Sir Bernard Tomlinson
Pathologist who advanced understanding of dementia and wrote a radical report on London’s NHS
SIR BERNARD TOMLINSON, who has died aged 96, had a distinguished career as a neuropathologist instrumental in transforming scientific understanding of Alzheimer’s Disease, and as a public servant, most notably as chairman of the 1992 inquiry into London’s health services.
Known as the “father of Alzheimer’s Disease neuropathology”, Tomlinson was a pioneer in the neuropsychology and neuromorphology of dementia. Before the late 1960s, when he carried out research with Sir Martin Roth and Gary Blessed, the consensus was that most cases of senile dementia were caused by “hardening of the arteries” (arteriosclerosis). Alzheimer’s Disease, first identified by Alois Alzheimer in the early 1900s, was generally regarded as a pre-senile condition, and comparatively rare.
In a paper published in 1968, Tomlinson and his colleagues demonstrated, from post-mortem examination of the brains of sufferers, that the majority of cases of senile dementia showed the characteristic tangles and plaques of Alzheimer’s, and they established a correlation between the degree of cognitive loss, as measured by tests, and such brain lesions. In a further paper, published in 1970, Tomlinson, Blessed and Roth again highlighted the significance of senile plaques as the key cause of dementia, claiming that Alzheimer’s accounted for more than 50 per cent of cases, with only 17 per cent being due to arteriosclerosis alone and 18 per cent showing a mixed picture.
By showing Alzheimer’s to be the chief cause of senile dementia, Tomlinson and his colleagues transformed attitudes to the disease, causing it to be redefined as a major social and public health issue.
During his career as a neuropathologist, Tomlinson also became involved in medical administration. As first chairman of the Joint Medical Staff Committee of the Royal Victoria Infirmary and Newcastle General Hospital in the late 1960s, he had campaigned (unsuccessfully) against plans by the regional health authority to establish a third general hospital in Newcastle, on the grounds that it would be wasteful and inefficient – even going over the head of the authority to meet the then health secretary Richard Crossman.
Though he had never been a Conservative (after the war he had joined the Socialist Medical Association and taken part in electioneering during the 1945 election in support of Labour’s proposals for the NHS), in 1982 he was appointed by the Tory Health Secretary Norman Fowler to chair the Northern Regional Health Authority, where he began by declining the offer of a new carpet for his office as a waste of NHS money, then refused to travel first class or stay at expensive hotels as other chairmen did when going to meetings in London. In 1991 he was brought out of semi-retirement by the health secretary William Waldegrave to chair an inquiry into London’s health services.
When Tomlinson published his report in October 1992, few disputed its broad findings: that inner London had too many hospital beds in relation to its population, that its hospitals, especially its high-profile teaching hospitals, absorbed a disproportionate share of NHS resources, and that it suffered from primary and GP services well below the national average. Tomlinson’s report was the 19th official study on the capital’s health services in a century. The thrust of his recommendations bore a strong resemblance to one which reported in 1892: too many hospitals taking an unfair share of the nation’s health budget.
Most of the report was accepted by the government, but his headline recommendations – the closure of Charing Cross, University College/ Middlesex, and St Bartholomew’s hospitals, and the merger of Guy’s and St Thomas’s, in addition to the closure of 10 smaller hospitals, so that resources could be transferred to primary and community health services – proved controversial. By 2011 only the Middlesex had gone. Barts, Guy’s and Charing Cross remained open (though the first two lost their A&E departments).
Tomlinson’s report was not the last word on the subject; yet another report on healthcare in London, by Lord Darzi, was published in 2007.
The row over the report was a bruising experience for Tomlinson, who had taken on the inquiry because “it needed to be done”, and recalled that he and his team had been pilloried as “vandals, destroyers, government lackeys”. The last charge was particularly unfair because, as he pointed out, “I was campaigning for a National Health Service before Labour’s health spokesman, Mr Cook, was born.”
Meanwhile testaments to his single-minded resolve and dedication to the NHS came from politicians across the political spectrum and senior health service figures. “If the Secretary of State wanted someone who would sit down and wait to be told what to do,” one observed, “then he wouldn’t have chosen Sir Bernard.”
Bernard Evans Tomlinson was born on July 13 1920 and brought up at Huthwaite, a small village in Nottinghamshire. He attended Brunts School in Mansfield, where he met his future wife. His applications to medical school were delayed through illness, but his headmaster fixed up an interview for him at University College Hospital, “which began with being taken to task for being a late applicant but ended up with being offered a place on condition I started that afternoon”.
His training was interrupted by the outbreak of war, but his choice of pathology as his speciality meant that he was able to begin his training in 1943 in the Emergency Medical Services Corps at Ashford General Hospital.
After two years’ National Service in the Royal Army Medical Corps, in 1949 he was appointed as senior registrar in pathology at Newcastle General Hospital and deputy director of the department of pathology. Appointed senior consultant in 1953, he became director of the department in 1955, was professor of pathology at Newcastle University from 1973 to 1985, and consultant neuropathologist for the city from 1976 to 1985.
In the 1960s he gave evidence at criminal trials including that of Mary Bell, the 10-year-old who strangled to death two younger boys in Newcastle upon Tyne and was convicted of manslaughter in 1968.
Tomlinson would later explain that his approach to the problems of London was shaped by his experience of the unequal distribution of services in the northern region, where he was chairman of the regional health authority from 1982 to 1991.
“Newcastle had gobbled up a large amount of the expenditure … The main thing I wanted to do when I became regional chairman was to see developments elsewhere,” he recalled. Events during his eight-year tenure included the Cleveland child abuse case, which he approached with common sense and objectivity, heading the team that disciplined two paediatricians in the affair.
In December 1995, at a time when the government was trying to calm fears about the safety of British beef, following publicity about “Mad Cow Disease” (BSE), Tomlinson caused a furore when he told the BBC Radio 4 consumer programme You and Yours that he would not eat beefburgers “under any circumstances … nor would I eat beef liver or meat pies”, and recommended a ban on all beef offal.
The health secretary at the time, Stephen Dorrell, maintained that there was “no conceivable risk from what is now in the food chain”, but four months later was obliged to tell the House of Commons that 10 young people had died of a new disease called new variant CJD, and “the most likely explanation’’ was “exposure to BSE”.
Among other appointments Tomlinson served as first chairman of the Joint Planning Advisory Committee of the Department of Health (1985-90), as president of the British Neuropathological Society from 1986 and as founding chairman of the World Federation of Neurology Research Group on Dementia. He was chairman of the Friends of Durham Cathedral (1991-94) and in 1990 he was nominated by the Privy Council to be a member of Council of the Royal Pharmaceutical Society.
He was appointed CBE in 1982 and knighted in 1988.
He married, in 1944, Betty Oxley, who survives him with their son and daughter.