In this citation I hope to show that Richard is and always was a man ahead of his time. He practiced through his clinical activities principles that were at the time unusual, but that are now becoming mainstream. He has advanced the interests of this association greatly in this way.
I first met Richard about 30 years ago when I became a registrar in neurology at Frenchay hospital, Bristol. I had not previous done any neurology. Richard’s practice convinced me to pursue a career in neurology and specifically neurological rehabilitation, a career choice I have never regretted for one minute. I will explain what characteristics inspired me then, and still inspire me.
Richard has always been primarily concerned with the experience of the patient – what do they worry about, what do they want to know, how can we make life better for this person? He was patient-centred when much of medical practice was still professionally driven and centred. Two examples will suffice.
He became interested in people with Friedreich’s Ataxia as a registrar, not simply in relation to the neurobiology and clinical presentation, but also in relation to the concerns of the families and patients. He set up what was probably one of the earliest disease-specific support groups and was the chairman of the Friedreich’s Ataxia Group for many years.
Second by 1978 he was running a follow-up clinic for people with multiple sclerosis where the main focus was on the practical problems of living with this disease. In 1980 he started collecting data on Activities of Daily Living (ADL) using the Barthel ADL index on every patient with MS. In so doing he discovered that faecal incontinence was quite common in the patients attending. Although these patients had been attending for some time this fact only became known once the question was asked, demonstrating the value of routine collecting simple data.
This interest in the patient’s perspective might reflect his own experience with head injury, a topic that neurologists rarely take an interest in. As an aside, I note that none of the 146 titles of talks and papers presented at this meeting concern head injury! Richard had a motor cycle accident and had a sub-dural haemorrhage as a result of the accident. He obviously made a very good recovery, though he does still limp from time to time. However it is possible that his concern about the patient’s perspective may have been reinforced by his own experience.
The second area where Richard was ahead of his time concerns the collection and use of routine patient data; this was part of his insistence on generating and using evidence to support service development. I have already noted that the routine use of the Barthel ADL index revealed previously unknown faecal incontinence in people with MS. There are other more important examples.
When I first met Richard in 1978 he had obtained money for and set up a Stroke Unit, and by 1981 he had collected a standardised set of data on many patients who had attended. Using a PDP-11 computer (which was larger than several filing cabinets put together) he with others started to investigate the natural history of recovery after stroke. Surprisingly no-one had studied this much before, and simply using data collected routinely by all staff led to a series of papers that are still quoted and are still good evidence.
Another example of his focus on using evidence concerns the collation and use of epidemiological evidence to drive rational service development. The paper we wrote in 1986 is still used as no better summary has been made.
This brings me to the third area where he was ahead of his time, namely being concerned with the development and provision of clinical services. At the time this was not a popular view within the medical profession in general and within the ABN in particular.
The best example is the work he undertook with others between 1984 and 1986 writing ‘Physical Disability: 1986 and Beyond’ for the Royal College of Physicians. This pioneering booklet outlined some principles of management of people with long-term conditions that are still relevant and unfortunately still have to be enacted. He also was instrumental in setting up the services sub-committee of the ABN, and co-authored several other reports on services.
The final area where he was ahead of his time was in his collaboration with other professions on an equal footing. He was truly committed to multi-disciplinary teams at a time when doctors still expected to lead and to be obeyed. He worked with and supported many people who have gone on as leaders in their own right, for example Professor Pam Enderby (speech and language therapist), Dr Clive Skilbeck (clinical neuropsychologist), Dr Victoria Wood (health service researcher) and Professor Jenny Butler (occupational therapist).
I would like to finish by thanking Richard twice.
The first ‘thank you’ is personal. I would like to thank Richard for all his support, encouragement and advice over the last 27 years. Without it I would not be here, and I would not have had such a rewarding career.
The second is on behalf of the Association of British Neurologists. Thank you for stimulating us to become patient-centred, to collect and use evidence on a routine basis to support service development and research, to become interested in and concerned about the provision of services, and to recognise the immense value of multi-disciplinary team working.
I am sure that you will now tell us how much more we need to do!!
Professor of Neurological Rehabilitation