NHS at 70: Celebrating a revolution in Scotland's healthcare

Elsie Stephenson, first Director of Nursing Studies Unit, Edinburgh Unviersity (January 1916-July 1967) 

Elsie Stephenson watched her father lose his battle against influenza and, aged just three, is said to have resolved at that point to become a nurse.

She went on to become instrumental in establishing nursing as a university-level profession.

By 1956 she had become Edinburgh University’s first Director of the Nursing Studies Unit, a shock appointment due to her own lack of university education and teaching experience.

Nevertheless she set about introducing new qualification standards for nurses and their educators, putting in place a new training scheme that expected students to graduate in arts or humanities before taking up their nursing qualification.

A degree programme in nursing was established along with a school for overseas students supported by the World Health Organisation.

Born in County Durham, she trained with the British Red Cross and worked with Yugoslavian refugees in Eygpt, in Italian refugee camps and in a mobile hospital in Germany, before travelling to North Borneo, Singapore, Brunei and Sarawak.

Her first-hand experience of emergency and relief work in Europe ignited her vision for nurses who would provide holistic community care and public health. She saw university education as providing the foundation for such innovative programmes, while at the same time it nursing courses were seen as a route for women to enter higher education.

The University’s Nursing Studies Unit was set up to bring academic rigour to courses aimed at qualified nurses, tutors and nurse educators. An undergraduate nursing programme was launched in 1960, the UK’s first of its kind.

She also established a research base to tackle the “practical problems of nursing” which enabled greater understanding of the profession

One of her Edinburgh students was Annie Altschul who went on to become Chair of Nursing Studies at Edinburgh 1976–1983. She instigated plans for an innovative joint degree programme, the MSc in Nursing and Education, which was launched in 1986.

She died of lung cancer in 1967, aged 51.

Gertrude Herzfeld

Gertrude Herzfeld blazed a trail for women in medicine when she became Scotland’s first practising woman surgeon and the first woman paediatric surgeon.

Born in London in 1890, she studied medicine at Edinburgh University, qualifying in 1914 with a MBChB degree. She remained in the city where she was appointed house surgeon at the Royal Edinburgh Hospital for Sick Children and the Chalmers Hospital shortly after qualifying.

The appointment meant she was the first woman to hold the post. She was also a surgeon to the Edinburgh Orthopaedic Clinic, which she helped to found.

She was also the first woman to take her seat in the Royal College of Surgeons – Alice Mabel Headwards Hunter was admitted before her but did not take her seat. She also went on to lecture in childhood surgery at Edinburgh University.

She specialised in paediatrics and gynaecology with responsibilities that incorporated areas which are today specialisms of their own, including plastic surgery and treatment of burns and trauma.

She also helped found the Edinburgh School of Chiropody and was president of the Medical Women’s Federation, helping to pave the way for more women to enter the medical profession.

She died in May 1981, aged 91.

Ronnie Stewart, porter

HE was the hospital porter on duty when Ninewells Hospital in Dundee opened on January 31 1974 and wheel in the new facility’s first ever patient.

It was a proud moment in a 48 year career at NHS Tayside for Ronnie Stewart, who finally retired last year.

Born in Dundee, Mr Stewart became a porter in 1969 spending a few years working at Dundee Royal Infirmary. He then volunteered, with other porters, to help prepare the wards for patients for the opening of the newly-built Ninewells Hospital.

In various roles since then, including general porter, chargehand porter and Assistant General Services Manager for Portering to his final position of Assistant Locality Manager/Transport Manager, Mr Stewart said he had probably walked every inch of Ninewells Hospital.

He said: “Over the years I have had the privilege of working with a great bunch of people and I will be leaving the NHS today with many happy memories.

“From my first portering job at DRI and up until my last post, I never forgot that I was here for the patients as I kept that thought foremost in my mind in everything I did.

“As you would expect, after a career lasting 48 years it has been a learning curve. Some might say a very long learning curve but I can honestly say that I have grown up with Ninewells Hospital and the hospital has grown up around me.”

“Working as a porter definitely kept me fit and I would guess the number of steps I have taken in my work over the years runs into the millions so I may have to take up golf again to help keep my steps up.”

Mr Stewart added that retiring after such a long career was a “wrench”, but added: “I will spend many moments thinking about my time in the health service and all the staff I have worked with, and reflect on all the good times we shared.

Professor Chris Oliver

Known to his Twitter followers as the “cycling surgeon”, Professor Chris Oliver retired in December 2017 after spending 20 years as a consultant trauma orthopaedic and hand surgeon at Edinburgh Royal Infirmary.

It was a long way from his original path training as a neurosurgeon at the National Hospital for Nervous Diseases in London in the late 1980s.

“I didn’t like neurosurgery because there was a lot of death and paralysis, and at that time there were no organ transplant coordinators and I not only had to ask for the organs - I had to harvest them. I didn’t like that. That’s changed a lot now.

“Then I had this moment where I thought ‘I’ll do orthopaedics because I can fix broken bones’.”

After working in England and Seattle in the US, Prof Oliver arrived at the ERI in 1997 where he spent the next two decades putting people “back together” after car crashes and horrific falls.

His patients have included Olivia Giles, the Edinburgh lawyer who had to have both hands and feet amputated after developing meningococcal septicaemia in 2002. He said the case was “very emotional” but he now counts Ms Giles as a friend. He also fixed stunt cyclist Danny MacAskill’s broken clavicle and once received a strange request from late rally driver Colin MacRae.

“He came to me once and said ‘I want you to chop my finger off because I’ve broken it and I want to race this weekend’,” said Prof Oliver. “I said ‘well, no, I’m not going to do that but I’ll patch you up’. He did very well. These sportsmen, they’re all nutters, you can’t get them to comply with any rehabilitation. They do their own thing.”

However, Prof Oliver blames the stress of seeing “terrible stuff” every day for the onset of Type 2 diabetes and morbid obesity, which led him to undergo gastric band surgery privately in 2007 after his weight climbed to 27 and a half stone.

In 2013, having lost 12 stone, he cycled 3415 miles across the US from Los Angeles to Boston and went on to become an advocate for better road safety and active travel policies in Scotland.

He said: “When I started the number of fatalities on the roads in Scotland from all traffic accidents were about 550, nearly two a day. Last year, in Scotland, the number of people killed was less than 160. That’s mainly down to better road safety.”

He remains an honorary professor at Edinburgh University’s Physical Activity for Health at the Physical Activity for Health Research Centre (PAHRC) and has led research into the dangers to cyclists from the Edinburgh tram lines, and also advises on 20mph traffic zones.

Sir John Crofton

For centuries, one disease in particular touched virtually every family in the land.

Easily spread through the air in cramped homes, tuberculosis affected whole families, leaving patients thin, pale and increasingly weak as it took hold.

In Scotland in 1948, TB claimed a life every two minutes. Doctors were overwhelmed, hospitals packed with patients.

Sir John Crofton was born in Dublin and raised in England. He arrived in Scotland in 1951 with new ideas for ending the scourge of TB. Initially treated with scepticism, he would prove his doubters wrong.

At the time the only treatment for most patients was bed rest, fresh air and nourishment, often in a packed sanatorium and usually for months at a time. A few patients endured surgery, not all of it was successful.

However within a few months of taking up his post as Professor of Respiratory Diseases and Tuberculosis at Edinburgh University, Crofton had secured extra beds for patients and greater access to specialist care.

New drugs had been developed to help treat TB but there was uncertainty over their correct use. He took the drugs and developed what became known as the “Edinburgh method”, a three tier approach that ensured the TB organisms would not become drug resistant and could cure many patients without them having to go under the knife.

Even better, it became clear that patients could be cured without having to stay in hospital – heralding the beginning of the end of the dreaded sanitoriums.

His successful Edinburgh system became the norm the world over and provided the foundation for similar combination style therapies to be used in the treatment of a range of conditions, such as HIV and cancer.

He went on to become Dean of the Faculty of Medicine at Edinburgh University and then its Vice-Principal.

His interests in public health stretched to prevention of disease by reducing smoking, and he played a key role in the launch of anti-smoking groups Ash-UK and Ash Scotland. He was also involved in the founding of Scottish Health Action on Alcohol Problems (Shaap).

He died in Edinburgh in November 2009.

Professor Heather Cubie

Professor Heather Cubie is best known today for her work on the human papilloma virus (HPV) and cervical screening, but her first job when she joined the NHS in 1968 was analysing infant blood samples in the pathology lab of the old Edinburgh Sick Kids Hospital.

She said: “Clinical science was relatively new then. I was known as a clinical physicist. For some reason they hadn’t really thought of clinical biology.

“I did work on taking blood samples from newborn babies who looked like they might have a genetic condition and then analysing the chromosomes for abnormalities - missing chromosomes, shortened chromosomes. That sort of science was very new then.”

In the 1970s, she returned to Edinburgh University to complete a Masters in the 1970s and build on her fascination with virology, and in particular HPV. She studied PE students with verrucas - types of benign tumours - and examined the link between the development of antibodies in their blood and HPV, at the time an obscure virus. At the time only dermatologists showed an interest in the work because there was no known link to cervical cancer but, ironically, despite a string of negative results which precluded her from pursuing the research to PhD level her work is now cited by other scientists.

After returning to the NHS, she carved out a career in virology, developing rapid antibody tests for rubella and molecular Respiratory syncytial virus (RSV), a common cause of respiratory tract infection in infants, but HPV remained her major interest and her work has been key to developing molecular testing for the virus following its recognition as a cause of cervical cancer and the introduction of a vaccine.

She said: “I’m really proud of NHS Scotland. When they rolled out the vaccination programme they knew there had to be great surveillance and Scotland’s unique CHI patient numbering system means that we’ve been able to link up vaccinations with cancer incidence and outcomes, and see exactly what difference it’s made.

It’s been absolutely fantastic, and nowhere else in the world has done that.”

In 2012 Prof Cubie, now 71, was awarded an MBE for her contribution to healthcare science for her work in training clinical scientists and, more recently, she has spearheaded a Scottish Government-funded project which has screened 20,000 women in Malawi for cervical cancer and delivered treatment to 80 per cent of women who needed it on the same day.

Eve Johnstone

Eve Johnstone came face to face with her first schizophrenic patient at the age of 20 while studying at university in her native Glasgow.

The encounter sparked a fascination that would lead to pioneering research and a range of important breakthroughs in understanding of the condition.

She was most intrigued by its apparently ‘random’ nature, striking patients seemingly out of the blue, bringing with it often with serious consequences.

The unexplained element of the disease prompted her to embark upon a number of ground-breaking research programmes, which ultimately helped to alter approaches to the condition and broaden understanding.

She broke fresh ground in 1976, when she used a CT scanner to produce brain images of schizophrenic patients which were then compared with ‘normal’ brains. As a result, she was able to show anatomical differences between the two.

Later, her 1994 Edinburgh High Risk Study focused on young people aged 16 to 22, who were considered to be liable to schizophrenia due to close family connections with people affected by

the condition. That study alone prompted the publication of more than 60 papers linked to its findings.

She was appointed Head of Psychiatry at University of Edinburgh in 1989, becoming one of the first female professors at the University’s College of Medicine.

Her research into schizophrenia has involved patients from across the UK, and in her university role she has passed on her expertise to students who would go on to hold senior positions in psychiatry at universities across the country.

As well as her research interests, she is a full-time Consultant Psychiatrist at the Royal Edinburgh Hospital. During her career she has authored more than 250 papers and written eight books.

She was awarded the Lieber Prize for Outstanding Achievement in Schizophrenia Research by NARSAD in 2007 and awarded an Honorary Degree in Medicine from University of Edinburgh in 2014.

Dr Elizabeth Wilson

As a pioneer of contraception, abortion and assisted dying, Dr Elizabeth Wilson was not afraid to take on controversial topics - and speak publicly about them. Born in 1926, she followed her father into medicine and admitted she could not think of a time when she did not want to be a doctor.

While training at King’s College Hospital in London, she met her husband - a research fellow from Edinburgh - and the pair settled in Sheffield where Dr Wilson worked as a GP.

She became aware of the difficulties in obtaining contraceptive advice, especially if you were unmarried, and co-founded the 408 Clinic - one of the first family planning services available in the UK for single women.

In 1967, the family moved to Glasgow and Dr Wilson focused her full attention on family planning and sexual health. She later recalled on one occasion meeting a patient in a Glasgow steamie in order to administer her contraceptive injection without her husband knowing.

Following her retirement in 1990, Dr Wilson worked for a year in Sierra Leone with Marie Stopes International. She later became interested in legalising assisted suicide and established Friends and the End (FATE).

In 2009, at the age of 83, she was arrested by Surrey Police on suspicion of aiding, abetting, counselling or procuring a suicide. The arrest was made following the death of Cari Loder, 48, who had multiple sclerosis. The charges were later dropped due to insufficient evidence, but Dr Wilson remained an outspoken advocate for giving people a choice at the start and end of life. She died in 2016.

Dr Laura Young

SINCE losing her eight-year-old daughter, Verity, in 2009 Dr Laura Young has been determined to make hospital a less daunting place for hundreds of other children.

The mother-of-three, from Gullane in East Lothian, set up the Teapot Trust charity in memory of her daughter, who she said loved to throw tea parties.

The charity runs one-to-one art therapy session in nine hospitals and hospices across Scotland, from Borders General Hospital in Melrose to the CHAS Rachel House Hospice in Kinross, as well as at two London hospitals.

Dr Young’s daughter Verity had battled the auto-immune condition lupus, a life-threatening condition where the immune system attacks the organs and joints.

She spent long periods of time in hospital and in December 2008 doctors discovered a tumour in her abdomen. She died from cancer in November 2009.

Dr Young said he daughter hated hospitals but loved art, and she wanted to give other children a way to communicate their emotions and be distracted from their conditions.

In 2017, Dr Young was named the Evening Times’ Scotswoman of the Year for founding the Teapot Trust.

She said: “Demand is such that we could double the appointments we have. We are working hard to get funding for evidence-based research into how art therapy helps children – we have so much anecdotal evidence, we see it happening in front of our eyes, but we need it backed up.”

“I wouldn’t be satisfied to leave now – there are many more children out there who could benefit from what The Teapot Trust does.

“We have to go for it. There is lots more to be done.”

Dr John Mills

Dr John Mills was a consultant gynaecologist in NHS Tayside’s Ninewells Hospital from 1975 to 2002, with a special interest in infertility.

The IVF Unit in Ninewells Hospital was set up in the early 1980s by Dr John Mills and Dr Geoff James and resulted in the first IVF baby in Scotland, who was born in September 1984.

Dr John Mills said, “It was very rewarding to set up and establish an NHS Tayside service, alongside a team of dedicated colleagues.

“IVF was all new back then but it is done much more routinely now and now millions of babies across the world are born as a result.

“It really was exciting and very rewarding to be part of such cutting edge work, and it meant we could help patients and families across Tayside.

“I got the opportunity to work with scientists and dedicated colleagues throughout my career. I was very lucky in my career to see the whole area of infertility move forward and advance. IVF is a very efficient form of treatment for couples who have fertility issues, with success rates comparable to normal conception rates. It was a very rewarding field to work in and it is good to see that advances are still being made today.”

Ninewells was also the first Unit in Scotland to offer NHS-funded IVF treatment.

Other ‘firsts’ for the Unit include:

1989 – first baby born following treatment using donated embryos

1994 – first baby born following treatment using frozen embryos

1995 – first baby born following intracytoplasmic sperm injection (ICSI)

2010 – first NHS centre in Scotland to offer egg sharing

In 1994, the Unit opened in Ward 35, a self-contained ward with its own in-patient and out-patient areas, laboratory and office accommodation. A new build consisting of laboratory and theatre accommodation was completed in 2012. The Unit now has a staff of 40, comprising clinical, scientific, nursing, administrative and counselling staff. In the 1980s, the success rate was less than 10%, the average success rate for patients under the age of 35 is now almost 40%.

So far, over 4,500 babies have been born as a result of IVF/ICSI/frozen embryo transfers at Ninewells Hospital (this does not include babies born from ovulation induction and donor insemination).

Professor Robert Steele

Professor Robert Steele, 65, seemed fated to end up in medical screening. His first job was as a house officer in Edinburgh in the 1980s under Sir Pat Forrest, a surgeon who was then in the midst of writing the Forrest report. This ultimately led to the rollout of breast screening for cancer across the UK.

Professor Steele went on to work as senior registrar in Aberdeen in the late 1980s where he was struck by the number of patients succumbing to bowel cancer. But when he moved to Nottingham in 1990 to work for Jack Hardcastle, who was then spearheading a trial of faecal occult blood test (FOBt) screening, he noticed a marked difference.

He said: “Most of the patients with colorectal cancer had quite advanced disease and there wasn’t all that much we could do for them. Then when I moved to Nottingham where the trials of bowel cancer screening were happening I found that most of my patients had early disease and were curable by surgery, so it was a really motivating factor to see the effect of a public health intervention on the frontline.”

When Prof Steele returned to Scotland in 1997, he led a successful bid to host the Scottish arm of the demonstration pilot of FOBt screening in Dundee.

He went on to chair the executive group that oversaw development of bowel screening across the UK and was subsequently appointed clinical director of the Scottish Bowel Screening Programme.

In this role, he has seen Scotland become the first part of the UK to introduce a simpler and more accurate bowel screening kit in 2017, which is expected to improve detection of the disease.

In 2016 he was appointed chair of UK National Screening Committee, the body in charge of recommending screening programmes for the NHS. He hopes that ovarian, lung and prostate cancer will soon have screening programmes, and has also raised the possibility of screening for other diseases in future including diabetes, cardiovascular disease and psychiatric disorders.

“We have to be absolutely sure that all the evidence points to more benefit than harm and we’re not there yet with any of these other conditions yet. but we may be in the future.”

Professor Gordon Waddell was an orthopaedic surgeon, academic and author who became world renowned in the field of back pain research. He was at the vanguard of the “back pain revolution”, which transformed and hugely improved the way back pain was treated worldwide.

Born and brought up in Bishopbriggs, he went on to specialise as a consultant orthopaedic surgeon, working full-time in the NHS from 1977 to 1995 with posts at the Western Infirmary and Gartnavel General Hospitals in Glasgow.

However, he was also a highly respected academic who, from 1992, held four honorary professorships in Scotland, England and Wales across four different disciplines: orthopaedics, osteopathy, disability research and behavioural medicine.

His research challenged conventional thinking around back pain treatments and was pivotal in the move away from rest, to staying active. He also played a central role in the development of the biopsychosocial model of medical care. His book, The Back Pain Revolution, is regarded internationally as a classic medical text.

His friend and colleague Professor Peter Croft said: “Almost single-handedly he transformed the way we thought about and approached our patients with back pain, and he led our professional bodies to tear up the rule book in ways that have led to radically improved health care.

“The fact that he did this as an orthopaedic surgeon who had the courage to criticise the excesses of surgery, and that he communicated his ideas in legendary talks, made him unique and special among back pain experts.”

Prof Waddell died aged 74 in 2017.