Graham Neale: memorial service eulogy
Susan Burnett
I must begin with an apology – an apology to Graham – he wasn’t one for public praise – and I can hear him now telling me to sit down and not embarrass him. Over the last few years we shared the office in the medical school building at Imperial where we had many good conversations about how to improve patient safety, we also talked football (more of which later) and right up until the end we shared some good humour. I know Graham liked a social gathering and to see ‘his girls’ as he called us, looking good, so I made a particular effort with my outfit today – and I’m wearing a skirt!
Graham was a very special doctor who touched the lives of a great many people, many that he worked with and helped directly and others around the world whose care was influenced by Graham’s work in patient safety.
Let me begin in 1997when Charles Vincent was running the Clinical Risk Unit at UCL. He met Graham through the Board of AvMA. Charles was trying to raise money for a study into adverse events in British hospitals and finding it incredibly difficult. Graham offered to help and through both their efforts they raised money for the first study. Graham was the clinical lead of the study, uncovering the figure of 10% of patients being harmed by their health care in our hospitals.
Without Graham the study that has been so influential in terms of the development of patient safety in the UK, wouldn’t have happened. Working with Maria Woloshynowych, Graham reviewed over a 1000 sets of notes, and the early findings were influential, being used by, the UK’s Chief Medical Officer, Sir Liam Donaldson, in the report ‘An Organisation with a Memory’ which led to the setting up of the National Patient Safety Agency – and that is where I was working when I first met Graham – I was leading the roll-out the national reporting system for adverse events and setting up the network of patient safety managers.
Despite the 12 years that have passed since the paper - written by Charles, Graham and Maria - was published on harm in British hospitals, it still stands out as a landmark piece of research.
This study brought together Graham’s clinical knowledge with his medico-legal work, and his outrage about poor clinical practice and about the lack of care that some people experienced when they had been harmed by their healthcare.
Graham’s medico-legal work was not just about helping patients and families get legal redress for harm caused by healthcare, he went further – he would try to find a good clinician to help them in the aftermath. I had many conversations with him about the best way to help someone he was in touch with – he would ask about how to report things to senior hospital managers; about how to get a patient some extra care at a different trust, how to report that he had found poor care in a system, without blaming the people involved.
In 2002 Graham came to join Charles Vincent in the Clinical Safety Research Unit in the Dept of Surgery at Imperial College where he was a mentor, friend and inspiration to all of us. Charles said that his abiding memory is of Graham bounding in to his office, probably on a weekly basis, with a new research proposal, a newly published paper and enough ideas for ten years of research and a team of 50!. He used to talk to us in the office about ideas for new studies, particularly his interest in finding ways to reduce diagnostic errors.
Charles has told me that Graham was different from other doctors that he knew, first because Graham was brave enough to criticise when patients had received poor care – whoever was involved – and second because he was brave enough to work with a psychologist – he must have enjoyed this though because he ended up working with lots of them!
Soon after he joined our team he began supervising the PhD research of Dr Sisse Olsen, getting doctors involved in reviewing their own records. This work led to the World Health Organisations toolkit to assess patient safety in poor and developing countries and it is here where Grahams work has permeated the lives of thousands around the world for the better. This work led to many publications and to a letter in the BMJ about the need for greater medical leadership in patient safety.
Sisse told me that about a month after she started her PhD she became pregnant – she was really worried about what Graham would say, but she had nothing to worry about, he was delighted and when it came to her writing up, Graham would call round to discuss the research and Sisse would hand him the baby and start writing!
His work on record review was influential with the NHS Institute for Improvement. Nicola Davey and colleagues at the Institute who were developing the Global Trigger Tool for use in UK hospitals have said how the publication of papers on the topic of record review inspired them and gave them the confidence to develop the trigger tools – a form of record review but looking for specific triggers that may indicate harm. These trigger tools are now used in most NHS hospitals in some form or another to uncover harm.
Graham also loved teaching medical students and kept this up for as long as possible, mainly at UCLH. He liked to ‘get them early’ as he would say – teaching them about patient safety before they were on the wards. Maria Ahmed joined our research unit as a junior doctor and describes Graham as an absolute legend. She recalls how Graham took her under his wing to supervise the first of her PhD studies to examine junior doctors' reflections on patient safety. She said he inspired a zest for research and encouraged her to 'always remain an academic' – seeking to understand and find solutions.
He often spoke about the students he taught with real pride and it is great to see how many of them have put messages on the memorial page on the internet. He also supported DAPS – doctors advancing patient safety – in fact whenever there was a meeting or event or group that he could advise or help or just learn more about patient safety, he was there.
Graham was known to many members of Clinical Human Factors Group too. He attended and actively contributed to one of their early Standing Group meetings at Imperial College and was really keen to see the group progress. In March of this year Graham wrote to the CHFG thanking them for drawing his attention to the Horizon Programme on the BBC called ‘How to avoid mistakes in surgery’. He shared some of his own personal experiences and continued to encourage the group to work to create an environment where the clinician could truly take an holistic and personal approach to ‘their patients’. The Clinical Human Factors Group leader, Martin Bromiley has written a lovely obituary on the group’s web site for Graham.
Graham was remarkable for his intellect, his extraordinary memory and range of interests but mostly his utter lack of self importance. No matter how eminent or how junior, whether a senior clinician or a patient, everyone received his absolute attention and where needed, his unfailing help. Even at the end of his life he was emailing to help our researchers – Anam Parand said received a list of the different carers that were visiting him to help her in her research about patient safety in people’s homes.
He was great around the office too. His desk was always piled high with medical records but he still had time to talk – many along our corridor at work have said how much they enjoyed his company over lunch in our small kitchen. He often spoke about his children – so we got to hear what you were all up to! Rachel Davis described how he used to come in to see the researchers in the morning asking ‘how are my girls’ – determined for Rachel to find herself someone wonderful to settle down with to stop her being so wild as he described her!
He loved clinical challenges and through this was a great teacher, always encouraging opinion and thought in others. Susy Long, a fellow physician, has fond memories of him testing her with the latest case he was grappling with - "so what would you have done girl?” he would ask - always testing, thinking and teaching.
If Graham had one failing though, it was that he was an Arsenal fan - I speak as a supporter of Taunton Town! When one of the German members of our research team, Anna Renz was trying to think of names for her new baby, Graham went through the list of German’s who had played for Arsenal - I think he wanted the baby called Jens Lehman! We teased him when Arsenal weren’t doing too well. Even towards the end when he lost the power of speech he was communicating to us – in particular to Renata Samulnik our Centre Manager on the next desk – he would write things down and with a few words on the paper accompanied by his big grin, he could make us laugh!
Today we are celebrating Graham’s life – and there is much for us to celebrate. Graham’s early work in patient safety - at a time when it was not the ‘done thing’ to criticise fellow doctors – how he helped to open up the profession, open up everyone’s eyes to the harm that was happening in our healthcare system, how he helped to get us talking and doing something about patient safety. Through his work with Sisse doctors around the world now have validated tools to review practice. Through his tutoring and teaching of medical students and fellow clinicians many more doctors are now engaged in work to improve patient safety. And through his medico-legal work many patients who have been harmed by their healthcare have not only received redress, but have been helped to have good care in the aftermath.
Much to celebrate - and to do Graham justice we must continue the work to improve patient safety – and to help patients whenever we can.
Thank you