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Professor John Moxham, Retired Professor of Respiratory Medicine, King's College London

Published on: 21 Jul 2022
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AUTHORS:  Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov 

In this series the Medspire team interviews doctors about their career, their specialty, the choices they have made and their advice for doctors and medical students. 

Here the subject is professor John Moxham, a retired professor of respiratory medicine at King's College London. Professor Moxham has had a distinguished career in research and last year was awarded the British Thoracic Society Medal for his contributions to respiratory physiology.

A podcast of this interview is available here:

 

How did you get to where you are today?

I started at UCL in 1968, and qualified in 1973. Then I became a house physician at UCH. I was a house physician on the professorial medical unit, and the professor was Professor Wrong, a nephrologist. I did the student magazine and, before he arrived, I wrote a long article about how it was the wrong choice, because the students wanted some other chap to be the professor. 

Nevertheless, I got on all right with Professor Wrong, even if we got off on the wrong foot. When I finished as a house physician, I did SHO jobs, including one in cardiology at the Hammersmith, which was important to me. 

Then I returned to UCH as a registrar, which was also great because I was very fond of UCH. During that period, I also started doing research. I became a junior lecturer working with Professor Richard Edwards, and he was keen that I worked on the respiratory muscles.  I was a senior registrar at the Brompton Hospital, and then a consultant physician and respiratory consultant at King's College Hospital in 1981. Dr Costello and I were the only two chest physicians. 

It is interesting to note how few consultants there were back in the day. I had beds at KCH, I had beds at Dulwich Hospital, and I had beds and did outpatients in St Giles. The whole KCH group had 2,000 beds and now it's got 900, which is the way of all hospitals. 

 

How did studying at the London School of Economics before starting medicine shape your career? 

I learnt a lot about economics, politics, history and sociology, and therefore a lot about society, which is not a bad thing if you're interested in medicine. I also did a lot of demonstrating. It was a pretty lively time. 

The Empire was breaking up and various countries were getting independence, so there was lots of demonstrating. There was also apartheid to demonstrate against, and it was the time of the Vietnam War. There were massive demonstrations, and I'm pleased to say I was in Grosvenor Square. 

During that time I also became increasingly convinced that I wanted to be a doctor and to work directly with people to try and help them. I'd thought about it when I was at school, but went off the idea - now I was very much back on the idea. 

My time at the LSE was very important to me and undoubtedly shaped me. I did a year's research for the LSE when I finished my BSc, which allowed me to make a bit of money and save a bit of money for what was to come. 

 

What attracted you to respiratory medicine? 

When I was an SHO and when I was a registrar, I didn't know what specialty I wanted to go into. As a registrar, in those days you rotated around a whole lot of specialties. The reason I got into respiratory medicine was because it was the specialty where I started to do some research. 

I would have been equally happy being a cardiologist or a gastroenterologist. It was because I started doing research that was relevant to the respiratory system that I ended up going into respiratory medicine. 

 

What was the motivation for your career in research? 

I rotated around the medical unit at UCH and the various professors, and every week the people involved in the unit had a meeting where they discussed interesting cases. Us juniors could go along to that meeting, but all the professors and consultants were in the room. 

I have always been on time for meetings - in fact I'm normally a bit early. Professor Richard Edwards was also always there a bit early. He also found it very difficult to talk to people. So he and I would sit there, and because there was nobody else there,  I used to chat to him. I wasn't working for him, but I got to know him. 

After a while, he said to me: ‘Would I like to do research?’ I said, 'I'd quite like to do some’. So I was appointed as an assistant lecturer to work with him on research. His interest at that time was skeletal muscle - he was particularly interested in making some progress with the respiratory muscles.  

He said: 'Why don't we have a go at sorting out the respiratory muscles - come and do research with me’.  So that's how I got into it. That was the focus of my research, and then I became more involved with respiratory medicine. 

 

What did you love about research? 

It's wonderful finding out new things. It's great working with other people - you can't do research on your own, but I like working in groups of people. I worked like crazy, but so did everybody else. 

It's wonderful working with people who are working really hard, but sharing with each other and helping each other to try and make some important progress. It may seem tiny, but it's not just looking at what exists, it's trying to find something new, which is brilliant. 

 

What are your proudest achievements as a researcher? 

We did a lot of work on pulmonary rehabilitation and people with chronic obstructive pulmonary disease, and we demonstrated, quite well, that you could improve outcomes for patients with COPD with pulmonary rehabilitation.  You could stop them going into hospital so often, and you could improve the quality of their life and their breathlessness. 

The work we did on pulmonary rehabilitation was important. At the time, other groups were doing pulmonary rehabilitation, but they weren't asking the patients to do very much. The patients reported that they felt better, but it was difficult to demonstrate physiological changes, and changes in what happened subsequently to them. 

We really pushed the patients, but they enjoyed that, because they were in groups. They formed clubs, and afterwards they carried on having their pulmonary rehabilitation classes because they had formed bonds with each other. NIV (non-invasive ventilation)was very important. I started using NIV, ad hoc, because I thought it might be a good idea. 

I remember persuading the friends of the hospital to buy me a couple of ventilators. Then we did a proper study on the use of non-invasive ventilation in patients who had exacerbations of COPD. Now, you would expect people to have this treatment, but back then, you came in with a severe exacerbation, you were treated with antibiotics, and basically you either made it or you didn't. 

If you didn't, well, some would get taken to ICU, but there were very few ICU beds, so a lot of people died. So we did a landmark study on non-invasive ventilation, which showed that it was good for patients and reduced mortality. 

Universities have to submit what they call ‘impact cases’, and both of those examples have been put in by King's College London as impact cases. I’m proud of that. We also did a lot of work working on the diaphragm and measuring the diaphragm EMG - the activation of the diaphragm. We found that the level of activation of the diaphragm tells you how hard you're working with your breathing, which tells you how bad your disease is, so that was helpful. 

Also, it correlates very well with your breathlessness. There's a very strong relationship between the neural drive, which is going down your phrenic nerves to your diaphragm, which we were measuring, and the sensation of breathlessness - in other words, the brain is aware of this level of drive. 

We proved that when people tell you how breathless they are, if you ask them very carefully, they are really telling you how bad their disease is. It's the old adage - you've just got to trust the patients, you can learn a lot just from talking to the patients, and ‘the patient is always right’. 

 

How can doctors get involved in research?

You need a very good supervisor - someone you really trust, who will support you, and is very bright. You've really got to ask around to try to get a good supervisor. You've got to be a great collaborator. You can't do a lot of this stuff on your own - you need other people around to help you with various studies, and perhaps be subjects for studies if you're doing studies on humans. 

You need to help them, and you need an ‘esprit de corps’ to drive that. When I first did research at UCH, there were four other people in this room. The room was on the ward, which was good - particularly when you're studying patients, as the division between academia - in some building - and the hospital is nonsense. 

They were a great team and I learnt a lot from them. They were working on very different projects to me. Interestingly, they all became professors. So, choose a good supervisor, join a team and work like crazy. 

 

What is value-based healthcare, and what was your role at King's Health Partners?

King's Health Partners is a collaboration of our hospitals. When we say ‘value’, we mean outcomes that matter to patients, divided by the cost of producing those outcomes, over the complete pathway of care. So if you really want to understand value, you have to measure the outcomes and costs across the whole pathway of care. 

That's a bit daunting, but it does focus your attention on how you have to be interested in outcomes, and they are outcomes that matter to patients. Over the last 20 years, people have been obsessed with ‘process’. But ‘process’ isn't ‘outcomes’. You need to measure outcomes and improve them, outcomes that matter to patients.

And you need to understand your costs of producing those outcomes, and to do it over the whole cycle of care, because a pathway of care may start in primary care. It's quite a big deal, but you've got to make a start. 

 

What made you focus on outcomes? 

I've always been very focused on what the patient thinks about things. I was inspired in many ways by Michael Porter who works at Harvard - he wrote a lot about value in the way I've described it. 

He lectured quite a lot in England because he knew he couldn't really pursue value in America because the healthcare system is so appalling and driven by profit - they're not interested in value in the way that I've described value. 

Obviously, if you're interested in value in that way in a UK system, then it becomes very important - you can see how everybody benefits if you increase value, because if you improve outcomes, obviously the patients are a lot happier. 

If you understand all the costs, then you can look at that pathway of cost, activity and cost, and say: ‘We could reduce the costs and get the same outcomes, or we can increase the outcomes for the same cost’. You can change the pathway. 

Michael Porter was very influential. In the meetings that I attended with him, there was also the head of the Cleveland Clinic. The clinic does outcome books. So although I started doing outcome books across King's Health Partners, the Cleveland Clinic had been measuring outcomes for a long time. 

If you don't measure your outcomes, you don't know where you are. And if you don't measure your outcomes, you don't know whether you're better this year than last year.

 

Is the NHS budget enough to meet its needs?  

If you compare us with international norms, we are towards the bottom of any funding table, so we certainly need as much as we've got. Indeed, one could make a strong argument that we need to spend a bit more. 

You've got to be a bit careful with this - that doesn't necessarily mean it needs to be in hospital, because clearly you could spend the money in other places in the healthcare system and have a big impact. Pound for pound, we'd probably get better and bigger increases in value if we strengthened primary care, than if we put it into the hospitals. 

I do think the hospitals need more, but nevertheless you can see that it would be good to increase primary care, and it is bad that in recent decades the ‘slice of the pie’ that goes to primary care has shrunk. Then, there's the question of mental health. It is seriously underfunded and, again, the slice going to mental health has shrunk. 

So you've got to be careful that you don't suck resources into the big hospitals to the detriment of, for example, primary care or mental health. You need to think about this issue in terms of value, and outcomes that matter to patients.

 

What was the impact of publishing outcomes? 

It focused the attention of the leaders more on outcomes. This was more successful in some areas than others. For example, the orthopaedic people focused very hard on their outcomes, improved them, and became much more outcomes-focused. 

Various other clinical academic groups made important progress.  But there were some areas where the measurement of outcomes was poor and remains poor. So there is a lot to do, but one hopes, whenever you do something like this, that the people who are taking it seriously and making progress have influence on their colleagues in other areas. 

I'm sure they do, but you have to accept that everybody is not improving at the same pace. Within the strategy of King's Health Partners going forward, there is a big emphasis on outcomes and on value. As the years go by we'll see how we get on, but at least we know what we're trying to achieve. 

 

Why is the UK slipping down the international ranks in health outcomes? 

We've had a terrible time in the last decade, with severe austerity following the financial crash. The people who've taken the brunt of that are actually the more deprived people in our community. So the issues that really drive health - whether you've got a job or not, how much you're paid, whether you've got a decent house, the basic determinants of health - have got worse. 

Every year for many years, life expectancy has increased - not by very much each year - it's a matter of a few weeks or so - but it does increase. As time goes by there's a steady increase in life expectancy. Over the last ten years, that's not been the case, and life expectancy has fallen - it's quite extraordinary. 

Last year, there was no increase in life expectancy in females at all. That hasn't happened for a hundred years. It's a very small increase in men as well. If you look across the spectrum of society, the better off have continued to have an increase in life expectancy, but the poorest have actually seen a reduction in life expectancy. We should be producing jobs, and building houses and schools.

I happen to work in the healthcare system, so I accept all that. But you have to do what you can do. Furthermore, there's not a lot of evidence that those running the government are doing very much about it anyway. So you have to say to yourself: ‘Where can I have some influence?’ We know the causes of death, and we have a deep understanding of why people die. 

Recently, the Bill Gates Foundation spent a fortune analysing the causes of death around the world in a big project called the ‘Burden of Disease Study’, and you can look at the burden of disease - what causes death for England, or for different areas in England. Whatever you do, and wherever you look, you come up with the same thing.  

At the top of the burden of disease is smoking, next is raised blood pressure, and then there is obesity. These are terrible things. Drinking too much alcohol is also very high on the burden of disease. And mental ill health is right towards the top. 

These five factors  may all be made worse by not having a job, living in crummy houses,  and not having any education. Nevertheless, we can understand those five things and we can set about trying to improve them. So you can control people's blood pressure, we've got drugs for it - at the moment we don't control it, but we could. 

We could do much more to reduce smoking and to control alcohol use. We could do much more in the world of obesity and in mental health. So it was for that reason that I came up with the view that we should focus on the ‘vital five’, because those five are what cause most deaths. 

 

What's your vision for the ‘vital five’ going forwards? 

The vision would be that everybody knows their vital five, and not only do they know it, but it's part of their basic health record and shared with everybody. Everyone also knows the sorts of things that would help with their vital five, and are given support to help themselves. That is the vision. 

It sounds relatively easy, but actually it's very difficult in a very stretched system. I would emphasise the word ‘everybody’, because what normally happens, when you produce any innovation in health, is that the people who take the most advantage of it are the best-educated, and these are the people who need it the least, so it doesn't do much for health inequalities. 

You've got to reach everybody, and at the moment, because we're a bit stretched, we tend to only reach those people who present, who want to see us, but the people we really want to reach we don't see.  

For example, if you take raised blood pressure - what I'm going to tell you is so shocking that you'll fall off your chair. Here we have a disease that we can measure very easily. We have very safe drugs. I take them. I've got raised blood pressure, but it's normal now and has been since I've been on treatment. 

This treatment is pretty cheap, because it's all off patent. Whether you're in Southwark or Lambeth, only half the people with raised blood pressure are known about. That's a salutary fact. Of the half that we do know about, only half have their blood pressure properly controlled. 

Currently, in Lambeth and Southwark, we are doing our job properly for everybody who's got raised blood pressure, in 25% and this is particularly low figures. But with the black community, for example, there is more raised blood pressure than other communities. It's also a bit more difficult to treat. They're not reached in the same way. 

If I was to walk down the street - I live in Camberwell - I could quite easily bump into 20 young black men and say: 'Watch your blood pressure,'  and they might tell me to ‘buzz off’. Presuming that they would answer the question, they would say they don't know, because they don't go to the doctor. and the doctor doesn't go to them. 

So there's a big piece of work to be done to reach people in relation to their vital five. We know that if you give brief interventions in relation to drinking alcohol, it reduces alcohol consumption, but you've got to reach everybody. 

We know that simple mental health therapies like CBT can help people, but you've got to reach them and deliver those therapies. We know that smoking cessation works, but you've got to invest in it and reach the smokers. Whether you talk about smoking, drinking, mental health or blood pressure control, there's a steep slope depending on your position in society. 

That's the trouble. We've got to reach everybody, and we could do it if we really wanted to. But we've got to want to do it, and we've got to have systems in place to do it. 

 

How do we better reach these people? 

There has to be a mass publicity campaign. Everybody needs to know their scorecard. There are some parts of society where we do reach everybody. All babies have some things done in relation to their health. 

A health visitor comes round, and there's a document, there’s the weight, and then there’s the vaccinations that are recorded, so it can be done. We have to do the same for the vital five. When you see somebody in whatever clinic you're in, the vital five should be at the top of the notes. When you send the letters out to the patients, there should be a box on the top with the vital five. 

In general practice, when you go and see your general practitioner because you've dislocated your wrist, at the top of your notes should be your vital five, for life. King's Health Partners must do this. 

 

What are the big successes and challenges about smoking in the UK? 

Sir Richard Doll discovered the link between smoking and lung cancer. He and others wrote a report for the Royal College of Physicians on smoking and health a long time ago. Like all people who write reports, they thought: ‘You get together some bright professors and they write a report and you publish it and, ‘hey presto’, it's fixed’. 

The report said people shouldn't smoke, that we should increase the price of cigarettes, and that we shouldn't expose children to cigarettes. And nothing happened. Because that's what happens with reports. 

Ten years later, in 1973, one of the main architects of that report said: 'This is ridiculous’,  and set up ASH, (Action on Smoking and Health). ASH is a campaigning organisation. By and large, doctors don't go around campaigning, but they should, and they should be advocates. 

I got involved in ASH a long time ago and I'm very pleased I was involved. I was chairman twice, and my most recent stint was ten years. ASH is a campaigning organisation, so it pressurises governments and persuades people to do things. It's a remarkable organisation - it's tiny, has about seven or eight full-time employees, and yet it's played such a big part. 

I used to go on television and radio. You know you're getting somewhere when people start getting really nasty with you. So when an editorial in one of the big broadsheets said I was ‘dangerous’, I knew I was having some impact, because the tobacco industry is powerful. We need to keep up the pressure in relation to smoking. Stopping advertising was a big success we contributed to. 

My God, we worked hard on that. Another important thing that ASH achieved is that when there's a budget, the price of cigarettes goes up a bit more than inflation every year. So there's a built-in, gradual, real increase in the price of cigarettes, which is helpful. 

Indeed, the UK has seen a steeper slope of the reduction of smoking over the last 15 years than any other European country. We've gone from being one of the worst to one of the best, because of the steepness of the slope. So it shows what can be done if you really get stuck in. 

We're doing so badly on some of the (?other health issues) because governments don't have any great interest in them. But it's really important for the profession to ‘step up to the plate’, make a bit of a fuss, and be advocates on behalf of their patients. I'm a great believer in advocates and people getting a bit cross. It's not done me any harm. 

 

What makes a great leader? 

Leaders don't achieve very much on their own. You can wander around saying you're a great leader, but you will achieve nothing. Important stuff is done in teams, so you've got to lead a team. Leaders have got to have followers. It's no good saying you're a leader if you don't have any followers. 

There's a lot of people in the system who will say: 'I'm going to do this, I’m going to do that’, and then they rapidly transfer that to: 'You should do this, and you should do that’,  but they don't have followers. A great leader has a lot of followers. You've got to be sincere. 

People have got to really believe that you are on the ‘side of the angels’. You've got to be determined and persistent. You've got to be nice to everybody, because if you're not, you won't have people following you. You need a vision, you need a strategy, but you've got to take people with you.

 

What inspired you to take on the role of medical director at King’s College Hospital?

I became medical director at King's College Hospital, because the chief executive walked into my office one day and asked me. At that time I had been dean of the faculty of medicine in the King's College Hospital Medical School, before we were all joined together into Guy's King's Thomas'. 

Then, when we were joined together, I became vice-dean of the whole faculty and was chairman of the education committee. I became unhappy, because I didn't think the teachers were receiving sufficient support and respect, the obsession with research was detracting, and teachers were being put ‘under the cosh’ and not adequately valued and respected. 

I started to feel unhappy, because I was chairman of the education committee, and I didn't like the very senior leadership's attitude to the teaching. So there I was, sitting in my dean's office on the Denmark Hill site, and in walks the chief executive asking: ‘Would I be medical director of the hospital?’ 

And I thought: ‘That's really cool, I'll do that’. I loved the hospital and I liked the idea of being the medical director. But it would also move me out of this rather unhappy position I was in. 

 

How do you facilitate organisational change? 

King's Health Partners was wonderful. When I was medical director we had lots of meetings with the new people. Professor Robert Lechler came to King's from Hammersmith and he started thinking about an academic medical centre, because that's what we called it at the time. 

I was still medical director of KCH then, but he involved me and others, and we were all very excited by this vision of an academic medical centre across all the organisations. We went to see some great places, including Johns Hopkins. Then, we were told we couldn't be an academic medical centre. 

The Department of Health ran a competition to become an academic health science centre, we applied and were successful. So then we were called an ‘academic health science centre’. I was then appointed director of clinical strategy and also at Value Based Healthcare for King's Health Partners. 

King's Health Partners has a strategy. You need a strategy. Their most recent one is very strong and on their website. About 18 months ago, this strategy was discussed at length with all the leaders of the constituent organisations. 

I was still working then. All the ‘great and the good’ from all three hospitals and the university were in the room and there were several meetings as they thrashed through the strategy, and what we should focus on going forwards. 

You've got to get everybody contributing, lined up, and supportive of what you're trying to achieve. I've often tried to do that in my roles, but the ultimate boss in that exercise was Robert Lechler who is a great leader. He's retired from KHP now, but he was undoubtedly the best leader I've ever worked with.  

You need structures to get all the key players in the room. We had an executive, there was a board that oversaw King's Health Partners, and there were meetings about future strategy. You've got to have all that in place. But you need a leader who can make sure this all happens. 

 

Is it always important to get on with all your team members? 

Often you can't get everybody with you. You've got to hope they're not too powerful, but I tended not to worry too much about those I call the ‘negative inotropes’. I work with the ‘positive inotropes’. 

There's always negative people, but don't waste your time with them. If you're running any part of the organisation, there will be people who will be performing really well, there will be people who are performing quite well, and then there will be those who will be performing really badly. 

I don't worry about the people performing badly - I might mention it, but I don't lose sleep over it, because there are always people who perform badly. But the big thing is to ignore them and drive the organisation on, and then they usually drop off and go off into a corner and sulk. 

They're not very influential because they can be seen to be not supporting the main drive, so they become more marginalised. 

 

Who are your leadership role models? 

Malcolm Lowe-Lauri was a very good chief executive at King's College Hospital when we were starting the AHSC, who came with us on these trips to America. There have been other chief executives of KCH who have been dreadful. 

There are lots of people that have inspired me over the years, and then there are those who I've not been inspired by. You mustn't give the bad people time. I've been very lucky, and actually, doctors are lucky, because they have much more autonomy than most people. 

But it is important to get out from underneath the oppressive load of not very good people. Just like when I moved from the university to being medical director at King's College Hospital when the opportunity arose. 

Similarly, later, when I was medical director there, I moved to King's Health Partners to be director of strategy, because at that time I didn't respect the chief executive of King's College Hospital. So you've got to be a bit ‘canny’ as you go forwards, but all the time trying to drive forward the aim of making things better. 

 

What are your proudest achievements? 

Well, I'm still married. When you work like crazy, and you're passionate about what you do, you give a great deal of time and effort, so you've got to be with the right partner who has got a great capacity for forgiveness and support. 

I have a wonderful wife. Mind you, this wonderful wife is why I went to King's College Hospital, and why I didn't go to other places. Back in the day, it was quite difficult getting consultant jobs in teaching hospitals, and I remember the first one that came up was in my old alma mater at UCH. But my wife said I couldn't go for it because, 'You'll just be forever treated like the senior registrar’, she said. 

She was probably right. So I didn't go for that. Then another job came up at the Royal Free. This was about every six months, because they didn't come up very often. She took the view that the people of Hampstead would have lots of doctors to look after them and that: 'You shouldn't really waste your time worrying about the people of Hampstead’. 

Then the job came up at King's College Hospital. I'd never been to King's, so we got on a bus - we were living in Hackney at the time - and came down to Camberwell. We walked around Brixton and Peckham. 

Then my wife said to me: 'This is a real place, this is full of real people, and they need really good doctors, so you can apply here’. Which was good. Mind you, nineteen other people applied as well, but all turned out happy in the end. So a recipe for success is to have a very supportive wife. 

I'm very proud of the research I've done. I'm proud of all the research fellows. I've had about 60 research fellows, and quite a few of them are professors, and they're scattered round the world. That gives you a certain pleasure, thinking about them pressing on. I'm proud of the fact that a lot of this research is very clinical, so it's actually improved patient care. 

I’m proud of what's been achieved with tobacco. I’m proud of being very involved in producing a textbook of medicine, which ran for four editions. It’s nice walking into a classroom, in another medical school, in another country, and seeing all these people reading your textbook of medicine. 

You do feel a bit of pride! We're all human. I'm really proud of the achievements of many of the people that I've had the privilege of working with, including the juniors who are now seniors - it's amazing what many of them are doing. 

 

What lessons have you learnt? 

You've got to work hard - there's no escaping that, unless you're a mega genius. You've got to enjoy it. I've really enjoyed doing all the stuff I do. You've got to be happy doing your job. You've got to be able to work with people - to be able to be part of a team but also lead one. 

You've got to be able to inspire people - to really support the good guys and not get too bogged down with the bad guys. Those are really important lessons. You've got to be persistent. You've got to have patience. You've got to keep on keeping on. In fact, we had a saying in the office, that: ‘It's all about keeping on keeping on’. 

 

How are you finding retirement? 

I was pleased that I retired when I did. I retired at the very end of 2019, before anybody knew anything about COVID. It was a good time to retire, and I had lots of retirement dos. Of course, all of us have been a bit inhibited by this virus. I do regular Zoom calls with the research group of which I was a part. 

We have a weekly exchange of research information and ideas and presentations, so I still do that. I get a pretty steady flow of correspondence where people want my view on things. But I have retired. I've been doing quite a lot of linocut prints - they're very primitive, but I rather enjoy them. 

My wife, who's an artist, has allowed me to use all her equipment, which is very good of her. We've managed to co-exist - it's amazing. We manage to work side-by-side without major conflicts, as long as I do the cleaning up properly. 

I have children who are grown up, and I have grandchildren. Two of my children live very close to me in Camberwell and between them they have five grandchildren. We've got a new one who's about three-months-old. It's nice to see a lot of them and to be able to be helpful. 

I've been reading a lot, and I've been writing, so I've been moderately busy, but nothing like I used to be. But that's all right. I'm reasonably philosophical about it. 

 

What's your favourite book? 

The book that I read many years ago - which I still look at from time to time and think is wonderful, and I've got it in front of me now - is George Orwell's The Road to Wigan Pier. I've got copies of it in the house, but I particularly like this copy because it was given to me by one of the leaders of the clinical academic groups when I retired. It's a first edition and very nice. 

My other favourite book is Ill Fares the Land by Tony Judt, and it's a more up-to-date book. He was a historian and teacher, but it's really about the state of the world and what we've got to do. My wife has produced these simple cards, she calls them ‘postcards from lockdown’. 

One of them reads: 'Of all the competing and only partially reconcilable ends that we might seek, the reduction of inequality must come first. Under conditions of endemic inequality, all other desirable goals become hard to achieve’. 

That's a quote from Ill Fares the Land. God, this is ridiculous - we even like the same books, me and my wife. This is getting serious.

 

Medspire podcasts are produced by Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov, both full-time junior doctors. They aim to inspire the next generation of doctors and scientists by exploring the career journeys of leading clinicians and researchers.