Q&A with Sir Simon Wessely

Professor Sir Simon Wessely, newly installed as President of the Royal Society of Medicine, is Regius Professor of Psychiatry at King’s College London and the first psychiatrist in the Society’s history to hold office as President. He describes what to expect from his presidency and where he thinks the priorities lie for the Society over the next three years.

You arrive at the RSM after relinquishing your role as President of the Royal College of Psychiatrists. Could you describe your presidential style?

I’m fairly easy-going and you’ll rarely see me wearing a suit and tie, unless it’s a formal occasion of course. You certainly wouldn’t describe me as fashion-conscious. I like to enjoy myself and tend to be irreverent, but once people know that I have a certain style they seem to warm to it. From a personal perspective I’m not a great person for form filling and I’m definitely not a fan of the regulatory society.

Give us a potted history

I read medicine and history of art at Trinity Hall, Cambridge and then completed my medical training at Oxford University. After deciding I wanted to be a psychiatrist I started training at the Maudsley Hospital in London. I also spent time at the National Hospital for Neurology and completed a Masters in epidemiology at The London School of Hygiene & Tropical Medicine.

Unexplained symptoms and syndromes were my main research interest at the start of my career. I started seeing patients with chronic fatigue syndrome — I still see patients in our clinical service at King’s— and then, in the mid-90s Gulf War Syndrome came along and I was intrigued by the similarities. It was obvious that the symptoms of chronic fatigue syndrome were very similar but with a completely different proposed causation.

No population-based research looking at Gulf War syndrome was being carried out so, with funding from the Pentagon and the UK Ministry of Defence, I set up an epidemiological study with colleagues which proved very successful.

I hadn’t worked with soldiers before but found them fascinating to work with and got on with the military very well. I was hooked and today this is now my main research interest.

What’s your vision for the RSM? Does it need to change and, if so, in what ways?

I’ve been using the RSM since I was a young doctor – indeed I wrote my second ever paper, which was a history paper on neurasthenia (1), in the RSM Library.

I’m not one for radical change but the RSM needs to carry on appealing to younger doctors and could do with being a little bit more edgy. I think we can probably go some way in achieving this by taking on some of the more difficult and controversial topics, such as inequality, rationing and funding in the health service.

Although the RSM doesn’t ‘do’ politics, health is a political issue and needs to be debated out in the open. With all the clinical disciplines represented under one roof there are no factional interests at play at the RSM, so as long as we remain non-partisan, we are the place where these debates should take place.

The recent Stephen Hawking speech at the RSM was a perfect example of a controversial meeting. It’s going to be difficult to top that one though – until we read the speech the night before we hadn’t realised quite how controversial it was going to be.

What did you think of the Hawking vs Hunt row?

To a certain extent it overshadowed the event itself — since the so called ‘weekend effect’ was never discussed. I can understand why Jeremy Hunt chose to defend himself but I’m not sure if it was wise for him to do this via Twitter. The result though was that the RSM probably got more publicity in a day than it normally does in a year.

I might be unusual in that I like the company of politicians and would like to get more of them to speak at the RSM. I’ve worked with 13 different ministers of state for military veterans and they have nearly all been hardworking, honest people. Being a politician is a very difficult job but, in my experience, much of what they do is not party political, there’s consensus across the political parties and they’re all trying to do their best in sometimes awkward and difficult situations.

How do you think RSM members view the Society?

From my previous experience at the Royal College of Psychiatrists, I understand that the danger of being at the heart of the organisation is that you can get obsessed by things that members aren’t that worried about, such as governance issues or how Council works.

What members do expect is for us to use our assets and resources sensibly in their interests such as having a website and event booking system that works efficiently and not being held waiting on the phone.

We also need to be aware of our London-centric bias. While some people like coming to London not everyone does or can, so we need to be constantly working on developing services for these members.

What is the future for the health service?

If the NHS is going to remain cost effective, the single biggest challenge we face is that we must somehow shift care from expensive secondary care into primary care and the community. This has only happened once in the history of the health service when there was a meaningful, tangible shift of serious resource from hospital to the community.

It was in my discipline, psychiatry, and was initiated in 1961 by Enoch Powell’s ‘Water Tower’ speech which triggered one of the biggest changes in the delivery of psychiatric care from being almost entirely asylum based then to now when we’re almost entirely community based.

Today the majority of all patients cared for by the NHS are seen in primary and community care settings, but the majority of the money is in secondary care. Somehow, and I’m not sure quite how, this needs to be changed so that the resource problems we’re currently seeing in social care, primary care and community care can be fixed.

Tell us the best thing about your job

In an academic career everyone talks about making an impact. Getting a paper published in a high-impact journal has always been the ultimate ambition. After you’ve done this a few times, though, you start thinking you’d like to make more of an impact.

The great thing about working with the military is that if they say they’re going to do something they do it very quickly. When I published a research paper with colleagues from King’s College in The Lancet that looked at the mental health of military reserves (2) it showed there was a problem.

We reported the results to the MoD in advance of publication and they prepared a response, briefed the Secretary of State and together we held a press conference. There was wide-spread coverage in the national newspapers the next morning and in the afternoon, the Secretary of State stood up in the House of Commons to announce a new mental health programme for reserves.

You don’t normally get this kind of impact and it proves that you can get a real buzz from being an academic. Every now and then in a research career you get the sense that you’ve helped thousands of people and that’s a good feeling.

If you were to re-run your career?

I’d definitely choose psychiatry if I could have my career again. But if I hadn’t done medicine I probably would have done history. Of all the things I’ve written, the one of which I’m most proud is the one no-one ever reads because it’s a single author paper in a history journal (3).

Although I’m an academic and epidemiologist, I believe there are certain issues that can’t be solved by epidemiology trials and stats – anthropology, history and sociology are just as valuable.

And beyond work?

I’m married to Clare Gerada, GP and former chair of the Royal College of General Practitioners. We have two sons of 27 and 25. Neither are doctors but they’ve definitely been influenced by our careers – one is a human rights lawyer and the other starts a job in social work in a few weeks’ time. The three of us are Chelsea season-ticket holders and we enjoy getting to the Oval to watch England play cricket when we can.

Reading and history are my distractions from work. If I had two hours to spare in a European city I’d spend it in a history museum or visiting historical sites.

To contact the President you can email president@rsm.ac.uk or follow him on Twitter @WesselyS

References

Wessely S. Old Wine in New Bottles: Neurasthenia and ME. Psychol Med 1990; 20;35-53
Hotopf M, Hull L, Fear N, Browne T, Horn O, Iversen A, Jones M, Murphy D, Bland D, Earnshaw M, Greenberg N, Hacker-Hughes J, Tate R, Dandeker C, Rona R, Wessely S. The health of UK military personnel who deployed to the 2003 Iraq War. Lancet 2006: 367: 1731-1741
Wessely, S. Twentieth Century Perspectives on Combat Motivation and Breakdown. J Contemporary History 2006: 41: 269-286