Addiction Lives

On 24 January 2023, Kieran Moriarty interviewed Sir Ian Gilmore for the Addiction Lives series. They talk about Sir Ian’s work with successive governments on health policy and why he resigned ‘rather publicly’ as co-chair of a Public Health England committee, as well as about the impact of COVID-19 on alcohol-related harm and the need to train liver specialists in addiction.

Kieran Moriarty: I’m Kieran Moriarty and it’s my pleasure this morning to interview Sir Ian Gilmore, who has occupied a number of positions…Professor of Medicine, particularly liver disease at Liverpool University, Registrar and then President of the Royal College of Physicians of London, President of the British Society of Gastroenterology, and Founder and Chair of the Alcohol Health Alliance, as well as being a Government Alcohol Adviser. So, Sir Ian, welcome.

Ian Gilmore: Thank you Kieran. Thank you for that generous introduction, some of which was true.

(Laughs) Could you tell us how you first became involved and interested in your area of study?

Well, I was really a latecomer to alcohol policy if you like and it’s probably too long a story to tell now, but certainly, I aimed to be a doctor from a relatively early age and as soon as I got to medical school, I knew I was more cut out to be a physician, rather than a surgeon. I think on day one, I tossed a coin in the dissecting room with my partner to see who would make the first incision and he won, fortunately, and was very good at it and became a surgeon. It was quite clear that I was much better holding the instruction book and reading out, telling him where to do the cutting. So, I was a physician at heart. I think you would agree that which specialty you go into within medicine is often a matter of happenchance and who you work for, who motivates you, and it so happened that gastroenterology was one of the specialties I was exposed to very early and liver disease in those days was very much part of gastroenterology. There weren’t really, apart from a handful of world figures, any pure liver specialists, liver disease was looked after by gastroenterologists. When I was appointed a consultant in Liverpool in the late 1980s, it was clear that they wanted someone with a liver interest and that matched my interest, it matched my research over the years. So, my day job was looking after patients with liver disease and most of those had it as a result of alcohol harm. To use the old public health analogy, I spent years pulling drowning people out of the water, without thinking of walking upstream to see why they were falling in, in the first place. So, alcohol harm was really a major part of my work. We were quite early on in setting up an alcohol care team in Liverpool with Dr Lynn Owens, a nurse consultant there and that’s how we began to get more aware of the wider harms from alcohol. Then, when I was Registrar of the Royal College of Physicians, it was the then President, George Alberti, who I think was one of the first people I was aware of, to see that tsunami of alcohol harm coming down the road in the early 2000s. He suggested that I set up a working party to look at alcohol harm. I got a group of people together and we received oral and written evidence as well, and you were kind enough to give us some evidence, Kieran, for that, and we produced a report, “Alcohol: Can the NHS afford it?” (1). Clearly a rhetorical question and it just seemed to hit the right time, because it got quite a lot of national publicity, which was really good for the subject, and it led to me being invited by the Academy of Medical Sciences to join a working party that was chaired by Michael Marmot. He is really the guru, if you will, of health inequalities. I remember vividly walking into the first meeting and there was Sir Richard Doll of smoking and lung cancer fame. There were people like Professor Klim McPherson, Professor of Epidemiology and Public Health in Oxford, Professor Robin Room, an Australian, one of the gurus of public health and alcohol and I just realised I was out of my league as a simple clinician. So, I volunteered on day one to be the secretary and do the writing if they told me what to write and so I sat at their feet for some months and just began to understand some of the principles of epidemiology and public health and how prevention had a bigger role than trying to salvage people when the harm was already done. So that was really where I came into alcohol policy, but then I suppose the biggest opportunity came when I was President of the Royal College of Physicians and actually had a chance, for the first time of my life, of people other than my mother sometimes listening to what I said and I took the chance to set up the Alcohol Health Alliance. There were several thoughts behind that. I think one was the feeling that everyone that we were working with, other organisations like Alcohol Concern at the time, like other colleges, the [British Medical Association], we all wanted the best for our patients, but we didn’t always say it in the same way, and we were often criticised for, you know, apparently contradicting each other. Of course, that made us easy meat for the drinks industry to discredit us. So, the idea was to bring people together, so we could be singing from the same hymn sheet. I was aware that the Royal College of Physicians had set up ASH (Action on Smoking and Health) had been a springboard for ASH years earlier and I thought we could do the same for alcohol. It turned out we couldn’t do the same because when ASH was set up it was heavily supported by Government financially and we got no support and we really had to look around to see where we could get some money from. And it was clear to me early on if we started trying to get serious charitable donations to support us, we would be fishing in the same pond as our member organisations like Alcohol Concern, who were literally living from hand to mouth. So, we started off as an informal alliance and we’re still exactly that. We still don’t have a legal entity; we still are a group of interested charities and similar non-governmental organisations. We started off somewhere over 10, we now I think have got over 60 organisations and happily, there’s hardly been a cross word said in those, what comes now to, 15 years.

Well, that’s a fantastic introduction and you’ve covered a huge amount of ground there. While you are on it, because I think this is the big ongoing thing, I mean one of the reasons why everybody has been together on this in the Alliance is your Chairmanship and your lightness of touch as well, has been very powerful as well with Government. But what would you say are the main issues currently facing the Alcohol Health Alliance and the country generally, particularly with regards to alcohol and liver disease as well?

Well, I guess it depends what side of the bed I get out of in the morning, whether I feel optimistic or pessimistic and you could certainly be quite severe on us and say that very little progress has been made in evidence-based policy, certainly in England, in the time of the Alcohol Health Alliance. But I think we’ve learned a lot, we’ve learned I think the importance of sticking to the evidence, rigidly to the evidence and not being sucked in by industry in any way. I think a key time was when we published a report called, “Health First” (2), and that was an evidence-based alcohol strategy that could be taken as a template by any geographical area, be it a county, a country, or a continent. That was just laying out the evidence in a very clear fashion and that’s been our Bible since. We’ve learned, I think, the importance of forming alliances, not just with other organisations that are interested in reducing alcohol harm as their primary objective, but also those with a big overlap, like for example charities dealing with domestic violence, where alcohol is a major, major contributory factor. Homelessness is another one. So, I think we’ve learned to use all sorts of different channels of influence. I think, as I say, you could say that we’ve brought about very little change in England, but I guess I console myself with the thought that it took 50 years from the [Royal College of Physicians] recommending a ban on smoking in public places, until it actually took place. Also, it’s been really great to work with Scotland and the Republic of Ireland (we actually cover the whole of the British Isles) and there have been fantastic advances in Scotland and Ireland in evidence-based policies. That obviously makes you ask yourself why have they made progress and we haven’t and I think the reasons are probably complex, but certainly both Scotland and Ireland had and still have to some extent, a greater burden of alcohol harm than England and that goes, at least in Scotland, with the areas of deprivation. I think also, in smaller countries, that public health innovators have greater access to decision-makers than is the case in Whitehall. And certainly, in Scotland, I think there’s an element of the current Scottish SNP wishing to put some clear water between themselves and Westminster and they have certainly managed to do that.

Let’s come to the 2012 Alcohol Strategy. We thought there was going to be a breakthrough there. I think, with your lead, you had persuaded David Cameron, the Prime Minister, to adopt the policy of minimum unit price, but then when he took on Lynton Crosby as his advisor, I think Lynton said, “bail the barnacles off the boat” (any policy that’s not popular), and he did bail the barnacles. So, perhaps you might comment on the strategy from 2012, and there is talk, I think one of the big things with the Alcohol Health Alliance, the big developments, is that we have appointed people who are expert in communication and policy, and they’ve had excellent liaison with some of the parliamentarians. So, can you discuss that whole area of government strategy and links with parliament and what you might hope for in a new strategy?

Yes. I think I’ve been involved long enough now to have dealt with several Governments and there is no doubt that the Labour Government have been more receptive to the idea of preventative polices, whereas the Conservatives I think have been more afraid of accusations of the ‘Nanny State’, and so on. But I well remember around 2003/4 probably, the No. 10 ‘strategy unit’ set up a group to look at alcohol policy and really produced I think a very good interim strategy. I was looking at it just the other day and it’s got there at the top, in the prevention strategies, price, marketing and availability. Those of us who were on that committee thought we had done a really good job when we saw the interim report, but then when the final version (3) came out there were various bits that we particularly favoured, like the ones I mentioned, seemed to have dropped through the cracks. So, I was already getting used to political influence, as it were, getting in the way of evidence-based policy. Gordon Brown, when he became Prime Minister, I think in 2007, he seemed quite receptive and again I got into No. 10 and round the table with Gordon Brown and was hopeful, but nothing came of that. And then as you intimated in about 2012 that David Cameron as Prime Minister of a coalition government, famously said ‘sometimes it’s important to do the right thing, rather than the popular thing’, and he was specifically referring to minimum unit price. I’m sure there will be books written on the various influences that caused that policy to bite the dust and you mentioned one, Lynton Crosby, and I’m sure that’s important. I’m sure the drinks industry was really getting at the backbenchers and the very powerful pro-alcohol lobby in the House of Commons. Obviously, the U-turn was a great disappointment to us. But there were positives; I remember soon after the U-turn the BMJ published a really good review article called, “Under the Influence” (4), exposing the government’s ties with the alcohol industry, where he used the Freedom of Information Act to find out the access that the drinks industry had to policymakers. For the first time for me, it brought into sharp focus what we were fighting against. The BMJ also published, in the same edition, an editorial I wrote with Mike Daube from Perth, Australia (5), about how that U-turn happened and how disappointing it was. So yes, these are all near misses if you like. I suppose something I’ve learned is that opportunities come along quite unexpectedly. Certainly, David Cameron’s Damascene conversion was a surprise, so it’s made me realise that we just need to keep pushing at that door, because sometimes it will open unexpectedly, and you just have to be ready for it.

For a new strategy, what influence do you think the Alcohol Health Alliance and maybe you in particular, given your position, may be able to bring to bear on a new strategy, say with minimum unit pricing, duty, advertising, licensing, labelling? What comments would you make on those?

I rather fear that the next two years leading up to the general election are not going to be a time for public trumpeting of any change in heart in the present government, but I do think there’s a lot of work that can be done behind the scenes. I think it’s great to have a chancellor who understands the issues, having chaired the Health Select Committee for a number of years very successfully. He was more successful as a Chairman of the Health Select Committee in a way than he was as Secretary of State for Health. But of course, we just don’t begin to understand what the various pressures are on ministers and I guess I’ve got more sympathy with ministers than I used to have. So, I think there’s a lot of work that can be done with the opposition party at the moment and I think they are showing signs of interest. As you intimated, it looks as if we may be getting somewhere in having a more rational licensing policy and that is being strongly resisted by the drinks industry, but I think would get one door beginning to open. I think the other area it’s worth just mentioning is the Commission on the Harms from Alcohol, that we set up, just about six months before COVID. So, it wasn’t the best of timing, but the Alcohol Health Alliance was looking at the landscape and there were no obvious opportunities to change policy coming up with the Conservative Government at the time, so in discussion with some politicians we set up this Commission, because it sounds influential, but it was just purely something that was dreamed up around a coffee table. We invited Baroness Ilora Finlay to chair it and through her and some of our own contacts we got another half dozen from the House of Lords and two or three from the House of Commons to join it. This means the Commission is predominantly parliamentarians with two or three other alcohol experts and we took evidence, both written and oral evidence, in Westminster, Cardiff, and Edinburgh, and so it really was a UK-wide initiative. As COVID closed in, we didn’t get to Belfast, but we did get some virtual meetings with them and produced a report. The report said nothing unsurprising, but it was evidence-based, it was reiterating what we know works. But the exciting thing about it was that the parliamentarians involved didn’t want to stop there once a report came out. Most commissions, you know the report is written, it sits on a shelf and gathers dust, but they got so involved that they really wanted to carry on and so we’ve used them as a fantastic resource for asking questions in parliament, in influencing behind the scenes and so on and they are still keen as mustard and have been a wonderful asset to the AHA.

One of the excellent parts of that commission was that you interviewed a good number of people with what people described as ‘lived experience of alcohol’, the terminology gets very difficult here, some people use the word ‘alcoholic’, some ‘alcohol-related’, some, in America, ‘alcohol-associated’. But I think that’s been a big change isn’t it, we’ve moved away from where we would have a token person with an alcohol problem on a committee, to actually their evidence dominated the Commission’s report.

That’s a very good point. When I said that the report produced the usual conclusions, I was being unfair to it. I think we really went out of our way to capture stories of personal experience, and as you know, it’s all very well telling a politician that such and such occurs in 4.3% of the population, but to actually tell them a story about how it’s affected someone’s life, how it affects their family. We particularly concentrated I think on the damage to those around people who are alcohol dependent, and I think that was really powerful. I’m always struck by the way that it was passive smoking that really swung the argument for banning smoking in public places and certainly second-hand smoke is very unpleasant and I’m sure carries some harms. But the harm to innocent bystanders is infinitely greater I think from alcohol than it is from smoke.

And some of the parliamentarians, particularly actually House of Lords, but also House of Commons, who were, had alcohol problems themselves, or were brought up in families where their parents had an alcohol problem, they have given very personal testimony in the Houses, often very emotional testimony. As you say, that often impacts more impressively than the evidence base, doesn’t it?

Absolutely and we’ve brought onto the commission recently an MP, Dan Carden, who happens to be an MP in my home city of Liverpool. His office is actually in Anfield, almost opposite the Liverpool football ground where he’s got his constituency headquarters. But he freely admits to having an alcohol problem in his twenties and has just been a fantastic resource for us and a tireless worker, to help individuals, but also to try and shape policy to protect others.

Yes, they used to have a soccer team at Liverpool, didn’t they, if I remember. He spoke actually in parliament the other day and he mentioned Dr Lynn Owens and your unit in Liverpool, and I was quite touched he mentioned our unit at Royal Bolton Hospital as well. So, um, and that leads me onto the whole area of treatment of alcohol-related disease and liver disease and also you mentioned COVID, perhaps we could, well let’s talk first about treatment and then we’ll come to the impact of COVID. Historically, people with alcohol problems used to be cared for either in liver units as you mentioned early on, or in addiction psychiatry units. But care was all in silos, whereas now there’s much more of an effort to bring about collaborative liver and psychiatric care for these patients. Would you like to comment on that?

Yes, I think there’s been a lot of progress in one way, in that we’ve got services more joined up and we’ll talk about alcohol care teams and their strengths, but I think the downside is that the pressure of beds is so great in the NHS now that it’s very difficult to actually keep patients in hospital for them to be detoxified, or to set them on the right path. I don’t think we need to get into a discussion of the NHS in 2023, but I think that the situation speaks for itself. But alcohol care teams, that you’ve written the definitive history (6) of, if you like Kieran, they have transformed the immediate experience of patients with alcohol-related problems in hospital. There has been a real problem in hospitals and there still is. There’s still a tremendous stigma, particularly in A&E departments of patients with alcohol dependence, who come back with repeated problems that are seen as ‘revolving door’ patients. They are seen as patients where it’s their own fault. But now in the majority of hospitals there is a team that is properly trained and linked into other services to help identify these patients and put them on the right path. I think that’s been great. I think there have been problems, as that’s been a Monday to Friday, nine-to-five service in most places and of course that is not when the alcohol problems present to our A&E department. But I think that more hospitals now are getting an out-of-hours service, at least over weekends and early evenings and the like. I think the worry now is the gap between the hospital and the community. I think the NHS has undoubtedly been fragmented particularly in community services. So many services put out to the lowest tender and a lot of patients are falling through those cracks. My particular interest in the last few years has been in alcohol-related brain injury and it’s only relatively recently that we’ve realised that when many patients don’t come back for their appointments, or don’t engage with alcohol treatment services in the community because they just have not taken in what they have been told, they’re suffering from that very real damage to the brain that comes from heavy drinking. So, we’re in the process of setting up in Liverpool a kind of assertive outreach service, so that once patients have gone home, rather than just disappearing into the blue beyond, will have some community nurses specifically there to support the patient and support the family in the community and make sure they get to their treatment and the like. And in a sense Liverpool is almost a home of alcohol-related brain injury in recent years, because there has been a wonderful psychiatrist called Ken Wilson on the Wirral, who has pioneered work and who chaired at Royal College of Psychiatrists Working Party on this topic about five years ago. So, we’ve had Ken as a source of support and encouragement and the great thing about alcohol-related brain injury is that it is potentially reversible. About a third of patients roughly will almost completely recover, a third will make significant improvements in their cognitive function, and a third will be disappointingly rather stuck. But that’s a lot better than many other causes of dementia.

Let’s come back to liver disease. In 2013, the National Confidential Enquiry into Perioperative Deaths looked at people who died with acute alcohol-related hepatitis and they found that care was less than good in more than 50% of patients, which was horrifying for many. It also highlighted the stigma associated with alcohol and that intensive care doctors were reluctant to admit patients with alcohol problems to intensive care, and historically there was always a lot of reticence about advising liver transplantation when it was indicated, and as a consequence of that report, Roger Williams from King’s Liver Unit set up the Lancet Liver Commission, which we were both involved with. Would you like to comment on that whole area?

Well, I think it was a really important light shone on that area of shame, really, in our liver services that these patients didn’t get the treatment they deserved. It was partly I think because hepatology was just emerging, many hospitals didn’t have someone with a particular interest or expertise in liver disease. There was the stigma side that you pointed out and I think that the report that’s come out within the last few months shows that there has been some improvement (7). It’s not as good as it should be, but I think it’s given us enough to encourage us to press on. I think the area that worries me even more than that is the addiction services. It seems to be that addiction psychiatry is almost a dying breed of specialty and that really bodes badly for the patients of the future. Alright, you can manage a very straightforward alcohol-dependent patient, if that’s not being too dismissive, with the help of a trained nurse, or an occupational therapist or whatever. But I think for the complex patient, particularly with multi-morbidities, often with mental illness, as well as alcohol dependence, they’re very complicated patients and I think these patients will suffer. What do we do about it? Well, I’ve been campaigning for some time to try and get those training in liver disease to have more addiction skills. We look after three sorts of broad areas in hepatology, one is alcohol-related disease, one is the consequences of obesity, and the third is the consequences of viral hepatitis, often acquired during injection of illicit drugs. So, you can’t think of a better place to start within medicine for developing the skills to manage these patients. And addiction has got strong links to psychiatry, but they are not exclusive links and for example in Australia, the Royal Australasian College of Physicians is the home of addiction, rather than Royal Australasian College of Psychiatrists, and wherever addictions exist, it’s going to need both. But let’s look at ways of supporting the specialty of addiction before it dies with us and dies on the vine.

Yeah, I congratulate you on the work in encouraging addiction training in liver specialists. On the Lancet Liver Commission, we’ve had Colin Drummond, who has drawn attention to the shortage of addiction trainees in particular, and also, he’s published his work on alcohol assertive outreach teams, where his alcohol care extends into the community and links with various other groups. Would you like to make any comment on that?

Well, it’s absolutely wonderful to see those outreach teams and that’s very much the model we’ve been adopting for those that we identify as ‘brain injured’. So, all the patients that come to our alcohol care team have a proper cognitive assessment and they will be fed into this assertive outreach – aggressive is perhaps the wrong word as it sounds as if they’re going to be manhandled, but it means you have to make the effort to get out there to find them. It isn’t something that will just happen anyway. The landscape is so complex in the community now that if it’s just left to anything approaching chance, then there is no real hope for the patients. So, Colin has been a fantastic example to us, and we are very much trying to emulate it.

He’s provided evidence base as well. I think he’s shown that the ‘return on investment’ for alcohol assertive outreach teams, I think is roundabout £3.50 for every £1 invested and Public Health England, I know they’ve come in for a lot of criticism, but as you say, my interest is alcohol care teams and I’ve liaised closely with them over the last ten years and they have persuaded NHS England and government to invest money in alcohol care teams, particularly in the most alcohol-dependent regions, and two of their members, Clive Henn and Iain Armstrong have been on the Lancet Liver Commission. So, I think we’ve got a lot to commend Public Health England for in the way they’ve helped develop alcohol care teams. Any comment on that?

No, I would agree with that 100%.

Because I’m going to come to Public Health England, as I’m sure you would anticipate. Before we do that, let’s talk about the impact of COVID, maybe generally, but also particularly on the impact on alcohol problems and liver disease.

Yes, clearly it was difficult to predict what the impact of COVID would be, both the direct impact of the virus, but also the collateral damage if you will. I think as time goes on and more data are looked at, the clearer it will become that the collateral damage will be just as big, if not bigger, than the direct impact of the virus. I don’t think I would necessarily have predicted what the studies are beginning to show, but they do seem to show clearly that those who were locked down and were moderate drinkers, tended if anything, to drink less, whereas it was those who were already at the heavy end of the drinking spectrum, who drank more. So, although the total consumption didn’t rise, in fact, if anything it fell a little bit, partly related obviously to access and pubs being closed, the interesting thing was that harm went up, because those who were already as it were standing on the edge of the cliff, were falling off the cliff because of that increase in drinking that resulted from the social isolation and the anxiety and all the other things. Also of course patients presented later with their problems because a) they were frightened to go to hospital, and b) the hospitals were often not geared up to take them unless they had a direct COVID-related problem.

I mentioned I’d come back to Public Health England and the time you rather publicly resigned a few years ago from co-chairing its committee giving advice on alcohol.

You are right that I did that as a last resort as PHE were going ahead with an education project jointly with the largely alcohol industry-funded Drinkaware. We were late to hear about it, but I am pleased to say that as a result PHE developed guidelines about who they would work with in future and this excluded commercial partners with a potential conflict. I am hoping that OHID, the successor to PHE, will do likewise.

You’ve mentioned some of the inspiring figures in your life. Any others that come to mind in your early days and perhaps have you any thoughts, any advice that you would give to medical students, junior doctors? In this time, morale is very poor as you know, what would you, any comments on that?

Well in terms of advice, I had to dig deep to think about this when I was congratulating new medical graduates in St Andrews during the summer and interestingly enough it was the first medical graduates they had produced for fifty years, because as you know, when Queens College broke off as the University of Dundee, the medical course went. St Andrews kept a pre-clinical course, but the clinical students mainly went to Manchester, where they were given a Manchester degree. So, it was uplifting to see the first cohort coming through last summer and I think I said two things to them. One was never forget, even when it’s three in the morning and you’re under stress, remember what a privilege it is for patients to trust you and pour out their most heartfelt problems to you. So, the privilege of being a doctor I think is still there, however great the strains. And the other advice I gave them was to be lucky. I think I’ve been lucky and it’s something, it’s hard to teach how you’re lucky, but if you are lucky in life, it’s a great help.

When you were younger, who helped you to be lucky then?

Well, I suppose in terms of my medical career and training in gastroenterology, Richard Thompson who was physician to the Queen and later became President of the Royal College of Physicians. He was a wonderful mentor in terms of committing yourself to medicine, but particularly to incorporating research into everything you do and that you can still do meaningful research while being an NHS clinician. Academically the other great influence on me was Alan Hoffman, who I spent a year with in San Diego, who was one of the most original thinkers I’ve ever come across. I remember coming home on the first day to my wife and she said, ‘well how did you get on?’ I replied ‘I’ve been given a Nobel Prize-winning project, but I’ve been given another 33 and I can’t spot which is the Nobel Prize-winning one’. Ideas just tumbled out of him, a truly original brain and sadly he died in his early 90s about 12 months ago.

He was a very special. I heard he was a very good poker player as well.

I didn’t know that. (Laughs) I think in terms of addiction I was lucky enough to work a little bit with Griffith Edwards and his passion and achievements were certainly an inspiration to me. I think without naming names, the Alcohol Health Alliance has really depended heavily and benefited hugely from two charities – one is Alcohol Concern, now called Alcohol Change, and the other is the Institute of Alcohol Studies. They’ve both had, I think, wonderful staff and they’ve both as organisations been very generous with their time and support for the AHA.

Sorry I must draw it to a close, what are your main hopes for the future?

Um, I guess at the moment they are centred on the wider NHS, you know, I think you and I have both seen ‘recurrent’ crisis in the NHS, but I don’t think we’ve seen anything quite as severe as this with nurses and paramedics and probably junior doctors’ strikes and so on and the pressure that hospitals are under. I just think we need some cool heads to sort this out. I think my own personal view is the worst thing we can do is to restructure the NHS again. I think people don’t acknowledge the progressive starvation that the NHS has gone through in terms of the financial support. And, you and I will remember those difficult times in the 80s and then when the Blair government came in, things got better as money was put into the NHS. So, I’m far from persuaded that we have a structural problem and I do feel we have a morale problem, but that is almost certainly related to the financial stringency that the service is under.

Do you get any time for relaxation at all?

Well as you well know Kieran, I’m not averse to swinging a golf club, that’s my Sunday morning form of religion if I’m not away, is to play at one of the finest golf courses in the country and in the world, the Royal Liverpool Golf Club at Hoylake and we look forward to hosting the Open Championship in July this year.

Well, Sir Ian, as I’ve told you on a number of occasions, you’ve been an inspiration and mentor to me for 25 more years or so and I’m sure when people have heard this interview today, you’ll be an inspiration and ongoing mentor to many more over the years to come. Thank you very much.

And thank you Kieran.

Editor’s note: This transcript of the interview with Sir Ian Gilmore has been edited slightly from the original interview.

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