Despite everything, Ruth Watt remembers her husband as the man he always was. The Alastair who put trousers in the wash with bananas and nails in the pocket, who melted new cycling shoes in the oven by misreading the heat-mould instructions.

The sportsman and proud dad, the diligent ‘clever doctor’. What happened to Alastair in his last 20 months has not tainted her memories of him.

But it’s hard to forget the man Alastair became towards the end, the sleepless, tormented ‘lost soul’ who believed he had failed. The man who walked out of the house into the darkness in December 2017 and was found in a field the next day, after a fatal overdose of insulin and anti-depressants.

In the years since, Ruth has wanted answers. Some of those answers she has now, through a successful legal action she brought against Alastair’s employer, the then Northern Devon Healthcare NHS Trust, with BMA Law’s support.

She has needed to understand, for herself and her teenage twins, why he did it. And she wants others to understand too, to sound a warning that those in the caring professions need good care too.

Alastair Watt was already finding his workload unmanageable before his accident in April 2016. He was a diabetes and endocrinology consultant at a busy district general and had been working single-handed since his colleague and fellow endocrinologist had retired in 2012.

Alastair was ‘exhausted and stressed’, says Ruth, and a cycling trip in Wales with his brother and friends would be a good tonic.

Sport was important to him: before cycling, he had played rugby to a high level while at medical school in London. He and Ruth met at Barts: she is a GP. But on that trip to the Brecon Beacons, his bike wheel clipped another’s tyre, catapulting him over his handlebars and resulting in a serious head injury.

He spent three-and-a-half weeks in hospital, being treated for a contrecoup subdural haematoma, then a rare form of hyponatraemia, cerebral salt wasting.

He spent five restless months at home. Initial speech difficulties and facial palsy resolved within weeks. Regaining the processing skills required for reading, writing, organisation, took longer.

Yet, their discussions about his symptoms and recovery showed ‘Alastair’s clinical knowledge and reasoning remained excellent’, Ruth says. He was much more talkative, more emotional: he raged over the Brexit vote, Donald Trump’s election.

‘But he was still the same person.’ Five months after his accident, occupational health cleared him to return to work. He was excited to be back.

Alastair raised concerns over his pre-existing workload in the ‘return to work plan’ he was encouraged to write that September.

Yet, it would be eight months before it was even discussed. His phased return to full-time work saw him mostly in clinic: his role covered everything from obstetrics and gynaecology to obesity to transition. He was also heavily involved in developing an integrated diabetes plan across primary and secondary care for North Devon on his own initiative.

‘He had an excellent team of nurses who supported him but he had no registrar, no colleague,’ says Ruth. For the first month, before he regained the driving licence withdrawn due to injury, he would often cycle the 52-mile round-trip to work.

By January 2017 there were calls for him to resume on-call work in the MAU (medical assessment unit): neither Alastair nor his occupational health consultant felt he was ready for the role’s fast pace and multitasking. But pressure was mounting: that spring, the trust announced its intention to offer 7/7 (seven-days-a-week) services, at the Government’s prompting.

There had also been a referral to occupational health by management, which Alastair felt was unwarranted and unfair.

In the months that followed, discussions focused on Alastair’s resuming on-call duties, rather than addressing his workload more generally, as the inquest heard and as The Doctor has previously reported.

Alastair continued to request a review of his workload. The consultant who led his first job planning meeting, in April 2017, had no idea Alastair used to have a colleague. Still nothing changed.

Finally, at a meeting in September, it was agreed Alastair would not do on-call, his workload would be slightly reduced – and he would take a pay cut.

‘He was so stressed before the meeting because he felt he couldn’t make them understand how much work he was doing,’ says Ruth. ‘Then he felt discriminated against because he wasn’t able to do the MAU work.’

Immediately after the meeting, he went off on sick leave for a fortnight, returned to work briefly, then went on sick leave again in mid-October. His mental health deteriorated sharply.

Soon, he was too anxious to walk his beloved spaniel, Oscar, or collect the children from the bus-stop. By November, he was having suicidal thoughts. ‘He just shrank, went off his food, stopped sleeping, couldn’t make a decision.

He believed he had lost his job and felt that he’d failed.’ The day he went missing, 12 December, he was incoherent, ‘probably psychotic’, and had convinced himself he had mismanaged some of his patients.

Alastair slipped out at nightfall, sparking a man hunt that spanned the 26 miles between their home and the hospital. Ruth joined the search, with friends. He was found in a field in their village.

The coroner concluded that Alastair took his life following a traumatic brain injury and work-related stress. ‘This is a small community and Alastair had a public death,’ says Ruth.

‘There were police everywhere. There were even rumours that he did drugs because police told locals they were looking for the syringe he’d used. I want people to know what happened.’

Ruth has wanted to make sense of what happened in the months immediately before Alastair’s death.

‘He turned in on himself and didn’t give me loads of detail.’ Her dealings with the trust management have been difficult and distressing.

She has had ‘no acknowledgement, no apology, no gesture’, she says. But of this she is convinced: Alastair’s isolation and repeated calls for a colleague were not heeded.

Much of what he did was ‘unrecognised and unvalued’, especially his work on the integrated diabetes plan which was mostly in his own time.

‘They never sat down with him and acknowledged all his roles and what work that entailed. His specialist work alone was more than full time, without the additional work and pressure of on-call.’

She has used FoI (Freedom of Information) requests to access Alastair’s work emails to managers on the subject of his job plan – and to look back through vacancies advertised on NHS Jobs.

The trust said at his inquest they had not been able to recruit for the role of endocrinology colleague for Alastair.

‘I found no evidence of any job adverts after October 2014 either through my FoIs or legal proceedings,’ says Ruth.

Ruth has also pushed to see the findings of an NHS Improvement investigation into the trust’s former management, which she finally achieved through court disclosure.

The medical director had faced a vote of no-confidence by senior clinicians early in 2017, amid accusations of bullying: he left the following year. Ruth believes this report should be made public.

‘We have to start talking openly about what happens when things go wrong, so lessons can be learnt. At the moment, it seems there’s a culture of fear in the NHS that shuts the conversation down.’

She is adamant she has no complaint against Alastair’s clinical colleagues. And she’s clear that her complaint is against the former management of the trust, not its current executive.

‘I know that the trust’s changed, and there have been masses of improvements. But openness and the acknowledgement that things didn’t go right for whatever reason would mean so much to me.’

Ruth insists that a lack of in-depth knowledge about brain injury, including among medical professionals, meant that Alastair’s struggles with complex processing were not recognised.

She acknowledges that he hid them too, for fear of looking unprofessional and, later, for fear of losing his job.

His processing ability was assessed before his hospital discharge in May 2016 – and never formally revisited in relation to his work. ‘Alastair looked okay so he was assumed to be OK,’ says Ruth.

But there’s a more general, more pressing point: ‘It’s important that we allow doctors to be ill and allow them the space to get better. “The workload was the workload”, we heard at his inquest.

Alastair had to suffer a pay cut because he was not able to do the work in MAU. This wasn’t fair because he was doing the work of two consultants already.’ Ruth was given compassionate leave after Alastair’s death and was supported fully in her own return to work.

Her colleagues shielded her from more stressful roles. She dropped a session, even changed her day off to help establish new routines in bereavement. ‘My colleagues said, “Anything you don’t feel you can manage, you hand over”.

And I knew that was true. I felt huge guilt about being off work: you feel you’re dumping colleagues in it. Alastair felt hugely guilty about being off sick. Even on his last day, he was worried about his patients: he was the only consultant.’

Ruth wants a wider conversation about workloads for frontline workers in the NHS. In her own practice, where she is a partner, she says, ‘We sometimes feel we’re not practising medicine as we would like to because of the pressure of time and the lack of human resource.

‘It’s dressed up as resilience and professionalism to fill in the gaps, to always do more, but you can only do so much. At some point, people will buckle and some things can make them more vulnerable, in Alastair’s case a traumatic brain injury … Management were too focused on what they needed Alastair to do rather than what he could realistically cope with.

‘If you’re very stressed, you can’t do good medicine. It’s how you make an intelligent, hardworking, ethical person like Alastair fail. He just burnt out: Alastair didn’t have a history of mental health problems. This Government’s not listening. But it must because we are human too.’

Ruth says she’s banned her children from going into medicine.

Ruth believes Alastair would not have approved of her personal injury claim against his employer – or of the settlement she’s received.

‘Alastair didn’t approve of people suing the NHS and I did agree with him, but I wanted answers and truths and taking legal action was the only way to get them. We’d never seen the need to be in a trade union like the BMA before but thank God we were because that’s how I got my answers.

'This was never about the money.’

Ruth and her twins keep Alastair in the conversation: they still go to the rugby, still discuss what he’d have thought. He definitely wouldn’t have approved of the trampoline. ‘We’re moving on with our life but I continue to be so outraged at what happened to him.

This comes with me: this is part of my future and my past. ‘The Alastair after the head injury was still Alastair, with the same principles and values. He still loved his sport, still loved his family. I want him to be remembered as the person he was, so full of life and energy.’ 

Images by Charlie Birchmore

Read The Hard Road Back

BMA Law’s personal injury scheme offers BMA members and their families free advice and representation* if they are injured through the fault or negligence of a third party.

This includes accidents at work, on the road or in a public place, and disease claims.

Key benefits:

• Most other lawyers acting for personal injury claimants take a ‘success fee’ of up to 25 per cent of damages for past losses and pain or suffering. BMA Law takes no such fee
• If you are employed under a standard NHS contract or GP partnership, BMA Law can often recover for the trust or practice the costs of sick pay advanced (and on occasion locum cover)
• If you received hospital treatment after a road accident, a successful claim ensures recovery of appropriate costs for the NHS trust providing treatment.

For a free consultation, contact 0300 123 2014 or email [email protected]

* Subject to reasonable prospect of success