Endocrinology is the study of diseases of the endocrine glands which produce circulating hormones. Diabetes mellitus, the commonest endocrine disease, is covered in the Diabetes section.
Eric G Oastler was the endocrinologist for the St Mungo College Medical School, Glasgow Royal Infirmary and the Royal Samaritan Hospital for Women, Glasgow from 1932. In 1956, he returned from the Southern General Hospital to become physician in charge of 2nd floor medical wards and published work on gynaecological endocrinology, experimental hypophysectomy, and on adrenal pathology, linking with JK Grant of the Regional Steroid Laboratory at the Royal Infirmary.
Oastler worked with WG (Giff) Whyte who specialised in the measurement of adrenocortical and gonadal function, and IMD Jackson who published in general endocrinology, thyroid disease, obesity and diabetes. Oastler retired in 1967 and died in 1990.
Edward M McGirr, a Glasgow graduate, joined the University Department of Medicine, Royal Infirmary in 1947 as senior lecturer, and became Muirhead Professor of Medicine in 1961 (see Medicine - Royal Infirmary). He spent time with J B Stanbury at Harvard University, Boston and subsequently performed innovative work in the aetiology of familial goitrous cretinism with James H Hutchison, later Professor of Child Health. He developed a thyroid outpatient clinic in ward 3, supported by his screening and diagnostic service for thyroid disease in the Radioisotope Department assisted by physicist, Dr JMA Lenihan. With Thomson and Murray’s support, he organised and supervised the early use of 131I for treatment of hyperthyroidism and published one of the first series of 900 treated cases in the UK. McGirr died in 2003.
I Provan Murray, a Glasgow graduate, was appointed to the University Medical Unit in 1958 to learn isotopic methods of thyroid diagnosis. He worked with Wayne and Murray at the Western Infirmary (see below); and for 2 years with JB Stanbury at Harvard University, and on return, continued to publish on thyroid diagnosis until 1963 when he became Associate Professor of Medicine at Prince of Wales Hospital, Sydney. Murray died in 2000.
Two strands of endocrinology then appeared at the Royal Infirmary, with Thomson leading the first comprising general endocrinology and thyroid disease. and with Boyle the second in metabolic bone disease.
Both strands involved close collaboration with the Department of Nuclear Medicine.
- John A Thomson, a Glasgow graduate, joined the Unit in 1960 and trained under both Oastler and McGirr. Thomson spent 1 year at Harvard University, Boston, with Professor Irving Goldberg and studied the biochemistry of thyroglobulin. He returned to Glasgow in 1967 and was appointed Senior Lecturer in Medicine with special responsibility for Endocrinology, becoming Reader in 1981.
Thomson published widely in general endocrinology but majored upon the clinical, laboratory, and immunology of Graves’ disease (toxic diffuse goitre), and the effects of antithyroid drug treatment with Elma M McDonald, Joyce M Bissett, Sheila G Baird, John Fyffe and Rhoda Wilson, biochemists in the Department of Medicine. He also published in neuroendocrinology and diagnosis/treatment of pituitary tumours, adrenal pathology, growth disorders and aspects of hypogonadism. Thomson retired in 1998.
- J Anthony (Tony) Boyle, a Glasgow graduate, joined the Unit in 1962 and worked on the diagnosis and treatment of goitre, that included genetics information from a twin study and iodine deficiency data from a goitrous area of Scotland, both with Greig. He pursued increasing rheumatological interests from the mid 1960s. Boyle died in 2008.
William (Bill) R Greig, an Aberdeen graduate, joined the Unit in 1964, proposing novel ideas on thyroid radiobiology and radioactive iodine therapy, both 131I and 125I. Greig also studied tests of adrenal reserve and simple goitre, both locally and abroad, and in monozygotic twins.
He went on to develop the Department of Nuclear Medicine at GRI from 1968 onwards but retired on health grounds in 1979 and died in 1983 at the age of 47.
I Ross McDougall, a Glasgow graduate, worked closely with Greig on 125I treatment for hyperthyroidism. Following a Harkness Fellowship with Joseph Kriss at Stanford University in 1972-74, he returned to Stanford in 1976 as Associate Professor of Medicine and Radiology. McDougall continued to study thyroid cancer and hyperthyroidism. He single authored a textbook on Thyroid Disease and co-authored two books specifically on Thyroid Cancer. McDougall retired in 2016.
Henry (Harry) W Gray, a Glasgow graduate, worked with Greig on 125I therapy for thyrotoxicosis, endemic goitre, on the physiology of technetium pertechnetate in thyroid, and in the use of dynamic radionuclide tests for thyroid diagnosis. After working in Nuclear Medicine with Henry Wagner Jnr in Baltimore, USA from 1974-76, he was appointed consultant physician in Medicine/Nuclear Medicine in 1977. While his main research was in Nuclear Medicine, Gray continued to work with Thomson in thyroid diseases. On Thomson’s retiral, he worked with Denis StJ O’Reilly and J Brian Neilly. Gray retired in 2007 (read some of Dr Gray's recollections as a student and doctor).
James (Jim) H McKillop, a Glasgow graduate, joined the Unit and became Lecturer in 1975, Senior Lecturer in 1982 and Muirhead Professor of Medicine in 1989. His main research interests were in Nuclear Medicine, immune disorders in thyroid function, free radicals in thyroid disease and antioxidant effects of antithyroid drugs with Wilson, Thomson and Professor Ewan Smith of the Department of Inorganic Chemistry, University of Strathclyde. He continued his clinical interest in thyroid diseases working with Thomson. McKillop retired in 2011.
The 1970s heralded a leap forward in diagnosis and management of endocrine disorders with the appointments of Drs John J Ratcliffe as head and Graham H Beastall to the Endocrine Unit in the Department of Biochemistry. Drs Wendy A Ratcliffe, Christina E Gray and A Mike Wallace also joined the team.
The advent of the immunoassay greatly improved the accuracy/specificity of the measurement of hormones in plasma or serum and the biochemist became an integral member of the endocrine team. Dr Anne Marie McNicol in the Department of Pathology also provided essential guidance for the endocrine multidisciplinary team while specialising herself in Cushing’s syndrome and pituitary tumours.
A succession of very able individuals joined the Unit to work with Thomson in general endocrinology and each contributed in different areas of the specialty:
- James (Jimmy) E Thomson, a Glasgow graduate, joined the Unit between 1974-77 and worked with Thomson on discrepancies in measurements of thyroxine and an assay for free T3. He was appointed consultant physician in endocrinology and diabetes at Inverclyde Royal Hospital in 1978 and retired in 2007.
- Ian D Hay, a Glasgow graduate, was Hall Fellow in the Unit between 1974-78 and published mainly in neuroendocrinology and neurosurgery for pituitary tumours. From 1978-81, he spent time at The Mayo Clinic as Research Fellow and returned there in 1983 to become Professor of Medicine where his primary research focus has been the outcome prediction and optimal management of papillary thyroid cancer.
- Elizabeth Anne Cowden, a Glasgow graduate, joined the Unit in 1975 and published on the neuroendocrinology of prolactin and its receptors in the kidney. In 1983, she obtained a position with Dr H Frieson at the University of Manitoba, Winnipeg and continued her studies. She later became Head of Medicine at Dalhousie University, Halifax, Nova Scotia but moved back to Winnipeg in 2006.
- Howard Cohen, a Liverpool graduate, joined the Unit as registrar in 1977 and published on the investigation and treatment of short stature and issues around growth and puberty in boys. After a one year sabbatical in 1982-83 with Prof MM Grumbach at the University of California, San Francisco in adolescent endocrinology, he became consultant in Medicine, Endocrinology and Diabetes in South Lanarkshire in 1984. Cohen retired in 2008.
- Donald W M Pearson, a Glasgow graduate, joined the Unit in 1979 and spent two years working with Thomson, Gray and McKillop in endocrinology and nuclear medicine. He spent time with Ratcliffe in the laboratory on an assay for plasma thyroglobulin and published on thyroid function testing. He moved to Aberdeen Royal Infirmary as Lecturer in Medicine in 1981 and was appointed consultant physician in Medicine/Diabetes there in 1984.
- Michael Small, a Glasgow graduate, joined the Unit in 1979 as a junior in endocrinology and progressed to Senior Registrar in 1984. He published widely on the interrelationships of thyroid disease, diabetes and haemostasis. Small became consultant in medicine/diabetes in 1987 at the Western Infirmary and retired in 2015.
- Colin Semple, a graduate of Oxford and Glasgow, joined the Unit as registrar in 1981 and published on the effect of illness on the secretion of androgens in the male. He was appointed consultant physician in Medicine and Diabetes/Endocrinology in 1988 at the Southern General Hospital. Semple retired in 2013.
- Derek Gordon, a Glasgow graduate, joined the Unit in 1983 with a research interest in pubertal development in males and treatment of prolactinomas. He moved to Law Hospital in 1992 and Stobhill Hospital and the Royal Infirmary in 1996 as consultant in Medicine, Diabetes and Endocrinology. Gordon retired in 2015.
- Linda Buchanan, a Glasgow graduate, joined the Unit for 2 years in 1988 and worked with Thomson, Wilson, McKillop and E Smith on immune disturbance and free radicals in thyroid disease and antioxidant effects of carbimazole therapy. She is currently a physician with an interest in endocrinology/diabetes at Forth Valley Royal Hospital.
- James J (Jimmy) Walker, a Glasgow graduate, joined the Unit in 1978 as part of his training in Obstetrics and worked with Thomson, and Wilson on the immunological changes of normal pregnancy, recurrent miscarriage and pre-eclampsia. He became Professor of Obstetrics in Leeds in 1994.
Metabolic Bone Disease
The second strand of endocrinology at the Royal Infirmary was metabolic bone disease.
Ian T Boyle, a Glasgow graduate, joined McGirr in 1963 to study thyroid disease but studied calcitonin instead with Ian MacIntyre at the Royal Post-Graduate Medical School. He then worked with Hector DeLuca in Madison, Wisconsin to study the kidney’s role in Vitamin D metabolism.
During his two years in the USA, Boyle was an essential member of the team that made spectacular breakthroughs in understanding of Vitamin D metabolism and, in particular, the fundamental nature of 1.25D (1.25-dihydroxyvitamin D). On return to Glasgow in 1974, Boyle established a clinic for metabolic bone diseases and studied the new bone-active drugs - calcitonin, 1.25D and bisphosphonates - with Dr Frances J Dryburgh of Biochemistry. Working with Dr Brendan Boyce of the Department of Pathology, he made the discovery of focal forms of osteomalacia and the mechanism of aluminium inhibition of mineralisation.
Boyle became reader in 1984, visiting Professor in the Department of Pharmacy and Physiology at the University of Strathclyde in 1994 and DSc (Strath) in 2000. Boyle died in 2001.
Ignac Fogelman, a Glasgow graduate, joined the Unit in 1975 and with Boyle combined his interest in radionuclide bone imaging with that of metabolic bone disease. In1983, Fogelman was appointed consultant in Nuclear Medicine at Guy’s Hospital and received a personal chair in 1996. He retired in 2015 and died in 2016 (See Nuclear Medicine).
M Linda Smith, a Glasgow graduate, joined the Unit in 1980 as registrar with Boyle assessing bisphosphonates and osteoporosis prevention in women. After training at Cambridge from 1984, Smith became consultant in Nuclear Medicine at the Royal Liverpool and Broadgreen University Hospital Trust in 1999. She retired in 2014.
Stuart H Ralston, a Glasgow graduate, joined the Unit from 1984 to 1987. Working with Boyle, he developed a major research interest in the aetiology and treatment of cancer related hypercalcaemia, osteoporosis and also metabolic bone disease in rheumatologic conditions. After distinguishing himself in both Edinburgh and Aberdeen Universities, Ralston returned to Edinburgh in 2005 as Professor of Rheumatology and Director of the Edinburgh Clinical Trials Unit based in the Western General Hospital.
Stephen J Gallacher, a Glasgow graduate, was a member of the Unit from 1987 to 1995. His research with Boyle related to the management of hypercalcaemia, and also the use of bisphosphonates in Paget’s disease and the diagnosis of hyperparathyroidism. Gallacher became Consultant in Medicine/Endocrinology/ Diabetes at the Southern General Hospital in 1995 and has been a prime mover in Fracture Liaison Services for patients with osteoporosis locally and internationally.
John Hinnie, a Glasgow graduate, joined the Unit in 1996 and published on lipoprotein effects and calcium homeostasis. He has been cited twice in the Human Mutation Database for the calcium sensing receptor. In 2000, he became consultant in Medicine/Endocrinology/Diabetes at the Victoria Infirmary and now the Queen Elizabeth University Hospital, Glasgow.
In 1982, the Ratcliffe husband and wife team left, JK Grant retired and Graham Beastall took over a combined endocrine unit in biochemistry. He became recognised over the next 20 years as one of the most distinguished scientists in the field and was awarded a CBE.
Around the millennium, two new changes occurred in endocrinology.
- Firstly, a range of molecular tests appeared, permitting investigation of genetic variants of disease.
- Secondly, the development of simple bench top mass spectrometers linked to gas or liquid chromatographic separation led to hormone and peptide/protein assays that are highly specific and inexpensive and routinely available for all biochemistry departments.
For further information on Endocrinology at the Royal Infirmary, see Dr Harry Gray’s blog.
Harry W Gray and John A Thomson
Sir Edward Wayne, Regius Professor of Medicine (1954-1967) had as his main interest the thyroid gland, and introduced radioiodine treatment at the Western Infirmary, as well as the studies using the kinetics of thyroid uptake of radioiodine. James Crooks, appointed Lecturer in 1954, developed a clinical score for the diagnosis of hyperthyroidism with Wayne and Provan Murray; this was widely used internationally in clinical research. Crooks moved in 1960 to the University of Aberdeen, prior to his appointment as Professor of Therapeutics in Dundee in 1969.
Christopher Nordin, who developed a major research programme on the role of Vitamin D in osteomalacia and calcium in osteoporosis moved to become Professor of Mineral Metabolism in Leeds in 1964 and led the MRC Mineral Metabolism Unit there, prior to moving to Adelaide in 1981. Deryk Stuart Smith trained with Nordin, and was appointed director of the Bone Metabolism Unit in Western Infirmary in 1970, utilising radioisotopes to measure exchangeable calcium and whole body calcium. He also developed a radioisotope CT scanner for measurement of bone mineral density, principally in investigation of osteoporosis.
Graham Wilson succeeded Wayne as Regius Professor of Medicine (1967-1977) and continued the interest in thyroid disease, and obtained funding for the Bone Metabolism Unit, opened in 1970. He also played a key role in supporting developments in medical education using pioneering approaches before his untimely death in 1977.
William Donald Alexander, Reader in Medicine, carried out highly regarded research in thyroid disease using the innovative use of radioisotopes of iodine pioneered by Wayne. Alexander held a travelling scholarship to the National Institutes of Health in Bethesda, working with Jan Wolff and Sydney Ingbar. He returned to Glasgow in 1964, where he was appointed Senior Lecturer, and subsequently Reader in 1970. Alexander’s studies focussed on the action of thiourea antithyroid drugs, an area where he had an international reputation. He also was responsible, along with Tony Hedley and James Crooks, for developing the Scottish Automated Follow up Register (SAFUR) for patients with thyroid disease; this was a pioneering approach to using clinical informatics to facilitate long term review of patients with a chronic condition.
- His clinical research trainees included John Lazarus who moved to Cardiff, where he was appointed to a chair in Endocrinology and continued major studies on iodine in health and disease; Donald McLarty, who became Professor of Medicine in Tanzania; Douglas McCruden, who held an MRC Fellowship with Alexander studying the actions of antithyroid drugs, before taking up a consultant physician post in the Vale of Leven Hospital; and Richard Young, who worked on the development of SAFUR, before moving to a post in Care of the Elderly in Renfrewshire.
- John Connell (see below) joined the unit in 1980 and worked with Alexander on thyroid disease, completing a research thesis on the impact of antithyroid drugs on the response to radio-iodine therapy, before moving to the MRC Blood Pressure Unit in 1983.
The establishment of the MRC Blood Pressure Unit at the Western Infirmary in 1967 led to extensive investigation by Anthony Lever, Jehoida Brown and Ian Robertson, all of whom moved from St Mary’s Hospital, London, of the roles of renin, angiotensin and aldosterone in hypertension. Their pioneering mixture of laboratory and clinical research allowed them to perform landmark studies on the diagnosis and treatment of a range of secondary, mainly endocrine, causes of hypertension, with particular impact on the recognition of the importance of aldosterone secreting adenomas. They were responsible for building the reputation of the Glasgow Blood Pressure Clinic, which played a major role in research studies over a sustained period.
The Unit closed in 1996 on the retirement of the Director, Professor Tony Lever. Lever, Brown and Robertson attracted a large number of clinical and non-clinical research fellows from across the UK and overseas, many of whom went on to build illustrious careers in research and clinical hypertension and endocrine practice.
These included -
Clinical and non clinical Research Fellows
- Richard Gordon (Brisbane)
- Paul Padfield (Edinburgh)
- Alastair Miller (Perth, Australia)
- Lawrence Ramsay (Leicester)
- Gareth Beevors (Birmingham)
- Stephen Ball (Leeds)
- Christopher Isles (Dumfries)
- David Webb (Edinburgh)
- Stephen Harrap (Melbourne)
- Mark Richards (Christchurch, NZ)
- Garry Nicholls (Australia)
- Brew Atkinson (Belfast)
- and Maurizio Panarelli (Glasgow)
Senior MRC non clinical scientists who made major contributions to the work of the Unit were Robert Fraser (regulation of corticosteroid secretion and action); Ian Morton (assay development and action of vasoactive peptides); Brenda Leckie (measurement and action of renin); and Christopher Kenyon (corticosteroid action). The senior technician in the Unit (William Brown) provided highly regarded expertise in the measurement of blood pressure.
David (Dai) Lloyd Davies moved from London with Lever, Brown and Robertson to a Senior Lecturer post in the Department of Medicine; he developed the use of measurement of body electrolyte composition to study patients with a range of cardiovascular endocrine conditions including acromegaly and Conn’s syndrome. Peter Semple developed studies on Angiotensin II, before moving to the Department of Medicine as Senior Lecturer in Stroke Medicine.
Anna Dominiczak joined the unit in 1986. Her research programme focussed on the genetics of high blood pressure and she built a major international reputation in this field. She was appointed to a personal British Heart Foundation Chair; she established the BHF Glasgow Cardiovascular Research Centre (with Connell; see Cardiovascular Disease) and was appointed to the Regius Chair of Medicine in Glasgow in 2009. In 2010 she became Vice Principal of the University and played a major role in attracting funding to develop a world class University research presence on the campus of the new Queen Elizabeth Hospital. In 2017 she was awarded a Damehood.
When John Connell moved to the Blood Pressure Unit, he developed studies on the control of aldosterone secretion and of its action in health and disease; he was awarded an MRC Travelling Fellowship to study the molecular control of aldosterone synthesis with John Coghlan in the Howard Florey Institute in Melbourne, before returning to the Western Infirmary as an MRC Senior Clinical Scientist (Consultant) in 1987; he was appointed Professor of Endocrinology (1995), in the Department of Medicine led by John Lowe Reid, who was Regius Professor of Medicine from 1984-2009. Connell moved to be Dean of the Medical School in Dundee in 2010, and Vice Principal of the University of Dundee in 2013. He led a research group funded by the MRC from 1987 to 2009, which carried out internationally regarded laboratory and clinical research studies on aldosterone and hypertension. His non-clinical research partners were Robert Fraser (see above); Gordon Inglis; Eleanor Davies, now Professor of Cardiovascular Endocrinology in the BHF Cardiovascular Research Centre, leading studies on the regulation and action of aldosterone; and Scott Mackenzie.
Connell, DL Davies (who retired in 2004), and Dominiczak, along with Alastair McLellan (see below), built a major centre for the investigation and treatment of patients with endocrine disorders, with particular emphasis on adrenal and pituitary disorders, which latterly developed into a major referral centre for investigation and treatment of adrenal disease as well as providing outpatient and inpatient care for patients with a wide range of endocrine conditions.
McLellan succeeded DA Stuart-Smith as Director of the Bone Metabolism Unit. He built a major service for the investigation and treatment of patients with osteoporosis. He is currently Dean of Postgraduate Medicine (West of Scotland Region) and Director of NHS Education Scotland.
From 1986 Connell and colleagues attracted a large number of endocrine trainees who have continued to lead the specialty in Glasgow and beyond. Many carried out highly regarded research programmes on endocrine and metabolic disease as well as their impact on cardiovascular function, and established high profile careers in the West of Scotland and beyond. The Endocrine Unit developed a number of major service innovations; with a programmed investigation ward, significant evolution of nurse-led endocrine services, including nurse led thyroid and bone clinics, and substantial development of the role of the endocrine specialist nurse.
Leadership of the Endocrine Unit passed to Marie Freel and Colin Perry in 2010, when Connell moved to Dundee. They continued to build the profile of the clinical service and in 2014, when the Western Infirmary clinical services moved to the new Queen Elizabeth Hospital in south Glasgow, developed a new and merged Endocrine unit.
Among the clinical trainees who passed through the Unit were:
John Petrie, Director of the Robertson Centre for Biostatistics and Clinical Trials Unit and Professor of Diabetes, worked on metabolic and endocrine regulation of vascular function; he moved to complete training in Dundee, where he was appointed to a senior lecturer post before returning to Glasgow as Professor of Diabetes in 2010.
Andrew Morris carried out research on metabolic regulation and was then appointed to a Lecturer post in Dundee; he is now Vice Principal of the University of Edinburgh.
Andrew Jamieson completed a PhD on genetic regulation of aldosterone production; he has held consultant posts in Scotland and the Middle East.
Stephen Cleland trained in clinical and research aspects of endocrinology with Connell, and was appointed to a consultant post in Stobhill Hospital, and more recently Queen Elizabeth University Hospital.
Martin McIntyre, a Glasgow graduate, was a clinical lecturer in Endocrinology in the Western Infirmary and undertook an MD under the supervision of Professor Anna Dominiczak on oxidative stress and cardiovascular disease. He became a consultant at RAH, Paisley and was subsequently awarded a Chair from the University of West of Scotland.
Colin Perry was a clinical research fellow under supervision of Connell and Professor Gwyn Gould and was awarded a PhD in 2003. Thereafter, he became a clinical lecturer and consultant at Glasgow Royal Infirmary before moving to Western Infirmary in 2010 to head up the endocrinology serviced there with Marie Freel. Both are now based in the Queen Elizabeth University Hospital.
Brian Kennon also undertook research with Connell in the field of aldosteronism and was awarded a MD. He became a consultant in Southern General Hospital (now Queen Elizabeth University Hospital). His clinical interests lie predominantly in diabetes and he was recently appointed as lead clinician of the Diabetes Managed Clinical Network.
Marie Freel was a clinical research fellow supervised by Connell and Eleanor Davies. She was awarded a PhD in 2006 and became a clinical lecturer. She was subsequently awarded an MRC Intermediate Fellowship to study the role of aldosterone and cardiovascular disease. She now works as a consultant endocrinologist at QEUH and, along with Colin Perry, leads on the management of complex adrenal and pituitary disorders.
David McGrane completed a PhD with Anna Dominiczak and is now a consultant in QUEH.
David Carty undertook a higher degree under supervision of Professors Dominiczak and Christian Delles. His research interest was predominantly in aetiology of pre-eclampsia. He became a clinical lecturer and was subsequently appointed as consultant in endocrinology at Glasgow Royal Infirmary.
Frances McManus was awarded a PhD in steroid research under supervision of Connell and Eleanor Davies. She became a clinical lecturer and was subsequently appointed as consultant in endocrinology at Glasgow Royal Infirmary.
Professor John Connell and Dr Marie Freel
Ian Murray established the first endocrine clinic in the 1940s. He was a founder member of the Glasgow Endocrine club. Later Stefan Slater established regular joint endocrine/biochemistry meetings at the hospital, and, with Professor Graham Teasdale, assessment of patients undergoing pituitary surgery. Thyroid, parathyroid, adrenal and pancreatic specialist surgery and radioisotope investigations and management were also performed. On the closure of the Infirmary services transferred to the Queen Elizabeth University Hospital.
Donald McClarty was an endocrinologist who emigrated to Dar es Salaam in Tanzania in 1977 to tackle diabetes there. His successor Matthew Dunnigan had interests in metabolic diseases, including bone and vitamin D (Asian rickets, with Krishna Goel (see Child Health); a partial lipodystrophy is named after him (Kobberling-Dunnigan syndrome or Dunnigan syndrome).
He and Hamish MacLaren were succeeded by Derek Gordon and Stephen Clelland, until services were transferred to the Queen Elizabeth University Hospital.
Southern General Hospital
Stephen Gallacher trained at the Royal Infirmary before appointment as consultant at the Southern General Hospital in 1995, developing osteoporosis services. He was joined by Colin Semple. Services transferred to the Queen Elizabeth University Hospital.