Louise King asked if I might contribute a few words on the above subject (presumably because I am the oldest member of the department) and I am delighted to do so. My experience spreads over 33 years, firstly as a surgical registrar at the Hammersmith and Southampton General Hospitals, secondly as the Nuffield Professor of Surgery and Honorary consultant in Surgery in Oxford and thirdly as the President of the Royal College of Surgeons of England.
My first experience of the National Health Service was in 1961 when I came from Australia halfway through my surgical training. In those days Australia had no complete formal training programme and everyone went overseas, usually to the UK, to complete their experience. It was mandatory really for Australian trainees to go to the UK for what was called “cutting experience”.
My wife, Jocelyn, and I arrived in 1961 in October just as winter was starting and we thought we might die from the cold. My first post was as a Dominion Fellow at Guy’s Hospital with Professor Sir Hedley Atkins. He had been a Visiting Professor at my Teaching Hospital in Melbourne (St Vincent’s Hospital) and I had made a couple of presentations to him and obviously must have impressed him a little as he then said that if I came to London he would give me a three month’s Fellowship at Guy’s. In those days at Guy's Hospital all the resident surgical staff wore suits on ward rounds rather than white coats, but apart from that they were the same as ward rounds in Melbourne. However, I soon had a disaster as I was so cold I was standing right next to a heater and it burnt a hole in the trousers of my one and only suit. The residents were all highly amused and said I wouldn’t be able to come on a ward round unless I had another suit. However, I did decide to come the next day in a traditional Australian attire of the time, namely reefer jacket and the grey flannel trousers (Fletcher-Jones). Hedley Atkins, I am glad to say, did not bat an eyelid despite my completely inappropriate dress. Hedley Atkins was very kind to me and used to ask me to assist at some of his private operations at Guy’s and would then pay me cash at the end, which helped to keep the wolf from the door. Following my short stint at Guy's Hospital, I then started my Resident Surgical Officer Post at the Royal Postgraduate Medical School at the Hammersmith Hospital with Professor Iain Aird. This was an eye opener in terms of academic medicine and surgery and, as I was to learn later, was modelled on the approach to clinical academic medicine in the USA.
I then did a locum registrar job at St. Mary’s Hospital in vascular surgery with Professor Irvine and then at St. George’s Hospital with Mr. Elliot Blake in plastic and paediatric surgery. Finally, I got a definitive appointment as a surgical registrar to Mr. Tom Rowntree at Southampton where I spent an amazing year and regarded it as one of the major planks of my clinical training programme. Tom Rowntree was a great teacher and a stern, but excellent boss. The NHS seemed to function very well in my opinion, but as I had not experienced health care in the UK before it was difficult to know how much of an improvement it was compared to what had existed before 1948 (when the NHS was established), but I suspect a lot. Tom Rowntree had 60 beds, 30 male and 30 female, and I was the only registrar with two house surgeons. Thus, we were certainly busy. I remember indeed that in those days the treatment for peptic ulceration, both elective and emergent, was a subtotal gastrectomy and in the year at Southampton I did something like 101/102 gastrectomies I believe. All in all, I regarded my two years working in the NHS in the early 1960’s as very beneficial and certainly with the year at Southampton to top things off I certainly had got a full clinical experience.
I then went to the USA to the Mass General Hospital where I had one year as a Senior Resident and then two years as a Research Fellow at Harvard with Professor Jack Burke followed by six months as a Fellow and Assistant Professor at the Medical College of Virginia where I was charged with setting up a Tissue Typing Laboratory in David Hume’s Transplant Unit which was, then, probably the major Transplant Unit in the world. I returned to Melbourne to the University of Melbourne Department of Surgery and the Renal Transplant Unit established by Priscilla Kincaid-Smith, an internationally renowned nephrologist, and Vernon Marshall, later to become Professor of Surgery at Monash University, where I set up another Tissue Typing laboratory. I also worked in general surgery as well as transplantation apart from my clinical responsibilities.
In 1974, I got a phone call from Richard Doll (the Regius Professor of Medicine at Oxford) to ask whether I would be interested in the Nuffield Chair of Surgery at Oxford. To cut a long story short, I ended up coming to Oxford in August 1974 to take up the Chair. In the early years I served on the Area Health Board and then on the Regional Health Board under the direction of the marvellous Dr Rosemary Rue, later to become Dame Rosemary Rue. This exposed me to all aspects of the National Health Service, long waiting lists, not enough beds, etc. but we did battle on and virtually abolished waiting lists in the NDS. I also had the pleasure of establishing the first Renal Transplant Unit in Oxford and the first proper Vascular Unit in association with Mr David Tibbs, consultant surgeon.
I always felt that the NHS was a magnificent contribution to the health care of the nation. Back in those days as Nuffield Professor I did a lot of travelling as a Visiting Professor both in the USA and Europe; and every time I returned my feeling was ‘thank goodness for a national health service’. The advances that I have seen in surgery during my working lifetime and in the NHS have been enormous and will continue in the coming years without question.
As President of the Royal College of Surgeons of England I saw the NHS at a higher level, so to speak. I had regular meetings with the Chief Medical Officer, Liam Donaldson, the Secretary of State for Health, Alan Milburn, and the Prime Minister, Tony Blair and his Senior Health Adviser, Simon Stevens, now Director of NHS England. This introduced me to a whole new perspective about the NHS and made me more aware of the problems they faced. However without question they were all passionate about the need for a better NHS.
The National Health Service comes in for a lot of criticism, but also a lot of praise which you hear less about. Personally, I think that the NHS, for all its faults is marvellous and there is nothing quite like it anywhere in the world, especially from a patient’s point of view. Long may it last!