THIS week the Herald is paying tribute to just a few of the remarkable NHS staff who have made a contribution to Scotland's health service during the past 70 years. 

From porters to surgeons and midwives to catering staff, as the 70th anniversary of the NHS on July 5 approaches this is an opportunity to look back on the many treatments and technologies pioneered in Scotland and the people who have dedicated their careers to making Scotland better.

The Herald: Mr David Koppel Mr David Koppel

FROM reconstructing a young man's face using parts from B&Q to fighting to bring the first face transplants to Scotland, David Koppel has been at the cutting edge of surgery in Scotland for nearly 20 years.

As an oral and maxillofacial surgeon in Glasgow and an honorary professor at Glasgow University, Mr Koppel made headlines in 2001 when he and his team realigned 20-year-old Stuart Young's face using a titanium and stainless steel frame purchased for £15 from the DIY chain.

The young patient had been born with Apert syndrome which restricted the growth of bones in his head, and resulted in fused fingers and toes.

In order to alleviate the conditon, surgeons led by Mr Koppel custom-built their own skull frame and detached Mr Young's face from his skull and used a technique called osteogenesis to encourage his jaw to lengthen and grow forward at a rate of 1mm per day, until it lined up with the rest of his face.

At the time, Mr Koppel said: "We could not use the commercially available frames because they have significant drawbacks and we thought we could do better.

Since then, Mr Koppel, who is based at the Queen Elizabeth University Hospital in Glasgow has been pushing to bring face transplants to Scotland.

He has been trained in the technique by experts in Paris, who performed some of the world's first face transplants. Only patients with severe disfigurements which could not be treated any other way would be considered for a face transplant, such as victims of gun shots, explosions, major road accidents and fires as well as those with conditions such as neurofibromatosis which causes benign tumours to grow.

However, funding to launch a Scotland-wide service in Glasgow was rejected by NHS National Services Scotland in 2016 on the grounds that too few patients would be eligible.

Speaking in 2016, Mr Koppel said the decision was "very disappointing".

The Herald: Prof Christopher FreemanProf Christopher Freeman

Professor Christopher L Freeman (April 1947 – August 2017)

Professor Chris Freeman devoted his career to unravelling the complexities of the human mind and, in particular, the perplexing riddle of eating disorders.

Widely regarded as the leading psychiatrist of his generation in Scotland, his contribution spanned teaching, research, training and the foundation of pioneering services designed to help patients battling conditions such as anorexia nervosa, bulimia and post-traumatic stress.

NHS at 70: Celebrating a revolution in Scotland's healthcare

Born in York, he arrived in Edinburgh intent on studying veterinary medicine. Instead, he switched to medicine, and in particular psychiatry.

His flair was quickly recognised: he obtained the Royal College of Psychiatrists’ Gaskell Gold Medal within a few years of completing his training at the Royal Edinburgh Hospital.

It was his determination to help patients in the grip of eating disorders and his interest in the use of psychotherapy, in particular cognitive behavioural therapy (CBT), that would arguably lead to his greatest impact.

In 1984 he was appointed as the first Consultant Psychotherapist in Cognitive Behavioural Psychotherapy in Scotland, and helped to shift the technique from being viewed with scepticism to mainstream.

He recognised the desperate need for treatment for conditions such as post-traumatic stress disorder, depression and eating disorders, and in 1987 founded the Cullen Centre in Edinburgh. It provided unique outpatient treatment for people with conditions such as anorexia nervosa and pioneered a home-based approach to their care.

It was a radical shift - previously patients with eating disorders had been treated on hospital wards. Patients with a range of conditions, such as OCD and trauma-related difficulties, found the support they craved.

The centre also developed as a training facility, and helped to mould understanding of the special needs of patients with eating disorders.

His other key interest was in supporting patients with symptoms of post-traumatic stress, and in 1997 helped established the Rivers Centre in Edinburgh, which treats combat victims and rescue service personnel in addition to victims of everyday civilian trauma.

His persistence in raising awareness of eating disorders led to the establishment of the Regional Eating Disorders Unit at St John’s Hospital, Livingston, in 2012.

He died in Edinburgh in October 2017.

The Herald: Billy JohnstonBilly Johnston

Billy Johnston, 55, clinical support worker at Edinburgh Royal Infirmary.

For years Billy Johnston sat behind the wheel of a van, delivering motor parts and then seething in a traffic jam as he battled to get home.

When that job ended he was the one mingling with tourists on Edinburgh’s Royal Mile, pushing his dustcart, sweeping up the litter on a zero hours contract that had no stability and even less enjoyment.

It couldn’t be further removed from where he is today, supporting nurses and medical staff, and caring for patients at Edinburgh Royal Infirmary.

The shift in career five years ago wasn’t just dramatic, it was life changing.

“I never envisaged myself doing this,” he said. “It’s like night and day.

“I’m doing anything from taking blood pressure to caring for patients who need help feeding, getting washed, dressed and taken to the toilet.

“I’m an odd job man. I gee the patients up. I walk in in the morning and regardless of where I am in my life a light switches on and I become alive.

“I love what I do.”

He found his calling by chance after quitting the zero hour cleansing role and finding himself scanning potential jobs. An advisor suggested care work, and next thing Mr Johnston was at Edinburgh’s Royal Victoria Hospital helping an elderly woman to the toilet.

“I remember thinking ‘I can do this’,” he said. “I’d never done any kind of caring role before, this was totally new and I just fitted.”

Mr Johnston, who lives in Craigmillar, now works at the Royal Infirmary’s Ward 106, a general mixed ward where patients’ needs can vary dramatically.

His natural flair and passion for the role has not gone unnoticed. Last year he was named NHS Lothian Staff Member of the Year in recognition of his dedication to the role.

“I left school in the mid-70s, worked on building sites and did different jobs,” he added. “To be named staff member of the year blew my mind. I had never felt so humbled in all my life.”

The Herald: Dame Denise CoiaDame Denise Coia

Dame Denise Coia, chair of Healthcare Improvement Scotland

Glasgow psychiatrist Dr Denise Coia has devoted her career to improving the mental health of Scots, a passion that was recognised last year when she was given the title of Dame of the British Empire.

Part of the Italian café dynasty, she spent a large portion of her working life in a health centre in the Gorbals, where her father Joseph was born after his family settled in Glasgow. The family later moved to Milngavie, where he ran a fish and chip shop and her uncle was a newsagent.

Celebrating 70 NHS Heroes for 70 Years: Day Two

She qualified in the 1970s, and made the switch to mental health after finding obstetrics “boring” as a young doctor. As a consultant psychiatrist she drove forward a range of improvements in the quality of mental health services and become an internationally-recognised leader in the field.

Among her key achievements was the design and delivery of specialist community provision which transformed mental health services in Glasgow.

She has held a number of high ranking roles, including Senior Principal Medical Officer Mental Health for the Scottish Government and Mental Health Advisor to Greater Glasgow Health Board.

She became inaugural Chair of the Healthcare Improvement Scotland in 2010. The organisation supports improvements across health and social care services in Scotland.

She is also a former Chair of the Royal College of Psychiatrists in Scotland and a former Vice-President of the Royal College of Psychiatrists as well as a current General Medical Council associate.

She is currently convener of Children in Scotland, which carries out a range of projects and roles designed to ensure children across Scotland have equal opportunities to flourish.

Her research interests have focused on supporting individuals and families of those with schizophrenia, and she was Medical Advisor to the National Schizophrenia fellowship in Scotland.

She has also supported young researchers through her role as Board member of Medical Research Scotland.

The Herald: Dr Anne Louise CunningtonDr Anne Louise Cunnington

PATIENTS with Parkinson's Disease are twice as likely to have an unscheduled hospital admission and average much longer lengths of stay once admitted.

Part of the reason for this is believed to be that they miss out on vital Parkinson's medication if they are admitted to hospital for unrelated emergencies such as heart attacks and falls.

Missing just a few doses of their regular drugs can have a very serious impact symptoms, such as tremors, speech and mobility.

One specialist trying to turn the tide on the problem is Dr Anne Louise Cunnington, a consultant geriatrician for NHS Greater Glasgow and Clyde and clinical audit lead for the UK Parkinson's Audit.

Last year, Dr Cunnington was instrumental in the roll-out of a new "dashboard" alert tool in the Glasgow region which she hopes will cut the length of time Parkinson's patients spend in hospital and provide a blueprint which could be expanded across NHS Scotland.

Under the system, any patients with Parkinson's from the Greater Glasgow and Clyde area are automatically flagged on the health board's 'Track' computer system with a yellow hazard triangle. When a hospital consultant or nurse sees the symbol, they can click on it for contact details for the patient's Parkinson's team.

Meanwhile, Parkinson's consultants and nurse specialists across the region will also get an automatic alert on their work computer if any of their patients are admitted to a hospital in the Greater Glasgow and Clyde region, ensuring that they can contact the ward to check that the Parkinson's medication is being administered as required.

Dr Cunnington said: “Patients with Parkinson’s, like any other patients, can be admitted to hospital for any number of reasons, such as a heart attack or serious infection, not necessarily because of their Parkinson’s. This means the focus of their treatment would be on the primary reason for their admission.

"If you look at patients' feedback they often are dissatisfied with the care they receive in hospital and it's often to do with medication.

“Not only does this improve things for the patients themselves, but it also saves money for the NHS as it’s proven that given the right medication, hospital stays will be shorter and beds will be freed up for other patients. It really is a win, win situation.”

The Herald:

A TEAM of nurses from NHS Lanarkshire have been devoting their own time to teaching life-saving resuscitation skills to schoolchildren. 

Known as 'Team Wishaw ED', the group is made up of staff nurse Caroline Casey, charge nurse Fiona Torrance, charge nurse Michelle Graham and staff nurse Fiona Macpherson, who all work in Wishaw General’s emergency department, and staff nurse Laura Gillies, who works in the hospital’s coronary care unit.

The nurses launched their project in April 2017 and have been visiting Lanarkshire schools ever since, training youngsters in cardiopulmonary resuscitation (CPR) by using their favourite teddy bears as 'patients'. 
In 2017, they trained more than 1700 school pupils in the technique. 

70 Years of NHS Scotland: Looking after patients from cradle to the grave

Caroline Casey said: “We had all talked for a while about the idea of spending some of our free time teaching CPR to primary school children.

“We found out about the organisation Save a Life for Scotland, which teaches people CPR. They helped us to set up and gave us training videos suitable for children. The kids love it when we go into the schools.

“We make it exciting for them – it’s not at all scary. The Primary 1-3 children practise the chest compressions on their teddies or other favourite soft toys. The older children use a CPR dummy.

“Of course, the little ones probably won’t have the strength to do CPR in a real situation but they are learning the skill for when they get older, and they can tell their parents about it. We also teach them other crucial information about things they can do in emergency situations, such as shouting for help or calling 999 and clearly explaining their location. 
“Many of the older pupils would hopefully be able to carry out the chest compressions effectively.

“I have two boys, aged eight and six, and they both got the training at school. They like to practise at home on their teddies and it’s great to see them so involved in it.

“We get a lot of satisfaction from volunteering to do this work and we hope to do the training in as many primary schools across Lanarkshire as possible.”

The Herald: Mr Fred PicardMr Fred Picard

HE performed the world's first computer-guided knee replacement 21 years ago and has been at the forefront of bringing the technology into operating theatres in Scotland. 
Mr Fred Picard, an orthopaedic consultant at the Golden Jubilee hospital in Clydebank, said the technique is delivering more accurate surgery for patients and would become the norm over the next 20 years.

Scotland is already leading the way in the UK with three times as many full knee replacements performed using computer-assisted surgery than in England and Wales - around 15 per cent compared to less than five per cent south of the Border. 

More than half carried out at the Golden Jubilee are already done using computer-assisted surgery, but Mr Picard said he believed “all knee replacements” will be guided by computers within 20 years.

Mr Picard was the lead surgeon on the world’s first computer-assisted knee replacement when her operated on a man in his 70s at a hospital in Grenoble, France. 

Celebrating 70 NHS Heroes for 70 Years: Dedicated staff are pioneering changes

Speaking about the technology in 2017, Mr Picard said: “Using conventional instrumentation there is still a lot of guesswork based on the surgeon’s experience, whereas when you use the computer you can assess absolutely perfectly the leg deformity, the range of movements - you can assess exactly what you’re doing from the beginning to the end of the surgery.

“It’s very much like satnav in your car - you know where you are all the time and you know where you are going.”

The computer plays a vital role in one of the most critical elements of a knee replacement procedure - the positioning of the implants.
The surgeon uses probes linked to a computer to map out specific areas of the body. This enables the surgeon to pinpoint exactly where cuts should be made and guides the patient’s new knee implant precisely into place.

The technique is used in around 40 per cent of knee surgeries in Germany and 25 per cent in Australia, where studies have shown it has significantly reduced errors compared to conventional surgery.

The Herald:

CHILDBIRTH  can take its toll on a woman’s body, sometimes resulting in distressing problems that can seriously impact on her quality of life.

Consultant Colorectal surgeon Mr John Camilleri Brennan and
his specialist team at NHS Forth Valley have focused on finding solutions to the upsetting problem of incontinence after childbirth. 

He has pioneered and established endoanal ultrasound to diagnose and help in the treatment of anal sphincter defects. Under his lead, the team has also developed a protocol for the management of tears and pelvic floor disorders.

Mr Camilleri- Brennan’s team was the first in Scotland and only second in the UK to introduce anal implants designed to tighten sphincter muscles. They continue to hold twice yearly training sessions for consultants, ensuring their expertise is shared. 

The multi-disciplinary team, which includes gynaecologists, urologists, gastroenterologists, physiotherapists and the continence advisory service, was recently awarded the prestigious William Cullen Prize by the Royal College of Physicians of Edinburgh (RCPE) in recognition of their work. 

Mr Camilleri- Brennan’s transformation of the service began in 2008 with the arrival of a £65,000 ultrasound machine. The equipment enabled staff to provide a more accurate diagnosis and was also helpful in recognising staging in rectal cancer. 

It has also enabled many of the 400 patients seen every year by the unit to be treated locally, without having to travel to Edinburgh or Glasgow. 

A graduate of the University of Malta, Mr Camilleri-Brennan received his postgraduate surgical training primarily in Dundee and Aberdeen, before pursuing studies in colorectal surgery at the University of Minnesota. 
He is now NHS Forth Valley’s lead clinician for colorectal cancer and holds an honorary senior clinical lecturer post with the University of Glasgow. 

Mr Camilleri-Brennan said the William Cullen Prize had recognised the work being carried out to try to improve the quality of life for women with disorders which often remain a taboo subject. 

He added: “We may not be able to find a perfect cure but can tailor treatment to help people manage their condition and enable them to have a better quality of life.”

The Herald:

TWO midwife sonographers from Raigmore Hospital in Inverness are heading to Ghana to help train staff in the Volta Region of the country. 

Raigmore Hospital has already supported the area after being approached by the Inverness District Scouts with staff in the maternity unit at Raigmore more than happy to donate items such as swabs and bandages which were no longer allowed to be used here in the UK due to regulations but could easily be used in Ghana.

Jocelyn Reid, lead midwife sonographer, said she is keen to carry on that relationship with the area and the HoHoe Municipal Hospital. 

She said: “I consider myself very lucky. Raigmore paid for me to do my ultrasound training and I want to use my skills and expertise to give something back to those who are less fortunate than we are in this country."

Old ultrasound equipment previously used in Raigmore Hospital, but replaced due to new standards that must be adhered to in the UK, is exactly the kind of thing the health centre needs.

She said: “We have these old machines which, although we can’t use them, are still in working order and would make a huge difference to the local community in Ghana. 

“By helping the staff learn how to use the machines and know what to look for it when scanning mums to be it will in turn help the region reduce their stillbirth and maternal mortality rate.

“The shipping of the containers has been organised for the equipment but we thought we should do what we can to get them filled and that’s where we need everyone’s help.”

Ms Reid and colleague Aileen Paterson are fundraising to pay for two containers, at a cost of £2000 each, to make the trip to Ghana and they’re also appealing to members of the public to donate any items that they don’t use anymore which could help the community in Ghana.

They are looking for: summer clothes for children aged 0-5years; maternity clothing; fembrace belts; nursery bedding; small toys, rattles etc; basins; and facecloths.

Ms Reid said: “We’ve really been overwhelmed by the support we’ve had from staff in the hospital and the wider community in Highland with donations coming in thick and fast.

"The response has been fantastic so far. I really hope it continues and would like to thank everyone for getting behind what we are trying to do.”

The Herald: Kevin RooneyKevin Rooney

Professor Kevin Rooney was national clinical lead for Sepsis in the Scottish Patient Safety Programme (SPSP) from May 2012 – October 2017. Led by Healthcare Improvement Scotland, this world-leading programme has since resulted in a 21 per cent reduction in Sepsis mortality throughout the country. 

Sepsis arises when the body’s response to infection spirals rapidly out of control injuring its own tissues and organs. Sepsis can be fatal, especially if not recognised early and treated promptly. Professor Rooney and colleagues in the Acute Adult workstream of SPSP focused on early recognition and treatment, with the aim of improving patient safety and care and reducing mortality.

Recognising that the support of clinicians would be vital to the success of any national programme, a programme was developed and delivered that engaged and connected clinicians so that they could work together on common challenges and implement improvements in their complex clinical environments.

Now, almost every NHS board as well as the Scottish Ambulance Service have implemented the ‘National Early Warning Score’. This focuses on the ‘4R’s’ – recognition, rescue, review and referral. 

Professor Rooney credits the hard work and dedication of NHS Scotland professionals with the improvements to the care of patients with Sepsis. 

He said: “The National Early Warning Score has made it easier for healthcare professionals to provide the right care for patients but more importantly, to make it difficult to do the wrong thing. NHSScotland staff are extremely passionate about helping to facilitate improvements and their dedication has been imperative to the remarkable progress in the fight against Sepsis.” 

2018 marks the 10th anniversary of the launch of the Scottish Patient Safety Programme and this important milestone provides an opportunity to reflect on its progress.

The world-leading work of Professor Rooney and his colleagues in SPSP and NHS boards has undoubtedly made an absolutely vital contribution to NHS Scotland’s progress in the continued fight against this relentless disease. 

Professor Kevin Rooney is a consultant in Anaesthesia & Intensive Care Medicine at the Royal Alexandra Hospital, Paisley.

The Herald:

AS a pharmacologist, Sir James Black's drug discoveries have transformed the treatment of conditions such as heart disease and stomach ulcers. 

Born in Uddingston, Lanarkshire in 1924, Sir James was the fourth of five sons. The family moved to Fife and, aged 15, he won a scholarship to the University of St Andrews to study medicine. His family had been too poor to send him to university, but he had been persuaded to sit the St Andrews entrance exam by his maths teacher.

After graduating in 1946, he decided against pursuing a career as a physician and paid off his debts by teaching in the Far East for a few years. In 1950, he took up a research post at Glasgow University's Veterinary School and went on to establish the Veterinary Physiology Department, where he developed an interest in the way adrenaline affects the human heart.

In 1958, he joined ICI Pharmaceuticals and developed propranolol, a beta blocker used for the treatment of heart disease. Propranolol has been described as the greatest breakthrough in heart disease treatments since the 18th century discovery of digitalis and has benefited millions of people.

Between 1964 and 1973, he worked for another pharmaceutical giant, Smith, Kline and French, where he developed his second major drug, cimetidine, for the treatment of stomach ulcers. It was launched under the brand name Tagamet in 1975 and soon outsold propranolol to become the world's largest-selling prescription drug.

A career in academia followed, with posts at University College London and King's College London, and served as director of therapeutic research at the Wellcome Research Laboratories. 

An extremely private man, Sir James was reportedly horrified to learn that he had won the Nobel Prize for Medicine in 1988. 
He was once described as the man who earned the most for the pharmaceutical industry through his drug development, though it earned him little personal financial gain. 

He died, aged 85, in 2010.

The Herald:

MARK Kerr retired from NHS Highland in April 2017 after 41years of working as a personnel manager, but his contribution to the health service continues. 

Since December 2017, Mr Kerr has been giving his time for free as a volunteer driver for Glasgow Children’s Hospital Charity, supporting the transportation of donor breast milk in Highland.

Mr Kerr said he has his sisters to thank for getting him involved.
He said: “Both my sisters work in special care baby units in Edinburgh and they heard it was a struggle to get supplies of donor milk to and from the Highlands so I was asked if I’d be interested in becoming a volunteer driver. An induction later and that’s what I’m doing.”

Donor breast milk is used in neonatal units across Scotland for sick babies whose mums, for whatever reason, do not have enough milk or are unable to supply their own breast milk.

Women across Highland can donate. Breast milk can be expressed at home and frozen while awaiting pick up or it can taken to Raigmore Hospital and placed in the freezer which is in the breastfeeding room at the main entrance of the hospital.

This unprocessed breast milk is then picked up by a volunteer driver, in this case Mark, who arranges to meet his Glasgow counterpart and swap the unprocessed milk for pasteurised breast milk which is then delivered to the neonatal unit at Raigmore Hospital. 

Mr Kerr added: “It’s a fantastic service which can help sick babies from across Scotland. I’m happy to be playing a small part in that.”