| Description | Prof JAMES FERGUSON interview at the Sir Duncan Rice Library, University of Aberdeen on Friday 17th November, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) JAMES FERGUSON, born on the 2nd of December, 1960 in Aberdeen Maternity Hospital, usually known by his colleagues as "Ferg". Still working as a Consultant Surgeon in Emergency Medicine at NHS Grampian. Family background, no medics, paternal grandfather ran a trawler out of Aberdeen, all of his sons including Ferg’s father were master mariners. Ferg was the black sheep of the family by going into Medicine, explains background with most of his uncles and his father dying of cardiac disease, father died at sea in the Indian Ocean, explains this later influenced his career and interest in emergency medicine, remote health care and telemedicine. Educated at Cornhill Primary School and then Robert Gordon’s College; started off wanting to be an astronomer, but by second or third year started thinking about Medicine. Started studying at Aberdeen University in 1978, explains. Being a medical undergraduate was fun but hard work, explains about studying at King’s College then Marischal College, then after five terms going up to the Medical School at Foresterhill, took just ten minutes to get from his bed at home in Cairncry to the lecture theatre! (0:05:47) Talks about first contact with patients in his second year, pays tribute to Alison Macleod for her teaching of his group in Clinical Examination. From there he developed an interest in Surgery. Explains his aunt, who was a nurse at the hospital, put his name forward to be a theatre orderly, used to do that during his holidays. Talks about getting on really well with everyone while working in the Professor’s unit or theatre, so when he applied for his House jobs he got a professorial post because everyone knew Ferg. Did his elective project on surgical metabolism in fifth year, and from then started doing locums. Recalls that his first encounter with a patient was with a dead body in January 1979 in The Drain in Marischal College, explains. Later contact with patients was on the wards, enjoyed speaking to people, explains. Talks about people who influenced him; Jack Miller, the senior lecturer in Ward 33-34, the professorial unit; Ian Broom, who was a biochemist then; senior registrars then were Ron Keenan and George Youngson. Jack Miller was a role model for Ferg, explains. (0:10:58) Graduated in 1983, then House officer at Woodend Ward 3 with Andy Hutcheon, another mentor, and Tony Jeffers, really enjoyed it but also tells how he did not want to do medicine, he wanted to fix people; then did his surgical job on the professorial unit, describes it and contrasts with experience of modern students, where they often don’t go to theatre, whereas Ferg was doing four, five or six hour operations, describes this. George Youngson was the senior registrar at that point, just got appointed as a consultant at the end of Ferg’s post. But Ferg did not go straight into Surgery, explains what happened. Did a year of Obstetrics and Gynaecology, six months at Aberdeen Maternity Hospital, then three months at Woodend gynaecological unit, then three months at ARI (Aberdeen Royal Infirmary). Sat and passed his primary (exam) for membership of the Royal College of Obstetricians and Gynaecologists. Having got that, Peter Terry, the senior registrar, was really supportive, explains. Ferg was thinking at that time he might do Obstetrics and Gynaecology, explains what happened when he went for the interview for the surgical rotation. Did surgical oncology with Ian Kernohan then Woodend with Ron Keenan and James Kyle. Then back to ARI to do Urology with John Steyn, Bill Garvie and Les Moffat. (0:15:38) Then in Feb 1987 he went to the Emergency Department, loved it, explains. Consultants then were Alisdair Mathieson and Graham Page, describes them as his mentors and heroes. At end of the six months he asked to stay on surgical rotation longer, and asked to go to Dr Gray’s Hospital in Elgin, working with Jack Miller and Ian Gunn, describes this as the best year of his life, explains in detail. But made him realise he did not want to be a general surgeon, explains. Talks about doing Accident and Emergency registrar training in Manchester. Explains he came back from Elgin to Aberdeen in August 1988, just after the Piper Alpha oilfield disaster. New consultant Tom Beattie was appointed to do paediatric emergency medicine, had trained in Edinburgh but also had contacts with other people, including Tony Redmond the consultant in South Manchester, who was doing a lot of remote work, going to countries when there were disasters. Tom Beattie said Ferg needed to get experience outside Aberdeen, so he applied for a job in South Manchester and got it with Tony Redmond, worked between Wythenshawe Hospital and Withington Hospital. Describes in detail how different it was to his experience in Aberdeen, a shock. But he got contacts with fellow trainees, and some of the consultants down there. At that point they were just setting up the Advanced Life Support Group, was not called that then, but starting to run advanced trauma life support course and advanced cardiac life support courses. Came back to Aberdeen after eleven months, explains how training worked in those days. But at this time Emergency Medicine was beginning to solidify and become a specialty. The first registrar post for the new type of training was in Aberdeen, so Ferg applied for it and came back in 1990. (0:21:28) Explains about how Aberdeen came to be the first place in the UK to do this emergency medicine training. Ferg kept going back to Manchester though to be an instructor, explains. Says the history of A&E in Aberdeen is quite interesting, refers to the time of the Second World War till the formation of the NHS; refers to the Platt Report in 1962, then the Wilson Report in 1972 which recommended consultants be appointed. Not entirely sure, but thinks the first formal appointment in the UK was David Milne, who trained in Aberdeen, and was made a consultant in Newcastle, but had done his emergency time in Aberdeen. The second consultant in the UK, he believes, was David Proctor, who was the consultant in Aberdeen. Thinks that is because Aberdeen had a well developed (A&E) system that both Davids had produced in the 1960s and into the 1970s. It worked really, really well. (0:25:00) Talks in detail about how Aberdeen, with a single integrated hospital site including A&E at Foresterhill, compares with A&E in Manchester. Recalls A&E in Aberdeen being at Woolmanhill Hospital when he was a schoolboy, and being treated there; also paediatric emergency being at the Children’s hospital, getting his head stitched there when he was four. Big disadvantage of Woolmanhill was its distance from the hospital, if you need to admit somebody you had to send for an ambulance. So department developed its own clinics, dealing with fractures, also doing surgical procedures. Idea was to turn around as many patients as you could from Woolmanhill, and admit the remainder (to ARI). Medical cases were sent by GPs straight to Foresterhill, so the department did not see many medical cases, it was mainly accidents and emergencies. That worked really well, but then it became obvious the department needed to move up to Foresterhill. So when Phase Two was built they built a specifically designed department to move into in 1977 or 1978. Describes the facilities the department had in the new building. All on one site, believes Aberdeen is still the largest single site hospital in Europe. (0:29:54) Specialists from other departments on hand to assist A&E in Aberdeen, talks about changes since he started there in 1987, make up of workload has changed dramatically. In March 1990 came back from Manchester as a Registrar, staffing of department quite small compared to now; three consultants, Charlie Burrows, the associate specialist had retired by that time; Senior Registrar Simon Mardel, then Ferg, two surgical trainees, and six GPs, explains; dealing with 55 thousand patients a year. About fifteen doctors in total. There are 15 or 16 doctors each shift now, explains in detail. When he came back in the early 1990s emergency medicine was developing quite rapidly, particularly round education, talks about one of his roles being helping Tom Beattie, and starting to run courses in Aberdeen. Rona Patey did ATLS (Advanced Trauma Life Support) course, explains. Tom wanted to start Advanced Cardiac Life Support course, Ferg ran first course in Aberdeen, explains. Worked with colleagues from Manchester setting up each other’s courses. Ferg then took the Advanced Paediatric Life Support course, explains. Really enjoying the clinical work, explains what they were doing. Has always lived near the hospital. (0:35:49) The other big thing was ED did Ship to Shore cover, explains in detail, including how Aberdeen became the default place for medical advice to offshore shipping; Portsmouth developed as the centre for the South of England. So right from 1987 Ferg was being introduced to Telemedicine, effectively, or Remote Medicine for delivering advice to those at sea. Also need to support the community hospitals run by GPs, and Dr Gray’s in Elgin. Talks about how he became interested in Remote Medicine and pre-hospital medicine as well. Then got involved with the British Association for Immediate Care (BASICS) because he met Colville Laird, who was setting up BASICS Education Scotland, explains. Also became chairman of the junior doctors committee, and when he got his consultant post was secretary of the local negotiating committee. Financial initiative to increase the consultant numbers in Scotland, Ferg co-ordinated this in Aberdeen, explains. Tom Beattie at that time moved to Edinburgh, so Ferg applied for and got his job, with a paediatric interest, explains. His colleague John Hiscox got the other post. Ferg was appointed consultant on Sept 19th, 1994. (0:41:07) Talks in detail about the influence of Aberdeen in the development of the specialty of Accident and Emergency. Building the department, Ferg was actively encouraged by Alisdair Mathieson and particularly Graham Page, explains; Graham Page was involved with Professor Nelson Norman in support for the offshore industry, explains how he and the junior doctors used to work for his companies in their spare time, explains. Talks about how as a consultant his interest began to switch to remote health care. At that time the Centre for Remote Offshore Medicine was involved in early trials for telemedicine, explains this involved taking calls from the British Antarctic Survey. Says they were running a Dept of Trade and Industry project; put video conferencing units into Peterhead, Orkney, and Shetland. Ferg got involved and really interested, developed this, was doing more and more with the Coastguard. Mentions that in the late 1990s the then British Prime Minister Tony Blair became interested in telemedicine. So Aberdeen got visit from official of the Scottish Office; had already reduced transfers from Peterhead to Aberdeen by 85%, explains in detail the results. (0:46:26) Scottish Govt wanted this scaled up, set up the Scottish Telemedicine Action Forum, led by Professor Ray Newton; Ferg was advisor on that, explains he then submitted a trial for £1.1m to put video conferencing in all the community hospitals and rural general hospitals in Orkney and Shetland, explains; support from John Bremner and Eileen Bremner on the science side, and Susan Fraser and Fiona Mair and EM trainees, Andy Rowlands, Andy Palumbo, and Dave Pedley, they were Ferg’s research registrars. Ran that study for two years, explains. Outcome was that in 2005 the Kerr Report, came to visit Ferg, said they want to do this at scale and set up a national centre for telehealth and telecare, and they wanted it to be in Grampian, explains. GP Gordon Peterkin was the lead, and Ferg was the clinical lead, set up in 2007. Describes how the A&E dept was run when he became a consultant there in 1994, four consultants taking it in turns to be head of service, explains in detail, including about decision to remove emergency medicine from surgical training rotations; need to interact with every other medical specialty. (0:52:11) Talks in detail about emergency medicine being a "team sport", to be a good ED (Emergency Dept) consultant you have to have good interpersonal skills. Also talks about the team he had underneath him for the remote medicine, had a business manager, Susan Fraser, who was fantastic. That team was the core of the Scottish Centre for Telehealth, explains. Doing a lot of practical research at that time, explains; Ferg was racking up research publications as part of this, starting to be seen as the telemedicine person for Scotland. They started to get recognised by the Royal College of Surgeons of Edinburgh for exams; the College of Emergency Medicine had not been formed at that time, it was developing, explains in detail. He and John Hiscox did the only A&E exam there was in 1991, in late 1990s they were asked to run the exams in Aberdeen; significance of this, none of the A&E depts apart from Aberdeen and Dundee had a ward, explains. Ran these exams for years in Aberdeen till the college was set up and moved to London; Ferg invited to places like Hong Kong and Singapore to examine, explains. (0:58:07) Talks in detail about a typical day for him as an A&E consultant, explains that everyone thinks A&E is chaotic, but probably less chaotic than most other departments. Trauma has been going down, refers to success of Safe Drive Stay Alive educational initiative set up in the 2000s for school kids, death rate down, one of the things Ferg is most proud of, explains. Moments of high drama, important, but not that common. Recalls incident in 1991 when they were asked to respond to a car that had turned over at a roundabout on the road to Garlogie. Ferg was a registrar at the time, went there with SR (senior registrar) Simon Mardel; two casualties were quite a distance apart, but they only had one box of kit between them; talks about lessons learned and how this influenced his interest in pre-hospital medicine and care. Now still does a lot of training for BASICS Scotland; also works for Scottish Rugby, pitch side management. (1:02:52) Garlogie casualties survived. Talks about development of a system in the dept for staff dealing with death, particularly if it involved kids. Letting parents into the resuscitation room, which would not have been done before. But explains his nature is that he does not usually get upset, because it is his job; recalls having to tell a mother that her fifteen-year-old had just died of cardiac arrest, and she hit him. That started him looking at the pyschological stuff as well, refers to Apex course. Talks about the hours he worked as a consultant in the 1990s. When there were three of them, it was one in three, and for a long time they did it a week at a time, explains in detail. It was very different then, because we did less stuff than we do now. Easier to run the dept then, because when you were on the night before you knew all the patients the next day, explains. By lunchtime, if there was nothing in theatre you needed to do, and you had one of the better juniors to do it, or the senior registrar - recalls Barry Klaassen and Linda (Hislop) - also had junior surgeons as well, you could go home and sleep and then come back to do the evening ward round. Remembers it as being intensive, but very satisfying, whereas now we do shifts. A lot easier than it was before, much less satisfying than when they moved into the new department, since then it has changed. (1:08:11) Shift system means they do not see a patient all the way through. Thinks they have 26 consultants in A&E now, covering Elgin as well, explains. Talks about relations with hospital management; Ferg a BMA (British Medical Association) man; at some points relations "quite hairy", particularly at time he came back from Manchester; Conservative govt White Paper looking at the purchaser-provider split. Alisdair Mathieson [on National BMA committees], was always encouraging Ferg to do the trade union part. At that time there was a period of animosity, they were negotiating on things that came out of the White Paper in the early 1990s, describes. Settled down in the mid-1990s when Alec Cumming became the chief executive (of NHS Grampian), explains. There were a few things we negotiated in the late 1990s, Peter Terry from gynaecology and Les Moffat were the leads at that time, Ferg got invaluable experience at that time. But management were generally really supportive, explains; this continued during the naughties, but round about 2010-11 there was a change. There were more doctors, Labour govt had increased the numbers. For a period of time there was very little conflict over terms and conditions of work and the workload that was being done. In the last ten years or so that has changed dramatically, they don’t really listen to clinicians so much now, explains, culture has changed from what he experienced for the majority of his career. Dates this to moving into the new department in 2012, started doing much more medicine. (1:13:21) Describes where the old department was, just up the hill from the helipad. Recounts falling off his bike and getting stitches in a space that he realised was the theatre that he had operated in for about thirty years! Recalls reporters who turned up at the helipad and could then run and film at the front door (of the old A&E dept). Reveals that there is now a one-way system alongside the helipad, but it’s the wrong way! Explains in detail the consequences for the new A&E dept, comments on how this decision was made. (1:17:13) Reflects on his plans and ambitions for the development of A&E in Aberdeen. Believes they were the best ED department in the UK, explains in detail why; includes him being recruited to the Scottish Govt performance team to look at Flow, implemented the four-hour target, explains in detail, importance of ED performing well. Need to put more resource into the community, because hospitals are expensive, we’re over-investigating and over-treating people, explains, including having to deal with patients in their late-90s. Ferg’s telemedicine stuff and Scottish govt stuff, interlinked because George Crooks became the lead for the Scottish Centre for Telehealth and Telecare, and he was head of Ambulance, which is why Ferg got involved with ambulance stuff; he’s also the head of the Digital Health and Care Institute, of which Ferg is a clinical lead. Most important thing in making health better is dealing with death, explains; nothing links up in the NHS now, comments on ambulances queueing, a complete systems failure. (1:21:45) Explains in detail about how in 2018 Grampian established the first major trauma centre in Scotland, starting with definition; how it works; influence of politics on deciding where and how many trauma centres Scotland should have; the four major cities. Explains about most common traumas in Scotland, why this is different in Aberdeen from the Central Belt, and the numbers involved. Explains why most treatment now is by protocol, because most people now don’t have the experience that he has; there’s less trauma, have reduced road traffic accidents significantly. Talks also about the EMRS (Emergency Medicine Retrieval Service); explains in detail about his difficulties re locations of emergency helicopter services. For major trauma now usually sending doctors by helicopter, to start resuscitation before patient comes to the hospital, explains; before it would have been what the paramedics could do on the way in. (1:30:24) Talks about drop in emergency cases from offshore, refers to Nelson Norman’s book outlining remote health care. When oil industry was doing the construction part that was when they were getting large amounts of trauma; as oil industry matured, the trauma got less and less. Ferg recalls in the 1980s jumping into helicopters for Graham’s (Graham Page) company, Aberdeen Industrial Doctors, and taking people off (rigs and platforms), the majority with medical conditions, explains. Talks in detail about dealing with offshore emergencies, NHS responsibility ends at the high water mark, so companies have to retain medical staff to support the rig medics offshore, Ferg developed and did a lot of the teaching for that, explains. Talks about the Coastguard, mentions Pete Lowson , formed a group with Nelson Norman and Prof Graeme Furness, got really good data, explains; all basically telemedicine at the end of the day, trying to set up a common database. Ferg was in Bergen a few weeks ago, trying to get world data now so as to design a better system. (1:35:21) Comments on his being a Reader in Emergency Medicine for Aberdeen University, while across the city the Robert Gordon University have made him a visiting professor; reveals that in 2006 or 2007, when the Scottish Centre for Telehealth was set up, he turned down professorships from both universities, explains why, and why in 2013 he accepted a Chair from RGU, as Prof of Remote Medicine. Talks in detail about the importance to him of his clinical work. Also talks in detail about being retained as a medical advisor by Eon Productions, the company who make the James Bond films, and what being James Bond’s doctor involves. Mentions Prof Sir Graeme Catto, a lot of people coming to visit from government and industry when they were developing telemedicine in the late 1990s. One company was First Call, who wanted to do it commercially. Made deal because the department was wanting an extra consultant and registrars, got support of Alec Cumming (then chief executive of Grampian Health Board). Got funding for consultant and registrar post, in return for providing remote advice, which they were already doing for the Antarctic Survey, and getting paid by that time for doing it for the Coastguard because Haslar, the naval base that were doing the ship to shore advice for England - a friend of Ferg’s, Chris Cahill , worked there - closed; in 2020 [later corrected to: in 1999] Aberdeen’s ship to shore calls went through the roof, explains. (1:41:38) Resulted in the Aberdeen department being formally contracted to do this work, explains this was set up in the department and Ferg ran it as the lead. At one point Roderick MacDonald, the managing director, had idea of writing something for James Bond, this was about 2004 or 2005. Ferg wrote down something about Bond getting poisoned, all about telemedicine and initially doing self-care, Roderick sent it in (to Eon). Ferg did not think anything would come of it, but went to see the film Casino Royale when it came out. Watched James Bond drinking poisoned martini, getting sick, then going to his telemedicine pod in his Aston Martin, explains scenario in detail. As Ferg is watching he is thinking this is getting more and more familiar. There was no credit on the film for this, Roderick went back to Eon and said he thought they had used their idea. Got invited down for Quantum of Solace (the next James Bond film), met Barbara Broccoli (producer, and controller of Eon Productions) and had lunch with Michael Wilson (Barbara Broccoli’s half-brother) and his son Greg Wilson. Michael Wilson apologised for forgetting he had passed on their idea to the Bond writers, so said for as long as Ferg liked he would be James Bond’s doctor! Basically this involves giving up to date medical information for the last few movies. (1:46:45) Comments on the current state of the NHS, particularly as it affects Accident and Emergency. Ferg’s job for the last twenty years has been looking at healthcare systems, and how they are working or not working. He’s frustrated because he has spent most of his career coming up with solutions that may make the system more effective and how this can be delivered in the community; hardly any of them have been adopted at scale. Explains in detail. Because of his James Bond connection Ferg ended up speaking at the Nobel Peace Prize summit in 2009, illustrating healthcare systems with Bond stuff. Resistance to changing archaic approach - "Forget SPECTRE Mr Bond - SLOTH is the enemy!". SLOTH stands for Secret League Opposed To Health; they’ve got us addicted to hospitals and we put everything into them, explains consequences. When he started in ED 36 years ago he hardly saw anyone with chronic disease. It’s all about chronic disease now. Not a hospital problem, should be a community problem. Two things he did not want to be, a GP and a geriatrician; he’s both now. Explains about resuscitation being what is wrong with the NHS. COVID pandemic showed up the inefficiencies, explains. Baby boomers now in their 80s and 90s, need care in the community but most being pushed into hospitals; we’re killing people, explains. Solution is to put a whole lot of money into Social Care; some countries already saying we are going to do everything in the community, only go to hospital if everything else has been tried. Because there is no alternative service in the community, people end up in hospital, Ferg not doing a lot of emergency medicine in his department, instead is looking after people who are moderately unwell at the end of their life. (1:53:02) Contemplates A&E after he retires. No sign of it getting better, needs fundamental change, explains in detail. Mentions Flow Navigation, explains. Talks about why he hates having to watch the TV programme Ambulance, on which his youngest daughter works as a production assistant, because it sends the wrong message to the public. Talks in detail about his Bond-related scenario idea for how to get the public to stop wanting to go to hospital, which he gave in a speech in 2013. Talks about need for planning for death; inadequacies of do not resuscitate orders in absence of a plan for managing death at home. Mentions system in Airedale where you would decide what you are going to do, and that was recorded on a database that was manned 24 hours, explains how it worked in supporting the family. They reduced their hospital admissions and the satisfaction of the relatives was through the roof. (2:01:22) Contrasts how the ED in Aberdeen was at the start of his career, and how it became more medical after they moved into the new department; mentions this in context of his father dying of a heart attack. As other services fall over, the default is coming to the ED, most of his patients are waiting for tests, and he feels they do far too many tests. (ENDS 2:03:08)
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