Liam: Thank you for joining me today. You’ll be speaking later this year at Acute and General Medicine. To begin with today, can you tell me about yourself and your background?

Julia: I’ve been a consultant in intensive care medicine with a specific focus on liver disease for more years than I care to remember! I started in 1992 as a consultant and I’ve really spent all of that time at King’s where I’ve had various leadership roles over the years. Most recently as clinical director for critical care across London as part of the ODN system.

Liam: Over the course of the last 32 years at King’s how has the most recent period compared with what had come before?

Julia: I think extraordinary would be the word. I think the power and ability of colleagues to come together has been absolutely amazing in delivering care under pandemic circumstances. I stand back in amazement at the ability of my colleagues across the professional groups and specialties who have truly all come together. We need to recognise that. It has taught us so much about how we can work together and do things differently. Also, what we don’t do so well. The wellbeing of our staff – it is paramount we address that going forward. There are vast amounts of learning under incredible circumstances.

Liam: Tell me about the session you’re delivering at AGM later this year?

Julia: I’m talking about liver and critical care. My declarations of interest so to speak are that I’m an optimist. Liver intensive care is a specialty that has changed massively over recent years.

If you break it down, there are several cohorts of patients. Those with true acute liver failure. Those with acute and chronic liver disease. Those undergoing liver transplantation. Those with liver trauma. And also, those undergoing major hepatopancreatic biliary surgery.

Acute liver failure has changed dramatically both in its incidence and in its nature. The vast majority of patients are now managed in a multi-disciplinary, multi-professional way and they often no longer need transplantation. Acute and chronic liver failure we now understand much more about it. It has various precipitants, and the management is changing quite significantly. The outcomes are improving. Perhaps most importantly we are now considering liver transplantation from the intensive care environment for some cohorts of those patients. Transplantation for liver disease is now a routine undertaking and a lot of ITUs will see patients with liver transplants going through them, not in their acute period but perhaps when they’re in for other surgery. Liver trauma has now mainly become a multi-professional radiological procedure in terms of its management rather than surgeons in theatre although they still have a role. And then managing the big liver sections, the pancreatic surgery and the biliary surgery is another component.

But as with all intensive care, what really makes it work is the team and the team functioning as one. What we’ve got to remember is that patients are at the centre of all of this. We use that phrase too flippantly. It is what drives us, and it is what gets me up in the morning.

Liam: If there was one key message people should take away from your session, what would it be?

Julia: I think it would be that of optimism. Let’s forget the nihilism of liver disease and that everyone dies. They don’t and they shouldn’t. Some will of course as there is no magic wand. But we really need to recognise that management is changing, and patient outcomes are improving. There are opportunities to refer.

Liam: Finally, in your clinical area you have already talked about some of the issues you’ll be discussing and also how things have dramatically changed over the course of your time within the NHS. What do you think the next 5-10 years will hold for your clinical specialty?

Julia: I hope it will retain a real sense of big steps forward, so we need to look at our infrastructure, how many beds we have in this country and the number of beds capable of delivering critical care. The staffing models for those. How we look after the staff who deliver care within those environments. The interactions with other specialties, particularly anaesthesia and paediatric ICU. Our medical colleagues. We’ve got to think about those different components of care and how we can deliver workforce solutions, technological solutions for different levels of care. Wellbeing is really pivotal in all of that. We don’t do it well in all sorts of ways, but we need a better understanding of what you’re coming into when you do intensive care, what the pressures and the strains are. How you look after your staff will deliver significant improvements in patient care and outcomes. That holistic bit of pulling together all the wonderful scientific growth we have seen together over these periods.

Liam: Thank you very much Julia. Look forward to seeing you at AGM later this year.