Focus on…Cardiff and the NHS
The NHS is marking 60 years since its first foundation. The health service is very different today in the major health problems it faces. However, throughout those 60 years, there has been a strong record of working with Cardiff academics to tackle those challenges together.
The first steps
When Aneurin Bevan first established the NHS in 1948, he promised he would not be interfering in the daily work of doctors.
Certainly, for a young medical student arriving at the then Welsh National School of Medicine in 1951, debate about the three-year-old health service was not a major priority.
Professor Eldryd Parry, a pioneer in tropical medicine and an honorary fellow of Cardiff University, recalls: “As medical students we didn’t really stop and think too much about it. People went on doing the work they had always been doing. I wasn’t conscious of anything like today’s lobbying of Government.”
Instead, the challenges were more immediate. While diphtheria had been almost obliterated, and polio was now quite rare, young doctors still had to deal with typhoid and scarlet fever and face the horrific task of treating tetanus victims.
Pneumonoconiosis was extremely common among South Wales coal workers while the children’s hospital on Cathedral Road was invariably full with children suffering from rheumatic fever – a classic result of poor living conditions.
1948 NHS established
1953 William Mushin is the UK’s first Professor of Anaesthesia
1954 Arthur Watkins is the first Professor of Child Health
1960 Archie Cochrane appointed David Davies Professor of Tuberculosis and Chest Diseases
1966 Dental School and Hospital opened
1967 Tenovus Centre for Cancer Research opened
1968 Professor Cochrane publishes Effectiveness and Efficiency: Random Reflections on the Health Service
1971 Opening of combined Welsh National School of Medicine and University Hospital Wales building
1984 Welsh National School of Medicine renamed University of Wales College of Medicine
1991 Institute of Medical Genetics isolates and characterises the muscular dystrophy gene
1998 Queens Anniversary Prize for chemiluminescent technology
2004 Merger with Cardiff University
2007 Sir Martin Evans, School of Biosciences, shares Nobel Prize for Medicine for stem cell breakthroughs
2008 Queens Anniversary Prize for Institute of Medical Genetics.
A new approach
In just a few years, a revolution began which was to sweep away many of these conditions.
Professor Parry says: “The therapeutics started changing very quickly. By the late 1950s we had drugs which could control high blood pressure. We had the first drugs for TB – before the war the treatment was going to a sanatorium for fresh air or to Switzerland if you could afford it. Energies which had been directed towards the war were re-directed towards the major health problems.”
The School of Medicine was an active player in this revolution, installing a new, scientific approach in its doctors.
Professor Parry remembers hearing the inaugural lecture of Professor Harold Scarborough, Professor of Medicine – “He was pleading for less dogma and more evidence for what people did in medicine. The wonderful thing about being based in Cardiff in the 1950s is that he built a team of very able senior lecturers and researchers who had a profound influence on a lot of students.”
Professor Steve Tomlinson, Provost of Cardiff University and former Vice-Chancellor of the University of Wales College of Medicine, agrees: “The Welsh National School of Medicine always punched above its weight and attracted the brightest and best people to teach and learn to be doctors.”
This pioneering approach was shown in the appointment of Professor William Mushin to the UK’s first chair in anaesthesia in 1953. His work Automatic ventilation of the lungs is still widely accepted as a classic on the subject. A year later, Arthur “Pop” Watkins, became the first Professor of Child Health.
A lasting influence
According to Professor Parry, Scarborough and his colleagues encouraged a spirit of inquiry and independent thought in their students, which had long-lasting benefits in the NHS, in medical research and healthcare around the world.
Professor Parry’s own career is a clear example. He has worked in Nigeria, where he was foundation Dean of a new community-oriented medical school, in Ethiopia and Ghana. In 1988, he founded the Tropical Health and Education Trust, committed to improving access to and the quality of health services in developing countries.
For Professor Parry, his experiences first as a medical student and then as a houseman at Cardiff Royal Infirmary, were key. “If you look at the conditions in the South Wales Valleys just after the Second World War, many people were very poor. A lot of the health problems were related to poor housing, overcrowding and disadvantage in general.
“It meant that we saw a lot of disease now unknown in the UK. What I’ve seen in Africa is very similar to what you would have seen in a regional urban centre like Cardiff in the 1950s. It was the best-suited training for work overseas that I could have asked for.”
A key appointment
In 1960, the School of Medicine made one of the most significant appointments in the history of both the NHS and medical higher education. Archibald “Archie” Cochrane was appointed David Davies Professor of Tuberculosis and Chest Diseases.
Professor Cochrane had already been working on the health of the mining population of the Rhondda Fach valleys since 1948, pioneering the use of randomised controlled trials. Now he was able to negotiate a place in the university curriculum for epidemiology and health statistics, saying: “I wanted all the students to appreciate the value of good data collection and analysis.”
In 1968, he published Effectiveness and Efficiency: Random Reflections on the Health Service, introducing the concept of evidence-based medicine – the application of scientific method to medical practice which has now influenced practitioners the world over.
His legacy persists at Cardiff, not least with the recent creation of the Cochrane Chair for Public Health, which is designed to have an impact on national and international public healthcare policy.
By the 1960s, while many of the diseases of the post-war period were coming under control, other problems persisted.
Some 40% of the population of Wales aged above 16 had none of their own teeth. The country was suffering a desperate shortage of trained dentists to tackle high levels of dental and oral disease.
To fill the need, the Cardiff Dental School and Hospital was opened by the Duke of Edinburgh. The School now trains dentists, dental nurses, hygienists, therapists and technicians and has brought about a significant increase in the numbers of dentists practising in Wales. The number of adults with none of their own teeth has fallen to 17% in Wales and the School and Hospital are working to bring it down further.
A new home
In 1971, royalty was back at Cardiff. This time the Queen was opening the new 800-bed combined University Hospital of Wales and Welsh National School of Medicine at the Heath Park campus.
Gwilym Prys Davies, Chairman of the Welsh Hospitals Board, said at the opening: “It is not only a fine modern building with the best possible equipment and facilities: it is the first of a new integrated teaching hospital/medical school designed for patient care, medical education and research.”
Professor Steve Tomlinson sees this combined site as a key development in the history of links between the NHS and the School. He said: “This was the first purpose-built academic medical centre in the UK, putting academics and NHS staff together under the same roof. This was really a very important idea at the time.”
The new hospital brought with it a further expansion in the School of Medicine’s remit. Following a generous benefaction from the Jane Hodge Foundation, Christine Chapman was appointed as the School’s first director of nursing studies. A course of studies leading to Bachelor of Nursing of the University of Wales was introduced.
197 occupational therapists currently in training
300 nurses and midwives
More than 1,000 medical students
More than 290 dental students
1100 postgraduates at the School of Medicine
153 nursing teaching and research staff, including 6 professors
Almost 500 School of Medicine academic staff and 300 support staff
2,500 Welsh doctors and dentists receiving training from School of Postgraduate Medical and Dental Education
A question of image
Medicine and nursing are not the only healthcare professions where training has been transformed over the lifetime of the NHS.
In 1973, training for radiographers, physiotherapists and occupational therapists, formerly based at Cardiff Royal Infirmary, was also transferred to the University Hospital of Wales campus.
John Newton, Vice-Dean and Director of Radiography at today’s School of Healthcare Studies, recalls that radiography training, run by the NHS, was very much on a prescribed national basis.
Since the 1980s, the transformation of technology in radiography and medical imaging has been accompanied by a move to recognition as an academic discipline. In 1995, Healthcare Studies joined the what had by then become the University of Wales College of Medicine and is now a School within Cardiff University. John Newton was, in 1985, the first radiography lecturer in the UK to have a degree in education. Now lecturers are expected to have education qualifications as standard.
This academic recognition has brought with it a transformation of the prospects for radiographers within the NHS. According to John Newton, standard pay in 1973 was around £600 a year, and it was almost unheard-of for men to enter the profession. He said: “Today people in clinical services are doing much better. It’s a recognition of their value and career structures in the health service.”
Professor Nick Craddock with Stephen Fry
Shaping a modern health service
The 1980s and 1990s saw many innovations which are now fundamental to today’s NHS and healthcare education.
1985 saw the launch of Heartbeat Wales by the Institute of Health Promotion, to combat the growing incidence of coronary heart disease. Concern about this killer was increasing on the academic front too, ultimately resulting in the establishment of the Sir Geriant Evans Heart Research Institute in 1999 after a major all-Wales funding campaign.
Links between researchers and the Cancer charity Tenovus had been close ever since its formation by Cardiff businessmen in 1943. The Tenovus Centre for Cancer Research was founded in 1967. In 1985, scientists began extensive studies on the effect of a new drug zoladex, now widely used as a treatment for breast and prostate cancer.
Psychological medicine became a greater priority, and a sub-department was established at North Wales, Hospital, Denbigh, in 1990. Today, the School of Medicine’s Department of Psychological Medicine is an acknowledged world-leader, carrying out research into the genetic causes of such conditions as depression, Alzheimer’s Disease and psychosis. Professor Nick Craddock’s study of bipolar disorder featured on an acclaimed documentary about the condition presented by Stephen Fry.
Professor Tony Campbell
In 1998, the College of Medicine received the Queen’s Anniversary Prize for chemiluminescent technology developed in the College by Professor Tony Campbell and colleagues in the 1970s. According to Professor Steve Tomlinson, this has had profound implications for health service patients in making diagnosis easier, quicker and safer.
There were physical developments too. A £13.5million award from the Government and the Wellcome Trust in 2000 enabled the creation of the Henry Wellcome Building for Biomedical Research, bringing together researchers in a number of disciplines under one roof.
Professor Steve Tomlinson was appointed Vice-Chancellor of the University of Wales College of Medicine in 2001. He recalls: “I recognised that what we had at the UWCM was world-class and I also recognised it was possible for us to do better.”
Key to that vision was merger with Cardiff University, completed in 2004. While the two institutions had always worked closely together, formal merger has brought about greater opportunities for interdisciplinary working between the Heath Park academics and bioscientists, opthalmologists, psychologists, social scientists and others. Some of these collaborations, such as those with social scientists, may not have been so immediately obvious before merger. A tangible benefit has also been the creation of the Cardiff University Brain Research Imaging Centre (CUBRIC), where scientists from a variety of disciplines try to better understand the structure and working of the brain.
New ways of teaching
The IT revolution has opened up new ways of training Wales’ healthcare professionals.
The School of Postgraduate Medical and Dental Education offers on-going education to the qualified doctors and dentists of Wales. It has been described by the Chief Medical Officer for Wales as “setting the pace for the UK.” The School has just launched a pioneering e-learning system, allowing Welsh doctors and dentists access to on-going development courses in a way they can fit around their clinical responsibilities.
The School of Medicine’s Postgraduate Taught Studies section is one of the UK’s leading providers to all healthcare professionals. It too is a leader in e-learning and responds to the desire to improve the quality of care to patients in Wales.
One example has been the creation of the MSc in Paediatrics and Child Health Studies, set up in 1995 to improve the health and health care of children in Wales and beyond. The course was a response to criticism of the UK from the Committee of the United Nations Convention on the Rights of Child of inequalities in child health. The multi-disciplinary course produces graduates who can evaluate new interventions in child health, promote children’s rights, and develop responsive, effective and appropriate care for children.
At the School of Healthcare Studies, professional training in such as areas as medical imaging has been transformed. Not only has there been the development of CT scanners, MRI and ultrasound, but students are taught how to manipulate and interpret the digital images they obtain. John Newton, Vice-Dean and a teacher for 35 years said: “A lot of workers in diagnostic imaging don’t see film any more – it’s all digital. In terms of teaching, the curriculum is now totally different in terms of content, resources and facilities.”
At the Dental School, the next generation of dentists learn their skills on the Dental Clinical Simulator suite, the first of its kind the UK. Students perform procedures on a virtual patient, giving instant feedback on their performance. The School also takes its training out to where the disease occurs. The St David’s Primary Care Dental Unit brings together University teaching with the local service provided by the Community Dental Service.
The School of Nursing and Midwifery Studies, now one of the top ten nursing research departments in the UK, has close working relationships with local service providers including Cardiff and Vale, Gwent and Velindre NHS Trusts. This helps develop education programmes meeting clinical and professional needs and promoting the development of practice through research and education.
The genetic revolution
Perhaps the most profound medical revolution of the past 60 years has been our understanding of our own DNA.
Again, Cardiff has been in the forefront. The Institute of Medical Genetics, opened by the Prince of Wales in 1987, identified the gene for muscular dystrophy in 1991 – one of the first diseases to be genetically tagged anywhere in the world. Other diseases have also been identified and the Institute is now starting to trial some of the first genetic treatments for them.
The Institute has just been recognised with a Queen’s Anniversary Prize for excellence in this field – including its work in health education. The Institute runs an M.Sc in Genetic Counselling – training healthcare workers in helping patients deal with the many difficult issues created by our new genetic knowledge. Many graduates are working in posts in the NHS in Wales and the course is run on a module basis, allowing students to upgrade their skills in specific areas.
The three anniversaries
Three anniversaries coincide in 2008 – the NHS (60 years), Cardiff University (125 years) and Llandough Hospital (75 years) – the hospital where Archie Cochrane first pioneered randomised controlled trials.
To reflect the hospital’s strong academic and research record, and its support of medical students during their training, it has now changed its name to University Hospital Llandough.
Hugh Ross, Chief Executive of Cardiff and Vale NHS Trust, which runs Llandough and University Hospital Wales, said: “Cardiff and Vale NHS Trust and Cardiff University have both benefited greatly from a close relationship over the years. Together we have achieved a great deal in terms of research and training clinical professionals. In this anniversary year for both the Trust and the University, we have renamed Llandough Hospital to University Hospital Llandough to reflect the important work of both organisations in protecting and promoting the health of the nation.”
Together, the NHS and healthcare academics have defeated many of the deprivation-linked diseases they faced 60 years ago. But now there are new enemies. As Professor Steve Tomlinson puts it: “Nature isn’t going to give up. The main killers today are coronary artery disease, high blood pressure, the various forms of cancer, and degenerative disease.”
Tomorrow’s doctors are going to face radically different challenges and medical training will have to change accordingly. Professor Tomlinson expects doctors will need to take a more proactive approach, cutting out the causes of disease, whether genetic or lifestyle-based. He points out that climate change will also create new health threats, whether through allowing the spread of existing and new diseases, and the impact of disasters such as drought and flooding. Professor Tomlinson also feels it is vital that the NHS and the universities maintain a balance between clinical research and the more theoretical blue-skies thinking which often leads to medicine’s most radical breakthroughs.
Professor Tomlinson said: “The role of the doctor will undoubtedly change. There will be a move away from the hospital-dominated NHS to more focus on primary care. A multi-discplinary team approach will become essential, linking health and social care, particularly as the population becomes older. That kind of balance in the healthcare professions is becoming increasingly important and is already being recognised and taken on board in the healthcare schools at Cardiff.”