Mike, this is an interview between Mike give him a Derek Hockaday on the twenty seventh of February one for Mike.
Obviously you came to Oxford, but what made you want to come to Oxford at that stage?
Because were you already a consultant at various? No, I was a lecturer.
A senior registrar at. Right. And so you put in a consultant job.
I applied for the job. I was working with Richard Beard, lots of marriage.
And I'd done research leading to an M.D. with Richard, which is on diabetes.
In pregnancy. Yes. And that was when Eric Turnbow was it.
Eric had arrived in Oxford from the chair in Cardiff in 1973.
He took over from Sir John stalwartly. And what was the opinion about Alec?
And did you have a big reputation or Alec once appeared, I believe,
in a Sunday Times kind of supplement where he was described as the obstetrician's obstetrician and he was very highly regarded.
Yes. And, uh, he was a man of immense enthusiasm.
Um, he was very good at getting money.
He had several MRC programme grants and project grants at a time when there were still grants that you could get clinical work.
The basic work was mainly obstetric clinical work.
I'll just stop this and tests that we're doing all right. I think I think we will be bit.
OK, let's go on then. Um, and how did you find the Oxford Department?
I mean, you came from Paris. What was the contrast between the two?
There wasn't a great contrast, really, from my point of view. I was moving from one academic department with a.
Head of department who was very much my mentor.
An inspiring man, which would be it sadly now deceased, to work with another man who was equally highly respected and very productive.
I think there was probably a greater emphasis on basic research in Alec's department,
and that's because he had for many years worked with the late Anderson.
Mm hmm. And she was a basic scientist. And I think she was medically qualified as well with her.
Her basic work was laboratory, not clinical, although Alec's interests were, I think, predominantly clinical.
And I think that was the main difference. The other big difference was the Nuffield Department has a very large laboratory
space and there were a number of other people there doing basic research.
And that differed from from areas where the laboratory side was was really quite small.
I think was the biggest difference between the two. And was that the advantage of it being.
Well, I mean, there some guy I knew of the first people who went to the news site.
So did you find it a good building, as it were? The maternity building is an interesting building.
It was described as designed by Saddam, still worthy,
and the plan was based on the fact that all women would remain in hospital for two weeks after delivery.
And so the number of beds in the original building was quite extraordinary.
And, of course, when it was built, it was the first hospital on that Headington site.
Obviously, that was the field and so on, but not on that site.
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.
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.
And in fact, the kitchen area and I think the dining area were converted into a medical record store,
which I've always described the building as being a Rubik's Cube,
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,
the number of changes that have occurred are extraordinary.
So, for example, the area that is now the gynaecology theatres in Ward was originally medical
secretaries offices and the medical records department in the laboratory space,
which is on level two where the academic offices are,
was obviously built with the future in mind because the John himself was very much a clinical individual.
Most an embryo was one of the clinical readers.
And it was in fact his post that I took when I was appointed or he retired and I was appointed to it.
And most of them continued to work after his retirement.
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.
And I said to most and most people retire to the to their garden, this is your garden, isn't it?
And he said, yes. So there was a sort of ethos of of laboratory work, which Marston was involved with.
And then Chris Redman became involved with a number of people were brought in, interestingly,
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.
And I think I think Dunstall worthy the who's a highly controversial man,
was very prescient in realising that it was important for the Department of
Health and Gynaecology to have a strong laboratory based research programme.
And I don't think that he actually personally did any work that the laboratory based.
But he knew that that was what was required to build a department in future years.
And he may have had the shadow shed somewhere over his shoulder because she had done basic work, as it were.
Yeah. One of the things that I did in preparation for our discussion today, I thought,
well, I don't know the dates of the various Nuffield professors and Chasseur,
who I knew when he returned to Hammersmith after his retirement chasseur,
was the first Nuffield professor Orangi, and he was appointed in 1987 and he stayed in that post in 1967.
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,
whether he was there from 67 to 73.
And then because as we've mentioned and there's no doubt I mean,
Cecil Moore is famous for the Discovery documentary Mentoring, and that work was done at University College Hospital.
So it was done before he came to Oxford. But the work that went on with a sort of utero tonic, obviously toxic substances,
which must an embryo then embraced and did a lot of work on prostaglandins in.
Lindsay then came in and found, I should say, when I was appointed, the other clinical leader was Gordon Stewart,
but Gordon Brown went to a chair in Bristol and in McKensie applied for that post and was appointed as a reader.
And he carried on Muffin's interest in prostaglandins, men with whom he had been working before,
so that that whole process carried on an increased regimen with his interest in pre-eclampsia,
developed the laboratory based investigation of the disease, if one can call it that, a pregnancy for which there is still no explanation.
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.
The Reverend Professor John Beasley used to do a talk on pre-eclampsia,
and the last slide was a sort of Nobel peace type award or a medical award, I should say, or the Oscar.
And he said this awaits the person who discovers the cause of pre-eclampsia, somebody still waiting to claim it.
Then, as I understand it, I always used to think of Chris Redman as the first physician to the foetus in utero.
I mean, is that fair? Because he before that, I mean, I'm sure other people were doing it,
but it seemed to me that he was taking the health of the baby in utero into consideration much more than previously.
Yes, I think that's fair. I mean, he he was an obstetric medicine consultant.
He wasn't a foetal maternal medicine consultant,
which is the breed that has arisen since starting in the 80s as a result of the Royal
College of Physicians gynaecologists recognising that this was an important role.
Chris, in many senses, was more like Michael the Sweet Queen, Charlotte's and you,
S.H., in being interested in maternal diseases complicating pregnancy.
I think it would be fair to mention a man called Geoffrey Robinson, who was an obstetrician who worked very closely with Chris Redman.
And he, I think, inculcated in, Chris, a recognition of the foetal aspects of things.
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.
Yeah, because foetal medicine was in its infancy, I.
I did a lecture or presented a lecture to the regional obstetrician gynaecological
group that I set up when I was chairman of the Regional Training Committee,
and in that I was giving a history of obstetrics during my 30 is John Radcliffe.
And one of the things that I started with and of which I had a slide was first ultrasound scanner at the time.
So this was made by Nuclear Enterprises, a company in Glasgow, I believe,
who in Donald had worked with Hughes, who was essentially the person who introduced medical ultrasound.
And there is a room on level two.
I said earlier that the government was unable to attend some level three, level two,
which is the sort of one of the ground floor entrances adjacent to the special care baby unit,
there was quite a large room, some 20 foot square, which contained the scanner.
It was an enormous machine, very simple.
And that was the totality of ultrasound in Oxford in 1979.
I mention that in relation to what you're saying about the foetal medicine side of things,
because up until that point, there was no way of visualising the foetus.
There was no way of observing its normality or otherwise and its state of health or otherwise.
If I were to say that 30 years on, you almost trip over the number of ultrasound machines and there were ultrasound,
something like 10 in the ultrasound department and others scattered around the hospital, I used to use ultrasound in gynaecological work.
I did when I last 10 years of my time there. So the great changes occurred and certainly foetal medicine is one of them.
There are now, I think, three or maybe four feet of internal medicine consultants.
I mean, that's the other big thing that's changed in the 30 years in that at the time that I was appointed,
there was the professor, the two clinical leaders who were consultants and three NHS consultants and a total consultant.
But it was six. I think it's close on 20 seconds with a workload that is not dissimilar.
I mean, the total number of deliveries in the directive itself,
as opposed to other hospitals such as the home total number of deliveries is around 6000 now, is about 5000 in 1979.
So there's an increase in workload.
The intensity of the work has increased in parallel with what happens in intensive care units, so A&E departments and so on.
So you do need the additional staff when you mention workload, I mean, how did you find the workload in your first five years?
We did you feel very busy or that you could have been doing more or.
My time obviously was split between my research interest and I had a laboratory based diabetes programme.
I also was involved in contraceptive research, specifically metabolic effects of oral contraceptives.
So I had a full research programme and I had a clinical workload.
I was reading an article by one of the former academics in Oxford who did a default with Alec Turnbull,
and he has since in Australia and he has since become a professor in Australia.
And I was interested to note that he said that he found it extremely difficult to do the sort of laboratory
work that he'd done for his difficulties years ago because the clinical work was all consuming.
And I think there's an element of truth in that.
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,
you will have difficulty maintaining a research interest.
The way things panned out with the 5000 deliveries that we had ultimate responsibility for somewhere in the
regions of 2000 fell to the academic department and the remaining three thousand to the Energy Department.
So there was not a lot of difference between the amount of work that we did, the gynaecological,
it was probably about half of what they did in terms of numbers of clinics and operating time.
So what did your laboratory do with the diabetes research?
What we're measuring. I was looking at well, I did.
I had two main programmes. One was looking at gestational diabetes or more particularly trying to establish a range of ranges of normal.
Yeah, a subject that was controversial when I first became involved with it in the early
70s and which I have to say was controversial when I retired in 2009 and remains so.
And I think the problem in regard to that specific issue,
which is what is gestational diabetes and how do you diagnose it, has become clearer in that.
Over at least four decades,
possibly five people mistakenly thought that they would be able to put a Cut-Off point and the work that's been done subsequently,
in particular a large multicenter study has actually shown as probably logic and biological knowledge would
dictate that it is essentially a continuum and therefore where you put your Cut-Off is somewhat arbitrary.
So that was one aspect where we studied 500 women doing glucose tolerance tests and of other things.
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
joint studies with Mary's is in essence a continuation of the work I've been doing for my M.D. thesis.
And then subsequently and that was to look at women who are diabetic, insulin dependent diabetics,
as they were called in Taiwan compared with Normal's and others who appear to have impaired the first tolerance called gestational diabetics,
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.
And most of that work was published. The amount of acid work was never published because it didn't really show anything.
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.
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.
So free fatty acids where they measured their memories are in Oxford.
They were measured in marriage. Yes, they were a cooperative study.
We did the amount of acids and, uh, we did our own glucose estimations and so on in the laboratory on level three.
Then you'd have been doing quite a bit of teaching, I guess. Uh, yes.
Um, I mean, the the way in which the system worked was that each firm would have medical students attached to them.
And I used to tutorials with students, um, on a weekly basis, sometimes twice weekly.
Um, so I have three, four students who come to my office on level three and we choose a topic and go through it.
And so when I when I think back on it, um, again with historical perspective in more senses and one of the, uh,
the tutorial that they really used to like was the one where I went down to the level of the delivery suite,
brought up a tray of instruments, which is called the destructive instrument set.
And it's a bit like looking at sort of things you'd imagine a torturer to use.
People are always fascinated by, um, I had quite a lot of experience of destructive operations,
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.
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.
Um. That, fortunately, did not happen, so the instruments were essentially historical,
but we're still there and still packed and sterile and still ready for use should that need arise.
And they used to find it fascinating. How did the medical students in Oxford compare with the ones that matter is just the same?
I never had any problem with medical students, and that's I think because I respected their intelligence and I know that some of
my other colleagues who tended to take a rather superior approach when lecturing,
found to their horror that Oxford students tend to be very quick to respond to things that they don't agree with.
And if they think the person who's teaching them is actually made a mistake or an error, they will not remain silent.
And and if you don't respect that and acknowledge something that you may have said that is
incorrect and you can find yourself in an adversarial situation with medical students,
I don't think that ever really happened at the time when I noticed medical students change was when they started.
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.
And some of those could be quite difficult.
But by and large, now I thought Oxford students were delightful. Hmm.
And did you get into the thought of the district and the region?
Yes, I used to do three very different times.
We had antenatal clinics, long established clinics at Fort Knox and on the Hilton and Chipping Norton,
the Memorial Hospital in Chipping Norton and also in the Mushroom Road having hospital in Abingdon.
So those are two that I did for many years and at the time that hospital contracts came in.
We expanded that. I was actually the chairman of the.
Department at the time and we had an additional there were other Abbington in Chipping Norton with the clinics didit,
but there were also clinics, which my other colleagues did in Watlington and everything else now can't at the moment.
But we increased the numbers and we went up to Farringdon and a sort of competitive approach to to Swindon.
So, you know, we could see an incursion into some territory.
And then the Horten, which wasn't part of the John Danforth Hospital trust at that time, moved into Kidlington.
So a week without a clinic in Kidlington as well. So this sort of competitive process, which didn't really, I think,
make any difference to the finances and possibly gave additional choice to patients.
I think its main benefit and students used to come to those peripheral clinics as well.
They were predominantly obstetric clinics, but we also had gynaecology clinics, certainly, and having the gynaecology clinic continue.
But I believe they've all been stopped when it comes to. And was the flying squad still going on with that system?
I have no record of being involved with the Flying Squad, which I think indicates that it probably stopped.
It was very much just over the thing even before he was professor, you know, on his way up.
I believe that it was the role that he was given when he first came to Oxford.
And I believe that it was Hazama who who gave him that as a remit.
And it was certainly needed at that time. I have an experience of the flying squad, been working in London.
And then as a medical student when I was in Winchester, I know I went out to the Flying Squad and then.
Yes, that creates memories of a woman who had a prolapsed cord and a midwife and an at home, obviously,
and a general practitioner who respected the midwife who had put the woman onto all fours,
as is appropriate to get the head of the cord and the memories of neighbours in adjacent houses,
watching this woman on all fours being carried to the ambulance with the general practitioner doing a
vaginal examination to keep the head above the parapet off the cord as they went to the ambulance.
And we then followed the ambulance to the hospital and they got to live births with babies crying experience.
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.
Right. We still have births in unusual places continue.
So we are going to have to land and do any premises, you any national committees.
And so I was involved with the Royal College of Physicians gynaecologists.
I was on the scientific advisory committee.
I was involved with the membership committee or the diploma and specifically the membership committees of the ISG.
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.
So for 25 or more years without examining Oxford or up in London.
And that was in London. Yes, that changed as well.
The nature of the to examination changed.
Originally, you had the clinical examination done in approximately 10 hospitals within travelling time from London.
So ranging from, say, Hillingdon in the West through to Graves' in the Middle East.
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.
They stopped that. I think I'm right in saying in the nineties, late nineties,
mainly because it became increasingly difficult to find women who were prepared to subject themselves,
particularly the kind of closer examination purely for an examination purpose.
But then, of course, going back to the medical students,
that has had an impact on them because there has been a reticence and understandable
reticence on the part of women to be examined by people who are not competent,
experienced, in other words, as part of their training, and whereas colleges like the Royal College general practitioners who in fact set the
standard for clinical examinations that involve actors and actresses who will play the part.
And that's the line that the Royal College of Obstetricians has gone down.
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
like bereavement counselling and and dealing with people who don't necessarily agree with what you're suggesting and so on and so forth.
The same thing has happened with women resisting the idea of being examined by medical students.
And as a result, in the years just before my retirement, the Nuffield Department set up surrogate is probably not the right term.
But women who are paid to come along and teach speculum examinations to students and very often both doing
it to themselves to demonstrate what has to be done and then taking the student through being done.
Most people would consider this to be a fairly unusual sort of job, but nonetheless,
that is the way things have progressed and probably to the benefit of all concerned because a student
is going to be more relaxed with somebody who knows what's happening and is actually guiding them.
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.
Uh, inevitably, students, when they first do particularly expected examinations, are incredibly tense.
And when you're tense, you don't. They do your best for the person who is performing the examination.
This show you mentioned your chairman, was that a rotating chairmanship of the place?
The answer is yes. And I did it for a very long time.
I'm not quite sure how many years or why I was chairman for a while and then march on.
It took over and then I took over again from him at the time that again,
problems with naming names now comes in our chief executive who went on to be the chief executive of NHS.
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.
I became chairman of the original Obstetric Gynaecological Training Committee,
and the big change that occurred from the point of view of postgraduate education was that in the.
Mid 90s, early to mid 90s, the new cowman process came into being with.
Essentially, a rotational training programme within the region that had previously been a rotational training programme.
Senior registrar level, which involved Redding, Oxford and Northampton, but at registrar level,
an individual would be appointed to the hospital and would have usually a two year
appointment and would work with a particular firm with the counterproposals proposals,
training programmes set up with a total of seven years training to, etc. the registrar and rotating between all the hospitals in the region.
And I was involved in setting that up, together with Pauline Whurley, who became the district the regional tutor, I think that title.
Was there any difficulty persuading people to fit in with that?
No. Well, I think that it assured some of the general hospitals who'd had difficulty getting good quality staff that they
would have trainees of the calibre that we had for many years enjoyed the other the other big change that,
of course, has occurred.
Um, to some extent, integrating that process was the change in the EU regulations and the fact that when I was first appointed there,
we had many trainees from Australia, New Zealand and South Africa did.
And with the change in the regulations and Home Office regulations, um,
plus I think certainly where Australia and New Zealand concerned a substantial
increase in the quality of the service and training available in those countries,
such that some would say in some areas it exceeds what is achievable in Britain these days.
They cease to to come to the UK.
And I think that was a great loss,
not least because there were a lot of exchange programmes and so quite a few people had the opportunity to go abroad,
as indeed I did when I was at St Mary's, as I went to Durban for 18 months, which was an invaluable experience.
Did you ever do that from Oxford Exchange at all? I didn't know.
I didn't actually get things done. So with Kalmen programme, one of the problems that arose and continues to be a problem,
which I don't think anybody is adequately solved, although people are trying to address it.
Precambrian training programme. You would spend, as I said, two years with a particular team, very often just a single consultant,
which meant that individual got to know you very well, your abilities, et cetera, et cetera.
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.
You would spend a year in one particular unit and then go to another hospital elsewhere.
And all of this coincides with increasing litigation culture and increasing expectation that the consultant,
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,
with the net result that you now have trainees who have a shorter training period,
who are getting less practical experience because there are more of them,
and plus the fact that they're rotating much faster so that your knowledge
of their abilities and qualities is less than it would have been previously.
And I think that's one of the negative features that I was aware of during my time.
And, um. As with most things been,
benefits in the wastage from speciality is much less in that as I think is applied across
all specialities during the just over four decades that I was practising medicine,
you got into a registrar post. There were far more registrar posts and there were senior registrar posts.
If you got a senior registrar post, you knew that you were pretty certain to get a consultant post.
But many registrars failed and failed to get into a senior registrar post, either because of inability or because of a lack of support,
for whatever reason, with the net result that they had to choose another speciality.
Many went into general practise, some went abroad.
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,
because they and I think that there has a positive side in some specialities.
So taking your region, especially diabetes, I think if you if you were somebody who had considerable experience, that registrar grade of diabetes,
then you actually became quite attractive in a general practise because you had a skill that was really translatable.
And the same would be true nowadays, particularly for women.
And I don't mean to sound sexist who've done gynaecology that makes them attractive in general practise
where increasingly the gynaecological work is consultations that were performed by women GP's.
But obstetrics skills have had limited attraction.
I mean, Oxford did its part.
I think the whole reformation of services, which the Flying Squad was one part, did develop the general practise obstetric unit within Oxford.
And when I was appointed, it was very, very active and they were responsible for several hundred deliveries a year.
And these were committed GPS who would come in 24/7 to look after and either be present at or indeed delivered their patients.
My full name was the one that most people know was extremely influential in that regard, both locally and nationally.
Uh, again, changes in contracts, particularly GPS contracts,
and the fact that they even for their general practise duties, let alone obstetrics, do not do it out of hours.
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.
You know, it's the end of the noughties article. You were mentioning being chairman.
Did you start and I blue or was it after he'd retired?
Alec became ill relatively shortly after my appointment.
Right. Um, I think it was nine to or thereabouts.
Ninety three, certainly at the point that Gordon Stereotactic got his appointment in Bristol and I was then the senior academic,
as it were, under Alec. And so my first involvement with university matters was deputising for Alec on the university
committees that he was required to attend as also a fellow green college at that time.
And I was involved with Green College Committees I.
Only became involved as chairman of the.
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.
And what did you really do as chairman in the hospital? I don't mean committees.
Initially, it was a question of organising the service and its provision,
which meant having knowledge of staffing both within medicine and obstetrics and gynaecology, ecocide and the midwifery side.
I had at that time an interesting conflict with our lead midwife at that point who.
That's the lady who. Had come from Canada, but was originally British and was very keen to establish midwifery led care.
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.
I got a bit of a clown and basically.
One of the things that I was involved in the organisation of was creating so-called team midwifery in different parts of the city,
to some extent there was already midwifery that care or midwifery that care further afield in Chipping Norton,
in some women were delivering in these peripheral units. But the idea was to have teams of midwives who would.
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,
usually in the general practise surgery, and then would follow them in and deliver them.
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.
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.
What subsequently happened, of course, was the whole contract process where GPS contracted to the hospital and together with the unit manager,
I had to review contracts and signed them off and so on.
It was from my point of view or rather fictional, and I think in truth it was fictional.
Um, and I suppose if I were to comment following on from that, uh,
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.
Yes. Um, and that applies throughout the hospital.
It's not in no way unique to our department and indeed at all levels.
And um, and in some respects it was was good.
But in other respects, one felt, but there were more managers than required.
Why did the doctors let that happen? You know, looking back, I often wondered in a way.
Not all doctors were interested in becoming involved in management.
Absolutely I was, because it seemed to me that that was the only way we were going to influence what happened.
And I think I'm right in saying that we were able to influence what happened.
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.
Uh, sir, the service and standards will improve for the patient, which is primary goal now.
And I certainly was very lucky to have managers with whom I worked extremely closely like interments, obviously the first thing.
And Richard Jones.
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,
but also for the hotel aspects of the service.
And it always used to frustrate me that if you compare this with what you might call a benevolent industry or little retail,
that's what I'm thinking of.
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,
John Lewis, and the quality of the toilets and all the other things are generally superb.
And it's always sadden me that it was difficult to achieve that sort of standard of provision of service.
And likewise, but with the hotel aspect of it, food and all the rest of it.
So I was involved and I try to involve myself in all those things, how effectively I did.
So I don't know. I used to do rounds particular.
I remember doing rounds with Richard Jones, who then went to South Africa as a hospital manager on a weekly basis.
And we would choose an area and and go through.
I think the other thing that many people would comment on with regard to that aspect of care,
which is the the quality of the facility that has been changed,
by the way, the services provided in the days when I was first appointed,
you would have a particular ward, would have its own cleaning staff, et et cetera.
That all changed again with the contracts that were made and so on.
And I think that meant that there was a certain loss of pride and also less control by the professionals who were providing care,
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.
So when you first came to Oxford, how did the nursing care compare between Mary's and Oxford any different?
I don't think the standards were any different at all. I think that.
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.
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.
I've always admired the obstetrical review of maternal deaths.
Were you involved in that? Because somebody must be. Yeah. Is that hard work or difficult?
Because you remind me of all the things that I did and one forgets about when
I was a regional assessor for confidential enquiries into maternal deaths.
And I took that from Arthur Williams. In fact, um, it it was challenging.
It was very interesting. It was an entirely honorary appointment.
Want to send the records. One made an assessment.
They were reviewed by a pathologist or any other speciality that was relevant, um, neonatal paediatrics, radiology and so on.
And then the report went off to the Department of Health.
So you didn't get and see the people involved sometimes spend it, but in the room it was largely a paperwork.
And so I rather fell out with it towards the end because there was no.
Legislation that required the various hospitals to provide the full records to be required and one
would have these notifications comes through you then utilising your own secretarial resources,
contact the hospital to get the information that was required, the records basically a copy of the record.
And very often they would not provide anything. And there was no way of putting pressure on that because there was no legislative requirement.
And rather curiously, towards the end and I don't goodness Lewis was the doctor,
one of the senior medical officers of health, who was responsible for specifically for the confidential enquiries,
which then, of course, also changed and became part of another component of the National Institute for Clinical Excellence,
which I think, again, has changed its name. But the enquiries.
Somebody funded and they offered you a nominal fee for doing this,
which I guess they then started to use almost as a lever to get the reports back that they were getting,
but they couldn't get the message, which I tried to get through to fill out to some extent with them.
And then that wasn't money that was required and it was some change in legislation that ensured the necessary records were available.
So you could do your report and paying money, which was a relatively small sum.
I cannot remember how much. It's not really relevant. Did not make it any easier to get the information you required.
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,
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.
And I can remember writing back and saying this is not the issue.
I don't care about the money just to find a way to resolve this fundamental issue.
I stopped doing that probably in the late 80s.
I think Susan Sellers is now a consultant in Bristol, took it over and I'm not sure what she said.
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?
You know, there were meetings, but I wasn't I was never part of the central committee of the Central Committee that considered everything.
But when it came to preparing the final reports, they did have meetings to get feedback from people.
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.
And could you give, you know, a summary of that, as it were?
Yeah, from the aesthetic point of view, to some extent, we've covered it, right.
I mean, basic obstetrics doesn't change, some would say,
with great relief and enthusiasm that there is no way that you can laparoscopically deliver a baby.
So basic surgery and which involves doing, you know, a laparotomy and a caesarean section remains basic obstetrics surgery.
Has the analgesic handling of labour changed?
Not in the 30 years. Narad delivering a baby vaginally has not changed.
No. I mean, epidural, which is what you're referring to easier had become very popular by the time I was appointed.
It's people like Selwyn Crawford at Queen Charlotte's who encouraged the going way back to the sort of 60s onwards.
Um, certainly when I worked at Queen Charlotte's in 1970 was readily available.
Many, many women had it. So I know that that hasn't really changed.
I think, if anything, the change has been for the natural childbirth group to sort of lead women to.
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?
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,
and Mackenzie used to do it and he was doing photocopy at one point.
So he was putting groups that are very like arthroscope into the uterus and doing his intrauterine transfusions
directly by visualising the umbilical cord and popping a needle into that and providing transfusion ultrasounds,
change all of that high definition ultrasound things that you do it by indirect needling of the
cord and transfusing the blood and autoimmune thrombocytopenia has been recognised in this time.
And people transfusions have become part of the treatment for that condition.
That's another controversial area. And the ultrasound anomalies scan normally done around about 20 weeks to identify foetal tissue.
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.
And that has ceased to be relevant because high definition ultrasound will identify the abnormality for you.
Yeah, indeed. Going back to the diabetes side, but I can talk to one of the few groups of women,
all of whom had an anomaly ultrasound scan once it became feasible to do it on a reasonable number,
which would be sort of mid to late 80s, once mobile ultrasound equipment was becoming available with real time ultrasound with
diabetics because of their high incidence of historic high incidence of abnormalities.
I have to say that. Ultrasound, in a sense, is the focus of everything that's really changed in that ultrasound, foetal monitoring,
ultrasound and reading has done a tremendous amount of work in that the computerised analysis and into Haltom traces and so on the.
Use of ultrasound to look at blood flow through the umbilical cord,
through the uterine arteries and so on and so forth, so that's a big area of change.
And it's what's actually facilitated the evolution of foetal medicine alongside maternal medicine from the gynaecological point of view.
There are two components to the changes that have occurred. The first component was that.
Obviously, gynaecologist's who essentially a pretty sort of innovative group,
we mentioned Donald earlier and the development of ultrasound to ultrasound,
of course, is a central component right across medicine, but it started in obstetrics.
Laparoscopy has a long history, but modern laparoscope using fibre optics and cold light sources has a much more, um, gynaecological development.
It was taken up by gynaecologists in this country and they were the first to use it operatively
for sterilisation and itself potentially controversial because back in the in the 70s and 80s,
it was being done using diathermy and some battle damage occurred at that time, putting really patients handbell battle damage.
And then it became the clips and rings and so on.
And then from that, the whole era of laparoscopic surgery has evolved, which again spreads right across the surgery.
History escapee, when I trained and again, really through until the mid to late 80s,
the only time you had a view of the inside of a woman's uterus was at the time of Caesarian section.
But with the advent of oestrus could be its routine, both under anaesthesia and on an outpatient basis.
In fact, together with Mark Charlock, set up the outpatient facility at the John Ritter following the model at.
Hospital in Guilford, so ultrasound has affected obstetrics, ultrasounds, also affected gynaecology because.
It gives the indirect image of what's happening inside the uterus.
So in my early days, my training days, my days as a consultant, if you had somebody with abnormal bleeding,
the only way you could really investigate it was by doing a curtilage diagnosis, the DNC, to cure it.
Nowadays, you can. Use a vaginal transvaginal transducer.
You can image the uterus itself so you can look at the structure of the uterus and Miami trim,
you can the endometrium and you can look at abnormalities such as fibroids from the mamita protruding into the individual cavity.
And with respect to scope, you can reset the fibroid under direct vision on a day case basis.
Amazing. I've jokingly said to many, many women over the years that history could be more correctly,
the operation which we which is used very frequently now in place of hysterectomy, which is the transvaginal resection of the endometrium.
So TIKRAI and this is an operation which uses a risk scope identical to that used for transducer of a section of the prostate.
So I'm often said to many women to reassure them this is this is the only operation done in women,
which was piloted in men over many years before it was ever used in women.
And it was a Frenchman, in fact, who first did it.
And then in truth, it was an Turnbull again who brought it into Oxford by encouraging one of his lecturers that,
my gosh, now they're all free to do some studies on it.
And Oxford was the first hospital in the country where individual resection I can just a lot of buzz about it.
Yeah, no, what happened was that Adam invited Alec invited over the Frenchman.
His name escapes me at the moment, and he actually came over and demonstrated it.
And it was done with a video link from the Churchill Hospital because at that time, gynaecology was at the church.
And so that's one of the other big, um, I mentioned earlier where the gynaecology ward and operating theatres are now.
Um, they were brought over from the church. We basically vacated the church.
So so that's that's the the one side of change in gynaecology.
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.
Right. And when I was appointed, I would do the full obstetric role and a full gynaecological role,
by which I mean I saw patients who had benign problems, both uterine and bladder.
And I also dealt with oncology as a result of Kalmen.
The oncology basically became a specialist interest.
There had always been people who had some specialist interest in Moctar, had a particular interest in in that we also did infertility.
Sorry, I've never met a. Steptoe and Edwards with IVF was created ultimately the whole reproductive medicine.
Speciality, some speciality. Women like Linda Cardosa, Kings and.
A number of men says he tried to remember the names of them, but then were sticks in my mind,
who are interested in your gynaecology have created a gynaecology subspecialty.
And oncology has also become very much a subspecialty with people now doing nothing other than oncology at the joint venture.
But is that down to the church of mine? When I was about to say, yeah,
what's actually happened is that having brought all the gynaecology into the womb in the centre site
is it is it was renamed the oncology has now moved into the oncology centre of the church and indeed,
the clinical oncologists are now part of the division of surgery and are not part of our division.
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.
Yes, absolutely. The reproductive medicine side has also expanded enormously.
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.
But they now have the Oxford Fertility Centre down in Cowley and the present head of department is closely involved with that and is,
in fact a reproductive medicine specialist. So the some senses.
The speciality has grown in much the same way as I suppose, one I've seen other specialities grow and diverge.
I always think of the orthopaedic surgeons who have had surgeons and trauma
surgeons in hip surgery or knee surgeons and in obstetrics and gynaecology.
You know, people who are general obstetricians, feet, internal medicine specialists in gynaecology,
you have your reproductive medicine, your euro, gynaecology or oncology, and again, your generalists.
And then I even mentioned family planning, which is another aspect which is sort of moved,
including the termination service termination of pregnancy service, which was sort of moved with that.
Am I in preparing for our discussion today?
And I thought I'll try and look out the obituaries of the various previous Nuffield professors.
And I found quite a bit out about Qasm, more so Joan stalwartly,
probably because he became president of the British Medical Association and was present to the RSM and so on and so forth,
and knighted had an obituary which was in The Independent. I cannot find anywhere an obituary for Alec Turnbull.
No, I can find out more about David Barlow, who was his successor between, well, up until 2000 five.
But I cannot find an obituary anywhere.
And I've actually contacted our college to see if they can get there must have been one presented to the
college council because any past member of council has an obituary read at the subsequent council meeting.
What reminded me of that was when I mentioned contraceptive services,
which I was actually involved with way back when Alex Gatherer was not sure what his title was now with Health Public Health,
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.
Anyway, Alec's name is now immortalised with the Alec Turnbull Family Planning Clinic in Cowley.
And if you do a Google search for Alec Turnbull, you will find the opening times of the Alec Turnbull clinic.
I find this simultaneously amusing and sad.
Yeah, because Alec had no interest specifically in family planning.
He never did any research on contraception. He never had any real involvement with it.
He was interested in all aspects of it, especially because he was a generalist, as we all were at that time.
And so I suspect he wouldn't be too concerned.
At my retirement dinner, I try to persuade the present head of department, Stephen Kennedy, to name the laboratories as the Turnbull Department,
because the lecture theatre within level four is actually called the Anna Anderson Lecture Theatre.
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.
But that hasn't happened yet. The other thing that hasn't happened is the Nuffield chair is vacant because
there is no Nuffield professor of obstetrics and gynaecology at the university.
And its wisdom, as I understand it, made several attempts.
And they specifically want to bring in basic science person, not a clinician,
which all the previous, yes, Nuffield professors of obstetrics and gynaecology had been.
And there is a precedent for it in other departments. And I think they've got very close.
I've never been on the search committees. I've never been involved in discussions other than in a casual basis.
And nobody's ever really given me the full details of what happened within the university.
And various times we were told that somebody was going to come and then discover
that the conditions that they had set were unacceptable and they pulled out.
Stephen Kennedy took over the head of department as the sort of senior academic at the
time of David Bowie's department and then subsequently has been given a personal chair.
So he is a professor of obstetrics and gynaecology, one of, I think, four or five within the department that maybe.
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,
but he he cannot claim to be that in that position.
I mean, it's the university thinks you can't be a clinician and a scientist or a clinician who can lead scientific endeavour.
And whether that's right or wrong, I don't know. It's a difficult one, the clinical advances.
Of our age group dependent on technology, you can't do anything without a technological base and.
Much of the therapeutic advance obviously stems from the pharmaceutical industry, so that's not relevant.
Much of our understanding has come from basic research in molecular biology,
and so I think there is still a place for both how difficult it is to do the two together.
I don't know, because in my latter years, I,
I used to say that the work that I did could be crudely classed as bucket chemistry because I wasn't involved.
Indeed, the question you haven't asked me was why I switched from academic to NHS.
And I did it because I found that I enjoyed my clinical work more than my academic work, but I enjoyed both.
But I had a decision, as it were, between the two. And secondly, I didn't envisage myself as running a large department.
I had at one point looked around the country and assessed the likelihood of
getting a post in any particular city based on the gravity of the incumbents,
or at least the time that that contract had to run. So I was of a serious to a degree of remaining in academe.
But in the end the work went over.
And although I continued to publish essentially on technical matters right up until my retirement and indeed I have one last paper to publish,
which is based brings me back to diabetes.
I looked after approximately 1300 diabetic pregnancies in my 30 years and I had a prospective computer based study.
But a record of all these women I presented the first 24 years that I was a meeting sorry about.
When I was nine, you presented tonight with the series of dramatic pregnancy.
Oh, yes, not in the first 24 years, three eight year time frames.
And my paper, which I haven't started writing and I should have done before,
become distracted, will be three, 10 year blocks to compare outcomes in that time.
And they've got better. It depends how you define better. We had, um, only, I think seven deaths and 1300 babies.
Yeah, we had about three or four congenital abnormalities, but the babies got bigger and the caesarean section rate has gone up.
The outcome. Overall, it is better if you compare it with what occurred before her monitoring.
The whole process of management is far superior, yes, but in truth.
You were talking about the diabetic outcomes, which may be finished on that, but you just getting through that.
Yes, no, I'm as I'm saying, roughly 1300 diabetic pregnancies with essentially good outcomes is very good.
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.
Yeah, yeah. Um, now I got to ask everybody this.
Is this something I haven't asked you that I should have?
No, I think we've covered everything that I would wish to say, and we've obviously covered a wide range of topics,
all of which ultimately relate to the work of a consultant in a teaching hospital.
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?
Uh, comparing the past with the present.
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,
that the amount of practical experience that students get compared with when he trained is substantially less.
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.
Um, I think they're now more like 135 in a year.
And at King's, the hospital work may well have increased.
But not in any way comparable to the increase in the number of students, and I think that.
Overall, what has happened, and we are talking about it earlier with regard to postgraduate training,
is that there are a larger number of people being trained,
which we need because we have been too dependent on doctors from abroad throughout my career.
I think what we've seen is an increase in the numbers of medical students.
Consequently, numbers of doctors, all of which is beneficial in the long run.
But in the short run,
it's meant rather less experience and with shorter training people achieving consultant roles who I think are far less experienced than we were.
I was appointed as a consultant at the age of 34, which at that time was very young.
Many of the people in my era being appointed in their late 30s.
One previous president of the Royal College of Obstetricians and Gynaecologists I know wasn't appointed as a consultant until the age of 40.
And that's not what I'm talking now about the 70s and 80s.
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.
It's ours are the working poor.
We really have reduced to having the. Oh, without a doubt.
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.
And the ship in question. One of the ships in question is the carnival dream.
Three and a half thousand passengers, one and a half thousand crew, 5000 people with the 24/7 responsibility.
And the experience is phenomenal. Yeah, yeah.
When I went to South Africa, I worked in a hospital which had 24000 deliveries a year.
Uh, we had a neighbourhood of 24 beds, each of which was used on average twice a day.
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.
And it's only if you do unusual things like that, as some of our trainees did,
you know, going to Africa and other places, would you get that sort of experience?
Ultimately, I'm sure people become very expert in what they're doing and some specialisation facilitates that.
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,
including neuro gynaecology, not that it was called at them, or oncology cancer services that people have to be now.
And they do eventually become much more competent, much more knowledgeable in each of their areas than I ever was,
partly because the knowledge wasn't there near the facilities and the technology wasn't there.
And great, if that's OK by you. That's a lovely interview.
Thank you very much to finish. Yeah, thanks.
But I don't think I've said anything to outrageous.