Martin McNicolBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e6247 (Published 17 September 2012) Cite this as: BMJ 2012;345:e6247
- Peter Davies, freelance journalist, London
The incidence of tuberculosis surged in the early 1970s among Asian people in the London borough of Brent, many of whom had been expelled recently from Idi Amin’s Uganda. At the epidemic’s peak, doctors saw as many as 360 cases a year. Martin McNicol, who has died aged 81, was a respiratory physician based at the Central Middlesex Hospital and former president of the British Thoracic Society. He was ahead of his time in managing the outbreak with chemoprophylaxis for newly arrived immigrants and the BCG vaccination at birth for all children born in Brent. Most people with active disease were managed as outpatients with excellent results, and by the 1980s the incidence of the disease fell⇓.
McNicol’s formative years as a house officer in the mid-1950s coincided with the early era of antibiotics: he later recalled excitement at the introduction of intravenous tetracycline and chloramphenicol, which heralded the possibility of controlling infection with drugs. In 1958 he joined Hammersmith Hospital, where he encountered the start of a more scientific approach to respiratory medicine under the epidemiologist Charles Fletcher, the physician Philip Hugh-Jones, and the physiologist John West. McNicol coauthored the seminal book, Respiratory Failure, with two other Hammersmith colleagues—the physiologist Edward James Moran Campbell and the anaesthetist Keith Sykes—and it was published in 1969.
He moved to the Central Middlesex Hospital as a research registrar, becoming a consultant in 1964. McNicol later reflected that he had wanted to work in such a hospital because it was “based on clinical service, taught students, and maintained a significant research presence.” McNicol’s influence in teaching and research helped attract many able junior doctors who went on to take prominent positions.
Non-invasive ventilation and haemofiltration
“He was a young dynamic physician who galvanised the place,” said his former consultant colleague John Riordan. For example, McNicol helped open one of the United Kingdom’s first coronary care units, developed a cardiac arrest service, and introduced high level cardiac intensive care for patients who needed detailed observation or intervention, such as respiratory support. When the hospital appointed a cardiologist, McNicol withdrew from the unit and established the hospital’s intensive therapy unit, which adopted non-invasive ventilation and haemofiltration long before it became routine in such units. This was one of the first units where respiratory physicians worked closely with anaesthetists, turning the Central Middlesex Hospital into a cutting edge clinical centre.
The hospital also gained a reputation for innovation in the management and organisation of care under McNicol’s leadership. Soon after being appointed a consultant, he became involved in management through the general medical advisory committee and the hospital medical committee, then the main official avenues through which doctors could influence the institutions in which they worked. He regarded management and multidisciplinary team working as key to improving care, and he encouraged doctors and non-medical staff to work together long before it came to be seen as essential to any well functioning healthcare organisation. For example, in the late 1980s he adopted a model from Guy’s Hospital and set up clinical directorates, jointly headed by a doctor, nurse, and manager. Each directorate had its own budget and they were designed to enable staff working with patients to have more say in deciding how resources were used, a principle to which the entire NHS now aspires.
Ever keen to improve quality of care and the patient experience, McNicol was one of the first in the UK to foster multidisciplinary pathway management. By the 1990s the Central Middlesex Hospital had multidisciplinary clinical records and defined pathways for all common inpatient conditions, innovations now viewed as crucial for efficient evidence based practice.
McNicol chaired Brent’s health authority for two years in the 1980s. These were politically divisive times, and some authority members, determined to resist at all costs what they saw as the Thatcher government’s programme of NHS cuts and closures, revelled in their “loony left” reputation. “Martin was good at managing the difficult politics of how to keep things moving,” said Riordan.
He went on to negotiate the merger of Brent and Paddington health authorities to form Parkside, which he believed essential for the Central Middlesex Hospital to bolster its influence and retain its teaching status, if not its very existence. Because north west London had too many hospital beds, and no medical school was based at the Central Middlesex Hospital, it might otherwise have been vulnerable to the interests of more powerful neighbours, such as St Mary’s or Charing Cross Hospitals.
He masterminded the hospital’s bid to become one of the first NHS trusts in 1991, even though it was a controversial aspect of the creation of the internal market, caricatured as “opting out” of the NHS. This was an ironic accusation to level at McNicol, who had never treated a private patient. He retired from clinical medicine to chair the trust from 1991 to 1995 and spent a year chairing the new NHS Trust Federation. In this role he worked with secretaries of state but found the experience stressful. As a senior clinician he stood out among other trust chairs, many of whom had business backgrounds and were new to the NHS. The Trust Federation eventually became part of the NHS Confederation. He was awarded officer of the most excellent order of the British empire in 1990.
In retirement he worked on reform of the healthcare systems in Russia for four years; studied the history of country house gardens; and was a keen photographer, especially of the minster at Beverley, where he lived. He leaves his wife, Moira, and three daughters.
Cite this as: BMJ 2012;345:e6247
Martin Wilkinson McNicol, consultant respiratory physician (b 1931; q 1953, Glasgow), died on 8 August 2012 from complications of psoriatric arthritis.