Dame Carol Mary Black (born 26 December 1939) is a British physician, academic, specialising in rheumatology. She was President of the Royal College of Physicians from 2002 to 2006, advised the British Government on the relationship between work and health from 2006 to 2016, and was Principal of Newnham College, Cambridge, from 2012 to 2019. She is an expert on the disease scleroderma.
Early life and student years An only child, Black was born into an unacademic family in Barwell, Leicestershire. She attended grammar school in the 1950s where she became head girl.
She studied history at the University of Bristol, graduating with a Bachelor of Arts (BA) degree in 1962. While studying at Bristol, she was elected President of the Student Union. She then worked as a schoolteacher in the Gilbert and Ellice Islands.
In 1965, Black enrolled as a mature student in the first intake of "pre-clinical" medical students to the University of Bristol, where she won prizes in surgery, obstetrics and pathology. In 1970, she graduated with Bachelor of Medicine, Bachelor of Surgery (MB ChB) degrees, at the age of 30. She obtained full registration with the General Medical Council the following year.
Clinical training and NHS work After graduating, Black stayed in Bristol to work in general hospital medicine as a junior doctor. She gained a higher degree by researching the rare skin and connective tissue disease scleroderma and in 1974 passed the Royal College of Physicians membership examination.
Black moved to Hammersmith Hospital in London the following year for specialist training. In 1981, she took up an offer of an appointment as a consultant rheumatologist at the nearby West Middlesex Hospital.
After eight years in an NHS general hospital as a consultant, Black opted for a move back into academic rheumatology by taking a job at the Royal Free teaching hospital in Hampstead, later becoming a professor and then the hospital's medical director. The rheumatology unit she established there has a strong interest in scleroderma: it is a national tertiary referral centre for patients with the illness and is the major European centre for clinical research into the disease, with a particular focus on trying to understand the pathological process of fibrosis or scarring that characterises the condition at a histological level. The unit also has a strong tradition of high-quality teaching aimed at medical students and specialists-in-training.
Black is an international expert on scleroderma. Partly as a result of her work, much can now be done to ameliorate the effects of the condition, although a specific treatment for the disease remains elusive.
Women in medicine At the age of 62, Black retired from full-time hospital work to become the President of the Royal College of Physicians in 2002.
Black's successful academic career in rheumatology, her NHS management role when she was medical director of her London teaching hospital, and her subsequent positions of influence (she chaired the Health Honours Committee between 2006 and 2009) gave Black a profile inside and outside medicine and led to her being championed by some as a leader of the profession and a role model for young women. Black was indubitably in the vanguard of the rise of women in medicine from the 1960s onwards: she became a consultant at a time when many women were entering medical school but few had become fully trained specialists, and this 'woman in a man's world' experience is something she is often asked to talk about.
However, when she was president of her royal college she made controversial comments about women in medicine, suggesting that the profession was being "feminised" and that this could make it harder to find specialists such as cardiologists in the future. To illustrate her concerns, she said that Russian doctors were poorly paid and had low status and that this was the result of having an almost entirely female workforce (rather than it being a reflection of Russian 20th century political history). She then drew a parallel between doctors and teachers, saying: "Years ago, teaching was a male-dominated profession – and look what happened to teaching". She later clarified her comments, explaining that her intention had been to warn that unless provision was made for female doctors to balance work and family life and be given extra support with childcare and flexible hours, they would tend not to enter what she called "the more demanding" branches of medicine or to serve on government committees.
She stepped down as President of the Royal College of Physicians in 2006 but still works as an adviser to the consultancy firm PwC and with the Work Foundation.
Modernising medical careers The NHS Plan published in 2000 set out the government's ambitions for the NHS. In return for a huge increase in funding, the government expected modernisation and reform.
The Modernising Medical Careers (MMC) programme was designed by the Department of Health with input from the medical profession as a way to update, streamline and accelerate the training of doctors in Britain. As part of this programme, all doctors who qualified after taking their 'finals' in 2005 began their postgraduate training with a two year foundation programme designed to teach them generic clinical and interpersonal skills, following a curriculum set by the Academy of Medical Royal Colleges that Black became the Chair of in 2006.
In February 2007, MMC hit a crisis caused by the abject failure of its online job-matching component: the Medical Training Application Service (MTAS). This led to loud criticism from within the medical profession that culminated in senior surgeons in Birmingham refusing to interview candidates recommended to them by MTAS. In response, the Department of Health announced an urgent review led by the Vice-Chair of the Academy of Medical Royal Colleges, Professor Neil Douglas. But when the review group declared that MTAS should continue, it triggered mass demonstrations by junior doctors; the London protest march was addressed by the Leader of the Opposition at the time, David Cameron, who described MTAS as "an utter shambles". Over the following weeks and months, there was a flurry of resignations of senior doctors associated with MMC, MTAS and the Douglas Review itself.
In May, Black and the Chair of the British Medical Association (BMA), James Johnson, wrote jointly to The Times endorsing the Douglas Review and the principles of MMC. Three days later, after what The Times called "widespread fury" from junior doctors, Johnson resigned as head of the BMA when his position became untenable. Black later told Parliament that the joint letter was "simply an attempt at unity which obviously did not work well. When the Douglas Review was doing its work the chairman of that body asked the Academy [of Medical Royal Colleges] and the BMA together to produce a letter which would be supportive of that review and would also correct some of the inaccuracies already in the press about it...we were supporting the principles as expounded by MMC".
The online recruitment system was subsequently discarded.
In the aftermath, the House of Commons Health Committee carried out an investigation: it criticised the leaders of the medical profession in general over the debacle and described the role of the Academy of Medical Royal Colleges as "weak and tokenistic". The Academy rejected this, saying that it did not reflect the nature of the Academy, the people in it nor the progress it had recently made.
Work, health and sickness absence In 2006, the government led by Tony Blair made Black its national director for health and work and asked her to promote its policies across Whitehall, especially within the Department of Health and the Department for Work and Pensions. She described her role as being to try to keep people "healthy, well, resilient and in work".
In March 2008, she authored Working for a healthier tomorrow, a report which focused on the impact of sickness absence on the health of the working-age population and on the economy.
The key points of the 2008 report were: Intervention in the early stages of an employee's sickness absence could help prevent the absence becoming a long-term one Managers should be flexible when an early return to work is recommended GPs should be "supported to adapt the advice they provide, where appropriate doing all they can to help people enter, stay in or return to work" The sick note should be replaced by a 'fit note' that outlines what the patient can do at work, not just what they can't do Occupational health services should be expanded, and more of these services should be provided by the NHS Occupational health services should also be made available to people who are out of work
The fit note was introduced in 2010.
Black stepped down from her national director role in 2012. She still leads the 'health at work network' at the Department of Health; through it, she is part of a drive to encourage commercial, public and third sector organisations to improve the health of their employees.
Views on sick-notes and mental ill-health In 2010, Black addressed the Fit for Work Europe organisation, of which she is a co-president (the organisation focuses on the consequences of musculoskeletal disorders when they affect people of working age). In her address, she said that the government had appointed her to her national director role because "...we had far too many people leaving the workforce with relatively mild musculoskeletal conditions, stress, anxiety, depression...and many of those people received no immediate help to keep them in the workplace...they were leaving the workplace to go into the benefits system". She also said: "If I had to summarise what we have been trying to do in the United Kingdom, it would be to say: get rid of the old system of the paper sick-note, put it in red because it's dangerous, it's not good advocacy for your patient".
The key assumption underpinning Black's thinking is that because people are living longer they will have to work longer – hence the need for more effective intervention when working people fall ill, so that they can remain in the workforce instead of retiring on medical grounds or going onto benefits.
In March 2015, Black expanded on her views in a talk to Investors in People. When outlining the common causes of sickness absence, she said: "Very often what the GP will write on a medical certificate...isn't really the truth. When I did the independent review on sickness absence for the government, I talked to lots of people who were collecting their sicknotes and what they said is: 'I hate my line manager. I'm never going back to that job'. But no GP I've ever known writes anything other than a 'medical' diagnosis; the closest they get is 'stress' or 'anxiety' – often not the truth at all". At the same time she drew a sharp distinction between what she called "real" illnesses such as "cancer", "diabetes" and "endogenous depression", and other phenomena such as "stress, anxiety, and mild depression", which she claimed were characterised by "little or no objective disease or impairment" and were "not serious illnesses". They were, she said, usually a normal human response to something like an unhealthy workplace or a poor line manager and should be handled accordingly, by tackling the original cause of the stress in the workplace, not only by addressing the individual responding to stressful circumstances.