The NHS is seldom out of the news whether it is to highlight a chronic shortage of staff, the lack of funding, the length of the waiting lists or the eternal debate over how the service should be funded. In the 70th anniversary year of the founding of the NHS, we caught up with eminent cardiologist, Dr Phyllis Holt to find out more about her career and why she believes cardiology is the most exciting discipline to work in.
Working in the medical profession requires lengthy, rigorous training initially by way of more general training in different disciplines and specialities in a hospital. The general training is followed by more specialised training in order to become a consultant. With a minimum training period of 7 years for most senior roles, joining the medical profession is not for those without a single determination of purpose and is, perhaps, why it is often referred to as a vocation rather than a just a job!
Whilst the British Cardiovascular Society’s report of September 2015 workforce survey shows that there were 1,389 consultant cardiologists in the UK with a further 58 vacancies, this number remains largely unchanged across a three year period of 2013-2015 which means that there are just 22 cardiologists per million population in the UK.
Cardiology is a very competitive specialty and staff have to withstand long hours and physical stress, not least as they are required to wear lead jackets for hours on end in a cardiac catheter lab.
In order to expand the numbers of consultants of any discipline, there have to be more medical students trained. Earlier this year the Government announced 5 new medical schools. One of these will be in Kent (Canterbury), fulfilling one of Dr Holt’s dearest wishes.
In respect of her own career path, having completed her undergraduate medical training at Manchester University, Dr Holt went on to pass her Royal College of Physicians examinations (both a written and practical examination) which is mandatory for anyone wanting to become a hospital medical consultant in the UK: “I wanted to become a cardiologist from my early days in medical school, as I was fascinated by the sounds of the heart. It is an ideal specialty in my view as it combines the need for diagnostic skills with practical skills”.
“Cardiology is a field where research is constant and thus treatment options are constantly changing and developing. Indeed the way we manage cardiac problems has changed completely – it’s never boring!”
Whilst working at Guy’s Hospital in the early part of her career, Dr Holt developed her long term sub specialist interest in the treatment of the electrical abnormalities of the heart – known as arrhythmias (where the heart beat is irregular be that too fast or too slow).
Working with Dr Paul Curry and Dr Edgar Sowton, whom Dr Holt described as ‘probably the best UK cardiologist of his generation’, Dr Holt helped develop the then pioneering technique of radio frequency ablation – this is a procedure that uses radio frequency energy (similar to microwave heat) to destroy a small area heart tissue that causes rapid and irregular heartbeats. As a result of her work, Dr Holt gained her MD degree and was elected a Fellow of the Royal College of Physicians. The work also gained international recognition and Dr Holt was subsequently elected as a Fellow of the European Society of Cardiology and then a Fellow of the American College of Cardiology.
Dr Holt’s qualifications meant that prior to her retirement from practice, she was able to diagnose and treat patients with cardiac problems and whilst not a cardiac surgeon, she would perform interventions (operations) such as angiography, angioplasty, implanting cardiac pacemakers (simple and complex) and ablation of sites of abnormal cardiac rhythm. In an average week post qualification, Dr Holt had planned procedures for two days a week and a further day when she was on call for emergency cases.
The sense of responsibility for having someone’s life in your hands and the ability to change it for the better must be a truly amazing yet somehow terrifying experience at the same time yet Dr Holt recalls only feeling slightly nervous:
“The first solo procedure I performed was a simple angiogram, having previously performed a number under supervision. I felt slightly nervous but was supported by the usual theatre team of excellent nurses and technicians. I do not believe that during the course of a long career any Interventionist ever truly relaxes during a procedure as each patient and situation is unique”.
When discussing what happens when procedures don’t yield the hoped for result, Dr Holt shared in the disappointment as much as the families involved:
“It is always deeply saddening not to achieve the desired outcome, particularly as I would have got to know the patient and their family well during the process and would inevitably share their sorrow”.
The elation on the other hand when the treatment has been a success also gave Dr Holt many proud moments in her working life whenever she and her team saw a patient walk out of the hospital who was not expected to do so. The number of beautiful orchids in Dr Holt’s home are testament to the many grateful patients that Dr Holt and her team have helped. When chatting with Dr Holt, the common theme throughout her responses – and indeed always the first response – is that it is always a team effort with a focus on wanting the best for her patients. Her experience was that working in a supportive, collaborative environment always produced the best outcomes.
With the same determination to best serve the public, it is not surprising that Dr Holt and all the Consultant Cardiologists in Kent pushed to make their dream of establishing an NHS Tertiary Cardiothoracic provision a reality. Unfortunately they could not realise that dream but undeterred Dr Holt and other consultants, including those from other specialties remained resolute that Kent deserved access to better facilities and they continued on doggedly supporting each other and their patients. In 2014, KIMS (Kent Institute of Medicine & Surgery) was opened and the first open heart surgery took place in November 2015 – the first ever in the County.
One of Dr Holt’s favourite quotes is Ralph Waldo Emerson’s “Do not go where the path may lead, go instead where there is no path and leave a trail”. Very apt given Dr Holt’s latest venture. With no sign of wanting to slow down having retired from active practice, Dr Holt and her husband, Franz Dickmann, Chairman of Sterling Health Security Holdings, are working on a new joint healthcare project with Swansea University and Carmarthenshire County Council worth £200m to create a Wellness and Life Science Village in Llanelli. Phase one is due to open in 2021.
The project has already been three years in the making and is a game changing concept that brings care out of the hospital and closer to the patient’s home, plus delivering revolutionary care to the frail and elderly. This will be delivered by the implementation of digital health technologies and Dr Holt is heavily involved in delivery of all clinical aspects of the development including digital health with partners from the industry.
As people live longer and the strain on the NHS as it is at the moment, the current funding model of the NHS is under constant scrutiny. Should the service remain free at the point of delivery? Is it still the envy of the world? Would a mixed private/public provision be a better alternative? Dr Holt is absolute in her view that the NHS is the best deliverer of health care. However, she also believes that there is an increasingly strong role for the private sector, industry and the NHS to work together in partnership and Llanelli is testament to that approach.
Speaking about the new Wellness and Life Science Village, Professor Richard Davies, Vice Chancellor of Swansea University, said: “This hugely exciting collaboration between Carmarthenshire County Council, the private sector and Swansea University is ground-breaking in integrating business development, education, healthcare, leisure, tourism, wellness support and research in life-sciences in one location”.
“The collaboration will strengthen the region’s ability to commercialise research in life science, attract inward investment from bio pharmaceutical and medical technology firms, and increase the export of high value goods and services in the field of life sciences. It is a sign of the University’s vital importance to the City Deal project and the impact we have on the region, both economic and in delivering 21st century health provision”.
The drive and commitment required to get a project such as this off the ground is relentless and yet for Dr Holt, it doesn’t seem like work and there is no sign of her giving up anytime soon: “I love my career, it is all I ever wanted to do. I cannot imagine doing anything else! I enjoy the challenge, in particular, I enjoy meeting new people, learning from them and learning new skills, for example my knowledge of what is possible now in health care with the use of digital technology are expanded exponentially. Foremost, I want to continue to contribute towards patient care.”
If everyone involved in the NHS has the same drive and determination as Dr Holt continues to show beyond her time in practice, then her wish that her grandchildren will always have access to and still be using the NHS seems eminently achievable.