The Medical School was Small…. Clinical Medicine Transformed Richard Mayou
(St John’s College, 1958) Emeritus Professor of Psychiatry. His research and clinical work was concerned with psychological consequences of major physical illnesses and with “unexplained” medical symptoms. He was founder of the national professional organisation for liaison psychiatry within the Royal College of Psychiatrists.
In October 1958 I arrived at St John’s College, then a small unpretentious place. The following Monday our Physiology year, including David Warrell and three school friends, met nervously outside the Anatomy dissecting room. We would have little awareness of clinical medicine or of the tiny Clinical School. When several of us asked Victor Coxon, the lugubrious Reader in Physiology, for advice about where to go for our clinical courses he told us that the RI was a dim provincial place with “no consultants with whom I would wish to sit down to dinner”. Of course, he was wrong and had not realised that Sir George Pickering, Regius Professor of Medicine 1956 to 1968, was making big changes. We met Sir George in our first year, when he invited us to sherry at 13 Norham Gardens. Lecturers were placed around the room, and we moved from one to another when Sir George rang a hand bell. Since then, we have seen Oxford Medicine utterly transformed and I have been fortunate to have had a truly unique view. Psychiatry In 1973, having trained at the Maudsley Hospital, I returned to Oxford as a Lecturer in Psychiatry (and later Clinical Tutor and Clinical Reader). The University Department, founded in 19689 as the first of Sir George’s new academic departments, was already growing fast. Professor Michael Gelder, the outstanding psychiatrist of his generation, was the dominant figure rapidly creating an impressive academic centre and promoting student teaching and graduate training. He also very remarkably achieved a modus vivendi between divided clinicians at the Warneford and at Littlemore, where the prickly Bertram Mandelbrote, on the so-called A side had broken off relations with colleagues on the B side. Michael, the local choice to succeed Doll as Regius, was tough and chilly at work (though charming in his personal life) and this was probably the reason that he never received the public recognition he deserved. Clinical Medicine was growing fast around us. Few of us knew that Richard Doll, who had succeeded Pickering as Regius in 1969, was quietly building on Pickering’s ambitions. There were new departments, beginning in 1972 with Paediatrics (Peter Tizard) and Clinical pharmacology (David Grahame-
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Smith) and crucially, two new Nuffield Professors, Peter Morris (1974) and David Weatherall (1974). Doll convened weekly Saturday morning planning meetings of key people: Gelder, Ledingham, Weatherall and Morris and one or two others. Dr (later Dame) Rosemary Rue of the Oxford Regional Health Authority helped to obtain NHS funding and championed parttime training for women doctors. Clinical Medicine Board I wanted to know more about Medical School and was elected to membership of the Board of the Faculty of Clinical Medicine in 1989. I found that the Faculty had a tiny office with the Secretary Jennifer Noon (later the very able David Bryan), an assistant and Mr Messer and Mr Tidy who looked after student administration. The Board met three times a term at 9.00am on Saturday mornings in the gloomy Van Houten Room at the University Offices. Coffee and a croissant from the Maison Blanc were essential. The general style of the Board and its committees was autocratic. The Regius, Henry Harris (19791992), had strong opinions but little understanding of clinical medicine. I was also a member of the largely inactive General Purposes Committee and of the Applications Committee where Sir Philip Randle, Professor of Clinical Biochemistry, briskly approved graduate status paperwork put without reference to the rest of the committee. I eventually discovered rather effective discussion in the Planning and Development Committee where the usual suspects were briskly and knowledgeably chaired by Michael Gelder. My impression was of an administration which was not keeping up with the dramatic success of the Clinical Departments, the growth and increasing regulation of the Clinical School, the financial complexities and external pressures on the University. The seventeen departments had considerable independence without the means to collaborate or communicate. All this had not mattered in the past, but problems were emerging. When Michael Gelder retired in 1994 Ken Fleming, Clinical Reader in Pathology, who had reformed the Applications Committee, became part time Director of Planning and Development. General Board of Faculties In 1991 Jim Holt unexpectedly told me he was standing down from his membership of the General Board, and asked me if I would like to replace him, assuring me that it would not be demanding. The Board was the University’s senior academic committee with extensive responsibilities but little financial power. As I arrived in 1992 its uneventful pattern of business was about to change dramatically. It was already apparent that the Central Administration was failing to cope with needs of an internationally distinguished research university. The Franks Commission of 1966 had diagnosed many of the problems, but their recommendations had been only partially implemented and now the Vice Chancellor (Peter North 1993-7) was about to launch the North Commission of enquiry. My arrival on the Board coincided with two more immediate and related issues which would severely test the failing administration: university funding changes and the relationship between Clinical Medicine and the central university. The newly established Higher Education Funding Council for England (HEFCE) had developed a funding model based on the 1992 Research Assessment Exercise. The Board had the task of developing RAE based formulae for allocation of Oxford’s income to departments. Discussion of the flawed