Lives of the fellows

John (Sir) Grimley Evans

b.17 September 1936 d.26 March 2018
Kt(1997) MB BChir Cantab(1962) MRCP(1963) FRCP(1975) MFPHM(1978) FFPHM(1982) MD(1985) DM Oxon(1985) FMedSci(1998)

Sir John Grimley Evans broke ground in medicine for the elderly in the later years of the 20th century. Both as an academic and a clinician, he helped steer the NHS response to what he described with typical vivid phrasing in his 1997 Harveian Oration as a ‘bolus of unprecedented survivors of childhood’.

His greatest achievement was driving the integration of older adults into acute general hospital care. At Newcastle upon Tyne from 1971 and Oxford from 1985, he helped end the routine dispatching of older patients to substandard care at separate facilities. Combining an enthusiasm for epidemiology and clinical medicine, he also broached key research fields, overseeing large community-based population studies on strokes and hip fractures.

Later in his career, he further contributed to the profession by chairing national and international committees and serving as vice president of the Royal College of Physicians. From I988 to 1995 he edited the British Geriatric Society’s Age and Ageing. Producing the journal from his front room, he established it as a respected academic publication in a two-person team with his wife, Corinne (née Cavender).

He was born in Birmingham, the son of Harry Walter Grimley Evans and Violet Prenter Walker. His drive and intellect emerged late in his school career at King Edward’s School in Birmingham. In the sixth form, however, he had entered the charge of Tony Trott, an English teacher famed for a string of illustrious protégés over his long career. This expert care brought out remarkable talent in both arts and sciences. ‘He started talking about poetry, and new worlds opened up,’ Grimley wrote. ‘I was a disorganised adolescent, in danger of dropping out, and Tony turned me around.’

He won an open scholarship in natural sciences at St John’s College, Cambridge and completed his medical degree at Oxford. A series of happy accidents then proved the ideal grounding for a career in geratology (a term he championed on semantic grounds against gerontology, technically ‘the study of old men’).

He was first drawn to surgery – typically, in his view, for a young doctor from an ‘underprivileged and non-medical background’. But he swiftly discovered he was unsuited, as he was ‘unable to do the same thing in the same way twice running’. Instead, through Donald Acheson [Munk’s Roll, Vol.XII, web] at Oxford, he discovered epidemiology. He then set out to find a branch of clinical medicine where he could apply its principles to evaluate and improve services.

No such opportunity emerged in psychiatric and general medicine roles he tried in the UK, so he took a research post in Wellington, New Zealand. With this came a spell on three coral atolls 300 miles off Samoa studying Polynesian Islanders. Their hale condition taught a valuable lesson: ‘inexorable’ age-associated changes were often, in fact, avoidable. ‘“Correcting blood pressure for age” as had been widely taught was nonsense,’ he wrote. ‘Blood pressure need not rise with age and if it does it is usually a Bad Thing.’

At 35 he applied these insights at Newcastle upon Tyne as one of the NHS’s youngest consultants. Hence came the influential ‘Newcastle integrated model’, combining acute general medical and specialist geriatric services. ‘From the known characteristics of disease in later life it was easy to predict that the key feature of a successful geriatrics service would be ready access of older people to acute hospital beds, not, as had been assumed, to long-stay beds,’ he wrote. Putting a specialist consultant on a general medical ward, he found, increased the number of older people admitted, but cut bed occupancy through shorter stays. This was done not by transferring them to geriatric beds but by getting them back home.

As professor of medicine (geriatrics), he also introduced a teaching course that won talented clinicians to his field. With his habitual dry humour, he condemned his own ‘disgraceful’ route to becoming a geriatrician, a path he characterised as simply declaring himself one.

He returned to Oxford to take up a new chair of geriatric medicine (later restyled clinical geratology). Here he instituted the integrated model and developed a new teaching programme. He held this post for the rest of his career, but meanwhile embarked on a decade of committee work. Central activities, he had decided, offered the most promising route to influence events. He served at the Royal College of Physicians, the World Health Organization, the Department of Health and the Medical Research Council. Chairing the Committee on Medical Aspects of Food and Nutrition Policy (COMA) was a particular interest as it lay on the intersection between science and policy-making.

In 2000, he took on the unwelcome task of leading the team to assess whether General Pinochet was fit to stand trial. He swatted away the many ensuing media enquiries, but later clarified his role in the decision not to prosecute. ‘All we did was to list the medical facts,’ he said. ‘Whether those medical facts constitute unequivocal grounds for decreeing unfitness for trial is outside our field of competence and outside our responsibilities.’

He retired in 2002, having seen the profession address many of the injustices that drove his work. He identified continuing threats, however. Older people, with limited life expectancy and often disabilities, he wrote, would inevitably be discriminated against by collectivist thinking and inappropriate application of evidence-based medicine.

Sir John Grimley Evans, known to all as Grimley, was the first member of his family to attend university. This background may have contributed to a Stakhanovite work regime and an outsider mentality that withstood accolades such as his knighthood in 1997.

Throughout his career he was also prepared to make enemies to make headway. His earliest memories, he wrote, were of ‘people dropping bombs on me’ in wartime Birmingham. To this he ascribed a lifelong belief that ‘conflict is a part of normal life’.

At 6’4”, he was a tall and distinguished figure. The carefully modulated tones that won him lead roles in school plays also made him a skilled public speaker. He wrote with immense care and erudition. His many interests included chamber music, opera, Anglo-Saxon studies, archaeology and poetry, especially the work of T S Eliot.

Fly fishing was a lifelong passion that suffered during his working life, when he cherished his weekends as chances to visit wards and patients. He cast with honour in the annual Oxbridge fly fishing contest. His ‘CRACKPOT’ study of 1998 was a light-hearted scientific attempt to answer vexed questions over the angler’s choice of fly (‘Does the fly matter? the CRACKPOT study in evidence based trout fishing. The Collaborative Randomised and Controlled Kennet Piscatorial Options Trail [CRACKPOT] Investigators.’ BMJ 1998 317 1678).

Grimley’s work priorities reflected deep compassion. Despite unending academic and public commitments, he always stayed personally involved in the care of his patients. ‘Clinical practice among older people is a professionally rewarding career,’ he wrote. ‘However awful a patient’s plight there is always something a multi-professional team can do to improve things.’ He strove to honour each patient’s own priorities, a commitment he linked to an episode in his youth. The dilemmas of truly following a patient’s wishes, he wrote, seem to elude those who have never suffered a significant illness.

He died suddenly in 2018 and was survived by his wife, two sons, a daughter and five grandchildren.

Piers S Grimley Evans

[Age and Ageing Volume 41, Issue suppl_3, 1 November 2012, Pages iii10 https://academic.oup.com/ageing/article/41/suppl_3/iii10/30358 – accessed 14 January 2018; BGS British Geriatrics Society Professor Sir John Grimley Evans MA, DM, MD, FRCP, FFPH (1936-2018) www.bgs.org.uk/professor-sir-john-grimley-evans-ma-dm-md-frcp-ffph-1936-2018 – accessed 14 January 2018]

(Volume XII, page web)

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