The nation's new Trauma Tsar

“I vowed never to let my trainees learn trauma surgery the way I had and that injured patients should receive far better care than I had witnessed,” he now recalls.

Hundreds of road accident victims and others arriving through the doors of Oxford’s John Radcliffe Hospital close to death have good cause to be grateful that Prof Willett kept to the pledge that he made to himself.

The trauma unit at the JR today enjoys an international reputation and continues to deliver some of the best survival figures for the most seriously injured. And it would seem his work has not gone unnoticed by the Government, with the Health Secretary, Alan Johnson, now giving him the task of improving emergency care across the whole NHS.

He will take up his post as the national clinical director for trauma care on April 1.

Already now known as the ‘Trauma Tsar’, he will be working at the Department of Health three days a week, allowing him to continue working as a consultant orthopaedic trauma surgeon at the John Radcliffe, while supervising various research programmes.

Mr Johnson made clear how much is expected of the Oxford surgeon.

“Prof Willett is a highly respected clinical leader, well equipped to improve quality of trauma care services throughout England.

”Trauma care needs to be recognised as a specialist form of medicine,” said the Health Secretary. “Patients who are severely and critically injured rely on the expertise of many specialist professionals. With this appointment, we will see further improvements in the planning of trauma services and more specialist trauma centres.“ Little wonder when I suggest it is a big ask from a part-timer, that the Oxford consultant jokes, “I’ve not signed the contract yet. Quite a few colleagues have already pointed out that I will be starting on April Fool’s Day.”

But after a working life in trauma, no one can doubt he is well placed to address weaknesses in emergency care that seem to have survived all the years of NHS reorganisations and record levels of investment.

“It has been a chronic unresolved problem since the NHS was formed,” he said.

The doctors drawn to trauma are not the ones seeking predictability in their lives.

“To go into trauma you have to be the kind of person who likes going into work, without any idea of what you are going to be hit with,” he told me.

“You have to make fast, critical decisions all the time. And you need to be someone for whom stress is a fuel rather than a problem.

“The treatment of patients with major injuries involves a complex chain involving care, day or night, from the ambulance paramedic at the scene, through the emergency department, intensive care and our specialist surgery units. And, of course, you have to be prepared to work unusual hours.”

He has been involved in planning for and dealing with major incidents both in Oxford and London.

He said: “I led the response to the Eastern Bypass crash a few years ago when young lads were ejected from a car. That incident really convinced me how far we had progressed in trauma and critical care in Oxford when we were presented with multiple seriously injured children in very rapid succession.

“That contrasted with my experience in the 1980s when as a junior I was involved in receiving victims from bombings in London.”

The Oxford Trauma Unit is one of the country’s busiest, receiving some 350 of the most seriously injured patients a year, either directly, or indirectly from other hospitals.

The vast majority of the patients have been involved in road smashes or industrial or farming accidents.

Despite the horrific numbers of stabbings reported daily, he tells me knife attacks constitute less than one per cent of the serious cases that he sees.

He regrets that many consultants “drift away” from acute work, as they increasingly focus on clinics and ward rounds.

“Senior people primarily work normal office hours. But a large number of severely injured people arrive when most of the senior people are not in the hospital.

“That is something I’ve been trying to change for 25 years. It is my whole raison d’être.”

This view was certainly born from his own early experiences working in trauma, when there would be only junior doctors on standby in hospitals.

“The plethora and complexities of injuries and surgical decision-making demanded the input of committed consultants.

But you had the most inexperienced doctors receiving the most complex cases. It was just illogical.

“Trauma is really such a different area. Medicine is, for most conditions, about being presented with symptoms, carrying out investigations and coming up with a diagnosis.

“But when it comes to major trauma, it is the reverse. There is no history, because the patient is likely to be unconscious.

“You may have no idea what the injuries are. You are trying to keep people alive.”

Unlike most orthopaedic surgeons, Prof Willett has exclusively focused on trauma surgery since 1991, and declines to do any private work.

Following a pelvic, acetabular and spine surgical trauma fellowship in Canada, he arrived as a consultant in Oxford in 1992, with a particular expertise in complex fractures, pelvic surgery and limb reconstruction.

He said: “Trauma was my interest from early in medical school and I geared my early surgical skills training to include neurosurgery, cardiothoracic and general surgery — skills that have stood me in good stead over the years.”

Soon after arriving at the John Radcliffe, he set about with a colleague creating a system, whereby a resident consultant surgeon is on call at the hospital to deal with trauma cases 24 hours a day.

He himself has been part of the 24-hour on-call for more than 15 years.

The system was radically new in the 1990s, and, more surprisingly, remains unique in British hospitals today.

He explained: “The unit has been based on three clear principles: all care should be given by or under direction of a fully-trained surgeon; every clinical experience should be a learning opportunity irrespective of the time of day; and that high-calibre research could only occur in an environment where there is 24-hour care.”

Of course, he fully recognises the challenge of applying such principles nationally, with the complication of specialisms spread across different hospitals in other parts of the country.

The distance between hospitals and the spread of specialist services means every region will have to operate different systems, with not every case needing to go to the major trauma centre.

But he insists: “Many of the components of good care exist in the NHS but lack structure and focus.

“At such a vulnerable time, patients need to know local systems are in place, so wherever they are, the NHS can be trusted to deliver that critical care.

“As trauma surgeons, we are the patients’ advocates. It is us who should be in their corner, fighting for them,” said Prof Willett.

Perhaps, at last, politicians have finally learnt that clinicians should be the people who develop the policies to improve the quality of treatment.

Prof Willett will certainly be fighting to improve services for elderly people who have suffered fractures, something he sees as key to the ‘Trauma Tsar’ job.

“Older people with hip and other fragility fractures are an important patient group I have long held as poorly treated in the NHS.”

He points to the fact that the John Radcliffe sees some 500 hip fractures a year, necessitating long stays. Nationally the cost to the NHS is about £1.8bn.

Again, nationally, he will be hoping to build on the geriatric, surgical rehabilitation and community services built up in Oxfordshire.

After spending so much of his career repairing the shattered bodies of accident victims, it should perhaps come as no surprise that he is a keen advocate of educating young people about accident prevention. In 1994 he established a course for ten-year-olds that was fully integrated into the national curriculum in schools.

He helped establish the injury minimization programme for schools (IMPS), which started in Oxfordshire to make youngsters more aware of risk.

The programme now sees hundreds of children visiting their local hospitals to view the consequences of injury and to teach first aid responses.

Leaving his office, you wonder how he is going to combine the new job and his work at the John Radcliffe. Before I can ask, he begins talking about a recent visit to Cambodia, where he had gone to offer advice on trauma care but had ended up performing operations on seriously-ill children.

The shortage of doctors there remains desperate he explains, one of the damaging long-term consequences of the murderous Pol Pot regime that brought about the deaths of up to 1.7m people.

Such tiring trips, he says, serve to only reinforce his opinion that the NHS is an institution capable of delivering cost-effective emergency care. And all the trauma that lies ahead is unlikely to shake that belief.