Palliative Medicine in the UK c.1970–2010 The transcript of a Witness Seminar held by the History of Modern Biomedicine Research Group, Queen Mary, University of London, on 28 February 2012 edited by c Overy and e M tansey volume 45 2013 ©the trustee of the Wellcome trust, london, 2013 First published by Queen Mary, University of london, 2013 the history of Modern Biomedicine Research Group is funded by the Wellcome trust, which is a registered charity, no. 210183. iSBn 978 0 90223 882 4 all volumes are freely available online at www.history.qmul.ac.uk/research/modbiomed/ wellcome_witnesses/ Please cite as: Overy c, tansey e M. (eds) (2013) Palliative Medicine in the UK c.1970–2010. Wellcome Witnesses to twentieth century Medicine, vol. 45. london: Queen Mary, University of london. cONTENTS illustrations and credits v abbreviations vii Witness Seminars: Meetings and publications; acknowledgements E M Tansey and C Overy ix introduction William Notcutt xxi transcript Edited by C Overy and E M Tansey 1 appendix 1 Drugs commonly used at St Christopher’s Hospice (1968) 83 appendix 2 Participants at the inaugural meeting that approved the formation of the Association of Palliative Care and Hospice Doctors in October 1985 87 appendix 3 Minutes of the inaugural meeting that approved the formation of the Association of Palliative Care and Hospice Doctors in October 1985 91 appendix 4 Some thoughts and personal reflections on nurses’ contributions to the start of multi-disciplinary teams in some hospitals by Ms Janet Gahegan 97 References 99 Biographical notes 111 index 123 ILLUStRATIOnS AND cREDITS Figure 1 Meeting at St Christopher’s Hospice c.1976. Provided and reproduced by permission of Sir Kenneth Calman. 4 Figure 2 Dame Cicely Saunders at the Witness Seminar ‘Innovation in Pain Management’, December 2002. Reproduced by permission of the Wellcome Library, London. 7 Figure 3 Tom West’s leaving party, 6 February 1992, held in Mary Baines’ home. Image and key provided and reproduced by permission of Dr Mary Baines. 8 Figure 4 Our Lady’s Wing, St Joseph’s Hospice, Hackney, 1957. Provided by Dr Michelle Winslow and reproduced by permission of St Joseph’s Hospice, Hackney. 25 table 1 Outline programme for ‘Palliative Medicine in the UK c.1970–2010’ Witness Seminar. 6 v AbbreviatiOnS AHP Allied Health Profession APM Association for Palliative Medicine CRMF Cancer Relief Macmillan Fund DGH District General Hospital DHSS Department of Health and Social Security DoH Department of Health FFA Fellow of the Faculty of Anaesthetics FRCS Fellow of the Royal College of Surgeons ICRF Imperial Cancer Research Fund IPE Interprofessional Practice Education JCHMT Joint Committee on Higher Medical Training LOROS Leicestershire and Rutland Organisation for the Relief of Suffering MRC Medical Research Council MRCGP Member of the Royal College of General Practitioners MRCP Member of the Royal College of Physicians NICE National Institute for Health and Clinical Excellence NSCR National Society for Cancer Relief PCT Primary Care Trust RCGP Royal College of General Practitioners RCT Randomized Control Trial SAC Specialist Advisory Committee SHO Senior House Officer SR Senior Registrar UCH University College Hospital vii WITNESS SeMINARS: MEETINGS AND PUBLICATIONS The Witness Seminar is a particularly specialized form of oral history, where several people associated with a particular set of circumstances or events are invited to meet together to discuss, debate, and agree or disagree about their memories. This format was first used by the Wellcome Trust’s History of Twentieth Century Medicine Group in 1993 to address issues associated with the discovery of monoclonal antibodies, and since then more than 50 meetings have been held on biomedical topics. This has proved an ideal way to bring together clinicians, scientists, historians and others interested in contemporary medical history and to encourage the creation and deposit of archival sources for present and future use. The History of Twentieth Century Medicine Group became a part of the Wellcome Trust’s Centre for the History of Medicine at UCL from October 2000 until September 2010. It has been part of the School of History, Queen Mary, University of London, since October 2010, as the History of Modern Biomedicine Research Group, which the Wellcome Trust continues to fund under a Strategic Award entitled ‘The Makers of Modern Biomedicine’. Once an appropriate topic has been identified, often with the help of external advisers, suitable participants are invited. This inevitably leads to further suggestions of people to invite. As the organization of the Seminar progresses, a flexible outline plan for the meeting is devised, usually with assistance from the meeting’s chairman. Each Witness Seminar is fully recorded, the discussion is transcribed and the unedited transcript immediately sent to every participant. Each is asked to check his or her own contribution and to provide brief biographical details. The editors turn the transcript into readable text, and incorporate participants’ minor corrections and comments. Biographical and bibliographical details are added as footnotes, as are more substantial comments provided by participants. The final scripts are then sent to every contributor, accompanied by forms assigning copyright to the Wellcome Trust. Copies of the original, and edited, transcript and additional correspondence generated by the editorial process are deposited with the records of each meeting in Archives and Manuscripts, Wellcome Library, London. ix For all our volumes, we hope that even if the precise details of the more technical sections are not clear to the non-specialist, the sense and significance of the events will be understandable to all readers. Our aim is that the volumes inform those with a general interest in the history of modern medicine and medical science; provide historians with new insights, fresh material for study, and further themes for research; and emphasize to the participants that their own working lives are of proper and necessary concern to historians. x acKnowledGeMentS The topic of ‘Palliative Medicine in the UK c.1970–2000’ was suggested as a Witness Seminar by Dr Bill Noble and Dr Michelle Winslow and we are grateful for their assistance over several months in planning the meeting. We are also grateful to Sir Kenneth Calman for his excellent chairing of the occasion; Dr William Notcutt for a very pertinent and personal introduction and to Dr Michelle Winslow for her comments and advice on the draft transcript. We also thank several people for providing images and documents for the Appendices: Dr Mary Baines, Sir Kenneth Calman, Dr Richard Hillier, Ms Janet Gahegan and Dr Michelle Winslow, and for permission to reproduce images we thank Dr Mary Baines, Sir Kenneth Calman, Mr Toney Feasey at St Joseph’s Hospice, Hackney, the Wellcome Library, London and Ms Sabine Tuck at the Association for Palliative Medicine. Additionally, our thanks go to Ms Denise Brady, Librarian at St Christopher’s Hospice for help with footnotes, also to several of the Seminar participants for their help with the reconstruction of a short missing section of the recording (pages 53–60). As with all our meetings, we depend a great deal on Wellcome Trust staff to ensure their smooth running: the Audiovisual Department, Catering, Reception, Security and Wellcome Images. We are also grateful to Mr Akio Morishima for the design and production of this volume; the indexer Ms Liza Furnival; Mrs Sarah Beanland and Ms Fiona Plowman for proof reading; Mrs Deborah Gee for transcribing the seminar and Mr Adam Wilkinson and Mrs Lois Reynolds who assisted in running the meeting. Finally we thank the Wellcome Trust for supporting this programme. Tilli Tansey Caroline Overy School of History, Queen Mary, University of London xi vOlUMeS IN THIS SeRIES 1. Technology transfer in Britain: The case of monoclonal antibodies Self and non-self: A history of autoimmunity Endogenous opiates The Committee on Safety of Drugs (1997) ISBN 1 86983 579 4 2. Making the human body transparent: The impact of NMR and MRI Research in general practice Drugs in psychiatric practice The MRC Common Cold Unit (1998) ISBN 1 86983 539 5 3. Early heart transplant surgery in the UK (1999) ISBN 1 84129 007 6 4. Haemophilia: Recent history of clinical management (1999) ISBN 1 84129 008 4 5. Looking at the unborn: Historical aspects of obstetric ultrasound (2000) ISBN 1 84129 011 4 6. Post penicillin antibiotics: From acceptance to resistance? (2000) ISBN 1 84129 012 2 7. Clinical research in Britain, 1950–1980 (2000) ISBN 1 84129 016 5 8. Intestinal absorption (2000) ISBN 1 84129 017 3 9. Neonatal intensive care (2001) ISBN 0 85484 076 1 xiii 10. British contributions to medical research and education in Africa after the Second World War (2001) ISBN 0 85484 077 X 11. Childhood asthma and beyond (2001) ISBN 0 85484 078 8 12. Maternal care (2001) ISBN 0 85484 079 6 13. Population-based research in south Wales: The MRC Pneumoconiosis Research Unit and the MRC Epidemiology Unit (2002) ISBN 0 85484 081 8 14. Peptic ulcer: Rise and fall (2002) ISBN 0 85484 084 2 15. Leukaemia (2003) ISBN 0 85484 087 7 16. The MRC Applied Psychology Unit (2003) ISBN 0 85484 088 5 17. Genetic testing (2003) ISBN 0 85484 094 X 18. Foot and mouth disease: The 1967 outbreak and its aftermath (2003) ISBN 0 85484 096 6 19. Environmental toxicology: The legacy of Silent Spring (2004) ISBN 0 85484 091 5 20. Cystic fibrosis (2004) ISBN 0 85484 086 9 21. Innovation in pain management (2004) ISBN 978 0 85484 097 7 xiv 22. The Rhesus factor and disease prevention (2004) ISBN 978 0 85484 099 1 23. The recent history of platelets in thrombosis and other disorders (2005) ISBN 978 0 85484 103 5 24.