Dr “Bobby” Irvine - BGS President 1981 - 1984 (Article 2)

Further reflections on Dr “Bobby” Irvine CBE (1920 – 2002)

Prof John Brocklehurst: I first got to know Bobby when together, we mounted an exhibit on the geriatric day hospital at the BMA Annual General Meeting in Bristol in the early 1960s. He remained a most supportive friend and colleague. St Helen’s Hospital in Hastings became one of the small number of places of pilgrimage for visitors from home and abroad, studying the new specialty for geriatrics. Beneath his outgoing and ebullient exterior, lay a very modest man. He went out of his way to acknowledge the contributions of nurses, social workers and other colleagues, to the success of the Hastings Unit. He was one of the “greats” of British geriatrics, and was much loved.

James (Jimmy) Williamson: I was privileged to visit Bobby’s unit in Hastings on two occasions; the first was to see the workings of the geriatric/orthopaedic service which Bobby had pioneered with his colleague, Michael Devas. It had seemed too good to be true with the rapid rehabilitation and early discharge of elderly patients after surgery. My observations convinced me that the scheme did indeed work well.

My first memory is of the remarkable team work of physician, surgeon, nurses, therapists and social workers. The next is of the good humour and happiness of the team (and patients) and the laughter that was heard so frequently.

Another is of a visit as a member of an SAC inspection team charged with assessing the quality of training for junior medical staff. Once again I was very impressed. This was, of course, all expertly supervised by Bobby himself. On this visit I stayed in the Irvine household and enjoyed the warm hospitality provided by Bobby and Peggy, his charming wife.

A favourite recollection of my stay with them concerns when we were preparing to leave for the hospital after breakfast. Before setting out, Peggy “inspected” Bobby and spotted a rather large dark stain on the end of his tie. When Bobby saw this, he immediately opened a drawer, took out a pair of scissors and snipped off the last few inches of the tie. We then sallied forth without further problems.

He was a large man in every way - physically, intellectually and as a “character”. He loved life and people, and it was impossible not to feel better for being in his company. He brought many good things into the lives of his colleagues and friends.

Members of the New Zealand Geriatric Society add their tributes to the late Dr Bobby Irvine who developed a particularly close relationship with geriatric medicine in this country, written by Richard (Dick) Sainsbury President, NZGS: This started with his friendship with Dr Ron Barker in the early 1970’s. Dr Barker was a pioneer New Zealand geriatrician who later became Director General of Health. Following the initial contact, four New Zealand senior registrars trained at the Hastings unit, Jonathan Baskett, John Campbell, Tudor Caradoc-Davies and Dick Sainsbury. For 6 of 10 years, in the 1970’s and 1980’s, the Hastings senior registrar position was occupied by a New Zealand advanced trainee and Bobby therefore had a very important role in the establishment of the discipline in this country.

In 1984 Bobby visited New Zealand as the major invited speaker for the National Conference organised by the New Zealand Geriatric Society and the New Zealand Association of Gerontology. Bobby made many friends in New Zealand, in addition to those that he trained. Those of us who worked with him were privileged to gain an excellent training in the field. The particular strengths of the Hastings unit were the orthopaedic-geriatric service and service innovation, as Hastings had one of the first age related services in the United Kingdom. The close linkage with psychogeriatrics was also a major feature. Ward rounds with Bobby were always a pleasure. He treated patients with dignity and compassion, and was genuinely their friend. He was a good teacher and a superb entertainer. He had an unnerving habit of appearing to be asleep during a clinical presentation, only to wake up at question time and ask a searching question. He was a firm believer in interdisciplinary team work. His skills in people management were demonstrated at the end of every ward round when he would observe, in a loud voice near the nurses’ station, “don’t you think these are the most marvellous nurses you have ever worked with?” Bobby will be sadly missed in New Zealand, but his imprint is indelibly printed on geriatric medicine in this country.

Peter Greenfield: I first met Bobby Irvine in 1959, within a week or two of entering general practice in Robertsbridge, East Sussex. My partner had asked Bobby to undertake a domiciliary visit to one of his patients, and I was told that it would be “good for my education” to accompany this relatively new and enthusiastic consultant from Hastings. This I did, and I can still recall the impression that the occasion made on me. Having hitherto been used to being at the bottom of the rigid hospital medical hierarchy which existed in the 1950s, I was amazed to find that Bobby, although a consultant, and 11 years my senior, treated me as an equal from the start. We were on first name terms after two minutes, and at the end of the visit I found that he was as keen to hear my views as to express his own about the patient in question. To someone as raw to the profession as I was, this did wonders for my morale and self-esteem!

During the 1960s I came to know Bobby even better, not only through the medium of DVs, but more particularly because I gradually took over my partner’s role as part time medical officer to Bobby’s long-stay geriatric unit at Battle Hospital. Around 1965, I was formally appointed to the post, and this coincided with the retirement of the matron and the administrator of the hospital - hence allowing Bobby to “import” senior staff of various disciplines from his flourishing geriatric unit at Hastings. Over the next year or so I was privileged to witness at first hand, the metamorphosis of a gloomy former workhouse, with its stern discipline and custodial philosophy, into a vibrant high morale unit, managed on a multidisciplinary basis, and from which patients could on occasion be discharged alive! All this, by common consent, was happening as a result of Bobby’s commitment, single mindedness and drive, laced with good humour and courtesy. I know now, of course, that this phenomenon was occurring in other parts of the country, but it was little short of miraculous to me, and an object lesson in what good geriatric medicine could achieve that I never forgot.

When for reasons quite unconnected with geriatric medicine, I decided in 1969 to apply for a job at the former DHSS, I needed to let Bobby know of my intentions. “Oh dear,” he said, “Are you sure this is a good idea?” After explaining my thinking he said, “Don’t do anything more until I have had a word with a friend of mine in DHSS.” I agreed, and within a couple of days he rang me back to say that jobs in the Department were quite good, and could even be interesting! The friend he had spoken to was Surgeon Rear Admiral Jack Holford, and little could I?have guessed that within 3 years I would succeed Jack as the medical “man in the Ministry”, dealing with old age care - and even becoming a member of the BGS!

Many will remember Bobby’s achievements on the national and international stage, but I will remember him as a good friend who had a major influence on my medical career, and to whom I am eternally grateful. It was an honour to have known a man with such a kindly, supportive and gentle manner at the personal level, yet who could be so persistent and persuasive with managers, officials and authorities in his efforts to improve the lot of older people. The medical world will be the poorer for his loss.

Dr Bobby Irvine: co-pioneer of geriatric orthopaedics in Hastings

The development of geriatric-orthopaedics, the system of interdisciplinary care of older people with hip fractures, was revolutionary in its time.

It was pioneered in Hastings by Bobby Irvine in collaboration with the orthopaedic surgeon, Michael Devas. It was to become the benchmark for the care of older patients with hip fractures. The principle of interdisciplinary care driven by regular meetings of senior specialists, of which this initiative was the first major example, has also provided the inspiration for developments in other areas of care, notably cancer services.

On Dr Irvine’s arrival in Hastings, he had 300 patients under his personal care, in four hospitals. Many of these patients would not have been expected to leave hospital. Many years later, he pointed out with justified pride, that one of the younger, “chronic sick” patients he had inherited had not only been discharged to live independently in the community, but was subsequently employed as a porter by the hospital in which he had been a patient. This well exemplified the complete change in society’s attitudes towards the disabled in general, and older people in particular - from paternalism to a striving for dignity and independence. This change had depended on pioneers from the 1940s, notably Marjory Warren, but was underpinned by the geriatricians of Bobby Irvine’s generation.

Bobby’s great successes in Hastings were built around collaborations borne of his generosity, ebullience and sheer stature, both physical and personal. He had an uplifting presence. It was perhaps important that he and Michael Devas were appointed around the same time, but it says much for the personalities and innovative flair of both men that they were quick to appreciate the advantages, to both their services, of joint working. This is now so much the norm, particularly in such areas as cancer care, that it is hard to remember that in 1959, when Drs Irvine and Devas started geriatric-orthopaedics, such collaborations were anathema to many. By his enthusiasm and commitment, Bobby Irvine championed multi-professional interdisciplinary care. Nurses of all grades were encouraged and enabled to contribute to the assessments of his patients at a time when nursing and medical hierarchies tended to be very separate.

Hastings had one of the first geriatric day hospitals. Again, it is easy to forget that the early day hospitals pioneered approaches to inter-disciplinary rehabilitation between medical, nursing and therapy professions that are now taken for granted. It says much that in remembering the revolution in geriatric nursing practice that occurred during his career, Bobby particularly singled out the importance of removing the restrictions to visiting times in elderly care wards.

Under Bobby Irvine’s leadership, the unit in Hastings became both nationally and internationally recognised. Prof Ian Philp, now DOH National Director for Older People’s Services, came from Scotland to work with Dr Irvine at an early stage in his specialist training, and two academic units in New Zealand are led by men who came to spend formative years in Hastings.

Stuart Bruce

Consultant: Hastings Hospital