Since 2007 my research has been situated at the intersection of health, history and policy and I have built a programme of work, frequently in collaboration with clinicians, social scientists and policymakers, that exemplifies the value of using history as an analytical resource to rethink current health challenges and produce a new evidence-base that can help shape policy and practice.
Quality in Healthcare
In 2017 I took up a Wellcome Trust University Award to work on a new project on quality in healthcare. The idea that healthcare quality could be defined and measured through outcomes, structures and processes emerged in the USA in the 1960s and then spread to other nations, including the UK. Drawing on interviews with clinicians, policymakers and patient groups in the UK and the USA, my work will historicise the emergence of this international movement, focussing on how it has transformed health policy and practice at every level producing a new culture of audit and evaluation. Quality improvement initiatives have been paralleled by increasing concern about patient safety and this research will produce new evidence to explain why this might be so and will bridge important approaches in the medical humanities and policy engagement.
Stroke, Medicine and Society
Stroke has always been part of the medical landscape but it is only since the 1990s, when the first acute treatment for stroke was established through a trial by the National Institute of Neurological Disorders and Stroke (NINDS) on recombinant tissue plasminogen activator (tPA), that it has been understood to be an acute medical emergency. Through interviews and archival work across the UK, Europe and North America and including some casestudies from developing countries, my work is analysing how the new treatments have driven the global reconfiguration of practice and understandings of stroke. In localities where stroke services have been reconfigured to meet the tight time-frame required for tPA administration, outcomes have improved measurably for all patients regardless of whether they received treatment or not. My most recent paper in the New England Journal of Medicine argues that these improvements have come about because the prioritisation of stroke in health systems and policy enabled the wider establishment of stroke units, drug interventions such as aspirin and anticoagulants, swallow tests and swift rehabilitation, the benefits of which were all well-evidenced before the 1990s. The history of stroke should encourage us to look at other disease conditions, currently viewed as low priority to see whether the evidence around treatment is being implemented. http://www.nejm.org/doi/10.1056/NEJMp1514696
The History of Guy’s and St Thomas’, 1970s to 2000s
This project, funded by Guy’s and St Thomas’ Charity, brought together the perspectives of decision-makers, clinicians, workers and patients to map key events such as the merger of the medical schools, the creation of one hospital Trust and the building of the Evelina Hospital for Children to capture the history of these pivotal medical institutions during a period of significant local and national social and political change. With Julian Simpson I am writing a book, British Healthcare and the NHS Since 1970, which is under contract to Bloomsbury and will tell the story of Guy’s and St Thomas’ against the wider social, scientific and political changes of the period. See: http://www.chstm.manchester.ac.uk/research/projects/guysthomas/
Health, History & Policy
A secondment to HiPPO between 2009 and 2010 enabled me to develop my interests in contemporary medicine and I am leading a collaborative seminar series with HiPPO and the London School of Hygiene and Tropical Medicine to explore the role of policy in history and the place of history in policy processes.
Black and Minority Ethnic Clinicians
Emma Jones and I co-authored Against the Odds: Black and Minority Ethnic Clinicians and Manchester, 1948-2009 (Carnegie Press 2010) which drew on new historical research and oral history to weave together the personal experiences of BME clinicians in Manchester with the wider histories of labour shortages, migration, discrimination, and the history of the NHS. Funded by Manchester PCT, the work was used as a resource by the Department of Health’s Equality & Diversity Committee.
Anaesthesia and Pain
My early research focused on the life and work of John Snow, anaesthetist and epidemiologist and publications included Operations Without Pain: The practice and science of anaesthesia in Victorian Britian, 1846-1900 (Palgrave 2006) and Blessed Days of Anaesthesia. How anaesthetics changed the world (Oxford University Press, 2008; 2009) which was Highly Commended in the Longman/History Today Book of the Year Awards, 2009 and published in Japanese in 2013.