British Journal of Neurosurgery, June 2014; 28(3): 387–389 © 2014 The Neurosurgical Foundation ISSN: 0268-8697 print / ISSN 1360-046X online DOI: 10.3109/02688697.2014.915009
HISTORICAL VIGNETTE
History of Neurosurgery at The Royal Free Hospital in London Heinke Pulhorn1, Robert Bradford1, Neil Dorward1, Mary Murphy1, Colin Shieff1, Lewis Thorne1 & Robert Maurice-Williams2 1National Hospital for Neurology and Neurosurgery, Queen Square, London, UK, and 2The Wellington Hospital,
Wellington Place, London, UK
Women onto the wards for clinical tuition. The dean under whose guidance this ground-breaking change occurred was Dr Elizabeth Garrett Anderson. At this time, though, the female medical students still had to go to the Irish Colleges for their exams as no college in England or Scotland would examine them. The school of Nursing associated with The Royal Free Hospital started teaching in 1889. In 1895 the Royal Free Hospital also became the first hospital to appoint Miss Mary Stewart as Lady Almoner, a fore-runner of modern-day social workers. Her position was created to interview patients to ascertain if they were eligible for treatment at the Royal Free Hospital and if so, whether they could contribute to their care. When the NHS was created in 1948 the Royal Free Hospital joined with several other hospitals to form the Royal Free Group. In 1974, the hospital moved to new premises yet again, when a modern hospital building was completed on Pond Street, Hampstead, on the site of the old Hampstead Hospital. This move was facilitated by Dr (later Professor Dame) Sheila Sherlock, a hepatologist, who in 1959 became the first female professor of medicine at The Royal Free Hospital School of Medicine. The new Royal Free was the first hospital to be designed with the aid of a computer. In 2011 the Royal Free Hospital became a Foundation Trust (Fig. 2) and will in the near future encorporate further smaller hospitals, such as Barnet and Chase Farm Hospitals NHS Trust.1
Abstract The recent move of the neurosurgical services from The Royal Free London NHS Foundation Trust in Hampstead to The National Hospital for Neurology and Neurosurgery at Queen Square signified the end of an era of neurosurgery in North London. It also represents also another chapter in the history of the remarkable North London hospital that is The Royal Free Hospital. This short article looks at the history of the Department of Neurosurgery at The Royal Free Hospital and the factors contributing to the reorganisation of neurosurgical services in North London. Keywords: neurosurgery; history; NHS; neurosurgical training
History of the Royal Free Hospital The Royal Free Hospital was founded in 1828 by William Marsden, a young surgeon from Yorkshire, as “The London General Institution for the Gratuitous Cure of Malignant Diseases”. At that time the only way to obtain treatment in London’s hospitals was to either afford the admission fee or to have a letter of recommendation by a person who subscribed to that hospital. Having witnessed the death of a girl unable to pay the admission fee and being turned away by three different hospitals, Marsden decided that a new approach was needed. In the early 1830s the hospital’s name changed to “The London Free Hospital” and subsequently this was altered to “The Royal Free Hospital” in 1837 when Queen Victoria renamed the hospital to mark its effort in the treatment of cholera victims during the 1832 epidemic. The hospital was originally in Greville Street, Hatton Garden, but in 1844 moved to larger premises, a structure of former army barracks, on Gray’s Inn Road. That building is still in existence and is now the Eastman Dental Hospital (Fig. 1). In 1877 the Royal Free Hospital officially became a teaching hospital when it was one of the first to allow female medical students from the London School of Medicine for
History of Neurosurgery at The Royal Free In the 1960s there were several smaller neurosurgical units in London that had developed naturally according to availability of space and premises as well as demand of demographics. This lead to a situation where relatively small hospitals conglomerated in a small geographical area all had a neurosurgical department. There was, for instance, The Brook Hospital in Greenwich, The Maudsley Hospital in Camberwell, The Middlesex Hospital in Fitzrovia and the Central Middlesex Hospital in Acton. Some of these hospitals
Correspondence: Heinke Pulhorn, National Hospital for Neurology and Neurosurgery, Neurosurgery, Queen Square, London WC1N 3BG, UK. E-mail: [email protected] Received for publication 15 November 2013; accepted 6 April 2014
387
388 H. Pulhorn et al.
Fig. 1. The Royal Free Hospital on Gray’s Inn Road (now the Eastman Dental Hospital), ca. 1860.
ceased to exist in the general re-organisation that followed the inauguration of the NHS, some were converted into specialist hospitals with one or two specialties only, such as psychiatry, and some into General Hospitals without neurosurgical departments. One of these neurosurgical units was at Whittington Hospital in Archway. At the time, however, this was a sizeable department with 54 neurosurgical beds. The first neurosurgeon to be appointed as a full-time consultant at Whittington Hospital was Ian McCaul in 1952. He had previously held a consultant post at The Brook Hospital. His services were augmented by Bernhard Harris, a general surgeon with an interest in neurosurgery, who was employed by the University College Hospital London (UCH), but came to Whittington Hospital in a part-time capacity as an attending surgeon. During the 1960s and early 1970s there was no neurosurgical unit at The Royal Free Hospital and the plan was to combine the units from Whittington Hospital and UCH (at Queen Square) to form a regional neurosurgery centre – probably at UCH. However, in 1975, when the autoclaves in the theatre suite at Whittington Hospital had to be overhauled and operating stopped for some time, neurosurgery was temporarily moved to The Royal Free, only 2½ miles away. McCaul was given a full-time, but temporary contract at The Royal Free.
Fig. 2. The Royal Free London NHS Foundation Trust (2012).
This new temporary neurosurgical department only had 28 ward beds, considerably fewer than it had had at Whittington Hospital and 2 neurosurgical ITU beds. Whittington Hospital had been justifiably proud of its neurosurgical department because neurosurgery brought huge credibility to a hospital that was locally not well supported or in high esteem. The reason for this attitude was that part of the hospital buildings had been the former Archway work house and therefore the local population was in general reluctant to be admitted there. Neurosurgery never moved back to Whittington Hospital, but stayed at The Royal Free with Ian McCaul as the lead clinician. The finality of this move led to some ill feeling among the two hospitals to the extent that none of his former colleagues from Whittington Hospital attended Ian McCaul’s retirement dinner in 1981. Even more than 30 years later, just before neurosurgery at The Royal Free closed, there was still a certain amount of resentment palpable between “The Free” and “The Whit” – although by that time nobody could quite remember why! In 1978 the Royal Free appointed its second neurosurgical consultant, Roger South – as a locum. He continued as a locum for 2 years, but when the substantive post was advertised in 1980 his appointment was by no means secure. With Ian McCaul in his early 60s, it was clear that the newly appointed neurosurgeon would effectively take over as head of the department of neurosurgery in this modern teaching hospital in London. Interest in the advertised post was, not surprisingly, huge. The successful candidate was Robert Maurice-Williams, who at the time was a consultant neurosurgeon at Brook General Hospital in Woolwich, another one of the “lost hospitals of London” that fell victim to the introduction of the NHS and several managerial re-organisations when it merged with the Maudsley Hospital on King’s College Hospital’s Campus on Denmark Hill in 1995. With MauriceWilliams’s appointment neurosurgery at the Royal Free was established. Roger South departed for a post in Hong Kong. Ian McCaul retired in 1981 and was succeeded by Kenneth Lindsay, who held the post for 5 years before taking up a consultant appointment in his native Glasgow in 1988. Also in 1988 Colin Shieff became the third consultant neurosurgeon at The Royal Free, followed by Robert Bradford, who was then the senior registrar at Queen Square, in 1989. In 1999 Neil Dorward was appointed as consultant neurosurgeon. During these years and under the guidance of Robert MauriceWilliams, the neurosurgical department at The Royal Free, though it still only had 28 beds, continued to grow. The original catchment population in 1975 had been approximately 1.2 million. By the turn of the century, it was 1.6 million and the catchment area covered North London, but went as far north as Peterborough. Paediatric neurosurgery was performed at The Royal Free Hospital until 1992 when it moved to Great Ormond Street, but all other subspecialities of neurosurgery were also on offer. Of course, The Royal Free Hospital also had an intensive care unit and the Accidents and Emergency (A&E) department as well as the rest of the hospital was well prepared for dealing with trauma. During this time The Royal Free was a major teaching hospital and many neurosurgical publications came out of the department. Maurice Williams wrote a successfully selling book entitled “Subarachnoid
History of Neurosurgery haemorrhage: aneurysms and vascular malformations of the central nervous system” which was published in 1987 and a quick glance at the PubMed database shows over 200 publications by Royal Free Neurosurgeons, in addition to contributions to several standard neuroscience textbooks. The Royal Free also boasted London’s first functioning image link; with Barnet General Hospital, established in 1988. The latest consultant appointments were Mary Murphy, a South London Trainee who had held a locum consultant post in Cambridge, and Lewis Thorne, the senior registrar at The Royal Free, both in 2007. Robert Maurice-Williams retired in 2007. By this time, the Royal Free Hospital was a head trauma centre with a sizeable A&E unit. As far as neurosurgery was concerned, it was also part of the North London training rotation with five registrars being employed at any given time. There was one dedicated neurosurgical theatre running 5–6 days a week. Frame stereotaxy was available, with the Hitchcock frame being extensively used. Furthermore, BrainLab and Medtronic Stealth systems were acquired for neuronavigation. The hospital had two CT and three MRI scanners as well as the services of three interventional and two non-interventional radiologists. The Royal Free Hospital was the first London unit to start coiling aneurysms on a regular basis in the early 1990s. Over the years the department of neurosurgery was moved around the hospital premises several times. Originally, it was located in Cordwainers ward, named after the City Livery Company, on the 9th floor, then it moved to Thorne ward, named after Isabel Thorne, one of the first women to qualify as a doctor in the United Kingdom and honorary secretary at the London School of Medicine for Women, on the 11th floor with arguably the best view over London of any of the London neurosurgical units. In 2005 the wards were renamed in an attempt to simplify the system and give up the old personal names of benefactors and famous members of staff and neurosurgery was finally settled on Ward 6 South. During the first decade of the new millennium the NHS underwent major changes to its managerial structure and its service provision.2 As part of these changes, specialist centres emerged and a drive ensued to combine skill and finances in bigger, but fewer units. At the same time trauma care in London was being overhauled to ensure adequate provision and access to trauma and emergency care for the growing London population and Major Trauma Units (MTUs) were being established.3 The Royal Free Hospital failed in its original application to become an MTU at the time when The Royal London Hospital, King’s College Hospital and St George’s Hospital were elevated to this status. Instead, the Royal Free became a designated “isolated head injury service”. However, even that status was revoked when St Mary’s Hospital became the 4th MTU in London. For neurosurgery in particular, although other medical subspecialties would also be affected, this meant yet another change. With seven neurosurgical units in London and The National Hospital of Neurology and Neurosurgery only 4 miles away, the decision was made to close neurosurgery at The Royal Free Hospital by combining it with
389
the Victor Horsley Department at The National Hospital. The initial impetus for this decision came from the paper “London Cancer Services: proposed model of care” published in 2010 that recommended that neuro-oncology in London should be dealt with in four rather than seven units.4 This plan had been voiced on and off since the 1980s, although at the time they mainly consisted of suggestions for establishing linked neurosurgical services between The Royal Free and The National Hospital by dividing up the subspecialites between the sites. This was particularly reasonable as the trauma set-up at the Royal Free was already in place. However, it was only in the aforementioned climate of change in the NHS structure and provision of services these suggestions were finally replaced by the complete merger of the two units.5 In 2010 some of the neurosurgical consultants from The Royal Free Hospital began operating part-time at Queen Square, but it would take until 2012 until the cranial service of neurosurgery was moved completely. Spinal surgery and pain management services continued to be provided at The Royal Free Hospital with two consultants and one registrar attending until 2013 when they also moved to The National Hospital, ending the chapter of neurosurgery at The Royal free Hospital.
Acknowledgements Most of the information in this article has been obtained in personal communication with the Royal Free neurosurgery consultants. Information quoted from websites is given in the reference section. The paper was drafted by H. Pulhorn after personal interviews with R. Bradford, L. Thorne, N. Dorward, C. Shieff, M. Murphy and R. Maurice-Williams. Final approval of the version to be published was given by R. Bradford. We would like to thank the Royal Free Hospital Archive Centre for allowing the use of the photographs. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References 1. Royal Free London NHS Foundation Trust. http://www.royalfree. nhs.uk [Last accessed 31 November 2013]. 2. National Institute for Health and Clinical Excellence: Guidance on Cancer Services – Improving outcomes for people with brain and other CNS tumours. June 2006. http://www.nice.org.uk/ nicemedia/pdf/csg_brain_manual.pdf 3. NHS London Trauma Office. http://www.londontraumaoffice.nhs. uk [Last accessed 31 November 2013]. 4. London Cancer Services: Proposed model of care – Summary. NHS Commissioning support for London, August 2010. http://www. londonhp.nhs.uk/wp-content/uploads/2011/03/Cancer-servicesmodel-of-care-summary.pdf 5. A model of care for cancer services: Clinical paper. NHS Commissioning support for London, August 2010. http://www. londonhp.nhs.uk/wp-content/uploads/2011/03/Cancer-modelof-care.pdf
Copyright of British Journal of Neurosurgery is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
HISTORICAL VIGNETTE
History of Neurosurgery at The Royal Free Hospital in London Heinke Pulhorn1, Robert Bradford1, Neil Dorward1, Mary Murphy1, Colin Shieff1, Lewis Thorne1 & Robert Maurice-Williams2 1National Hospital for Neurology and Neurosurgery, Queen Square, London, UK, and 2The Wellington Hospital,
Wellington Place, London, UK
Women onto the wards for clinical tuition. The dean under whose guidance this ground-breaking change occurred was Dr Elizabeth Garrett Anderson. At this time, though, the female medical students still had to go to the Irish Colleges for their exams as no college in England or Scotland would examine them. The school of Nursing associated with The Royal Free Hospital started teaching in 1889. In 1895 the Royal Free Hospital also became the first hospital to appoint Miss Mary Stewart as Lady Almoner, a fore-runner of modern-day social workers. Her position was created to interview patients to ascertain if they were eligible for treatment at the Royal Free Hospital and if so, whether they could contribute to their care. When the NHS was created in 1948 the Royal Free Hospital joined with several other hospitals to form the Royal Free Group. In 1974, the hospital moved to new premises yet again, when a modern hospital building was completed on Pond Street, Hampstead, on the site of the old Hampstead Hospital. This move was facilitated by Dr (later Professor Dame) Sheila Sherlock, a hepatologist, who in 1959 became the first female professor of medicine at The Royal Free Hospital School of Medicine. The new Royal Free was the first hospital to be designed with the aid of a computer. In 2011 the Royal Free Hospital became a Foundation Trust (Fig. 2) and will in the near future encorporate further smaller hospitals, such as Barnet and Chase Farm Hospitals NHS Trust.1
Abstract The recent move of the neurosurgical services from The Royal Free London NHS Foundation Trust in Hampstead to The National Hospital for Neurology and Neurosurgery at Queen Square signified the end of an era of neurosurgery in North London. It also represents also another chapter in the history of the remarkable North London hospital that is The Royal Free Hospital. This short article looks at the history of the Department of Neurosurgery at The Royal Free Hospital and the factors contributing to the reorganisation of neurosurgical services in North London. Keywords: neurosurgery; history; NHS; neurosurgical training
History of the Royal Free Hospital The Royal Free Hospital was founded in 1828 by William Marsden, a young surgeon from Yorkshire, as “The London General Institution for the Gratuitous Cure of Malignant Diseases”. At that time the only way to obtain treatment in London’s hospitals was to either afford the admission fee or to have a letter of recommendation by a person who subscribed to that hospital. Having witnessed the death of a girl unable to pay the admission fee and being turned away by three different hospitals, Marsden decided that a new approach was needed. In the early 1830s the hospital’s name changed to “The London Free Hospital” and subsequently this was altered to “The Royal Free Hospital” in 1837 when Queen Victoria renamed the hospital to mark its effort in the treatment of cholera victims during the 1832 epidemic. The hospital was originally in Greville Street, Hatton Garden, but in 1844 moved to larger premises, a structure of former army barracks, on Gray’s Inn Road. That building is still in existence and is now the Eastman Dental Hospital (Fig. 1). In 1877 the Royal Free Hospital officially became a teaching hospital when it was one of the first to allow female medical students from the London School of Medicine for
History of Neurosurgery at The Royal Free In the 1960s there were several smaller neurosurgical units in London that had developed naturally according to availability of space and premises as well as demand of demographics. This lead to a situation where relatively small hospitals conglomerated in a small geographical area all had a neurosurgical department. There was, for instance, The Brook Hospital in Greenwich, The Maudsley Hospital in Camberwell, The Middlesex Hospital in Fitzrovia and the Central Middlesex Hospital in Acton. Some of these hospitals
Correspondence: Heinke Pulhorn, National Hospital for Neurology and Neurosurgery, Neurosurgery, Queen Square, London WC1N 3BG, UK. E-mail: [email protected] Received for publication 15 November 2013; accepted 6 April 2014
387
388 H. Pulhorn et al.
Fig. 1. The Royal Free Hospital on Gray’s Inn Road (now the Eastman Dental Hospital), ca. 1860.
ceased to exist in the general re-organisation that followed the inauguration of the NHS, some were converted into specialist hospitals with one or two specialties only, such as psychiatry, and some into General Hospitals without neurosurgical departments. One of these neurosurgical units was at Whittington Hospital in Archway. At the time, however, this was a sizeable department with 54 neurosurgical beds. The first neurosurgeon to be appointed as a full-time consultant at Whittington Hospital was Ian McCaul in 1952. He had previously held a consultant post at The Brook Hospital. His services were augmented by Bernhard Harris, a general surgeon with an interest in neurosurgery, who was employed by the University College Hospital London (UCH), but came to Whittington Hospital in a part-time capacity as an attending surgeon. During the 1960s and early 1970s there was no neurosurgical unit at The Royal Free Hospital and the plan was to combine the units from Whittington Hospital and UCH (at Queen Square) to form a regional neurosurgery centre – probably at UCH. However, in 1975, when the autoclaves in the theatre suite at Whittington Hospital had to be overhauled and operating stopped for some time, neurosurgery was temporarily moved to The Royal Free, only 2½ miles away. McCaul was given a full-time, but temporary contract at The Royal Free.
Fig. 2. The Royal Free London NHS Foundation Trust (2012).
This new temporary neurosurgical department only had 28 ward beds, considerably fewer than it had had at Whittington Hospital and 2 neurosurgical ITU beds. Whittington Hospital had been justifiably proud of its neurosurgical department because neurosurgery brought huge credibility to a hospital that was locally not well supported or in high esteem. The reason for this attitude was that part of the hospital buildings had been the former Archway work house and therefore the local population was in general reluctant to be admitted there. Neurosurgery never moved back to Whittington Hospital, but stayed at The Royal Free with Ian McCaul as the lead clinician. The finality of this move led to some ill feeling among the two hospitals to the extent that none of his former colleagues from Whittington Hospital attended Ian McCaul’s retirement dinner in 1981. Even more than 30 years later, just before neurosurgery at The Royal Free closed, there was still a certain amount of resentment palpable between “The Free” and “The Whit” – although by that time nobody could quite remember why! In 1978 the Royal Free appointed its second neurosurgical consultant, Roger South – as a locum. He continued as a locum for 2 years, but when the substantive post was advertised in 1980 his appointment was by no means secure. With Ian McCaul in his early 60s, it was clear that the newly appointed neurosurgeon would effectively take over as head of the department of neurosurgery in this modern teaching hospital in London. Interest in the advertised post was, not surprisingly, huge. The successful candidate was Robert Maurice-Williams, who at the time was a consultant neurosurgeon at Brook General Hospital in Woolwich, another one of the “lost hospitals of London” that fell victim to the introduction of the NHS and several managerial re-organisations when it merged with the Maudsley Hospital on King’s College Hospital’s Campus on Denmark Hill in 1995. With MauriceWilliams’s appointment neurosurgery at the Royal Free was established. Roger South departed for a post in Hong Kong. Ian McCaul retired in 1981 and was succeeded by Kenneth Lindsay, who held the post for 5 years before taking up a consultant appointment in his native Glasgow in 1988. Also in 1988 Colin Shieff became the third consultant neurosurgeon at The Royal Free, followed by Robert Bradford, who was then the senior registrar at Queen Square, in 1989. In 1999 Neil Dorward was appointed as consultant neurosurgeon. During these years and under the guidance of Robert MauriceWilliams, the neurosurgical department at The Royal Free, though it still only had 28 beds, continued to grow. The original catchment population in 1975 had been approximately 1.2 million. By the turn of the century, it was 1.6 million and the catchment area covered North London, but went as far north as Peterborough. Paediatric neurosurgery was performed at The Royal Free Hospital until 1992 when it moved to Great Ormond Street, but all other subspecialities of neurosurgery were also on offer. Of course, The Royal Free Hospital also had an intensive care unit and the Accidents and Emergency (A&E) department as well as the rest of the hospital was well prepared for dealing with trauma. During this time The Royal Free was a major teaching hospital and many neurosurgical publications came out of the department. Maurice Williams wrote a successfully selling book entitled “Subarachnoid
History of Neurosurgery haemorrhage: aneurysms and vascular malformations of the central nervous system” which was published in 1987 and a quick glance at the PubMed database shows over 200 publications by Royal Free Neurosurgeons, in addition to contributions to several standard neuroscience textbooks. The Royal Free also boasted London’s first functioning image link; with Barnet General Hospital, established in 1988. The latest consultant appointments were Mary Murphy, a South London Trainee who had held a locum consultant post in Cambridge, and Lewis Thorne, the senior registrar at The Royal Free, both in 2007. Robert Maurice-Williams retired in 2007. By this time, the Royal Free Hospital was a head trauma centre with a sizeable A&E unit. As far as neurosurgery was concerned, it was also part of the North London training rotation with five registrars being employed at any given time. There was one dedicated neurosurgical theatre running 5–6 days a week. Frame stereotaxy was available, with the Hitchcock frame being extensively used. Furthermore, BrainLab and Medtronic Stealth systems were acquired for neuronavigation. The hospital had two CT and three MRI scanners as well as the services of three interventional and two non-interventional radiologists. The Royal Free Hospital was the first London unit to start coiling aneurysms on a regular basis in the early 1990s. Over the years the department of neurosurgery was moved around the hospital premises several times. Originally, it was located in Cordwainers ward, named after the City Livery Company, on the 9th floor, then it moved to Thorne ward, named after Isabel Thorne, one of the first women to qualify as a doctor in the United Kingdom and honorary secretary at the London School of Medicine for Women, on the 11th floor with arguably the best view over London of any of the London neurosurgical units. In 2005 the wards were renamed in an attempt to simplify the system and give up the old personal names of benefactors and famous members of staff and neurosurgery was finally settled on Ward 6 South. During the first decade of the new millennium the NHS underwent major changes to its managerial structure and its service provision.2 As part of these changes, specialist centres emerged and a drive ensued to combine skill and finances in bigger, but fewer units. At the same time trauma care in London was being overhauled to ensure adequate provision and access to trauma and emergency care for the growing London population and Major Trauma Units (MTUs) were being established.3 The Royal Free Hospital failed in its original application to become an MTU at the time when The Royal London Hospital, King’s College Hospital and St George’s Hospital were elevated to this status. Instead, the Royal Free became a designated “isolated head injury service”. However, even that status was revoked when St Mary’s Hospital became the 4th MTU in London. For neurosurgery in particular, although other medical subspecialties would also be affected, this meant yet another change. With seven neurosurgical units in London and The National Hospital of Neurology and Neurosurgery only 4 miles away, the decision was made to close neurosurgery at The Royal Free Hospital by combining it with
389
the Victor Horsley Department at The National Hospital. The initial impetus for this decision came from the paper “London Cancer Services: proposed model of care” published in 2010 that recommended that neuro-oncology in London should be dealt with in four rather than seven units.4 This plan had been voiced on and off since the 1980s, although at the time they mainly consisted of suggestions for establishing linked neurosurgical services between The Royal Free and The National Hospital by dividing up the subspecialites between the sites. This was particularly reasonable as the trauma set-up at the Royal Free was already in place. However, it was only in the aforementioned climate of change in the NHS structure and provision of services these suggestions were finally replaced by the complete merger of the two units.5 In 2010 some of the neurosurgical consultants from The Royal Free Hospital began operating part-time at Queen Square, but it would take until 2012 until the cranial service of neurosurgery was moved completely. Spinal surgery and pain management services continued to be provided at The Royal Free Hospital with two consultants and one registrar attending until 2013 when they also moved to The National Hospital, ending the chapter of neurosurgery at The Royal free Hospital.
Acknowledgements Most of the information in this article has been obtained in personal communication with the Royal Free neurosurgery consultants. Information quoted from websites is given in the reference section. The paper was drafted by H. Pulhorn after personal interviews with R. Bradford, L. Thorne, N. Dorward, C. Shieff, M. Murphy and R. Maurice-Williams. Final approval of the version to be published was given by R. Bradford. We would like to thank the Royal Free Hospital Archive Centre for allowing the use of the photographs. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References 1. Royal Free London NHS Foundation Trust. http://www.royalfree. nhs.uk [Last accessed 31 November 2013]. 2. National Institute for Health and Clinical Excellence: Guidance on Cancer Services – Improving outcomes for people with brain and other CNS tumours. June 2006. http://www.nice.org.uk/ nicemedia/pdf/csg_brain_manual.pdf 3. NHS London Trauma Office. http://www.londontraumaoffice.nhs. uk [Last accessed 31 November 2013]. 4. London Cancer Services: Proposed model of care – Summary. NHS Commissioning support for London, August 2010. http://www. londonhp.nhs.uk/wp-content/uploads/2011/03/Cancer-servicesmodel-of-care-summary.pdf 5. A model of care for cancer services: Clinical paper. NHS Commissioning support for London, August 2010. http://www. londonhp.nhs.uk/wp-content/uploads/2011/03/Cancer-modelof-care.pdf
Copyright of British Journal of Neurosurgery is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
