Obituary - Dr John Alastair Lack

Alastair Lack died of amyloidosis at the age of 79 years. In the 4^th edition of Raising the Standards (RCoA, 2020) the editors paid tribute to Lack and colleagues, who edited the first edition in 2000 – noting that the original strapline ‘continuous quality improvement in anaesthesia’ had become generally recognised in the application of the emerging science of improvement across all branches of healthcare.

Alastair graduated MB BS, University of London in 1965. After house jobs in London, he was appointed SHO and then Registrar in Anaesthetics at Westminster Hospital. At the age of 25, he passed the FFARCS in 1968, becoming the youngest person to attain the fellowship at that time. Then in 1969 he undertook engineering at Imperial College, fulltime for one year and externally for a second, obtaining its Diploma in 1971 for his thesis on telecommunication of physiological signals. Next, he went with his wife to Stanford University in California, USA to be Assistant Professor of Anesthesiology 1971-73. They returned to England in 1973 when Alastair worked briefly as a Senior Registrar in Anaesthesia, before being appointed Consultant Anaesthetist at Salisbury General Hospital (SGH), Wiltshire in 1974.

At SGH Lack soon distinguished himself by developing his system of scavenging waste anaesthetic gases, enabling the hospital to be probably the first in UK to have theatre pollution control in 1975. The system incorporated the coaxial (parallel) Lack circuit with a shroud over the spill valve, enabling the waste gases to be ducted via lightweight plastic tubing to a wall socket, from which copper piping led to the outside. It was adopted by the 1976 DHSS Standard for passive theatre pollution control.

From 1976 to 1985 Lack voluntarily took on an extra commitment at SGH: Consultant-in-Charge of the Accident Department. In this role he single-handedly set up and ran the Salisbury Immediate Care Scheme, assisting ambulance crews in resuscitation and training paramedics. In 1987 he was one of the co-founders of the Society for Computing and Technology in Anaesthesia (SCATA), becoming its chairman and subsequent President. This soon led to the development of computer programs for theatre management, anaesthetic logbooks for trainees and critical incident reporting. The European Society for Computing and Technology in Anaesthesia and Intensive Care was formed in 1989 and lack was its chairman for 1992-96.

From 1991 Lack began serving the RCoA as its Representative on the Conference of Medical Royal Colleges Information Group, which he continued until 1994. He became a member of the Professional Standards Committee in 1992. Notably, in 1996 he was appointed Chair of the Critical Incident Monitoring Group, which had set up a pilot study the previous year.

Lack was elected to the Council of the RCoA in 1997 and continued chairing the Critical Incident Monitoring Group. In 1998 a second pilot critical incident reporting scheme was rolled out. This was supported by funding from the Department of Health and involved study in over 70 volunteer sites. In this year Alastair also began chairing a steering group for collection of ‘audit recipes’ within 10 major themes of anaesthesia. By the end of 1999 this collection was completed and compiled under 17 headings.  It was published in January 2000 as Raising the Standard – A compendium of audit recipes for continuous quality improvement in anaesthesia (Editors: J Alastair Lack, Lucy A White, Anna-Maria Rollin, Gavin M Thoms). Each recipe provided information on the evidence of best practice, suggested indicators, the standard or target for best practice to aim for, suggestions as to data to be collected, and clear references. The book was made available free on the College website or as hardcopy for the purchase price of £25. In November 2000 the College had its own stand at the NICE Conference and this engendered much interest in its publications and work on audit, guidelines and professional standards. Concurrent with this activity, Lack was President of the World Federation of Societies for Computing & Technology in Anaesthesia 1997-2000.

In March 2001 Lack, as Chairman of the Patient Information Working Group, took stock of a survey (carried out the previous year), which showed that only 58% of the anaesthetic departments surveyed provided information to their patients about anaesthesia. He then launched a second phase of the project seeking information on methods of patient communication and examples of good practice. By July that year, Alastair became Chair of the RCoA Professional Standards Committee/ Directorate. Next, regarding critical incident reporting, he produced an updated Anaesthetic Event Report and list of coded Factors involved with Anaesthetic Incidents. On the back of this work, he received a Clinical Excellence Award of the NHS (gold equivalent).

Through 2002 Lack realised that ‘Best Practice’ was a balance between quality, quantity and cost. While Raising the Standard had been well received as a standard of quality, there remained the task of measuring quantity and cost. He therefore announced the start of work on another College publication: ‘Guidance for the Provision of Anaesthetic Services’.

Early in 2003 came the publication of Raising the Standard: Information for Patients (Editors: JA Lack, A-M Rollin, GM Thoms, L White, C Williamson), produced jointly by the RCoA and the AAGBI. It comprised a book of 140 pages with a supporting booklet Anaesthesia Explained, a series of explanatory leaflets for patients, website access and an associated CD-ROM. In July 2003 the College began to distribute to all Fellows, Members and trainees a free CD-ROM, which included the latest editions of ‘Good Practice and Appraisal’, ‘Raising the Standard’, ‘Guidelines for the Provision of Anaesthetic Services’, ‘Personal Development Planning for NCCGs’, ‘The CCST in Anaesthesia’ and ‘RCA Electronic Anaesthetic Logbook’. Alastair Lack then completed his six years on the College Council, having served it remarkably well.

Although he retired from clinical practice in 2003, Alastair Lack then began writing and lecturing on mediaeval and reformation history and serving as a guide at Salisbury Cathedral. Further awards came to him: in 2004 the BMA Medical Writing Award (Patient Information Leaflets – Crystal Mark) and in 2005 the SCATA Award ‘for extraordinary contribution to innovation in anaesthesia’. He continued interest in the NHS: in 2011 he was elected a governor of Salisbury NHS Foundation Trust and in 2016 Chair of the Lead Governors Network (England). He is survived by his wife, Maggie, and three children: Juliette, Kate, and Christopher.

Dr Alistair McKenzie