| Description | Prof CRAIG RAMSAY interview at the Sir Duncan Rice Library, University of Aberdeen on Wednesday April 5, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) CRAIG ROBERT RAMSAY, born on 10th December 1971 in Dunfermline, Fife. He is currently the Director of the Health Services Research Unit (HSRU) in Aberdeen, appointed to the post in 2016. He is also the Professor of Health Care Assessment. Parents also from Dunfermline; Robert Ramsay, a mechanical engineer, and Jane Ramsay. Father worked at the Rosyth dockyard, including on the then new Polaris submarines. No medics in Craig’s family background, basically came from a family of coal miners, also working on the railways; father first person in family to go to university, though did not complete that when Craig came along. Went to Canmore Primary School and then Dunfermline High School, leaving in 1989. Interests at school included sport, and mathematics. (0:04:23) Talks about his school careers advisory service, suggested a job as an actuary; an actuary primarily interested in statistics, got Craig thinking about what he would do as an undergraduate. Ended up going to Edinburgh University, tells story about asking at Open Day to speak to someone from the Statistics Dept. Very different to doing a medical degree because can do other subjects; did Meteorology and Astronomy; but got more and more interested in biological projects, generating data on people and then looking at the consequences. Went on to do a joint degree in Mathematics and Statistics, graduating as a BSc (Bachelor of Science) in 1993. Then went to Napier University in Edinburgh, time of challenging job market, also he was aware that computers were going to become an important aspect of the future. (0:10:08)) Course he studied at Napier was called Information Systems, explains what it involved, and what he found most useful in his career. One year to get a Masters degree, Craig got to nine months and got the Diploma; but then got chance to work for the Information Statistics Division, explains. Describes what the job was like, no such thing as personal computers in those days; generating national Scottish health statistics, hundreds of us doing different things, explains in detail how it all worked, main frame computer. Craig was actually in charge of the Scottish Drug Misuse database, explains; used to interacting with clinicians and clinical staff; but a step removed from patients, Craig found this unsatisfactory. (0:15:16) Craig describes in detail what the Health Services Research Unit (HSRU) in Aberdeen is, and how it operates; opened 1988. Mentions that ten years previously the Health Economics Research Unit (HERU) had been commissioned; perceived need to make good use of resources for the health service. But became apparent in a few years that it was not known if they were actually making a difference; what do patients really want? That’s where HSRU came in, explains. Addresses the funding of the HSRU, how this enabled them to do work with other universities and have a remit that covered the whole of Scotland, and then even wider. (0:21:05) Talks about what it was like for him to join the HSRU in 1995, and what its staffing and reputation was then. Explains his move there was for what turned out to be his wife, who had a job in Aberdeen. Quickly realised he was in a special environment in the unit, vibrant and exciting, explains. Advantage of Aberdeen Medical School being a big campus, but had a lot of national and international collaborators; people were thinking big, explains in detail. Mentions the Cochrane Collaboration, explains, that was just starting; people leading the unit, Prof Ian Russell, Prof Adrian Grant, Prof Jeremy Grimshaw. The unit had about 40 people at that stage, explains location. Explains the advantage of Chief Scientist’s Office funding for the uni; a national centre, continually being assessed, building a reputation in the first five years. (0:26:45) Describes what he was doing in those days, employed on two projects, explains in detail. The first PCs (personal computers) had arrived in the unit as Craig arrived. Refers to Logistic Regression, now takes the blink of an eye, but back then it would run for twelve hours; so spent a lot of his time waiting on analysis. For Craig the most interesting part of the job is interacting with medical staff; ran a consultancy service between their unit and the Medical School, explains. Importance of understanding the clinical problem. (0:31:35) Explains how he was regarded by medical staff; have to be good at negotiating and understanding. Challenge still is taking a research finding that you know works and getting that integrated into the health service, explains in detail. Explains how in his early days at the HSRU he was also working towards a PhD in Public Health, and what that was like for him. Prof Adrian Grant got him interested in surgeon learning; thought the quickest way to do it was a PhD while he was working; naive. Part time PhD over five years, but explains how a fortuitous event then allowed him to do his PhD as part of a work project. (0:37:23) Explains about his PhD academic responsibilities, supervisors in both the Medical School and what was then the Dept of Statistics; had teaching duties for statistical students at Old Aberdeen, explains. Talks about the importance of the HSRU, national, international impacts. Talks again about Cochrane Collaboration, involving about twenty individuals internationally under auspices of Iain Chalmers (Sir Iain Chalmers) in Oxford; HSRU’s old (previous) director was one of the twenty. This organisation now has produced thousands of studies, explains; HSRU been involved with that, has won awards, including the Queen’s Anniversary Prize in 2017. HSRU’s work right now is being used for medical treatment of 25 million of the population of the UK, explains. (0:41:40) Talks in detail about work of the HSRU over the last thirty-odd years; specialising in evaluating if a new development in medicine works or not, explains about clinical trials. First automated system for a clinical trial, explains. (0:46:12) Talks about how these studies are designed; passionate about role of the patient in decision-making around research; explains about Core Outcomes. Patient Advisory Group is now part of the governance of the unit, explains. Talks about the importance the HSRU attaches to public engagement; particular passion of Craig’s since he became Director, explains, about getting their findings discussed in the public domain. Number of approaches. Craig personally does a show at the Edinburgh Festival Fringe, explains. Blogs (websites with regularly updated information and comments, usually informal in style). Move towards patient at the centre, Realistic Medicine, explains. (0:52:53) Explains more about the shows he does at the Edinburgh Fringe; has done lots of dental research, dental health of interest to lots of people, always something new to bring to a show; Politics of the Tooth Fairy, for example. Talks about the very first clinical trial by 17th Century ship’s surgeon James Lind into Scurvy, subject of a show they do for schoolkids; selling ideas and getting people thinking, and they start asking you things. Talks more about the Scurvy trial, problem of Proven Changes, took the Royal Navy a century to put Lind’s findings into practice. (0:56:57) Talks about the responsibilities and challenges he faced on becoming a Senior Statistician at the HSRU in 2004; organisation and co-ordination, how to take advantage of the newer computer systems coming in; taking a more strategic look across the programmes; how do we develop people? Explains in detail, unit was ahead of the university in this respect. Medical careers were getting difficult, how could they carve out time for doing research? Unit up to about 55-60 people by those days. Talks about becoming Programme Director at the unit in 2007; a big change, explains; no longer a statistician. (1:02:59) Talks about going to Canada a year later; going to need some headspace for ideas as Programme Director. Went to Ottawa Health Research Institute for a year; previous colleague worked there, Prof Jeremy Grimshaw, who had been Programme Director at the HSRU. With the Surgical Unit they had in Ottawa, Craig asked to set up a research group for a whole lot of surgeons who wanted to do things; explains how this worked, including very early morning meetings. Came back after a year to the HSRU to what he regards as being Programme Director properly, explains. (1:08:14) Talks about being given a personal chair and becoming a Professor in 2011; very pleasing. Talks about the changes he has seen in the HSRU since he first started working in it. Very much a family feel originally under the first Director, explains. But much bigger now, sitting at 80-odd people; doing a lot more than we were then, requires lots of systems to be added. New accommodation built for them in 2006, at the Health Sciences building at the Medical School at Foresterhill, explains how this affected them. Governance has changed over the last 25 years, explains. (1:13:25) Talks about how it is decided what the HSRU will study. The staff of the unit formally decide it, explains, including input of the Chief Scientist’s office. Refers to decision in late 1990s-early 2000s to remove Mental Health research from the unit. Normally very much left to explore ideas. Talks in detail about the challenges he faced on becoming the Director of the HSRU in 2016. Predecessors included Prof Marion Campbell who took over from Adrian Grant. Explains the formalisation in the mid-2000s of a clinical trials unit called CHaRT (the Centre for Healthcare Randomised Trials). Craig on becoming Director of HSRU was aware that the Director of CHaRT was about to move on, so losing personnel was one of his worst challenges. Has since faced issues about funding of units, being assessed about whether they should continue at a national level; means from 2024 will no longer be receiving Chief Scientist’s Office funding. (1:19:23) Refers to the HSRU and HERU getting a Queen’s award in 2017, highest moment of his academic career, explains. Talks about attending the awards event dinner at St James’s Palace, then Buckingham Palace the next day to receive the award. Talks about how the HSRU now work with almost every department at the Medical School in Aberdeen. An interdisciplinary department, which makes it quite unique, explains. Explains the HSRU’s involvement with medical undergraduates. (1:26:06) Explains in detail about his research interest in Teeth. Went to a conference in Cape Town, South Africa in the late 1990s, after he had been at the HSRU for only a few years; included conference on Cochrane Collaboration. A colleague told him he had to go and speak to Jan Clarkson from Dundee, she turned out to be a dental researcher. The methods Craig had been working on were exactly what she needed for her studies. Started to collaborate, have now collaborated for twenty-odd years, and have probably changed the face of dental research in the UK, explains in detail. Gives example of Fissure Sealant. Also only national trial to try and get dentists to prescribe fewer antibiotics, explains. Running biggest portfolio of studies looking at Primary Care Dentistry, led out of Scotland, but all national studies, explains. Craig says all this is his proudest work. (1:32:42) Assesses how the HSRU has changed from his perspective of nearly thirty years at the unit. Thinks there is a level of professionalism now that was not there at the beginning; a necessary change. Refers to reading the opening address given when the unit opened in 1988; key things mentioned - waiting lists, communication with patients, service reorganisation, new technique at the time called Lithotripsy. A study of lithotripsy completed three years ago, took thirty years. Some of the intractable problems from 1988 are still intractable problems. Thinks there may be waiting list problems in thirty years, but hopes they are not the size of the waiting list problems we have now. (1:36:11) Lists the unit’s greatest achievements during his time working there; impact on the surgical community; other research units or institutions in Scotland and UK targeting medical treatment, we’ve taken perspective of focussing on non-drug techniques and evaluating surgical techniques. That area is one we are known for internationally, and have made real changes in that field. Now a Royal College of Surgeons of England centre as well, not just Scotland. Also the national centre for Urological Surgery. People say if it’s a complex problem, that’s what we’ll tackle, we don’t do easy things; that’s an earned reputation. Craig is confident about the future of the unit, explains. (ENDS 1:40:07)
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