Dr Adrian Crisp MD
How would you describe yourself in terms of religion and belief?
In religious terms I am cultural Christian, brought up in the Church of England. I used to go to college chapel as an undergraduate. Without profound beliefs, but I still feel quite strongly that the Christian religion is the cultural religion of this country, and of Western Europe and we should support it.
Was this the tradition you grew up in?
It was what I grew up with, I was brought up in an Anglo Catholic C of E environment, which was very important to me until I came to Cambridge as an undergraduate, when my beliefs went rather mid-market, and I began to disapprove of those Anglo Catholic things. But my beliefs have all now really disappeared, but I still regard the Christian religion as a great prop for our society and it deserves to be supported.
Would you describe Great Britain as an equal and tolerant society?
Yes, I don’t think that we could do any better really. It’s a free a society as it is possible to imagine, people are free to believe what they wish.
Have you ever experienced any pressures or problems living in accordance with your own beliefs?
No, I haven’t had any problems personally or professionally I have been able to do exactly as I please. I worked early in my career with an RC doctor. He was put under considerable pressure to carry out termination of pregnancy. This was way back in the 1970s. He stuck up for his beliefs, but he was put under considerable pressure by those who saw themselves as having to do his work for him. His seniors put pressure on him to conform.
Do you regard the Human Rights Act and a greater awareness of human rights as a positive thing for our society?
Yes, it has been a positive thing. I still have a great sympathy for not only human rights but also human responsibilities. Again a major theme of belief and behaviour, with rights come responsibilities, an equal and opposite part. Human responsibilities should be enshrined in law as well as human rights. Possibly we could do more to have human responsibilities in law, in some solid way.
What do you think about faith schools?
I’m strongly against. Faith schools within the state sector should not exist. If privately some schools need to be set up then so be it, but they must be entirely funded from within.
Should religious businesses be permitted exemptions from equalities legislation?
I believe in secular rules which should apply to everyone. Obviously we have to make sure that they are sensible and practical and ethical by the current standards of thought. They should apply to all of society. I remember working in London in medicine, and certain people of certain religious faiths got more days off, and I didn’t think that was fair as other people in the team had to pick up the work. With us, if you happened to be rostered on duty for Christmas or Easter, then you did it. Patient care came first, not your own individual beliefs or wishes.
Do you think that living in a Parliamentary democracy is a good thing?
As Churchill said, it was the least bad option tried over centuries and millennia. I can’t envisage a further Darwinian evolution of an even fairer system, one can quibble about voting systems, but I think that a Parliamentary system is the right one, even though there are imperfections.
Do you believe that you have a moral obligation to vote?
Yes, my wife is Australian born, and there you have to vote, and I think that I do support that and would support the practice of fining people here. It has a great moral sense, people are then participating unless they have a mental or physical reason that excuses them.
Does it concern you that the House of Lords is not elected?
Yes it does. I would like to see an elected senate or upper chamber, that would perhaps be elected by PR, but not totally by PR, I would like to identify constituencies within society that deserve representation. For example, I would like to see plenty of doctors to represent medicine and how we organise that, universities……but not necessarily political appointees. It sounds a bit elitist but I don’t think that is wrong here. I would not give it the power to delete Commons legislation, just to modify. But the current House of Lords can’t go on as it is, it is a shame our politicians haven’t been able to work towards a more effective second chamber.
What do you feel about the Lords Spiritual?
I don’t see it as a particularly valid thing, I see no reason not to have a faith representative in my new senate, and I think that all of the major faiths should be represented if that happened.
How do you feel about the devolved assemblies?
I do think that the devolved Parliaments have been a good thing. A long time ago I thought that UK should be a federal country. I’m in favour of devolution of most parts of day to day things to those components.
What responsibilities come morally with power and influence?
I think that what we said at the beginning, I do have a strong belief that ethical standards should underpin all application of power so there need to be mechanisms to ensure that political and economic power is subject to internal ethical review, to make sure that people always behave for the good of society. In this country and in the EU and internationally. It is not acceptable for power to promote the advantage of that particular narrow view.
What responsibilities do all citizens owe to society?
To contribute to the greater good, it all sounds a bit apple pie, but it comes back to what I was saying about responsibilities being give equal weight to rights. Everyone has to do their bit.
Would you say that the current make up of Parliamentary representatives is a reasonable representation of society as a whole?
I don’t think that the House of Commons represents all of society, but I’m not necessarily disturbed by that. I don’t see it being the job of the House of Commons to exactly reflect society by gender, religion or race and other human characteristics. You are hoping that society is structured to allow people with the right ethical and moral standards to rise to the top, and if they have those qualities they will work for everybody in society. But it is a concern that the quality of representatives seem to be declining rather than rising. But I don’t think that the House of Commons should be mandated by quota to reflect all of those different components of society.
Have you ever felt so strongly about a social or political situation that you done something to try to change it, and if so what?
I have spent my whole professional life in medicine, and have strong views. I qualified in the early 1970s and I would say that at the end of the 80s and early 90s that medicine lost its way. Governments started to increase the pressure, under the guise of finance, but there was more to it than that. They wanted to castrate the profession. I have spoken about it, I have debated it with the local MP. I have written to the newspapers, and have tried to reflect my feelings. Of course writing to the paper achieves nothing, but it makes you feel better.
In the twentieth century, before the NHS there was very good medical practice and a strong ethic of the doctor looking after the patient to the best of his or her ability. That policy was carried through into the NHS, but government could not leave it alone. So now there is a massive barrier to doing your best for the patient. Now everyone is looking over their shoulder at managers. Doctors are expected to serve the state not the patient. This has been exacerbated by financial strictures, but there is more to it than that. Governments want to break and control doctors, allowing political views to effect how medicine is practice. To the great detriment of our patients. For example, I strongly disapprove that patients can only access specialist services through their GPs. Meanwhile the GPs are being lent on not to refer people. It’s no longer tenable nor correct to have this system, for our patients to be truly free. If they wish to see a cardiologist they should be allowed to do so. For a set of symptoms there is a 20 fold difference in the likelihood of referral. We have some very high and some very low referring practices, but the average UK practice refers too few people for things like cancer. We have some of the lowest cancer survival stats because of that.
I suppose the other thing I would record is my own role during my stint chairing the Addenbrookes consultants. I believed strongly that the hospital should be smoke free. Nobody should smoke on site. When I was up for election, my platform was that within my three stint Addenbrooke’s would be a smoke free zone. We initially won, but the protests were immense, the nurses, the visitors, there was huge trouble. So management caved in and appeased the smoking lobby. More recently, of course it has become standard practice. But I did stand up and it did make a difference. In the long term we won the battle.
Again, freedom without responsibilities. We’ve become a liberal society, but individuals have responsibilities. By smoking they are doing harm to those around them.
In your own interactions with public authorities, have your own beliefs been respected?
Yes I think so, but I don’t really have any unconventional beliefs.
There was one medical example. For my first 15 years in Cambridge, the department had 20 beds, so that you could bring in people in big trouble, emergencies, and we could run a really good service. Then from the early 90s onwards they whittled away these beds and we ended up with none. So if any our patients were acutely ill, they had to go to one of the other teams. It was a huge decline in the quality of care, I battled hard to try and reverse this trend, but I failed. I had no power to do anything other than verbally disagree.
Is it important to you always to act within the law?
The starting point is that the law should be obeyed by everyone, because our system is based on that. The law has been established by democratic principles in Parliament, so you have to obey these rules. Are there examples where one could step outside the law? If by some political nightmare this country became the tool of extreme left or right wingers one would have to consider stepping outside that and joining the resistance movement. But I don’t anticipate that happening.
Do your personal beliefs require you to speak out against injustices affecting third parties?
Yes they do. And in medical practice the GMC in its code of principles enjoins us if we see bad practice to identify it and do something about it. That has been an improvement in my time in medicine. In the past it was important to keep your mouth shut and that was very wrong.
The only other area I was particular interested in the way that contracts for setting up building work were being constructed. One example, we were going to do up our post graduate medical centre, and I was responsible for that at that stage. We had our own funds generated by post graduate teaching courses and so I and those around me, found a decent architect to redesign the centre and having developed those plans went out to local building firms to quote. Not huge funds, over £100k but not immense, we got three quotes and chose a particular local firm. We had to get it signed off by management and they objected to our going off our own bat, and said they had a list of approved firms and that we must use one. So we went through the whole business of tender with the approved firms, and they were twice as expensive! Considerably higher, but we were obliged to pay almost twice as much. So this told me that there was a caucus of people within the bidding public sector who were pitching high quotes. If this was magnified up to big projects this was wasting the NHS a huge amount of money. But I went to the high scions and was told to keep quiet. I would have loved to go to the press, but I knew that I would be suspended and probably lose my job. I was gagged and I wasn’t very happy with that, there was no freedom of expression. It was an autocratic system not running for the best interests of the whole medical system.
Is the Rule of Law applied equally?
I am not really in a position to answer that, I don’t have the personal experience. Certainly our system of the law relies enormously on the integrity of the police, one hears, reads that it may not always be as fair as it should be. But it’s purely second hand, not based on experience.
How do you feel about the general trend to increase State/police powers over the past 15 years?
I don’t believe it has gone too far. The forces of evil we’re up against are quite strong and growing stronger in terms of IT and things, and we have to match them. In other words I trust the political system to work to our best interests. I believe that the vast majority of police and organisations have good integrity, they can be trusted not to exceed their brief. The thing that worries me the most is that until recently fear of one’s own death would be quite a deterrent, but the fear of death makes no difference to people who have no respect for their own lives, so there is no deterrent. When up against people like that, government needs all of the levers to fight against it.
Anything which you would like to add?
I don’t particularly…..we’ve touched on human rights law, which if I understand it, the ECHR is the senior, final court of appeal. I would like to see a real, well expressed code of responsibilities set down in legal terms. It’s a huge project and very difficult, but I would like to see it enshrined in legal responsibilities. Many would say that it would limit true personal freedom, but it’s a price which has to be paid when rights are, correctly, so strong. We do need to emphasise the other side as well, personal and public responsibility as well as rights.
Would you see these responsibilities as aspiration or actually enforceable?
I would like to see some enforcement. Financial penalties to influence behaviour could be developed. But at least a code of behaviour needs to be established and it should be cross party, and agreed. Not party political. I’m sure that most people would sign up to it. A Bill of Responsibilities, not just a Bill of Rights. It would have to be able to change too, as society changes. Maybe revised every ten years. But I think that it’s worthwhile area of thought.
Dr Adrian Crisp was educated at Magdalene College, Cambridge and University College Hospital, London (UCH). He gained wide postgraduate experience in Obstetrics and Gynaecology and General Practice before focussing on General Medicine, Endocrinology and Metabolic Bone Diseases at UCH. He undertook further specialist training in Rheumatology and Metabolic Bone Diseases at Guy’s Hospital, London and at Massachusetts General Hospital and Harvard Medical School, Boston, USA.
On appointment to Addenbrooke’s Hospital in 1985 he founded the clinical service in metabolic bone diseases and osteoporosis and raised funds for the first Bone Density Unit in East Anglia in 1989. He combines a busy clinical practice in bone and joint diseases with a strong interest in medical education. He was Associate Dean in the University of Cambridge School of Clinical Medicine and Eastern Postgraduate Deanery from 1998-2005. He was Director of Studies in Clinical Medicine at Churchill College, Cambridge from 1991-2011, and is a Fellow of Churchill College.