetrical review of maternal deaths. 376 00:50:14,000 --> 00:50:20,830 Were you involved in that? Because somebody must be. Yeah. Is that hard work or difficult? 377 00:50:20,830 --> 00:50:25,390 Because you remind me of all the things that I did and one forgets about when 378 00:50:25,390 --> 00:50:30,610 I was a regional assessor for confidential enquiries into maternal deaths. 379 00:50:30,610 --> 00:50:40,790 And I took that from Arthur Williams. In fact, um, it it was challenging. 380 00:50:40,790 --> 00:50:52,060 It was very interesting. It was an entirely honorary appointment. 381 00:50:52,060 --> 00:50:56,290 Want to send the records. One made an assessment. 382 00:50:56,290 --> 00:51:05,980 They were reviewed by a pathologist or any other speciality that was relevant, um, neonatal paediatrics, radiology and so on. 383 00:51:05,980 --> 00:51:09,160 And then the report went off to the Department of Health. 384 00:51:09,160 --> 00:51:16,540 So you didn't get and see the people involved sometimes spend it, but in the room it was largely a paperwork. 385 00:51:16,540 --> 00:51:28,100 And so I rather fell out with it towards the end because there was no. 386 00:51:28,100 --> 00:51:42,020 Legislation that required the various hospitals to provide the full records to be required and one 387 00:51:42,020 --> 00:51:49,400 would have these notifications comes through you then utilising your own secretarial resources, 388 00:51:49,400 --> 00:51:56,030 contact the hospital to get the information that was required, the records basically a copy of the record. 389 00:51:56,030 --> 00:52:05,780 And very often they would not provide anything. And there was no way of putting pressure on that because there was no legislative requirement. 390 00:52:05,780 --> 00:52:15,140 And rather curiously, towards the end and I don't goodness Lewis was the doctor, 391 00:52:15,140 --> 00:52:21,380 one of the senior medical officers of health, who was responsible for specifically for the confidential enquiries, 392 00:52:21,380 --> 00:52:31,430 which then, of course, also changed and became part of another component of the National Institute for Clinical Excellence, 393 00:52:31,430 --> 00:52:40,410 which I think, again, has changed its name. But the enquiries. 394 00:52:40,410 --> 00:52:47,230 Somebody funded and they offered you a nominal fee for doing this, 395 00:52:47,230 --> 00:52:54,670 which I guess they then started to use almost as a lever to get the reports back that they were getting, 396 00:52:54,670 --> 00:52:59,920 but they couldn't get the message, which I tried to get through to fill out to some extent with them. 397 00:52:59,920 --> 00:53:14,740 And then that wasn't money that was required and it was some change in legislation that ensured the necessary records were available. 398 00:53:14,740 --> 00:53:22,870 So you could do your report and paying money, which was a relatively small sum. 399 00:53:22,870 --> 00:53:28,930 I cannot remember how much. It's not really relevant. Did not make it any easier to get the information you required. 400 00:53:28,930 --> 00:53:38,020 So in other words, if it was coming up to the end of the three year cycle and they knew that you still had six or seven from the previous three years, 401 00:53:38,020 --> 00:53:46,060 that you had not provided a final report on, they would threaten that in future, you know, you will no longer you will not receive the funds. 402 00:53:46,060 --> 00:53:49,510 And I can remember writing back and saying this is not the issue. 403 00:53:49,510 --> 00:53:55,510 I don't care about the money just to find a way to resolve this fundamental issue. 404 00:53:55,510 --> 00:54:00,430 I stopped doing that probably in the late 80s. 405 00:54:00,430 --> 00:54:06,940 I think Susan Sellers is now a consultant in Bristol, took it over and I'm not sure what she said. 406 00:54:06,940 --> 00:54:13,900 But when you were doing it properly, as it were, did you then go up to London and meet everybody nationally and talk about it? 407 00:54:13,900 --> 00:54:20,530 You know, there were meetings, but I wasn't I was never part of the central committee of the Central Committee that considered everything. 408 00:54:20,530 --> 00:54:25,930 But when it came to preparing the final reports, they did have meetings to get feedback from people. 409 00:54:25,930 --> 00:54:33,490 Yeah. Now, I don't want to have a lecture, but you said you did a lecture on upsetter changes in practise in your time. 410 00:54:33,490 --> 00:54:37,600 And could you give, you know, a summary of that, as it were? 411 00:54:37,600 --> 00:54:44,560 Yeah, from the aesthetic point of view, to some extent, we've covered it, right. 412 00:54:44,560 --> 00:54:49,090 I mean, basic obstetrics doesn't change, some would say, 413 00:54:49,090 --> 00:54:55,540 with great relief and enthusiasm that there is no way that you can laparoscopically deliver a baby. 414 00:54:55,540 --> 00:55:04,870 So basic surgery and which involves doing, you know, a laparotomy and a caesarean section remains basic obstetrics surgery. 415 00:55:04,870 --> 00:55:10,360 Has the analgesic handling of labour changed? 416 00:55:10,360 --> 00:55:17,980 Not in the 30 years. Narad delivering a baby vaginally has not changed. 417 00:55:17,980 --> 00:55:27,140 No. I mean, epidural, which is what you're referring to easier had become very popular by the time I was appointed. 418 00:55:27,140 --> 00:55:38,380 It's people like Selwyn Crawford at Queen Charlotte's who encouraged the going way back to the sort of 60s onwards. 419 00:55:38,380 --> 00:55:45,490 Um, certainly when I worked at Queen Charlotte's in 1970 was readily available. 420 00:55:45,490 --> 00:55:49,130 Many, many women had it. So I know that that hasn't really changed. 421 00:55:49,130 --> 00:56:01,250 I think, if anything, the change has been for the natural childbirth group to sort of lead women to. 422 00:56:01,250 --> 00:56:11,920 Become suspicious of all, resistant to the idea of to do so, where's obstetric change that's changed in the foetal medicine side of things? 423 00:56:11,920 --> 00:56:26,270 Um. I mentioned earlier, Mrs. Kandinski and resist disease, that is an area that the department has had an interest in over a long period of time, 424 00:56:26,270 --> 00:56:31,430 and Mackenzie used to do it and he was doing photocopy at one point. 425 00:56:31,430 --> 00:56:40,490 So he was putting groups that are very like arthroscope into the uterus and doing his intrauterine transfusions 426 00:56:40,490 --> 00:56:49,670 directly by visualising the umbilical cord and popping a needle into that and providing transfusion ultrasounds, 427 00:56:49,670 --> 00:56:56,150 change all of that high definition ultrasound things that you do it by indirect needling of the 428 00:56:56,150 --> 00:57:07,970 cord and transfusing the blood and autoimmune thrombocytopenia has been recognised in this time. 429 00:57:07,970 --> 00:57:15,140 And people transfusions have become part of the treatment for that condition. 430 00:57:15,140 --> 00:57:29,180 That's another controversial area. And the ultrasound anomalies scan normally done around about 20 weeks to identify foetal tissue. 431 00:57:29,180 --> 00:57:41,300 The move when I arrived, one of the areas that Turnbull was very involved with was screening for neural tube defects by measuring serum mufid protein. 432 00:57:41,300 --> 00:57:49,090 And that has ceased to be relevant because high definition ultrasound will identify the abnormality for you. 433 00:57:49,090 --> 00:57:54,440 Yeah, indeed. Going back to the diabetes side, but I can talk to one of the few groups of women, 434 00:57:54,440 --> 00:58:00,530 all of whom had an anomaly ultrasound scan once it became feasible to do it on a reasonable number, 435 00:58:00,530 --> 00:58:11,480 which would be sort of mid to late 80s, once mobile ultrasound equipment was becoming available with real time ultrasound with 436 00:58:11,480 --> 00:58:18,530 diabetics because of their high incidence of historic high incidence of abnormalities. 437 00:58:18,530 --> 00:58:37,270 I have to say that. Ultrasound, in a sense, is the focus of everything that's really changed in that ultrasound, foetal monitoring, 438 00:58:37,270 --> 00:58:51,600 ultrasound and reading has done a tremendous amount of work in that the computerised analysis and into Haltom traces and so on the. 439 00:58:51,600 --> 00:58:55,950 Use of ultrasound to look at blood flow through the umbilical cord, 440 00:58:55,950 --> 00:59:04,110 through the uterine arteries and so on and so forth, so that's a big area of change. 441 00:59:04,110 --> 00:59:17,130 And it's what's actually facilitated the evolution of foetal medicine alongside maternal medicine from the gynaecological point of view. 442 00:59:17,130 --> 00:59:25,760 There are two components to the changes that have occurred. The first component was that. 443 00:59:25,760 --> 00:59:37,130 Obviously, gynaecologist's who essentially a pretty sort of innovative group, 444 00:59:37,130 --> 00:59:41,030 we mentioned Donald earlier and the development of ultrasound to ultrasound, 445 00:59:41,030 --> 00:59:51,900 of course, is a central component right across medicine, but it started in obstetrics. 446 00:59:51,900 --> 01:00:10,470 Laparoscopy has a long history, but modern laparoscope using fibre optics and cold light sources has a much more, um, gynaecological development. 447 01:00:10,470 --> 01:00:19,620 It was taken up by gynaecologists in this country and they were the first to use it operatively 448 01:00:19,620 --> 01:00:29,220 for sterilisation and itself potentially controversial because back in the in the 70s and 80s, 449 01:00:29,220 --> 01:00:38,700 it was being done using diathermy and some battle damage occurred at that time, putting really patients handbell battle damage. 450 01:00:38,700 --> 01:00:43,260 And then it became the clips and rings and so on. 451 01:00:43,260 --> 01:00:56,340 And then from that, the whole era of laparoscopic surgery has evolved, which again spreads right across the surgery. 452 01:00:56,340 --> 01:01:05,190 History escapee, when I trained and again, really through until the mid to late 80s, 453 01:01:05,190 --> 01:01:12,960 the only time you had a view of the inside of a woman's uterus was at the time of Caesarian section. 454 01:01:12,960 --> 01:01:20,830 But with the advent of oestrus could be its routine, both under anaesthesia and on an outpatient basis. 455 01:01:20,830 --> 01:01:31,430 In fact, together with Mark Charlock, set up the outpatient facility at the John Ritter following the model at. 456 01:01:31,430 --> 01:01:46,100 Hospital in Guilford, so ultrasound has affected obstetrics, ultrasounds, also affected gynaecology because. 457 01:01:46,100 --> 01:01:51,560 It gives the indirect image of what's happening inside the uterus. 458 01:01:51,560 --> 01:01:58,670 So in my early days, my training days, my days as a consultant, if you had somebody with abnormal bleeding, 459 01:01:58,670 --> 01:02:07,490 the only way you could really investigate it was by doing a curtilage diagnosis, the DNC, to cure it. 460 01:02:07,490 --> 01:02:16,970 Nowadays, you can. Use a vaginal transvaginal transducer. 461 01:02:16,970 --> 01:02:23,210 You can image the uterus itself so you can look at the structure of the uterus and Miami trim, 462 01:02:23,210 --> 01:02:37,280 you can the endometrium and you can look at abnormalities such as fibroids from the mamita protruding into the individual cavity. 463 01:02:37,280 --> 01:02:48,200 And with respect to scope, you can reset the fibroid under direct vision on a day case basis. 464 01:02:48,200 --> 01:02:55,700 Amazing. I've jokingly said to many, many women over the years that history could be more correctly, 465 01:02:55,700 --> 01:03:04,460 the operation which we which is used very frequently now in place of hysterectomy, which is the transvaginal resection of the endometrium. 466 01:03:04,460 --> 01:03:15,770 So TIKRAI and this is an operation which uses a risk scope identical to that used for transducer of a section of the prostate. 467 01:03:15,770 --> 01:03:20,120 So I'm often said to many women to reassure them this is this is the only operation done in women, 468 01:03:20,120 --> 01:03:23,900 which was piloted in men over many years before it was ever used in women. 469 01:03:23,900 --> 01:03:26,540 And it was a Frenchman, in fact, who first did it. 470 01:03:26,540 --> 01:03:36,890 And then in truth, it was an Turnbull again who brought it into Oxford by encouraging one of his lecturers that, 471 01:03:36,890 --> 01:03:41,630 my gosh, now they're all free to do some studies on it. 472 01:03:41,630 --> 01:03:50,540 And Oxford was the first hospital in the country where individual resection I can just a lot of buzz about it. 473 01:03:50,540 --> 01:03:58,580 Yeah, no, what happened was that Adam invited Alec invited over the Frenchman. 474 01:03:58,580 --> 01:04:03,140 His name escapes me at the moment, and he actually came over and demonstrated it. 475 01:04:03,140 --> 01:04:08,540 And it was done with a video link from the Churchill Hospital because at that time, gynaecology was at the church. 476 01:04:08,540 --> 01:04:17,510 And so that's one of the other big, um, I mentioned earlier where the gynaecology ward and operating theatres are now. 477 01:04:17,510 --> 01:04:22,610 Um, they were brought over from the church. We basically vacated the church. 478 01:04:22,610 --> 01:04:27,800 So so that's that's the the one side of change in gynaecology. 479 01:04:27,800 --> 01:04:40,150 I've mentioned training programme side with Kelman's name attached to it becomes name is also attached to the whole issue of cancer management. 480 01:04:40,150 --> 01:04:49,010 Right. And when I was appointed, I would do the full obstetric role and a full gynaecological role, 481 01:04:49,010 --> 01:04:59,450 by which I mean I saw patients who had benign problems, both uterine and bladder. 482 01:04:59,450 --> 01:05:04,190 And I also dealt with oncology as a result of Kalmen. 483 01:05:04,190 --> 01:05:10,160 The oncology basically became a specialist interest. 484 01:05:10,160 --> 01:05:17,690 There had always been people who had some specialist interest in Moctar, had a particular interest in in that we also did infertility. 485 01:05:17,690 --> 01:05:29,590 Sorry, I've never met a. Steptoe and Edwards with IVF was created ultimately the whole reproductive medicine. 486 01:05:29,590 --> 01:05:42,670 Speciality, some speciality. Women like Linda Cardosa, Kings and. 487 01:05:42,670 --> 01:05:48,880 A number of men says he tried to remember the names of them, but then were sticks in my mind, 488 01:05:48,880 --> 01:05:55,930 who are interested in your gynaecology have created a gynaecology subspecialty. 489 01:05:55,930 --> 01:06:08,080 And oncology has also become very much a subspecialty with people now doing nothing other than oncology at the joint venture. 490 01:06:08,080 --> 01:06:11,980 But is that down to the church of mine? When I was about to say, yeah, 491 01:06:11,980 --> 01:06:22,030 what's actually happened is that having brought all the gynaecology into the womb in the centre site 492 01:06:22,030 --> 01:06:31,390 is it is it was renamed the oncology has now moved into the oncology centre of the church and indeed, 493 01:06:31,390 --> 01:06:37,460 the clinical oncologists are now part of the division of surgery and are not part of our division. 494 01:06:37,460 --> 01:06:54,040 I was my division. And then you've got the benign gynaecologists who are doing the surgery that relates to menstrual problems and function of. 495 01:06:54,040 --> 01:07:02,170 Yes, absolutely. The reproductive medicine side has also expanded enormously. 496 01:07:02,170 --> 01:07:11,650 And at the time of my retirement, they were still based on the fall in the John Radcliffe taking over one half of level them. 497 01:07:11,650 --> 01:07:26,530 But they now have the Oxford Fertility Centre down in Cowley and the present head of department is closely involved with that and is, 498 01:07:26,530 --> 01:07:35,150 in fact a reproductive medicine specialist. So the some senses. 499 01:07:35,150 --> 01:07:41,720 The speciality has grown in much the same way as I suppose, one I've seen other specialities grow and diverge. 500 01:07:41,720 --> 01:07:46,370 I always think of the orthopaedic surgeons who have had surgeons and trauma 501 01:07:46,370 --> 01:07:53,330 surgeons in hip surgery or knee surgeons and in obstetrics and gynaecology. 502 01:07:53,330 --> 01:07:59,690 You know, people who are general obstetricians, feet, internal medicine specialists in gynaecology, 503 01:07:59,690 --> 01:08:05,580 you have your reproductive medicine, your euro, gynaecology or oncology, and again, your generalists. 504 01:08:05,580 --> 01:08:12,560 And then I even mentioned family planning, which is another aspect which is sort of moved, 505 01:08:12,560 --> 01:08:17,930 including the termination service termination of pregnancy service, which was sort of moved with that. 506 01:08:17,930 --> 01:08:25,010 Am I in preparing for our discussion today? 507 01:08:25,010 --> 01:08:31,580 And I thought I'll try and look out the obituaries of the various previous Nuffield professors. 508 01:08:31,580 --> 01:08:39,620 And I found quite a bit out about Qasm, more so Joan stalwartly, 509 01:08:39,620 --> 01:08:48,080 probably because he became president of the British Medical Association and was present to the RSM and so on and so forth, 510 01:08:48,080 --> 01:08:56,290 and knighted had an obituary which was in The Independent. I cannot find anywhere an obituary for Alec Turnbull. 511 01:08:56,290 --> 01:09:12,290 No, I can find out more about David Barlow, who was his successor between, well, up until 2000 five. 512 01:09:12,290 --> 01:09:17,300 But I cannot find an obituary anywhere. 513 01:09:17,300 --> 01:09:22,040 And I've actually contacted our college to see if they can get there must have been one presented to the 514 01:09:22,040 --> 01:09:32,180 college council because any past member of council has an obituary read at the subsequent council meeting. 515 01:09:32,180 --> 01:09:39,500 What reminded me of that was when I mentioned contraceptive services, 516 01:09:39,500 --> 01:09:49,640 which I was actually involved with way back when Alex Gatherer was not sure what his title was now with Health Public Health, 517 01:09:49,640 --> 01:09:56,000 but I don't know why he was his district. That's the other big change, of course, in the regional health authority and so on. 518 01:09:56,000 --> 01:10:07,010 Anyway, Alec's name is now immortalised with the Alec Turnbull Family Planning Clinic in Cowley. 519 01:10:07,010 --> 01:10:16,500 And if you do a Google search for Alec Turnbull, you will find the opening times of the Alec Turnbull clinic. 520 01:10:16,500 --> 01:10:20,180 I find this simultaneously amusing and sad. 521 01:10:20,180 --> 01:10:24,350 Yeah, because Alec had no interest specifically in family planning. 522 01:10:24,350 --> 01:10:29,990 He never did any research on contraception. He never had any real involvement with it. 523 01:10:29,990 --> 01:10:39,290 He was interested in all aspects of it, especially because he was a generalist, as we all were at that time. 524 01:10:39,290 --> 01:10:44,990 And so I suspect he wouldn't be too concerned. 525 01:10:44,990 --> 01:10:55,610 At my retirement dinner, I try to persuade the present head of department, Stephen Kennedy, to name the laboratories as the Turnbull Department, 526 01:10:55,610 --> 01:11:00,950 because the lecture theatre within level four is actually called the Anna Anderson Lecture Theatre. 527 01:11:00,950 --> 01:11:12,140 And that was Alec who named at the end of the semester there in tribute to his late colleague, who sadly died really quite young of breast malignancy. 528 01:11:12,140 --> 01:11:22,970 But that hasn't happened yet. The other thing that hasn't happened is the Nuffield chair is vacant because 529 01:11:22,970 --> 01:11:28,400 there is no Nuffield professor of obstetrics and gynaecology at the university. 530 01:11:28,400 --> 01:11:32,990 And its wisdom, as I understand it, made several attempts. 531 01:11:32,990 --> 01:11:38,780 And they specifically want to bring in basic science person, not a clinician, 532 01:11:38,780 --> 01:11:45,470 which all the previous, yes, Nuffield professors of obstetrics and gynaecology had been. 533 01:11:45,470 --> 01:11:51,680 And there is a precedent for it in other departments. And I think they've got very close. 534 01:11:51,680 --> 01:11:58,190 I've never been on the search committees. I've never been involved in discussions other than in a casual basis. 535 01:11:58,190 --> 01:12:04,520 And nobody's ever really given me the full details of what happened within the university. 536 01:12:04,520 --> 01:12:09,690 And various times we were told that somebody was going to come and then discover 537 01:12:09,690 --> 01:12:16,490 that the conditions that they had set were unacceptable and they pulled out. 538 01:12:16,490 --> 01:12:22,550 Stephen Kennedy took over the head of department as the sort of senior academic at the 539 01:12:22,550 --> 01:12:28,580 time of David Bowie's department and then subsequently has been given a personal chair. 540 01:12:28,580 --> 01:12:37,170 So he is a professor of obstetrics and gynaecology, one of, I think, four or five within the department that maybe. 541 01:12:37,170 --> 01:12:48,550 But he's not the nephew of professor. No, it's very odd and I've no idea how the finances have been organised for that particular endowed chair, 542 01:12:48,550 --> 01:12:57,040 but he he cannot claim to be that in that position. 543 01:12:57,040 --> 01:13:05,770 I mean, it's the university thinks you can't be a clinician and a scientist or a clinician who can lead scientific endeavour. 544 01:13:05,770 --> 01:13:20,760 And whether that's right or wrong, I don't know. It's a difficult one, the clinical advances. 545 01:13:20,760 --> 01:13:37,270 Of our age group dependent on technology, you can't do anything without a technological base and. 546 01:13:37,270 --> 01:13:48,350 Much of the therapeutic advance obviously stems from the pharmaceutical industry, so that's not relevant. 547 01:13:48,350 --> 01:13:54,860 Much of our understanding has come from basic research in molecular biology, 548 01:13:54,860 --> 01:14:05,600 and so I think there is still a place for both how difficult it is to do the two together. 549 01:14:05,600 --> 01:14:08,430 I don't know, because in my latter years, I, 550 01:14:08,430 --> 01:14:16,940 I used to say that the work that I did could be crudely classed as bucket chemistry because I wasn't involved. 551 01:14:16,940 --> 01:14:23,900 Indeed, the question you haven't asked me was why I switched from academic to NHS. 552 01:14:23,900 --> 01:14:30,500 And I did it because I found that I enjoyed my clinical work more than my academic work, but I enjoyed both. 553 01:14:30,500 --> 01:14:37,790 But I had a decision, as it were, between the two. And secondly, I didn't envisage myself as running a large department. 554 01:14:37,790 --> 01:14:43,250 I had at one point looked around the country and assessed the likelihood of 555 01:14:43,250 --> 01:14:48,680 getting a post in any particular city based on the gravity of the incumbents, 556 01:14:48,680 --> 01:14:57,650 or at least the time that that contract had to run. So I was of a serious to a degree of remaining in academe. 557 01:14:57,650 --> 01:15:01,250 But in the end the work went over. 558 01:15:01,250 --> 01:15:10,400 And although I continued to publish essentially on technical matters right up until my retirement and indeed I have one last paper to publish, 559 01:15:10,400 --> 01:15:13,820 which is based brings me back to diabetes. 560 01:15:13,820 --> 01:15:23,330 I looked after approximately 1300 diabetic pregnancies in my 30 years and I had a prospective computer based study. 561 01:15:23,330 --> 01:16:21,070 But a record of all these women I presented the first 24 years that I was a meeting sorry about. 562 01:16:21,070 --> 01:16:26,920 When I was nine, you presented tonight with the series of dramatic pregnancy. 563 01:16:26,920 --> 01:16:31,900 Oh, yes, not in the first 24 years, three eight year time frames. 564 01:16:31,900 --> 01:16:36,400 And my paper, which I haven't started writing and I should have done before, 565 01:16:36,400 --> 01:16:43,900 become distracted, will be three, 10 year blocks to compare outcomes in that time. 566 01:16:43,900 --> 01:16:57,040 And they've got better. It depends how you define better. We had, um, only, I think seven deaths and 1300 babies. 567 01:16:57,040 --> 01:17:09,820 Yeah, we had about three or four congenital abnormalities, but the babies got bigger and the caesarean section rate has gone up. 568 01:17:09,820 --> 01:17:27,350 The outcome. Overall, it is better if you compare it with what occurred before her monitoring. 569 01:17:27,350 --> 01:17:38,880 The whole process of management is far superior, yes, but in truth. 570 01:17:38,880 --> 01:17:46,260 You were talking about the diabetic outcomes, which may be finished on that, but you just getting through that. 571 01:17:46,260 --> 01:18:03,720 Yes, no, I'm as I'm saying, roughly 1300 diabetic pregnancies with essentially good outcomes is very good. 572 01:18:03,720 --> 01:18:17,940 I mean, compared to what I knew about, oh, if you if you bear in mind that if you go back to the 60s, even the mortality rate was 20, 25 percent. 573 01:18:17,940 --> 01:18:23,190 Yeah, yeah. Um, now I got to ask everybody this. 574 01:18:23,190 --> 01:18:28,160 Is this something I haven't asked you that I should have? 575 01:18:28,160 --> 01:18:40,700 No, I think we've covered everything that I would wish to say, and we've obviously covered a wide range of topics, 576 01:18:40,700 --> 01:18:49,760 all of which ultimately relate to the work of a consultant in a teaching hospital. 577 01:18:49,760 --> 01:19:01,580 Mm hmm. Is there anything going back to when you were a student or, you know, the young doctor in training that you feel you'd like to comment on? 578 01:19:01,580 --> 01:19:05,120 Uh, comparing the past with the present. 579 01:19:05,120 --> 01:19:27,410 I mean, recent present. I have a son who is a young doctor, and I know that even he observes he's now in his mid thirties, 580 01:19:27,410 --> 01:19:36,440 that the amount of practical experience that students get compared with when he trained is substantially less. 581 01:19:36,440 --> 01:19:45,200 This is in part because the number of student numbers has gone up. Yeah, when I was a student at King's, I think there was 35 in my head. 582 01:19:45,200 --> 01:19:49,370 Um, I think they're now more like 135 in a year. 583 01:19:49,370 --> 01:19:57,590 And at King's, the hospital work may well have increased. 584 01:19:57,590 --> 01:20:10,370 But not in any way comparable to the increase in the number of students, and I think that. 585 01:20:10,370 --> 01:20:18,530 Overall, what has happened, and we are talking about it earlier with regard to postgraduate training, 586 01:20:18,530 --> 01:20:22,430 is that there are a larger number of people being trained, 587 01:20:22,430 --> 01:20:30,050 which we need because we have been too dependent on doctors from abroad throughout my career. 588 01:20:30,050 --> 01:20:41,000 I think what we've seen is an increase in the numbers of medical students. 589 01:20:41,000 --> 01:20:46,820 Consequently, numbers of doctors, all of which is beneficial in the long run. 590 01:20:46,820 --> 01:20:47,780 But in the short run, 591 01:20:47,780 --> 01:21:01,190 it's meant rather less experience and with shorter training people achieving consultant roles who I think are far less experienced than we were. 592 01:21:01,190 --> 01:21:07,610 I was appointed as a consultant at the age of 34, which at that time was very young. 593 01:21:07,610 --> 01:21:21,410 Many of the people in my era being appointed in their late 30s. 594 01:21:21,410 --> 01:21:28,760 One previous president of the Royal College of Obstetricians and Gynaecologists I know wasn't appointed as a consultant until the age of 40. 595 01:21:28,760 --> 01:21:33,530 And that's not what I'm talking now about the 70s and 80s. 596 01:21:33,530 --> 01:21:46,190 So that that has been a change. And I think it isn't necessarily a change for the better, but it's an inevitable change. 597 01:21:46,190 --> 01:21:49,670 It's ours are the working poor. 598 01:21:49,670 --> 01:21:54,290 We really have reduced to having the. Oh, without a doubt. 599 01:21:54,290 --> 01:22:06,470 Yes. Yes. I mean, my son went to work on a cruise ship together with his wife, who's also a doctor in the Caribbean. 600 01:22:06,470 --> 01:22:12,380 And the ship in question. One of the ships in question is the carnival dream. 601 01:22:12,380 --> 01:22:19,340 Three and a half thousand passengers, one and a half thousand crew, 5000 people with the 24/7 responsibility. 602 01:22:19,340 --> 01:22:23,720 And the experience is phenomenal. Yeah, yeah. 603 01:22:23,720 --> 01:22:31,850 When I went to South Africa, I worked in a hospital which had 24000 deliveries a year. 604 01:22:31,850 --> 01:22:38,120 Uh, we had a neighbourhood of 24 beds, each of which was used on average twice a day. 605 01:22:38,120 --> 01:22:49,730 And that sort of experience is not available to somebody going through a routine process of training in the United Kingdom at the present time. 606 01:22:49,730 --> 01:22:53,990 And it's only if you do unusual things like that, as some of our trainees did, 607 01:22:53,990 --> 01:23:02,660 you know, going to Africa and other places, would you get that sort of experience? 608 01:23:02,660 --> 01:23:11,720 Ultimately, I'm sure people become very expert in what they're doing and some specialisation facilitates that. 609 01:23:11,720 --> 01:23:26,570 There's no way that you could be expert to the level that's nowadays required in infertility, as it was gynaecology of the benign variety, 610 01:23:26,570 --> 01:23:40,040 including neuro gynaecology, not that it was called at them, or oncology cancer services that people have to be now. 611 01:23:40,040 --> 01:23:46,940 And they do eventually become much more competent, much more knowledgeable in each of their areas than I ever was, 612 01:23:46,940 --> 01:23:51,650 partly because the knowledge wasn't there near the facilities and the technology wasn't there. 613 01:23:51,650 --> 01:23:55,490 And great, if that's OK by you. That's a lovely interview. 614 01:23:55,490 --> 01:23:59,670 Thank you very much to finish. Yeah, thanks. 615 01:23:59,670 --> 01:24:01,680 But I don't think I've said anything to outrageous.