I met Graham when I was working on ward B2 as a Staff Nurse in the early 60s. He was Christopher Booth's houseman. 

I don't know what made me look him up. Part of me wishes I hadn't. I am devastated that he is no longer loping along corridors or swooping through the ward.

Probably the nicest man I have ever met, and I shall always remember what wise councel  he gave, and what support to a not very confident nurse.

Nor will I forget that on the day after I married, (supposed to be a secret) he organised the entire Booth team to come in on that Saturday morning to greet me.Yes even Christopher!

I feel I am missing a dear friend even though I have not been in touch in the intervening years.

I am sad that his last years were not entirely healthy. My best wishes to his family,

Sheila Somerville, nee Henry.

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

Graham and I met in January 1964, in the main corridor of Hammersmith Hospital when I started working for Sir Christopher Booth. I have the greatest respect for Graham who was a hard working and dedicated physician with enormous human compassion – in short a wonderful ‘doctor’s doctor’.

There are many anecdotes, which come to mind as I recall the start of our friendship. For example, as part of my initiation rites, Graham introduced me to the dramatis personae around the hospital. In B block, we bumped into Hugh McMichael who, Graham explained, was Chris’ houseman at the time. "No relation to Sir John McMichael?” I asked. "Oh yes, that's his son", Graham replied with a deadpan non-committal expression. We then walked into the Lower Medical Corridor where we met Chris' senior registrar of the day, Michael Brain, which again provoked my inevitable question, "Is there any connection to Lord Brain, the neurologist?" With just the suggestion of a mischievous smile, Graham again confirmed the filial link. As you might imagine, this only served to convince me that, contrary to its reputation as a free-thinking, meritocratic, liberal institution, the Hammersmith was clearly a den of nepotism. But of course the truth was very different since both these individuals richly deserved their appointments, which clearly had been made on merit alone.

Our first few professional years together were challenging, stimulating, interesting, career-changing, exciting, rewarding and mostly fun despite the hard work, with some bouts of stress, anxiety, self-doubt and even, occasionally, mild depression. At that time, the gastroenterology team consisted of an unlikely cocktail of different personalities, which nonetheless worked well together under Chris' leadership. It is impressive to see how so many of the friendships forged at that time, remain strong today.

The “gastro lab” in the Lower Medical Corridor was far from luxurious but the team working there was an effective and productive one, and above all, a happy one. Gilbert used to affectionately tease Graham, referring to him as ‘The Lurcher’ a name based on his inimitable loping gait as he strode down the corridor, often bearing large volumes of urine samples for his research. I also recall Graham’s work with Gil attempting to unravel the mysteries of rickets and osteomalacia in post-gastrectomy patients, and in those with small bowel bacterial overgrowth.

Graham’s greatest strength though, was perhaps the pursuit of clinical science at the bedside, and his enormous patience and persistence, in successfully unraveling complex clinical problems which had defeated other lesser mortals.

Others in the department included Mike Brain who was pursuing his dual haematological and gastroenterological interests, Jimmy Stewart who was TK Stubbins research fellow and was carrying out innumerable Crosby capsule biopsies in patients suspected of having coeliac disease or tropical sprue, and Gilbert Thomson who was continuing his research on vitamin D absorption. Gil’s work also involved collaborating with Graham on the bio-assay of circulating vitamin D, using rachitic rats. We all enjoyed the help of Janet Heath who was remarkably tolerant and hard-working with such diverse tasks as homogenising faecal samples, preparing the everted sacs for studies of intestinal transport, as well as quantitative laboratory assays. All this seems a million miles away from the genomics, proteomics, cell and molecular biological techniques, of today. However, our clinical research and relatively simple laboratory-based investigations were, in their own modest way, ground-breaking at that time.

A few months after I arrived at Hammersmith, Evelyn and I decided to get married. We were searching for suitable accommodation. At the same time, Graham was also trying to rent a flat and the Postgraduate School office had given him the address of accommodation at Fife Road in East Sheen. This proved to be exceptionally good accommodation. However, in an extraordinary act of generosity Graham kindly agreed to relinquish his option on this house so that, as newlyweds, Evelyn and I might benefit from it. In the end, it was not a question deciding whether or not we would inherit his option, but rather whether we would ‘pass muster’ during an exhaustive interview/cross-examination by the landlady, to see if we were suitable tenants. We shared the house with the lady in question, Miss Catherine Judson, who subsequently became a good friend. In fact, I suspect that in some ways we became her surrogate children while for us, she became a parent substitute. Either way, Evelyn and I will always be grateful to Graham for his role in launching us on our married life in this elegant house. In fact, Catherine was a Telegraph-reading, true blue Tory who was at the opposite end of the political spectrum from Graham’s own left-wing principles. Indeed, having forsaken his option on this desirable accommodation, he often rationalised this subsequently by suggesting that his, and Catherine's, political views would never have been compatible.

Gilbert and I landed up in Boston during the summer of 1966 and whilst we were away, Chris Booth became the Director of the Department of Medicine at Hammersmith. By the time I returned from the States after my two-year stint there, Chris had managed to engineer consultant appointments for Graham, Gilbert and, subsequently, me. At the same time, gastroenterology had gone from strength to strength and the unit had been joined by Soad, Tim Peters, Adrian Douglas and shortly thereafter by others including Bill Doe, Gershey Hepner, Vint Chadwick, Elwyn Elias and a long list of other bright registrars and research fellows. Conducting a teaching ward round and struggling to keep some semblance of order with this lot was a baptism of fire for a novice consultant!

But again we have a more personal reason to recall our return from Boston. At that time, Graham was living in a flat in Acton and, for the second time, he rescued us by kindly letting us use his flat there for about a week, until we found some alternative accommodation. This was a godsend and, 41 years later, we are still grateful to him for it. In fact, all was well until the first morning when Evelyn had gone out shopping and I was dashing out the door, perhaps late for an outpatient clinic (as usual!). Unfortunately, we did not realise that the door was self-closing and when it slammed shut behind us, we were left outside with the only Yale key available on the inside - we survived!

As young new consultants, there was a fast learning curve but, as always, Graham had a wonderful "networking" talent and a great capacity to develop collaborative links with other departments, including biochemistry and the invaluable resource of detailed balance studies in the metabolic unit. We were all particularly impressed by a very bright young Irish nursing sister, Rosemary Geoghegan, who was in charge of the unit but none more so than Graham…and the rest is history.

Even though our professional paths diverged in the 1970’s, when Graham was appointed to the Chair of Medicine at Trinity College Dublin, and I moved to Guy's in January 1974 (exactly 10 years after I first arrived in London), this did not diminish our friendship and I have happy memories of visiting Graham in Dublin on a couple of occasions. On one such occasion the magnetic fame of a distinguished speaker from London resulted in an audience of at least three - Graham, one of his colleagues and the determined speaker with a punctured ego (me). I squirm to think about the insensitivity of insisting on giving my talk to such a small and probably totally bored audience - perhaps concerned that if I didn't, I could not legitimately claim my admittedly modest travel and hotel expenses.

On another occasion, Graham and Rosemary kindly entertained us at their home in Dublin and we also dined in the elegant College of Surgeons building in the presence of the then Taoiseach. By that time Graham had already become remarkably ‘street-wise’ about the machinations of Irish politics.

Perhaps one of the criteria for a personal, as well as a professional friendship, is the social activities away from work. Evelyn and I both have warm memories of a wonderful summer weekend with Graham, and his family near Cambridge; with delightful walks through the East Anglian countryside and beside the River Cam.

Evelyn and I both greatly admired Graham and his principles and the many things he has achieved in his professional life.