Lives of the fellows

Martin Wilkinson McNicol

b.29 January 1931 d.8 August 2012
OBE(1990) MB ChB Glasg(1953) FRCP Glasg(1967) FRCP Edin(1969) FRCP(1971)

Martin Wilkinson McNicol was a respiratory physician at Central Middlesex Hospital, London, president of the British Thoracic Society (BTS), and chairman of the NHS Trust Federation. His professional career was directed to improving the experience and outcome for patients. This was achieved, at various times of his life, through clinical work, teaching, research, service development and health service management.

Martin was born in Glasgow, the son of Martin Wilkinson McNicol, who worked in insurance, and Elizabeth Straiton McNicol née Harper. He was the youngest of three siblings. His brother, George, also qualified in medicine, became principal of the University of Aberdeen and a fellow of the RCP. Martin went to Glasgow Medical School, qualified in 1953, and held junior hospital posts at the Western Infirmary and Stobhill Hospital. It was however a move to Hammersmith Hospital, London, in 1959 to work with Charles Fletcher [Munk’s Roll, Vol.X, p.146], John West and Philip Hugh-Jones [Munk’s Roll, Vol.XII, web] that set the direction for his subsequent career. Hammersmith was the main UK focus for an emerging, more scientific approach to clinical, epidemiological and physiological aspects of respiratory medicine. Martin developed a particular interest in respiratory failure, where he collaborated with Moran Campbell [Munk’s Roll, Vol.XI, p.93] and Neil Pride.

Martin then spent a short period at Sully Hospital, Cardiff, where he was exposed to respiratory intensive care and the final days of sanatoria treatment for tuberculosis. He moved to Central Middlesex Hospital, London, as a research registrar, and was appointed as a consultant physician in 1964. Martin was then busy on several fronts – clinical work, research, service development and managing Willesden Chest Clinic and the district tuberculosis service. Within his first three years Martin had introduced one of the first coronary care units in the country (with Keith Ball [Munk’s Roll, Vol.XII, web]), a hospital wide cardiac arrest service, a high level cardiac intensive care unit, a lung function laboratory that included blood gas analysis, and a ward-based assisted ventilation service (and later an intensive care unit).

Martin’s arrival at Willesden Chest Clinic coincided with the move to out-patient based treatment for all but the sickest patients with tuberculosis. The workload was high, however, particularly after Idi Amin expelled the Indian community from Uganda, giving Willesden the highest incidence of tuberculosis in the country. Martin introduced clinics for new immigrants and BCG at birth for all babies in Brent. As chair of the Joint Tuberculosis Committee he helped develop treatment guidelines for tuberculosis, the forerunner of guidelines for many other respiratory conditions.

Martin’s research was unusual at this time in that it took place in a district general hospital, albeit teaching affiliated, and it was concerned with common conditions. He carried out the first large survey of blood gas tensions in patients with exacerbations of COPD (chronic obstructive pulmonary disease) during the last major London smog (‘Severity of respiratory failure. Arterial blood-gases in untreated patients’ Lancet. 1965 Feb 13;1[7381]:336-8). This paper, together with the book Respiratory failure (Oxford, Blackwell Publishing Ltd, 1969) co-edited by Martin, Moran Campbell and Keith Sykes, led to major changes in the management of respiratory failure. He introduced flow-guided catheterisation into the coronary care unit, and supervised studies on the haemodynamic effects of myocardial infarction and the response to treatment.

Martin enjoyed teaching and his somewhat combative approach was extremely popular. His advice was widely sought on many fronts, and highly regarded; throughout his life he encouraged many, women perhaps in particular, to take on challenges they had thought outside their reach.

Within three years of his consultant appointment, Martin became involved in management at Central Middlesex Hospital, and was soon appointed chairman of the hospital management committee, a post he held for many years. He was one of the first to foster multidisciplinary working pathways, encouraging medical and non-medical staff to work closely together, long before it was fashionable to do so, setting up clinical directorates run by a doctor, nurse and manager with their own budget. Central Middlesex gained a reputation for innovation in hospital management under his leadership.

Martin chaired Brent Health Authority from 1986 to 1988, a time of political upheaval with considerable resonance in Brent. He helped negotiate the merger of Brent and Paddington Health Authorities, to form Parkside Health Authority and was vice-chair from 1988 to 1991. He helped mastermind Central Middlesex Hospital’s bid to be one of the first NHS trusts in 1991, leading some to accuse him of opting out, though in fact he was a staunch supporter of the NHS and never treated private patients. He chaired the trust from 1991 to 1995, one of few clinicians to take on this role. The hospital now has a ‘McNicol Drive’, recognising not only Martin’s major contribution to the trust, but also the iconic image of him arriving on a motor bike, wearing a bow tie.

Other appointments included being sub-dean for teaching for Central Middlesex, membership of the Acheson and Calman committees, being on the board of Harlesden City Challenge and the North West London Training and Enterprise Council, and, less to his liking, chairing the new NHS Trust Federation, which he did for a year.

As chairman of the British Thoracic Society in the late 1980s, Martin saw that the specialty was under threat, with resources diminishing and consultants not being replaced. With the president, Jack Howell, he overhauled the way the Society functioned to ensure that the interests of patients were paramount and the Society was able to champion their needs. Martin chaired the new executive committee initially, and saw the Society grow into an extremely effective and highly regarded professional body. Martin’s major contribution to respiratory medicine was recognised by his appointment as president of the British Thoracic Society in 1989 and the award of the BTS medal in 2008. He was also awarded an OBE in 1990.

Working with Martin was fun. He had robust views, which he enjoyed debating, and a good sense of humour, but had no time for cant, pomposity, privilege based on who you were or who you knew, or complacency. He inspired great loyalty based on respect for his values, his integrity and his concern for patients.

After retiring from the NHS, Martin headed the Overseas Development Authority health sector reform programme in Samara, Russia. He also studied the history of country gardens in the West Country, and continued to develop his expertise in photography. He moved to Beverley in 2008. He died from complications of psoriasis. He was survived by his wife Moira (née Sutherland), three daughters (Elizabeth, Kate – a doctor – and Jane) and six grandchildren.

Anne Tattersfield

[Brit.med.J., 2012 345 6247]

(Volume XII, page web)

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