Peter Harris, President of the Vascular Society of Great Britain and Ireland, talked to Vascular News about his career and his involvement in the evolution of vascular surgery in Europe. He also outlined the radical changes that vascular surgery is on the brink of in the UK.Explaining how he became involved in medicine, Peter Harris said, “As a schoolboy I was always interested in animals, and I wanted to be a vet. However, at the last minute I switched my application to medical school rather than veterinary school, choosing humans as more interesting.”
Harris decided that vascular surgery was the area for him at an early stage, he explained, “None of my family were involved in medicine. I knew nothing about medicine except what you see in the media. My influences were definitely people. When I was a student, I did a senior term on the Professorial Vascular Unit, at Manchester Royal Infirmary. Michael Boyd was the professor there, and basically the people made me feel welcome. I decided right then, and that was before I qualified in medicine, that vascular surgery was for me.”
Harris then expanded on the influences that encouraged him in vascular surgery. “Michael Boyd was a very strange man in that he was a vascular surgeon who did not believe in vascular surgery. He thought that vascular surgery was dangerous stuff, which of course it is in the wrong hands. So he spent a lot of his time preventing his staff from doing vascular surgery, which was a shame because he had in his team some extremely talented operators. First and foremost was Ken Bloor, who was a master technician and who trained a whole cohort of very talented vascular surgeons. He was a supreme technician and very frustrated because his boss, although a vascular surgeon, was really opposed to technical vascular surgery.”
Continuing, Harris recalled, “I worked with Bloor and he was a very charismatic man and so was his immediate prot©g© David Charlesworth. Charlesworth also had great technical talents. He was a very rapid surgeon, who did operations more quickly than anybody else and who also got through more operations than anybody else. I was influenced by that although I moderated my own style a little. David Charlesworth was certainly a major influence in terms of acquisition of technical skills. He also got me involved in the academic side of vascular surgery, which has been a passion for me ever since.”
On going to Liverpool, Peter Harris worked for a short time with Edgar Parry, just before his retirement. Parry carried out the first renal transplant and the first aortic reconstruction in Liverpool in the very early 1960s.
“Finally, amongst the people who have influenced me in a different sort of way, not so much as a teacher but as a colleague and somebody who I respect and who I have worked well with over the years is Roger Greenhalgh,” said Harris. “Roger and I worked together at Charing Cross Hospital before I left there in 1979 for Liverpool and we have maintained not only our professional connections, our paths have crossed many times over the years, but also our friendship. I greatly value the professional association and friendship of Roger.”The Liverpool opportunity
According to Harris his “big break” was getting appointed to a post in Liverpool, although it did not seem that this would be the case at the time. “I was in London, at Charing Cross Hospital, and looking for jobs in the home counties, preferably in London, but in the late 1970s there was an excess of qualified senior registrars and people were pressurized to take jobs elsewhere,” explained Harris.
“When I arrived in Liverpool what I found was a vast population of patients with vascular disease. It was something that I hadn’t been used to in London. I was, therefore, able to do an enormous amount of work, and that is what I did. I just knuckled down and did a huge amount of clinical work. I just kept my records carefully and within a few years I found that I had bigger series of operations than most of my contemporaries and indeed, bigger series, than many of my seniors. I committed these to papers and gradually built up a reputation, simply because of the environment that I found myself in.”
In 1989, Peter Harris became Secretary and Treasurer of the Vascular Surgical Society of Great Britain and Ireland and at this time there was a lot of political activity occurring in Europe around vascular surgery. A series of meetings were held in Val d’Aosta, Italy, organized by Domenico Palombo, and the Vascular Surgical Society decided to send Harris as its representative to these meetings.
“We sat down and wrote a mission statement for vascular surgery in Europe and we set about planning how our objectives might be implemented,” recalled Harris. At the same time, Hero van Urk, Roger Greenhalgh and others in the European Society were evolving a similar plan. The UEMS, the representative body for specialists in Europe, agreed that vascular surgery should have a seat at the table.
A meeting was then held in Edinburgh of the Section of Surgery of the UEMS where it was formerly agreed that vascular surgery would have representation as a division of the Section of Surgery on the UEMS. Harris found himself appointed as the first President of the Division of Vascular Surgery of the UEMS in 1996.
Harris recalled, “We sat down with a blank piece of paper and we had to set the agenda. The purpose of the UEMS is really to harmonize training in European Union countries, so that there can be free movement of specialists from one country to another. That posed major problems for vascular surgery since vascular surgery was not recognized as a specialty in all European countries. So we had to devise a mechanism that would give us influence in all European countries. We formed a European Board of Vascular Surgery, which we were allowed to do within the rules of the UEMS. European Boards have the power not only to set standards of training in Europe, but also to access those standards by issuing certificates of training. We wasted no time in setting up the EBSQ-VASC assessments, the first of which took place in Venice in 1996.
“On October 15 this year (2004) our ambitions were finally realized when the management council of the UEMS officially accepted vascular surgery as a section in its own right. This means that vascular surgery now has full speciality status in the EU with all sorts of repercussions, not least in the UK where there is intense debate about its future status and identity.”
In addition to this Peter Harris was also instrumental in the establishment of Eurostar, the database that monitors the results of endovascular repair of aortic aneurysms across Europe. The evolution of the Eurostar database is tackled in a separate article on page 6.
Changes in the UK
Becoming President of the Vascular Society of Great Britain and Ireland last year meant a lot to Harris. He described it as “the one accolade that I have always aspired to but until recently never thought that I would ever achieve. So it is a very pleasant surprise and an amazing honor”.
During Harris’s presidency, enormous progress has been made by the Vascular Society. “It is an incredibly exciting time,” said Harris, “I think that what we are looking at is nothing short of a revolution in vascular surgery in this country. If you look at the history over the last 10-15 years, we have been getting progressively into the doldrums for a number of reasons.”
In the last year, however, the Vascular Surgical Society has become the Vascular Society of Great Britain and Ireland and that Harris said is a highly significant development because it means that UK vascular surgeons are broadening their horizons. “We recognize that the management of patients with vascular diseases encompasses surgery, for sure, but increasingly also medical therapies. Enormous advances in vascular biology are having major impact with applications in the medical management of vascular disease especially risk factor control, which may well reduce the requirement for surgical interventions in the future. On the other side, there are rapidly evolving endovascular technologies, which are also enhancing the outlook for patients with vascular disease. There is growing acceptance that the vascular specialist of the future should encompass skills in all of these areas,” said Harris.
He continued, “You can say, and this would be quite wrong, but there is a danger that this change will be interpreted in this way, that vascular surgeons are broadening their horizons to encompass activities that should be undertaken by others. At present we provide comprehensive vascular services in our hospitals by working in multidisciplinary teams, especially involving our colleagues in vascular radiology. This model, which by and large works very well, will continue to be the norm for the present generation of vascular surgeons and radiologists. But, it is unlikely to be sustainable indefinitely not least because there is a growing shortage of interventional radiologists. We are also beginning to see problems in recruiting people into vascular surgery and it is essential that we make the vascular specialties more attractive as a career pathway. We feel that the Vascular Society should encompass all aspects of the management of patients with vascular disease. It is evolving into a disease-based society rather than a technique-based society and, in partnership with our colleagues in radiology we are developing proposals for disease-based training. This would result in future generations of vascular specialists with hybrid medical, surgical and radiological skills relevant to vascular diseases. These trends are in marked contrast to what is happening in the US and other parts of the world where there is a turf war. There is no need for a turf war in the UK and nobody wants a turf war, and indeed I am confident that we will avoid this completely.”
At the Vascular Society meeting in Glasgow last year, when the change of the name of the society was approved, the membership also gave a mandate to council to undertake work to develop proposals for radical reform of vascular surgical training.
“An enormous amount of work has been done to define a training program that will meet the future expectations of vascular specialists within the constraints imposed by shortened duration of training and reduced working hours,” Harris told Vascular News. These proposals will be presented to the Society at its AGM in Harrogate in November. Harris emphasized, “The central plank of these proposals, and this is the most radical and exciting concept that I believe has the greatest potential, is that of a Common Training Pathway. Why is it a Common Training Pathway? Because it is a training pathway for surgeons, radiologists and indeed vascular physicians with an interest in vascular disease. If adopted and implemented, it would create a completely new specialty – with specialists within this field being known as Vascular Specialists. This is radical because it cuts across the traditional divides between surgery, radiology and internal medicine. It would also attenuate considerably our links with ‘general’ surgery.
“It is going to take a lot of work to get it accepted and you might think that there would be a lot of opposition to it, but during the last year we have approached and had meetings with presidents of all of the surgical royal colleges and the President of the Royal College of Physicians, all of whom have been supportive. We have received encouragement also from the chairman of the Joint Committee for Higher Surgical Training, representatives of PMETB and Sir John Temple who is Chairman of the Specialist Training Authority. Most importantly we have formed a joint working group with representatives of the Royal College of Radiologists, and within this group have agreed to develop further the concept of a Common Training Pathway for vascular surgeons and vascular interventional radiologists. We should not be surprised that there is some meeting of minds on this issue because we share similar problems and because there is a massive overlap between what we do and what we want to do, and what they do and what they want to do. There is a massive overlap in aspirations – really we want to do the same things. I am very excited about that and provided that nothing goes wrong we have the makings of a really exciting new departure for vascular training and practice in this country, which I think could be a model for others around the world to follow.”
Along with its name change, the Vascular Society has adopted a new constitution that allows it to incorporate the British Vascular Foundation (BVF) and that incorporation has now taken place. So the BVF, a charitable body for raising money for research, is now part of the Vascular Society, which extends the function of the society considerably. Harris, himself, has run three London Marathons to raise money for the BVF, this year finishing in a time of 3 hours 47 minutes.
Also this year, under Harris’s presidency, the Vascular Society has made considerable progress towards persuading the Department of Health to implement a National Screening Programme for Abdominal Aortic Aneurysms. Most vascular clinicians are totally convinced by the evidence available, but it is the politicians who have to be persuaded. During the year the BVF have used their contacts to apply political pressure, which included an ‘early day motion’ being lodged in the House of Commons.
As a result of these initiatives a joint Department of Health/NHS working group has been established under the chairmanship of Dr Muir Grey, Director of the National Screening Committee to consider in detail the implications of establishing a national AAA screening program in England. Peter Harris will be representing the Vascular Society on this working group.
Vascular Society meeting
With the structural changes to the society, accompanying changes to the annual meeting are intended. Harris said that they are looking at moving towards a less formal and therefore more relaxed occasion, although the same rigorous scientific standards will apply to the scientific program. According to Harris, this year the annual dinner will see fewer speeches and the entertainment will be provided by the Bootleg Beetles. Harris continued, “We have persuaded the Society for Vascular Nurses and the Society for Vascular Technologists, who meet alongside our meeting every year, to join us for the annual dinner and we are aiming to make it a fun event.”
This year’s annual meeting theme will be ‘Broadening Horizons’. The Kinmonth Lecture will be given by Roger Greenhalgh, who will be presenting and debating the first results to be published from the UK EVAR trials. “Our colleagues from interventional radiology have been invited to attend this lecture because one mustn’t over look the fact that the EVAR trials have been a landmark collaborative venture between vascular surgeons and vascular radiologists in the UK. I believe that our country is probably the only country in which a collaborative trial of this size could have been completed so successfully and this is because we have such good working relationships between surgeons and radiologists,” said Harris.
Peter Lyon Harris
Born: 4th September 1944
Manchester Royal Infirmary
Stepping Hill Hospital, Stockport
University Hospital of South Manchester
Charing Cross Hospital, London
King Edward VII Hospital, Windsor
1988-92: Medical Director, Broadgreen Hospital NHS Trust
1988-94: Member of Council and VAC, VSSGBI
1989-93: Chairman, UK Joint Vascular Research Group
1989-94: Secretary and Treasurer, Vascular Surgical Society of GB and Ireland
1990-94: Member, Editorial Board of the British Journal of Surgery
1990-94: Chairman, Audit Committee, Vascular Surgical Society of GB and Ireland
1992-97 : President, Division of Vascular Surgery, European Union of Medical Specialists
1994-97: President, European Board of Vascular Surgery
1996-now : Joint Founder and Chairman, ‘Eurostar’ Registry of Endovascular Procedures for Repair of Abdominal Aortic Aneurysms
1999-now : UK Representative, International Council of the International Society for Endovascular Specialists
2001-02: Joint Chairman, Organising Committee of the UK Endovascular Forum
2000-02 : Member, ad hoc Committee of the Society for Vascular Surgery and the American Association of Vascular Surgeons on Reporting Standards for Endovascular Aortic Aneurysm Repair
2004-05 : President, The Vascular Society of Great Britain and Ireland
2004-05 : Council Member Association of Surgeons of Great Britain and Ireland (Ex-officio)