Energy renewables and offshore turbines

SOUTHAMPTON MEDICAL SOCIETY

President: Dr Nigel Dickson FRCGP

A meeting of the Southampton Medical Society was held on the 5th October 2022.The President was in the chair. The meeting started with a two minutes silence in memory of Pharic Gillibrand.

The minutes of the last meeting were approved.

The President introduced the speaker Mr Alan Chivers who spoke to the title “Energy Renewables in 2022-30; Joined up Solutions”. He said that he had been enthusiastic about renewables for between 40 and 50 years. As there are so many renewable energy technologies he was going to concentrate on offshore wind development. Offshore wind, he said, is the only energy source that is cheap, has little environmental impact, is reliable, economic and quick to deploy. It attracts huge investment and has a global significance. The UK is leading the way. We have the best wind resources in NW Europe. People often ask why not use solar panels? The answer is that 180,000 panels would be needed to reach the output of one wind turbine. Offshore wind is now the cheapest form of renewable energy in the UK. People also worry about bird deaths. He said that birds do get killed but great care is taken to avoid windfarms on migration routes and the height of the latest turbines is above the flight path of most sea birds now.

The seabed is owned by the Crown Estates and plots are auctioned every 5 years with companies paying very large amounts for leases.

Wind turbines are connected by cables to an offshore substation and then to an onshore one for transmission. The turbines sense the wind direction and rotate accordingly. The rotor size and power rating have increased steadily and continue to do so. Two of the latest turbines now produce power equivalent to one of the older 30 megawatt gas electricity generating stations. These latest turbines are the height of the Shard skyscraper in London. The connecting cables come in 20 metre diameter rolls and are pulled through underground tunnels already prepared. The substations are getting very much larger too.

The monopol foundations need to be able to withstand the harsh conditions of the sea. They are driven 50 metres into the substrata by 500 ton hammers. Specially designed vessels are needed to transport the large pieces of equipment and components and ports have to be redesigned to accommodate the ships and the equipment. Floating hotels are provided for workers as the distances offshore are great and the hotels obviate travelling time to the site. The work is strictly controlled by Health and Safety, the Maritime and Coastguard Agency and the Civil Aviation Authority who collaborate on regulations for offshore work.

What can go wrong?

The safety of workers is regulated. In 2021, the last full year of figures, there were no fatalities. The turbines now have internal lifts to avoid long ladder climbs and their associated accidents. The hotels are connected by covered walkways. Most accidents occur during lifting operations. Working at height and with electricity account for others. The emergency services cannot help as fire ladders cannot reach the heights needed and the farms are too far offshore for emergency vessels to reach quickly. It is therefore incumbent on the owners to make up for this through training, drills and rehearsals etc.. There is zero tolerance for injuries in the offshore industry.As a comparison we need to remember the toll of injuries and deaths from carbon exploitation.

The President then thanked Alan for his excellent, and insightful, talk.

Sir Stephen Holgate on air pollution and disease

SOUTHAMPTON MEDICAL SOCIETY

President: Dr Alan Roberts FRCP

A meeting of the Southampton Medical Society was held on Zoom on the 6th March 2022.The President was in the chair.

The minutes of the last meeting were approved.

The President introduced the speaker Professor Sir Stephen Holgate who spoke to the title ‘Air Pollution - the greatest environmental health risk of our time’. Sir Stephen recalled the Great Smog of 1952 which was largely due to domestic coal burning. The number of deaths peaked at 4,200 resulting in the worst weekly total since the cholera outbreak of 1866. The next year there were 12,000 deaths. It resulted in The clean Air Act of 1956 with its emphasis on smokeless fuel. This produced a dramatic improvement. However there is a new crisis due to air pollution from liquid fuels - petroleum and gas burning. Factories and cars are producing CO, CO2, SO2, NO, NO2, hydrocarbons and suspended particles which the encouragement to use diesel fuel caused. The ‘Every Breath We Take’ report of 2016 estimated that 40,000 premature deaths were caused due to lung cancer, asthma, heart disease, and stroke. Successive governments have tried to hide the figures.

We are dealing with tiny particles 30 times as small as a human hair which are absorbed into the circulation through the lungs and damaging the organs. Research has shown it affects particularly vulnerable people - the elderly, pregnant mothers which result in low birth weights, and children who develop smaller lungs and have slower development. These are lifelong effects which start in utero. Research on the placenta has shown black carbon particles from car pollution are found on the fetal side of the placental circulation and also that the telomeres are shorter in these babies.

The average person in Britain spends 8% of their time outside and over 90% indoors. The exposure occurs at home, school and workplace. Asthma, which is normally thought of as an allergic disorder, is now thought to have its origins in air pollution.

Ella Adoo Kissi died in 2013 at the age of 9. For the inquest Sir Stephen was asked to help show that pollution had caused her death. Initial analysis suggested that air pollution was a cause of her asthma and a contributing cause of death. She lived beside a very busy road where air pollution was frequently at illegal levels. On going through her notes he found 27 admissions. They recorded devastating attacks of asthma with apnoea and even cardiac arrest. The episodes were fewer in spring and summer mainly occurring in autumn and winter. Virus infection and allergies were excluded as the cause. Post mortem showed there was no epithelium left in lungs and that the epithelial cells had been replaced by mucous producing cells with mucous plugs causing asphyxia. At the inquest he said that the UK government experts threw everything at the case to prove that pollution was not a cause of her death. The coroners finding that air pollution had caused her death was a first in legal history. The legally binding conclusion presented the case for dealing with London’s air pollution. As a result the Mayor of London called upon the health profession to inform patients of the risks and advise them how to protect themselves.

As we get down to lower levels of pollution we get disproportionate benefits. But toxins also come off the land from ammonium fertilisers and pesticides. We should remember  too that wood burning stoves are as bad as cars. We need to reduce all these chemicals. The health professions have not yet got hold of these problems. We should keep the health message on the agenda and put over  the benefits of clean air to the population who should demand it from the government.

The President thanked Sir Stephen for his excellent talk and said what a huge pleasure it was to have him speak to us.

There being no other business the meeting was closed.

Covid Vaccine Development

SOUTHAMPTON MEDICAL SOCIETY

President: Dr Alan Roberts FRCP

A meeting of the Southampton Medical Society was held on Zoom on the 2nd of March 2022. In the absence of the President, Dr Alex Freeman took the chair. The minutes of the previous meeting were approved: Proposed by John Dracass and seconded by David Rowen.

Dr Freeman then introduced our speaker Professor Saul Faust of Southampton University who spoke to the title “ Covid Vaccine Development”.

In January 2020 there were pictures appearing on social media of severely ill Chinese in Wuhan with a new virus. Researchers at Oxford University had already identified the virus, which had similarities to SARS1 and MERS with a spike protein, and started developing a vaccine. Astra Zeneca was not involved at this time. It was yet to be discovered if a vaccine could produce antibodies against the spike protein and also produce a cellular response. They needed to know if it was safe, if it would protect against infection, if there was a risk of enhanced disease and how long the protection would last. Would boosters be needed? Normally the development process takes one to two years before trials are started. On 12th March 2020 Saul said he was approached by the HPA to help set up a phase 1 trial - the first site outside Oxford.  The number of centres was increased to 5, involving 1,077 participants at this stage. By the end of May there were 20 sites and 10,812 volunteers. Saul borrowed the Southampton University sports hall, recruited 67 staff who would be involved in actively monitoring the volunteers.The subjects were swabbed every time they got any symptoms and had to be reviewed in a safe manner by the staff in case the volunteers had Covid. The first volunteer was injected in April 2020. Astra Zeneca ran the Oxford trial. At this point the UK government set up the Vaccine Task Force under Kate Bingham which consisted of scientists and business people with a remit to survey the different vaccines worldwide and invest in different technologies to ascertain which might work. They put a lot of money into a vast number of trials. A National Network was set up for vaccine delivery which would involve more than 100 centres and recruit more volunteers and train more staff. The vaccines surveyed were produced by Astra Zeneca, Imperial College, Novavax, J&J Janssen, Valneva, Medicago and GSK.  Six new trials were launched in 2021. In 2022 Pfizer and Moderna vaccines were added for further assessment in the UK. Sanofi and Moderna are also testing a vaccine against the Omicron variants. Different dose regimes were looked at including spacing between doses to find out which was most efficient. There was not enough information concerning immunocompromised patients. The National Immunisation Schedule Evaluation Consortium looked at mix and match schedules, concomitant influenza and Covid vaccination, choice of 3rd dose vaccine and the 3 month interval [which showed a maximum antibody response by day 7]. Southampton is running the 3rd dose booster study in 35 sites tracking the longevity of immune responses and the need for a 4th dose. They are also at present involved in live viral challenge trials in which young healthy participants with no Covid risk factors who have been fully vaccinated are given Covid 19. Janssen is now restarting work on its viral vector vaccines.

How to accelerate vaccine development is important and UK trials are looking at comparing preclinical and actual trial data, immuno-responses and efficacy, ongoing need and risk for clinical trials of different vaccines. Internationally Professor Faust considered the FDA has behaved very badly and what is despicable is that it has still not recognised the AZ vaccine. At the G7 in Cornwall the EU blocked any agreement on vaccines. The Oxford vaccine has now made 2 billion doses, and is being produced in 15 countries, of which 2/3rds are going to low income countries. Three doses of the Oxford vaccine are, longterm, just as good as 2 doses of Oxford and one of Pfizer.

In all there were 47,646 participants, 25 studies and 123 sites. Important side effects recorded were blood clots with AZ and Janssen vaccines which were rare and an  extremely rare myocarditis. Because of these side effects trials on pregnant women were stopped which resulted in pregnant women not wanting the vaccine and there not being enough information. The UK government were very poor at communicating what was happening. The University of Cambridge put out on social media a comparison of the chances of side effects from the vaccine versus the Covid infection.

Professor Faust said that the MHRA were unbelievably good. This hugely benefitted the research th UK which was not always the case with research in other countries. Ethics committees were excellent as well - very approachable and prompt in their replies. He expressed his thanks to everyone involved in the Covid vaccine development.But what can we do to improve communication with the government?

The media chose not to highlight the needs of children.

Astra Zenica do not deserve the bad press they have received. They have done more than enough.

The global roll out on the whole has been very good. The problem is getting the vaccine into people rather than the supply. The sell by date is a problem and a million out dated doses have been dumped.

Concerning antivaxers one is unable to do anything but one can cure vaccine hesitancy.

Dr Freeman thanked the speaker very much for a marvellous talk and said she looked forward to following his work.

A History of Southampton through disease and health

SOUTHAMPTON MEDICAL SOCIETY

President: Dr Alan Roberts FRCP

A meeting of the Southampton Medical Society was held on Zoom on the 2nd of February 2022. The President was in the chair from Australia. The minutes of the previous meeting were approved.

The President then introduced our speaker Mr Andy Skinner MA ,of Southampton City Council Cultural Services, who spoke to the title ‘A History of Southampton in Health: Plagues, Pestilence and Pandemics’. He said that Southampton’s history went back to the Bronze age and he showed us a Bronze age funeral urn which was discovered at an archeological site in Moorgreen where there was a small Bronze Age settlement. Medicines were limited then to herbal remedies. Burned grains were also discovered at the site indicating that beer was made.

In 43CE the Romans built a fortified settlement called Clausentium on the east bank of the Itchen river. Stumps of stilts on the waters edge can be seen which indicate there was a port here. Roman coins and lead ingots were discovered. From here Slaves, and lead mined in the west country, were exported. The Antonine Plague spread here possibly due to it being a port. Galen mentions the plague in his thesis on medicine in which sensible general advice along with mythical treatments linked to the 4 elements of Earth, Air, Fire and Water. It was believed when these become out of balance ill health results.

After the Romans left in 410CE Britain was invaded by European tribes who interbred with the native population creating the Anglo Saxons.

There is a quote from Cicero on the side of the Civic Centre reading Salus populi suprema est lex. [The health of the people should be the supreme law.] The Anglo-Saxon era is referred to as the Dark Ages due to our limited knowledge of the period. The Islamic and Eastern world were more advanced in learning and medicine than England.

In 1066 Southampton emerges as a maritime centre - a major trading town. Southampton has a rich archive collection from this time. The Southampton Oak Book of c1300 contains trading information, maritime law, type of bread to bake, town regulations re health [eg butchers were only allowed to sell “sweet” meat] and no rubbish in the streets. Southampton had its own piped clean water supply - one of the best in the country.

The water was fed by gravity and piped to Conduit House [near the theatre] and then piped to districts. The spring was near Springhill School and permission was given to the Franciscans to channel the water. Their mission was to look after the poor, serve the community and minister to the sick. There were a number of industries dependent on clean water such as brewers and butchers.

In 1348 the plague reached Southampton and a quarter of the population died [in Bristol 50 per cent died]. The town gate was barred, a red X was painted on the front door if any occupant was unwell and those from such a house had to carry a white stick when outside. Six men and women were employed as bearers of the sick to transport them to plague booths where they were locked in. The plague had a devastating effect on the city. The disease kept returning for a few hundred years.

In the 17thC John Speed, the mapmaker, had a son who became a Southampton doctor and  his grandson and great grandson also became local doctors. The last one [also called John] was a meticulous recorder of events and wrote a history of Southampton.

In 1620 the Mayflower sailed from Southampton [not Plymouth]. Illnesses were brought in by Europeans sailing to the USA via Southampton such as smallpox, measles, flu and cholera and was called the Great Dying. In 1665 the plague returned and again had

a devastating effect

In the mid eighteenth century a chalybeate spring was discovered and Southampton became a spa town. Sea bathing became popular and was seen as a cure for many illnesses - even rabies.

By 1850 the docks were expanding. There were horrific slums around Bugle Street. In Simnel Street 250 people died of cholera in 3 months and 474 in Southampton as a whole. Dr Francis Cooper was appointed the first Officer of Public Health as the result of the public outcry at the death of a young pregnant woman, Elizabeth Biggs, from starvation and lack of care. He campaigned for improvements in housing, sanitary conditions, policing, education and health care especially for the poor. He died prematurely from cholera. The sewage system was woefully inadequate for an expanding town and Sir James Lemon, the Borough Surveyor, installed a new sewage system. He also replaced the springs supplying water in use since mediaeval times. In 1838 The Royal South Hants was built and the General Hospital in 1900.

In the WW1 Southampton was a major receiving port for the injured. They were sent on by ambulance trains to various receiving centres. A Private Albert Dartnell RAMC kept a diary of the sick and wounded arriving in Southampton. He noted that there were more sick than wounded.

In the last two years Covid has had an impact on public health greater than ever before. Four hundred and seventy people have died. Professor Elkington and Professor Hywel Morgan at Southampton University played a key role in the development of the PeRSo-DW hood.

The President thanked Andy Skinner for such a fascinating talk.

DR FOOTT Bursary winners

SOUTHAMPTON MEDICAL SOCIETY

President: Dr Alan Roberts FRCP

A meeting of the Southampton Medical Society was held on Zoom on the 12th of January 2022. The President was in the chair. A period of silence was held in memory of Dr Tom Wade West. The minutes of the previous meeting were approved - proposed by Mr Gordon Masson. The speakers for the evening were young doctors who had received Foott Memorial Bursaries for their electives - which in 2021 had to be taken in the UK. The President introduced each speaker in turn.

Our first speaker was Dr Hanad Ahmed. He spent his elective at SGH having had to cancel  placements first in Cape Town, then Toronto then Papworth due to the Pandemic. He spent 12 weeks in the cardiothoracic unit at Southampton General Hospital. It was divided between Adult Thoracic surgery, adult cardiac anaesthesia and the ICU, and paediatric thoracic surgery and the PICU. He focussed his time on research and being in theatre - learning what it is like to be a cardiothoracic surgeon. He described a couple of patient cases, for one of them he became involved in the writing of a research paper, in which he is named, on the use of endobronchial valves in the management of persistent airleak in Corona virus 19 disease. It has been published in the Annals of Thoracic Surgery. He was extremely positive about his experiences and the trouble consultants and staff took to make him welcome. He experienced, he said, the highs of success and the lows of failure and how it tested the integrity of one’s character.

Dr Ellen Bodger was introduced next. She divided her time between a Moderately Secure Forensic Psychiatric unit in Leicester and Palliative care at the Countess Mountbatten Hospice in Southampton. The psychiatric unit is for offenders who cannot manage prison. The patients, both male and female, have severe personality disorders. She described how her time there was spent interviewing patients and helping with their medication. She found the terrible backgrounds of the inmates and what they had seen and suffered an eye opening experience. It was daunting to be in a unit with so much security. She also learned a lot about the law - which you do not get taught at medical school she added. She said the patients were on a journey of discovery; learning to cope with uncomfortable situations and reflecting on their dislikes as well as their likes. Patients are often on the unit for 4 years before they are able to be transferred to a lower security prison.

Ellen then spent 3 weeks in the Countess Mountbatten Hospice. She attended ward rounds and patient reviews. She found her elective helped with misconceptions about palliative care. It is not a place of death and not sad. It was an uplifting experience learning how death was managed in a positive and dignified way. The aim was to help with symptom management. About 50% of patients would go home, not necessarily to die immediately.  Ellen considered she had learned skills very useful for a junior doctor.

She compared the patients in her two electives and found that both adapted to the concept of a limited time ahead in their present situation and how positively both groups learned to view this. The difference being how those dying accepted the ending of life while the prisoners could look forward to trying to start again.

Dr Katie Evans was introduced next. She is interested in infectious diseases and joined a team examining the clinical impact of a point-of-care diagnostic test for respiratory virus detection in patients presenting with acute respiratory illness comparing no antibiotic treatment to routine clinical care with antibiotics in a randomised controlled trial. The test distinguishes between viral and bacterial infections and a result is available in an hour and a half. It has been particularly helpful during the Covid epidemic as a PCR test takes at least 24 hours for a result. One thing that has been shown is that patients are more likely to get Covid whilst in hospital rather than having it on admission. It is a long project and may need 5 years more before reporting. Katie said she learned that research takes patience and persistence. POCT is a remarkable, and expensive, advance in patient care. It reduces the turn around time, reduces nosocomial infections and will have a beneficial effect on NHS expenditure. Be prepared for unexpected outcomes she said.

The last speaker was Dr Methusha Sakthipakan. Covid having cancelled a visit to St Lucia she went to the Barnet, Enfield and Haringey Mental Health Trust. She spent time in old age psychiatry, both community and inpatient care, adult ward and liaison psychiatry and in the St Ann’s eating disorder clinic. She attended daily team meetings and was encouraged to perform a daily reflection on the days activities. All outpatient consultations were on-line which she felt were unsatisfactory. It was difficult to see the patients faces clearly, the clothes they were wearing or their general demeanour. She also attended ward rounds and assisted with ward based diagnosis. She saw a number of cases of severe psychosis as a consequence of drug taking which she found quite scary. In liaison psychiatry she went to A&E departments and general hospital wards and saw the results of overmedicalisation and institutionalisation. Finally she spent time in the St Anns eating disorder unit. The treatment was based on a collaborative approach. Structure was very important.  For younger patients family therapy was encouraged. Covid has resulted in a heavier workload especially from older patients.

Whilst there she performed a data audit and also wrote a handbook for medical students on electives.

All of the speakers thanked the Society for their award.

The President said he was impressed by the very high standards of the presentations and that he had found the talks very interesting.

The Treasurer was also impressed. He proposed that the usual award for best presentation should be presented to each of them. This was seconded by the Hon. Secretary.

In general discussion afterwards a member asked the speakers if they thought that an elective spent in the UK was more valuable than one spent abroad?  There were differing views on this.

Bert Hinkler - Local Hero [Story of a local pioneer aviator]

SOUTHAMPTON MEDICAL SOCIETY

President: Dr Alan Roberts FRCP

A meeting of the Southampton Medical Society was held on Zoom on December 1st 2021. The President was in the chair. The minutes of the previous meeting were approved.

The President introduced the speaker Dr Martin Radford who spoke to the title “Bert Hinkler - Local Hero”. Dr Radford said that Bert Hinkler is almost unheard of locally though he lived in Southampton and his achievements were comparable to those of Amy Johnson and Lindberg.  He was born in 1892 in Bundaberg, Australia, where he grew up. He was very bright but left school at 14 and had various jobs. Living near a lake he was fascinated by the flight of the ibis with led to an interest in flight and aerodynamics. He built a large glider on which the pilot’s position was lying on his mother’s ironing board onto which it had been bolted. It was pulled into flight by his friends running along the beach.

In 1909 Bleriot made the first crossing by plane of the English Channel. An American Entrepreneur Arthur B Stone, purchased one of these machines and shipped it to Australia where he flew it at country shows. In Bundaberg it developed mechanical problems which were fixed by Bert Hinkler, who was then hired as Mr Stones’ mechanic. In 1913 he worked his passage to the UK and got work at the Sopwith factory before joining the RN Air Service in 1914 as a gunner. He was awarded the DSM and recommended for pilot training. Throughout this period he was designing improvements for the aircraft. After demob he became a test pilot for Alliot Verdon Roe in Hamble. In the early nineteen twenties the firm started making planes for personal use called the Avro Baby. Bert purchased one and flew over the Alps to Turin non-stop a journey of 918Km. This was the first time it had been done by a small plane and he was awarded the Britannia Trophy for the achievement. He shipped the plane to Australia and flew from Sydney to Bundaberg a distance of 1270 Km. Back in the UK he was promoted to Chief Test Pilot for Avro and tested the Avro Aldershot, a heavy bomber, and early versions of autogyros which were the precursors of modern helicopters.  In 1923 he won the prize for best aerobatic display at the Lympne Annual Airshow. He followed this by becoming the first man to land a plane on a mountain when he landed on Helvellyn which just happened to be witnessed by a lone walker, a Professor Dodds who signed a statement to confirm the event. His next achievement was flying from London to Riga a distance of 1660Km. He decided to raise funds for a flight to Australia and purchased an Avro Evian. The route had to be planned around available fuel stops. For navigation he used pages torn out from the Times Atlas of the World. He had to fly over the Alps in daylight which meant it was night when he arrived in Rome. The airport was closed and he had to land without assistance in the dark using only a torch. He took a bus to a Rome Hotel for the night and picked up his plane in the morning. Then onto Malta, Benghazi and Ramleh.  He made an emergency landing in the desert and was helped by Bedouins. Then onto Karachi, which he just made after the plane developed a leak. There the world’s press discovered him and would then fete him at every landing from then on. By this time he had already beaten the world record for a solo flight. Then onto Calcutta, Rangoon, Singapore and over the water to Darwin where there was a great reception.He then flew to Brisbane and onto Bundaberg. After which he returned to England. In 1929 he designed and flew an  Amphibian plane which he called the Ibis. Unfortunately there was no market for it in the UK due to the Great Depression so he took it to Canada and the USA but still with no success. He decided that his future lay in epic flights. He acquired a De Havilland Puss Moth and flew to England from Canada via Brazil and Morocco which was another first. He was unable to find work in the UK and so returned to the USA. In 1932 he started to plan another epic flight to Australia. He departed from the airfield at Heathrow on January 7th 1933. He still needed to cross the Alps in daylight but the planned departure at 2am was delayed by fog. Two friends who came to see him off had to park their cars at the end of the runway with their headlights on so he could see the direction of the runway to take off. By the end of June 8th he still had not arrived in Rome. Doubts about which route he had taken impeded searches and it was not until the spring thaw that he was found dead by a shepherd under a tree with the wrecked plane nearby. An autopsy showed he had died from injuries and exposure. Mussolini, who knew about Bert’s achievements, ordered a state funeral. He was buried in Florence.

His house in Thornhill was bought by Southampton City Council and used for letting. A plaque was placed on it. In 1982 SCC decided to demolish it to make way for a housing estate. A Bundaberg resident heard about this and raised funds to buy it and ship it out to Bundaberg where it was rebuilt. It is now the Bert Hinkler Museum.

In his lifetime he won many awards but in Southampton there is only Hinkler Road and a pub named after him. There is a small plaque in a Southampton park.

Dr Radford was thanked by the President for his interesting talk. There being no other business the meeting was closed at 9pm.

General Practice Past, Present and Future

SOUTHAMPTON MEDICAL SOCIETY

President: Dr Alan Roberts FRCP

A meeting of the Southampton Medical Society was held on Zoom on the 2nd of November 2021. The President was in the chair. A period of silence was held in the memory of Dr Alan Johnson.The minutes of the last ordinary meeting were circulated beforehand and approved. The President introduced our speaker Dr Nigel Watson who spoke to the title “General Practice; Past Present and Future”. Dr Watson started by outlining the history of the NHS from its inception in 1947 to the present. He was asked by the Health Secretary to chair a committee on general  practice for the NHS 10 year plan, concentrating on the GP partnership model, which reported in 2019. He visited general practices country wide - both good and bad. He found the workload of GPs was too great; the working day was getting progressively longer and the demand on the workforce was greater than its capacity to  cope. Furthermore young GPs were no longer wanting to become partners in part due to the increasing financial risks of being left the last one in harness. He said the risk needs to be reduced. There is a need to reduce the unlimited financial liabilities of partnerships. Indemnity should be provided by a state backed system. More senior partners are retiring earlier now and fewer doctors are interested in replacing them. This is accentuated by general practice being out of favour as a full time career.  His report also recommended that we need to increase the number of medical students and that the Wass report should be implemented. The committee recommended that an early career Primary Care Fellowship should be created that would last for two years for aspiring GP partners after they have completed their basic compulsory GP training. New young partners should have business training as an inducement. In a GP’s mid career, to improve career opportunities, there should be training for future leaders in the NHS. Dr Watson said the treasury was unwilling to put money into practices directly. There was a need to expand the primary care teams fully in general practices. This would cost in the region of £1.4 billion if done properly. The report also covered creation of primary care networks, reducing the workload and reducing bureaucracy. The committee also noted that the gap between GPs and specialists was getting much wider and they outlined the services that could be provided by the Primary Care Network. There needs to be a clear vision for General Practice and its role. In the last 2 years ways of working had changed due to the pandemic with technology playing a major role and a reduction in the traditional face to face approach. In the future Dr Watson foresaw larger practices, perhaps with the development of pods, and GPs leading a team of primary care providers. These practices might have 50,000 patients with 6 pods of 5000. There would be separate pods for emergency care and home visits and these would have specialist GPs. Other specialist hubs could be introduced as needed which might cover the majority of medical care eventually.

There was a lively discussion concerning these matters afterwards.

The President thanked the speaker for his very interesting talk.

There being no other business the meeting was closed.

Reflections of an NHS Chaplain

SOUTHAMPTON MEDICAL SOCIETY ON ZOOM

President Dr Alexandra Freeman FRCGP

An ordinary meeting of the Society was held on Wednesday April 7th 2021 which preceded the AGM. The President was in the chair. She introduced the speaker, the Reverend Canon Nick Fennemore who spoke to the title “Reflections of an NHS Chaplain”.

He outlined his career in the church. He had always wanted to be a hospital chaplain and had had to bend the rules a bit to become a full time chaplain. He now works for Southern Health Foundation Trust as well as carrying out duties at Winchester Cathedral as a chaplain to the various communities that together make up the Cathedral family. He undertakes pastoral care activities on behalf of the Dean and Chapter. As with all Cathedral clergy, he assists in leading worship at the various Cathedral services. After ordination in St Alban’s Abbey in 1979 Nick worked in parishes for seven years. In 1986 he became a hospital chaplain and served in the NHS in Carshalton, Oxford, Portsmouth and a hospice in Chichester. Nick is also head of the chaplaincy, delivering spiritual and pastoral care, at Southern Health NHS Foundation Trust. During his time in Oxford he was invited to become an honorary canon of Christ Church Cathedral.These positions have enabled him to develop different pastoral and theological interests which include medical ethics, teaching pastoral studies, developing liturgical services for families who have lost loved ones through death, dying and bereavement. He was particularly interested in pastoral care for families who had lost babies at or around the time of birth. He found that this group were vulnerable and were unsupported at a particularly emotional time. They would be discharged from the birthing unit without their baby and it was left up to the families to provide their own support. He also found that parents of babies in ICU were in similar need of support. As a result he developed a system of support for people in this situation. This included a multi-faith and no-faith approach.

More recently he has been chair of the End of Life Group for Southern Health whose aim is to try and create the same level of care throughout the whole of South Hampshire. Hospital chapels are important he said. They are a haven for people under stress, of any faith and none. He related how on one occasion when he was conducting a ceremony in a hospital chapel a Muslim man came into the chapel to pray quietly in a hidden corner. He considered the occasion an important reminder of the importance of these spaces.

The President thanked Nick for a most inspiring talk. The meeting then conducted the AGM of the Society, which is  reported separately.

The story of Funga Dr Skeates 6/10/21

A meeting of the Southampton Medical Society was held on October 6th 2021 at the Ampfield Golf Club in a ‘hybrid meeting’ with some members present at the talk and others following it on Zoom. The President was in the chair. The minutes of the last ordinary meeting were circulated beforehand and approved. The President introduced our speaker Dr Stuart Skeates, both a former GP and Past Vice President of the British Mycological Society. He spoke to the title Fungi: The Kingdom of Surprises. What are they? A mushroom [Norman]  or a toadstool [Anglo Saxon - Paddock in Scots and Padder in Dutch]?  They are the visible reproductive organs of funga. But hidden beneath the ground is a vast network of fungal mycelia. These grow from the tip and are 1 cell wide - rather like neurones. These cover large areas - the largest in the world covering several thousand acres. In the Linnaean classification they have their own Kingdom which may be the largest of all. Funga have a symbiotic relationship with plants and trees. The funga extract nutrients from the soil and deliver them to plants and trees by either forming a cuff around the roots, or invading them. In return the plants deliver sugars from photosynthesis. Thus a communication network is created between trees and plants using this network of fungal mycelia. It is postulated that it can be used as an advance warning system to prepare plants and trees for attacks by hostile insects etc.. Fossils of funga have been carbon dated to 635,000,000 years ago [sic]. Funga rot down dead wood and break it down which results in coal formation when the conditions are right. This ability to break down materials is used commercially to clear up oil spills, to detoxify contaminated land and uranium spills from nuclear reactors as funga are not harmed by radiation. They thrive in Chernobyl. Funga can also spread easily with certain crops causing serious problems such as potato blight, [causing the 1845 famine in Ireland], chocolate blight, [so endemic in S America that much chocolate is now produced in Africa], coffee, rubber, cereal and rice crops. Dutch Elm Disease and Ash Die Back are examples from this country. Funga are the origin of certain drugs such as Penicillin, Cephalosporins and Griseofulvin. Funga are also used to destroy the ergot of rye in dog food. They are involved in the production of chocolate, Marmite, Quorn, cheese, soy sauce, wine and stone washed jeans. Finally, residents near distilleries have complained about sooty black mould which is spreading over their houses. It already covers the distillery and nearby vegetation. The mould feeds on the alcohol vapour that escapes from the wooden barrels used for maturing spirits.

The President thanked Dr Skeates for a fascinating lecture. There being no other business the meeting was closed.

March 3rd 2021 The Foott Memorial Lecture 2021,Dr Pearl Hettiaratchy OBE DL FRCPsych. 'Five Decades in Clinical Practice; Caring,Influencing Change and Keeping Going’.

The President took the chair and welcomed everyone to the Zoom meeting.  She introduced Dr Pearl Hettiaratchy OBE DL FRCPsych. and asked her to deliver the Foott Memorial Lecture for 2021, entitled 'Five Decades in Clinical Practice; Caring,Influencing Change and Keeping Going’.

Dr Hettiaratchy said that she was now in her 56th year of clinical practice. She was a Tamil by birth and attended medical school in Sri Lanka. She, and her husband, who is a  child and adolescent psychiatrist, decided to come to Britain to train in psychiatry with a view to returning to Sri Lanka after exams. My journey, she said, started at St. James Hospital Portsmouth in June 1968 on a clinical attachment to test my spoken and written English by the then Wessex Regional Health Authority. These were difficult early days in a new country, adjusting to a whole new way of life, with limited or no resources – no security, no home, family or friends. However, they had each other, their degrees and their Faith. She completed both DPM and Membership exams within four years and was persuaded to stay in the UK and appointed a consultant psychiatrist in Portsmouth in 1975 in old age psychiatry - the first sari wearing consultant in the region. Her husband was appointed consultant in child and adolescent psychiatry in Basingstoke at the same time. She approached her consultant post with passion and enthusiasm, introducing novel and innovative approaches in the treatment of the elderly, improved access to services for them and she started a widespread programme of teaching and training of all staff. This saw the development of psychotherapeutic services to patients and carers, the UK’s first Travelling Day Hospital for the Elderly and The Wessex Region’s Day Release Course in Old Age Psychiatry. She was appointed Chairman of the Portsmouth Division of Psychiatry. In 1984 she was invited to be  a consultant in Winchester which she saw was an opportunity to set up a community-based service with no institution to dismantle first. Her early months and years in Winchester were traumatic, having to cope with racism, overt and covert. She was the first female consultant appointed in Winchester in any specialty. She said she dealt with all these difficult issues sensitively and professionally. Throughout her career she combined clinical work with contributions to other health-related organisations. These included the Royal College of Psychiatrists, where she was on committees  for Psychiatric Practice and Training in a British Multi-Ethnic Society, Executive Committee Section of Old Age Psychiatry, Nursing Committee, Unethical Psychiatric Practice, and worked with the DOH on mental health services to ethnic minorities. She also served on the GMC Professional Conduct Committee, the Review Body for Overseas Qualified Doctors, the Steering Group on Performance, the Race Equality Group and the Working Group on the Professional Conduct Committee. She was also invited to join the Mental Health Act Commission – later to become the CQC. She was a deputy Lord Lieutenant  of Hampshire. Pearl decided to retire from her consultant post at the age  of 60 in 2002 but continued with the other activities including adding the Brendon Care Trust, the Alzheimers Society, the Samaritans and an honorary consultantship at the St Cross Hospital for the Clergy. In 2019 she returned to Jaffna to assess and advise on the mental health provisions, services, training and funding needed there. In 2020, now 80, she continues with much of her work and was recently revalidated to continue as a practising psychiatrist. She finished her talk with her personal approach to life: try to achieve excellence, always give a personal touch to your dealings, always give of your best, own up to mistakes and always be professional. You have to believe in yourself.

The President thanked Dr Hettiaratchy for her most inspiring lecture. She said that she had a very happy time working under her as a junior doctor.

There being no other business the meeting was closed.