Sir Anthony Grabham

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Keith Breeden

The climax of the career of Sir Anthony Grabham, the most accomplished medical politician of his generation, came in a meeting with the prime minister, Harold Wilson, in 1975. Barbara Castle, who was secretary of state for health, was proposing to phase out private practice from NHS hospitals and change the consultant contract to favour full timers over part timers. Consultants opposed this strongly as they felt it betrayed the contract they’d agreed with Aneurin Bevan at the start of the NHS.

At the time Grabham was the chair of the Central Committee for Hospital Medical Services (CCHMS, the “consultants’ committee” of the BMA), and he put together a “grand alliance” of the BMA, the royal colleges, BUPA, and a member of the Hospital Consultants Association (HCA), a body that then threatened the BMA’s pre-eminence in representing consultants. For £20 000 (about £90 000 now) the alliance hired Lord Goodman, a friend of Wilson and the fixer of his day. He arranged a meeting of the group with Wilson and with a single phone call ensured an editorial supporting the consultants in a leading newspaper.

Goodman’s advice was that only Grabham speak in the meeting despite him being the most junior. Grabham expected Wilson to be a “rough diamond,” but he was dressed smartly and smoking a big cigar when the doctors arrived. Surrounded by older and grander men, including the presidents of the royal colleges, Grabham put the consultants’ case in what we can be sure was his clear, precise, polite, but firm manner. Wilson asked the then president of the Royal College of Surgeons what he thought, but, following Goodman’s advice, the president said that only Grabham would answer for the profession.

The meeting was a success in that a compromise was found whereby private beds would not be phased out in NHS hospitals where no adequate private facilities were close by—which was the case in most parts of the country. The compromise was proposed by David Bolt, a great friend of Grabham, who followed him as chair of CCHMS. Known as “Grabham and Bolt,” they were classic “good cop, bad cop” negotiators—with Grabham as the bad cop.

Grabham, however, set great store by politeness and dignity, and always maintained both in his meetings with Barbara Castle. Castle was famously fiery, but she was, reported Grabham, “not enough of a corkscrew. She said what she thought—a terrible weakness in a politician.” She described the experience of negotiating with Grabham as like being “shot at with silver bullets,” and told a colleague that he was greedy and arrogant, but “the best negotiator I ever dealt with and a huge force in committee meetings.” (Ken Clarke, a later secretary of state for health, had the same view.) Castle referred to his skills in her published diaries. Ten years later they sat side by side at dinner and Grabham introduced himself, saying that he was Tony Grabham and that they had met before. She asked: “You’re the Tony Grabham?” Grabham confessed that he was, and she responded: “You were a bugger.” They got on well at dinner, however, and Grabham remarked that “there was a tinge of left wing in me.”

George Godber, widely regarded as the best chief medical officer the NHS ever had (obituary at http://www.bmj.com/content/338/bmj.b710) and part of the negotiations, told a colleague with scorn in his voice “To think at the end of my life I was worsted by a Grabham.”

A second climax came at the annual meeting of the BMA in Liverpool in June 1979, when Grabham was asked to run against Jim Cameron to be chair of the council of the BMA. Cameron was well loved, and his great success had been in 1966 to negotiate the family doctor charter that revitalised general practice. Cameron became chairman of the council of the BMA in 1976 and promised to step down after three years. When it came to 1979 he decided to run again, but many people thought that he was not performing well: the membership of the BMA had fallen close to only 50% of British doctors, weakening it politically and financially.

Grabham was persuaded to run against Cameron by John Marks and Tony Keable-Elliott, both general practitioners, later leaders of the BMA, and good friends of Grabham. Grabham won the election, which upset many old friends and admirers of Cameron, and in doing so he showed the ruthlessness that was essential for his success.

Grabham was elected to make changes, and he illustrated the change in his first meeting of council he chaired by finishing it at 2.30 pm when normally it went on into the early evening. This was, he conceded later, “ill judged”: he was tougher than he needed to be. He and the other leaders set about increasing BMA membership by improving services—particularly introducing regional services and industrial relations officers who could help doctors in their disputes with their employers. At the time the HCA threatened to be a serious rival to the BMA for the membership of consultants, but the innovations introduced by Grabham and the other leaders increased BMA membership to 75-80% of doctors, restoring its political clout, improving its finances, and seeing off the HCA.

He also moved the BMA into science and ethics, recognising perhaps the desirability of the BMA seeming to be more than simply a trade union, and developed the public relations capacity of the association. The largest ever increase in membership of the BMA came during his chairmanship.

In his time Grabham dealt with three prime ministers, James Callaghan and Margaret Thatcher in addition to Wilson. Callaghan made little impression. Grabham met Thatcher first when she was leader of the opposition, seeking support in the battle over private practice. She didn’t offer support. He met her again when he was chairman of the BMA council, and she was the first prime minister to refuse to implement the recommendations of the review body on doctors’ pay. He found, as might be expected, that he “couldn’t budge her.” Grabham also met Jeremy Thorpe when he was leader of the Liberal Party and “found him attractive, pleasant, and willing to listen to arguments.”

During his chairmanship Grabham also started BMA Services (BMAS), which helped members with their financial affairs. He was given the idea by similar services offered by the Canadian Medical Association. A joint venture with Jardines, BMAS brought money into the BMA and also tied in members, who would lose the services if they resigned. BMAS was eventually sold for some £20 million. With his financial mind, Grabham also served as deputy chair of PPP, the medical insurance company. It was eventually sold for more than £500 million, and the proceeds went to found the PPP Foundation, which is now the Health Foundation, the best funded of the health think tanks. Some say that Grabham’s skills in leadership, and financial negotiation combined with his ruthlessness meant that he should have been a major business leader.

Born in Newcastle in 1930, Grabham came from a family of public servants. His grandfather was the head of all the fire brigades in the northeast and his father an inspector in the police. Grabham did all of his medical training in the Royal Victoria Infirmary in Newcastle. During that time he worked as house physician to Henry Miller, a neurologist famous for his writing, erudition, and wit. Miller didn’t like Grabham and once asked Grabham on a grand teaching round if he had tested the patient’s sense of smell. He hadn’t. “Useless, useless,” concluded Miller. Grabham learnt his surgery from George Fegetter, who was “straight, kind, and an outstanding surgeon,” all qualities that Grabham admired.

Grabham also spent two years in the army as regimental medical officer—one in Celle in Germany, and one in Derna in Libya.

A lifelong supporter of Newcastle United, Grabham would have liked to stay in the North East, but there were no jobs and he wanted “to run my own show.” He wrote to every region asking about jobs and was invited for an interview for a job in Kettering, where he was appointed as a consultant at age 34, which was young at the time. He was one of only three surgeons, and they all had to do everything—abdominal, breast, thyroid, vascular, urological, and paediatric surgery. Grabham regarded himself as a “middle of the road general surgeon,” not a brilliant one. But little gave him greater pleasure than “to get up in the middle of the night and operate to stop a bleeding ulcer.”

Grabham became interested in medical politics through “self interest.” He was frustrated by the underfunding and failings of the NHS, and by the poor performance of the BMA. He wasn’t one simply to moan—rather he entered the political fray and rose rapidly through the BMA. Why was he successful? He was effective, decisive, ruthless, had stamina, and could “take the rough with the smooth,” although he insisted that he “had little rough in his life.”

The most prestigious of Grabham’s chairmanships was that of the Joint Consultants Committee (composed of the BMA and the presidents of the royal colleges), the body that negotiated all hospital matters with the government (excepting pay and terms and conditions of service). The role had always been filled by a leader of the royal colleges, but Grabham stood for election and became the first BMA man to become chairman of this influential body. He served from 1984 to 1989.

One place where he didn’t rise as high as he hoped was the General Medical Council. He was on the council for 20 years and ran twice unsuccessfully to be president. He may not have succeeded because he was too closely associated with the BMA, but it’s also said that few of the women on the council voted for him. Asked if he was a misogynist, he answered “not true, but you can’t please all the people all the time.”

In 2002, however, Grabham did become president of the BMA, and in his presidential address he described himself as a child of the NHS but said how he had long wondered if there might be a better system. He bemoaned the chronic underfunding of the NHS. A third of the NHS, he said, was of the highest quality, a third reasonably good, and a third “verging on third world medicine.” He advocated “carefully and critically reviewing other healthcare systems—possibly along continental lines of social insurance rather than a tax based healthcare system,” although he knew that this view was not popular and against BMA policy.

In 1993 after several years on the Journal Committee, the committee of the BMA that oversaw the BMJ Publishing Group, Grabham became the chair of the committee. He described this as “undoubtedly one of my most enjoyable chairmanships.” I was chief executive of the group at the time, and, although very different people, we worked effectively together and liked and respected each other. During this time the group began electronic publishing, launched new journals, started Clinical Evidence, which went to 40 000 British and 500 000 American doctors, and initiated other new ventures. Thanks in part to Grabham’s business brain, the group’s turnover grew from £12m in 1991 to £55m in 2004, and profits from breakeven to £9m. He also negotiated the BMJ Publishing Group (now BMJ) becoming a distinct legal entity rather than simply part of the BMA.

Christened a Roman Catholic, Grabham described himself in later life as a “genteel Roman Catholic agnostic.” When his final illness was diagnosed he returned to the church and found it comforting. He confessed and took communion.

Ruthless, ambitious, and arrogant are words that have been used about Grabham, but so has the word kind. My wife, who cared not a fig for the hierarchy of the BMA, has never forgotten him ringing her after her brother in law killed himself. His favourite reading in retirement was said to be the obituaries because only nice things were said about people, although in the obituary he wrote of David Bolt, he recognised reluctantly that “It has become customary for obituaries to reveal something of the subject’s weaknesses.” Grabham was generous, tipping the driver who had ferried him and colleagues around India for a week the equivalent of six months’ wages. And he had an unequalled talent for holidays, with several a year, almost always in the sun, arranged well in advance.

An insight into Grabham’s character can be gained from one of his favourite pieces of writing, William Osler’s Aequanimitas, in which he writes: “In the physician or surgeon no quality takes rank with imperturbability.” Osler then defines what he means by imperturbability: “Coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril, immobility, impassiveness.” Osler also advocates “a certain measure of insensibility” as “not only an advantage, but a positive necessity in the exercise of a calm judgement, and in carrying out delicate operations.” No better description could be offered of Grabham as a man, leader, politician, and surgeon.

Grabham developed a spindle cell sarcoma of the thigh in 2014, which rapidly spread to his lungs. I visited him a few weeks before he died, to gather material for this obituary, and he was his same imperturbable self. He leaves his wife, Pam; his children—Sarah, who has Down’s syndrome; Ruth, who is a general practitioner and medical director of a clinical commissioning group; John, who is a consultant colorectal surgeon; and Matthew, a company director in Florida—and two grandchildren, Tom and Fiona.

Consultant general surgeon Kettering General Hospital; chairman of the council and president of the BMA (b 1930; q University of Durham 1953; FRCS 1970; knighted 1988), died from spindle cell sarcoma on 22 February 2015 .