70 Years of NHS Scotland: Looking after patients from cradle to the grave

Prof Anthony Busuttil

Professor Anthony Busuttil’s ‘patients’ would, sadly, never meet the man who would often provide much needed answers for their loved ones.

During his career in forensic pathology, he has attended some of the most disturbing incidents in Scottish criminal history – at Lockerbie, the Dunblane shootings and countless murder scenes.

Born in Malta, he came to Scotland in 1969 having already graduated in medicine and surgery at the island’s Royal University of Malta.

His first appointment was as a Senior House Office in Laboratory Medicine in the Pathology Department of the Western Infirmary, Glasgow, and he held various posts in the city before arriving in Edinburgh in 1976 as consultant pathologist at the Western General Hospital.

He went on to become Regius Chair of Forensic Medicine at Edinburgh University, Head of the Forensic Medicine Section of the Department of Pathology and Medical Director of Clinical Forensic Medical Services for NHS Lothian.

He conducted the pathological investigation that followed the bombing of Pan Am Flight 103 over Lockerbie, and has been a regular expert witness in Sheriff and High Court cases on both pathological and toxicological matters.

He has taught medical and law students, passing on his significant expertise gleaned from a career that has spanned both hospital pathology and criminal.

His role at Lockerbie saw him identify all 259 passengers and 11 Lockerbie residents who also died in the attack. He later said: "I'll never forget seeing some of the children in the mortuary. It was terrible, but I had to think on a technical level about what I required to carry out my job.”

Tragically, the experience would prepare him in part for the Dunblane shootings, which he described as “the ultimate challenge.”

Speaking on the 20th anniversary of the incident, he said: “You could not go into that gym, you could not work with the bodies of five-year-olds at the hospital and not be incredibly moved. You thought about the loss of their futures, at the pain and suffering of the parents. And you thought of your own children, and thanked God for them.”

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

In 1998 he was awarded Membership of Order of Merit by the President of Malta, and in 2000 was awarded the OBE for Services to Medicine.

Dr Martin Perry

CONSULTANT rheumatologist Dr Martin Perry is working to bring a world-class arthritis database from Sweden to Scotland.

Dr Perry, who has been based at the Royal Alexandra Hospital in Paisley since 2011, hopes to have the pilot project up and running from April two of Scotland's largest health boards - NHS Greater Glasgow and Clyde and NHS Lanarkshire.

The Rheumatoid Arthritis Quality Register pilot is based on a model first developed at the Karolinska Institute in Sweden around 20 years ago, which allows patients with rheumatoid arthritis to regularly log their symptoms via a database which links them directly to their clinicians.

Dr Perry, 42, said: "It allows patients to input information in ways that other systems currently available in Scotland don't. You can feed into this how you're feeling whenever you want and this links up to the clinicians' desktop.

"It means patients can track their own disease activity, they're more aware of how the condition is progressing and it alerts clinicians if it's not doing well."

The Swedish registry is widely respected for improving patient self-management, as well as providing an important insight into patients' demographic and socioeconomic circumstances, such as employment status.

Celebrating 70 NHS Heroes for 70 Years: Day Two

Dr Perry comes to the project after a two-year secondment at National Services Scotland where he was part of a working group that helped deliver substantial savings to the NHS drug budget by switching patients from brand-name biologics - effective but highly expensive medications shown to relieve pain and reduce disability - to cheaper, but equally effective, alternatives.

The project highlighted a shortage of national data on rheumatoid arthritis patients, which Dr Perry hopes the new database will address.

It could also be rolled out to other chronic conditions.

Dr Perry said: "In Sweden it's used across conditions and in Dartmouth in the USA it's been used in cystic fibrosis and inflammatory bowel disease (IBS) so the potential is here for a model that, whilst we pioneer it in a discrete area, could extend across chronic conditions. So it's potentially not just going to include rheumatology but could include lots of other conditions."

Fiona McCullock and Hilary Sturrock

AS creative clinical technologists at the Beatson West of Scotland Cancer Centre, Fiona McCulloch and Hilary Sturrock have used their artistic skills to help ease young patients' fear of radiotherapy.

In 2017, the pair began using water-based acrylic paint, donated by the Beatson charity, to revamp plain radiotherapy masks into children's favourite superhero, animal or cartoon character.

During radiotherapy to the brain, head or neck, a made-to-measure radiotherapy mask is worn by patients to help keep their head still.

The former art students, who both attended the Duncan of Jordanstone College of Art and Design in Dundee, realised that this can be frightening for young children and set about working with the patients to devise a fun version of these masks. So far, their designs have included Pikachu, a tiger, the Hulk and a butterfly.

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

Each child's design is stored specially at the hospital for their own use during treatment.

Ms McCulloch said: “Radiotherapy treatment wearing one of these masks can understandably be a very frightening experience for children, and can often feel claustrophobic.

“It’s fantastic to see the positive impact the designs are having, and it’s such a pleasure working with patients and creating their ideas and designs.”

Radiographers at the Beatson hope that over time this initiative will see a decreased use of anaesthetic, which is sometimes required to calm patients and limit movement.

Ms Sturrock added: “I feel grateful to have the opportunity to put my previous study toward such a worthwhile and positive experience for these young patients.

“Although some design requests can start off as a challenge to envision, we have had such great feedback. The radiographers treating these patients have commented on the positive impact a personalised mask or device makes to the child’s experience.”

Morag McKeller

Morag McKellar has spent more than 40 years trying to improve health through better nutrition, from working directly with patients as a hospital dietician to advising on prison menus and national diet action plans.

Her 43-year career in the NHS began in 1975 when she qualified as a dietician.

She said: "It was something I sort of fell into - I wouldn't say I set out to be a dietician. My mother had worked as a nurse, and I was interested in health and science, and the science of nutrition was something that I found interesting.

"There's a perception that it is all about cooking and eating, but that's outdated - that's what it was about 80 years ago.

"For me it's really about the science of nutrition and how you can help someone's recovery and improve their health by helping them make the right choices about what they eat.

"I think that's the most rewarding bit of the job, when you can see someone getting better and making a change.

"I suppose the most frustrating, or challenging bit, is persuading people to make those changes. Sometimes you hear people say 'I've been to the dietician three times and I haven't lots weight' - well, that's not all the dietician's responsibility."

Celebrating 70 NHS Heroes for 70 Years: Day Two

In the 1990s, Ms McKeller was instrumental in developing guidelines which have shaped the vision of what a balanced diet should be, such as the Scottish Diet Action Plan which laid out recommendations for fruit and vegetable intake, and advisory limits for sugar consumption. She also played a key role in the development of the NHS Forth Valley Food Policy, the first of its kind in Scotland.

As a Public Health Nutritionist, she has been recognised both locally and nationally for her work on nutrition strategy and related public health policies, and she was elected a Fellow of the British Dietetic Association in recognition of the significant contribution she has made to the development of the dietetic profession.

Now aged 65, she heads up the Allied Health Professional services for children in NHS Forth Valley.

Rosemary Fletcher

AFTER 41 years as an occupational therapist in Forth Valley, Rosemary Fletcher is still giving up her time to the NHS by coordinating the volunteers that provide an invaluable boost the the health service.

Mrs Fletcher joined the NHS in 1970 at a time when occupational therapy was almost entirely about hospital-based rehabilitation.

She said: "The approach of occupational therapy in the days when I trained was activity-oriented in terms of leisure activities and craft activities. It's changed over the years, but enjoyed doing the craft activities but also helping people to problem solve.

"The focus then was about using various activities to help people in their rehabilitation whereas now it's concentrating a lot more on people's personal activities - what we call the activities of daily living. There's less point in you being able to do lots of craft activities if you can't actually get out of bed, dress yourself and get prepared for the day and for your life, basically.

"There's a lot more pressure now because of the way the NHS is structured. There's a lot more rehabilitation going on in the community, so even when people are at home they still need ongoing rehabilitation.

"When I first qualified, people stayed in hospital until they were much better - until they were really independent, and that was when we used activities to help them and support them to recover."

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

Mrs Fletcher, who rose to Head Occupational Therapist for Acute Services at NHS Forth Valley by the time she retired in 2011, said she would still choose a career in OT today.

"The best thing is helping people and supporting people to live independently or as best a life as they can," she said. "I did have a couple of opportunities to move sideways into other jobs but I always wanted to come back to occupational therapy. It was always a challenge. The days were never the same because every individual has got their own story to tell and their own problems, and they're own approach to how they're going to deal with them."

She is now in charge of recruiting and deploying members of Forth Valley's Retired and Senior Volunteer Programme (RSVP), a team of older people who provide support to staff and patients at Forth Valley Royal Hospital.

Mrs Fletcher said: "People over 60, like me, haven't come to the end of their life. They've still got a lot to offer and it's about how we can fit these people into roles that they are going to enjoy and get benefit from themselves, as well as giving back to the NHS."

Bruce Ritson

Bruce Ritson, retired consultant psychiatrist, former Chair of Scottish Health Action on Alcohol Problems (SHAAP)

Throughout his psychiatry career Dr Bruce Ritson has seen face to face the problems caused by Scotland’s difficult relationship with alcohol.

“It leads to every sort of mayhem, there’s the destructive impact on family life – whether it’s the husband or wife or both,” he said. “It has a devastating effect on work, on crime with alcohol a prevalent factor in violent crime in particular, on physical health but also mental health, depression and brain damage.”

Inspired by the anti-smoking movement and its success at highlighting the health implications of tobacco, Dr Ritson and a group of colleagues formed the Scottish Intercollegiate Group on Alcohol, an informal group of doctors from Scotland’s medical colleges with an interest in raising awareness of the dangers of alcohol abuse. The group later became Scottish Health Action on Alcohol Problems (SHAAP) in 2006.

Celebrating 70 NHS Heroes for 70 Years: Day Two

As chair of the organisation, Dr Ritson became a key figure in bringing attention to the scale of Scotland’s difficult relationship with alcohol, highlighting its physical and mental health implications as well as social impact.

With colleagues, including the late Evelyn Gillan, the organisation’s director before moving to Alcohol Focus Scotland as chief executive, Dr Ritson helped push forward the argument for minimum pricing of alcohol.

Dr Ritson completed his basic medical and postgraduate training at Edinburgh University and Harvard Medical School, later becoming a senior lecturer in psychiatry at Edinburgh University and consultant psychiatrist at Royal Edinburgh Hospital.

His motivation to campaign on alcohol issues was sparked by witnessing the difficulties it caused for his patients and their families, exacerbated, he believes, by the relaxation of licensing laws in the Eighties which saw alcohol become more freely available in supermarkets and corner shops.

“The emphasis was on making Scotland a more continental country, and maybe it did, but it didn’t stop the old habits,” he says.

“There was evidence that alcohol was a growing problem in Scotland which manifested itself in all sorts of areas of life. We were influenced by groups like ASH Scotland and the victory to limit smoking in a public place was a model for us.

“Alcohol is available and so cheap. If we make it less available people would drink less.”

Now retired, Dr Ritson was awarded an OBE for his work in 2013.

Dr Rod Mitchell

Dr Rod Mitchell is trying to crack the puzzle of preserving fertility in young boys stricken by cancer.

Chemotherapy can harm reproductive organs and while Edinburgh scientists previously spearheaded techniques which now allow tissue from pre-pubescent girls to be removed, cryogenically frozen, and re-implanted in adulthood to restore fertility, it is not yet clear how to do the same for boys.

Dr Mitchell, 44, qualified as a paediatrician in Aberdeen before specialising in paediatric endocrinology - the study childhood hormones and related diseases - in Edinburgh. A subsequent PhD in male reproduction led him into his current field.

He said: "I realised as I was doing it that there was a group of patients that we see in clinic that are not well catered for in terms of fertility. These are boys we see after they've had cancer treatment having problems with fertility, and we having been able to do anything about it until now."

Seeing this unmet need, Dr Mitchell, now principal investigator at the Centre for Reproductive Health in Edinburgh alongside his work as a consultant paediatric endocrinologist for NHS Lothian, applied for ethical approval for a study into preserving male fertility in childhood cancer patients.

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

Since launching in 2016, the project has taken samples of testicle tissue from seven boys aged one to 14.

Dr Mitchell said: "The patients are identified by the oncologists who are looking after their cancer. They will then contact me with a patient who is suitable and then myself, along with the oncologist, will counsel them about fertility and then recruit them to the study if appropriate.

"The tissue that we're taking from the boys right now, we still don't know how to make that useful for them in the future - that's the target of the research. But they know we're storing it for them, that it's there.

"The way I look at it, the first pre-pubertal girl where this has worked - in terms of taking tissue, storing it, transplanting it back and then having a live birth - took 20 years. We are starting behind them but I feel is that we've learned a lot from how the female fertility preservation service was established and run ,so we feel very much that we can do this for the boys in a shorter period.

"I use the classic '10 year to solving the problem' timeframe."

Dr John Montgomery

AS a much admired Glasgow GP, Dr John Montgomery has helped pioneer a blueprint for health and social care integration at practice level.

But it is a far cry from the classroom video which first stirred his interest in medicine as a teenager in the 1970s.

Dr Montgomery, 57, said: "I remember very clearly, I think it was third year at secondary school, and they brought in this new fangled video cassette player into the classroom and to try it out they showed us a Horizon programme that they happened to have on video and for some reason it was a video of an orthopaedic surgeon performing an operation on somebody's back and I thought at the time that was pretty cool."

He went on to study medicine and immunology at Glasgow University - at the time, the only university in the UK offering a course in the emerging science - but after toying with the idea of paediatrics or a research career, opted to train as a GP.

He said: "I realised it was a quicker path to helping and treating patients. That's what go me into it I suppose - this ability to very quickly improve health outcomes for an individual patient and improve health outcomes for an entire practice population."

Celebrating 70 NHS Heroes for 70 Years: Day Two

Dr Montgomery became a partner aged 28 at the David Elder Medical Practice in Govan, where has remained for 30 years. He says the work, especially the relationships built up with patients, has been an "absolute joy". In a sign of the affection in which he is held, one patient used to knit baby clothes for his children; another, knowing his love of Star Trek once sent him a Christmas card with a greeting in Kling-on.

In the 1990s, Dr Montgomery was key to developing the city's first practice-based diabetes clinics in recognition of an "exploding" health crisis. He said: "Before that patients would go to hospital and they'd see a different person every time, go back every six months, go to different places for their feet, their eyes, their diet and also the incidence was exploding and we knew hospitals weren't going to be able to manage."

In 2015, Dr Montgomery helped devise and launch Govan SHIP (Social and health Integration Partnership), a Scottish Government-funded initiative which linked up four GP practices with social workers, health visitors, district nurses and other frontline staff in a model which enabled extended GP consultations and extra home visits.

The scheme has been credited with reducing health inequalities in one of Scotland's most deprived areas and boosting GP morale.

Dr Montgomery added: "Our turnover is unbelievably low. The majority of folk only leave the practice when they retire - it's been very satisfying. There's a lot of laughter goes on, a lot of camaraderie within the practice."

David McColl (Image: Kirsty Anderson/Herald&Times)

AS a dentist in one of Scotland's poorest communities, David McColl, deals with "incredible" levels of decay.

He has spoken out about children as young as two requiring multiple extractions and facing lengthy hospital waits to have their rotten teeth removed under general anaesthetic.

Mr McColl, originally from Belfast, graduated from Glasgow University in 1987 and bought his first practice in Castlemilk, Glasgow in 1990. In 1992, he opened his second practice in Govanhill, where he is currently based.

He said: "I certainly wasn't aware of the levels of deprivation in Glasgow - I don't think anyone is when you're a student. I think it's only when you get out into a working environment that you realise what the levels of deprivation are.

"Govanhill has probably been the biggest challenge. Over the past few years with the influx of economic migrants you've got a lot of Roma and Slovakian population in Govanhill now and that brought its real challenges because many of them are deprived from a health perspective.

"They're coming with a different culture and attitudes, they don't really know how to access healthcare properly, they need interpreters to work with them. But more than that it's the children - the levels of decay that we see in the children has been incredible."

His practice has 11,500 on its register.

"The thing I like best about dentistry is treating patients. To me, that's the easy bit - that's the bit I'm trained for. The difficult things are government bureaucracy. As a dentist you have to run a business and you have to comply with health and safety, employment law - we don't have a human resources department, that's just me. For me, that's time taken away from clinical care and to me that's largely wasted time, because you should really be using your skills for the treatment of patients."

Lindsay Reid

FRESH from school, with just a few weeks’ training much of which involved how to wear her uniform correctly, was enough to see student nurse Lindsay Reid allowed onto the ward of Aberdeen Royal Infirmary.

“It was July 1958,” she recalls. “About 50 of us student nurses had had around three months of preliminary training, things like how to make a bed and give an injection – we practiced using oranges – how to wear our hats. The uniform rules were very strict.”

She was placed on the hospital’s gynaecology ward. “We were thrown in at the deep end, I didn’t understand half of it, I had never actually been told the facts of life and here were women who were very ill, dying of cancer.

“I loved looking after the patients, speaking to them and looking after them.”

Her passion, however, was midwifery. But it would take several years, including a number of moves across the UK and abroad with her Army Chaplain husband before she finally qualified.

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

One her first deliveries was in a hospital in Cyprus, where she had to quickly learn the Greek word for ‘push’ – Spróxte.

Back in Fife, she worked as a midwife at Forth Park Maternity Hospital in Kirkcaldy, and then as a midwifery sister working in the community.

“We are talking the Eighties, and mothers were not encouraged to have home births which I thought was very sad,” she recalls. “They were being told how hard it was and they would be better in hospital. It made some women very unhappy.

“One mother insisted. I was sent to talk to her. She said “I want to have my baby at home, and I said ‘that’s okay’. The relief on her face, body and manner was palpable.

“I was there for the birth, and it was just lovely.”

Dr Reid worked in Falkirk and Stirling, going on to teach midwifery and pursue a PhD at the University of Glasgow, focussing her research on the history of midwifery.

She received one of the UK’s highest midwifery honours in 2013 when she became an Honorary Fellow of the Royal College of Midwives.

Morag McLaren

Morag McLaren, NHS Forth Valley, former mental health nurse

To outsiders, the long dark wooden huts behind the boundary wall of the local asylum were places of fear, where strange people with curious conditions were kept locked away – for their own safety and for others.

Inside, however, young student nurse Morag McLaren quickly discovered that far from all patients at Bellsdyke psychiatric hospital in Larbert, near Falkirk, would give any real cause for concern.

It was the 1970s, she was just 17 years old and Bellsdyke cared for almost 1300 patients, some of whom had spent almost their entire life living on its wards. Dementia patients were housed side by side with patients suffering from depression, some with what today would be recognised as relatively minor learning difficulties, others chronically ill, with violent tendencies which required them to be kept secure.

“There were people who had been committed as young teenagers by their families who had spent almost all their adult lives there, sometimes for good reasons, occasionally less so,” adds Ms McLaren.

Young nurses were kept on a tight rein too, expected to be tucked up in their nurses’ home rooms before 11pm and hauled before matron if there was any hint of boyfriends lurking around after hours.

Celebrating 70 NHS Heroes for 70 Years: Day Two

Talk of ‘care in the community’ started in the Seventies, but it would take another decade before long term patients – some of whom had spent years within the hospital – would be ready to take their steps towards independent living.

When they did, the changes were remarkable. “One patient would get dressed and then within an hour be walking around naked,” remembers Morag. “Many years later I was working in rehab, preparing patients for going to the community. An ex-nurse called, frantic because she had just seen her walking down the street.

“I explained she had gone through rehabilitation and was settled in a group home, had learned to shop, budget for herself and was able to go out and about by herself.

“A few years earlier no one could have dreamed that patient would be able to do that.”

Ms McLaren, who recently received a 40 years’ service award, is now NHS Forth Valley Assistant Director of HR in charge of organisational development and training.

“A lot of the work is trying to ensure that we have a good culture and that we achieve the kind of care we want,” she said. “I’ve moved from someone who worked with patients to helping staff deliver the best care they can.”

Helen Little (left)

Starting out as a nurse before serving as a Clinical Teacher and a professional secretary Helen Little served in the NHS for 52 years.

Ms Little, 82, said: “I started in September 1952, as a pre-trainee nurse at the Grove Hospital - an annexe of Dumfries and Galloway Royal Infirmary.

“General Nurse Training began in 1953 and was completed in 1956.

Reflecting on her work at Dumfries and Galloway Royal Infirmary, she said: “I had a great number of roles, starting at The Grove as a naive, shy young girl.

“During the next three years we gradually received more responsibility.

“In my third year I was in charge of an acute Medical Ward while the senior staff were on holiday. The ward could not have been busier, with a paralysed lady with severe tetanus and a very ill chap attempting to smoke with his oxygen in situ.

“After marrying in 1957, a colleague and I were permitted to work part time - the first ever in DGRI.

“Of course I had to leave just before the birth of my son as we had to resign and then apply where a post was available.

“Lochmaben Sanitorium did and I worked nights, week on, week off, for about a year. I was then lucky to be appointed night sister at the Grove Hospital, on the same rota.

“About four years later I obtained the role of Pupil Nurse Tutor. When, unfortunately the Pupil Nurses were no longer accepted, my position changed and I became a Clinical Teacher.

“In 1995 there was another change, as Clinical Teachers were lost and I was created Professional Secretary to DG Nursing. I worked here developing nursing and midwifery procedures until 2009, enjoying a contented, happy working life.”