Obituary - Dr Julian Costello

Robert Treharne Jones looks back on the life of Dr Julian Costello

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Despite being born in Coventry Julian Costello, who has died at the age of 66, trained and practised in Wales for almost his entire career, and considered himself very much an honorary Welshman. Mechanically-minded from an early age, he brought enthusiasm, thoughtfulness and innovation to his practice, and to his second career in clinical informatics.  

He decided his career path at the age of 14, and entered the Welsh National School of Medicine in 1973. His interest in gadgets was invaluable when anything broke down in his student house, and he became known as ‘Mr Fixit’. 

After his vocational training he entered the oldest practice in Newport as partner in 1984. Dilapidated premises forced the pace of change and within a year Julian had become a GP trainer, and masterminded the installation of the computer system in the purpose-built new surgery.

Julian’s organisational skills saw the practice move to a more stable business model, and his burgeoning interest in IT saw him join the Meditel User Group, as well as the Primary Healthcare Specialist Group (PHCSG) of the British Computer Society, helping to shape the functionality of GP systems to improve patient care. 

In 1997 Julian was appointed as one of the medical consultants at AAH Meditel, and eventually his interest became overriding and he left his surgery in 2004 to pursue his second career. He maintained his clinical skills with out-of-hours and locum work so that he could have a fuller understanding of the IT requirements of front-line clinicians. 

Clinical coding became one of his main interests, and his appointments reflected his expertise. He became clinical lead at Niche Health, while his work with NHS Wales Informatics Service (NWIS) brought his knowledge and expertise in clinical terminology to the advancement of healthcare IT in his adopted country.

In 2005 he was a member of the Connecting for Health team dispatched to iSoft’s Chennai development facility in India, to advise on the ill-fated Lorenzo GP system. As well as playing  a full part in the discussions Julian immersed himself into the local culture, investing in the local dress, including a Nehru jacket, and posing for photos alongside the impressive-looking commissionaire at the team’s hotel!

In 2016 he was appointed senior clinical adviser to NHS Digital as part of the Expert Reference Group, and at one time or another he sat on the Joint GP IT Committee, and the Informatics Group of the Royal College of GPs, as well as the Committee of the PHCSG.

Just three years ago Julian moved to the East Midlands to be nearer his wife’s family, but he continued doing the work he loved with NWIS, IGPR, NHS Digital and SNOMED, and he was elected a Founding Fellow of the Faculty of Clinical Informatics.

Colleagues recall his cheerful enthusiasm, and warm and welcoming nature which meant he was often the first to greet new members to any group. Widely knowledgeable, yet often unassuming, it seemed his head was clearly bursting with ideas to make NHS IT better, and benefit both the patient and the clinician.

He took the news of his final diagnosis with his usual defiant optimism, and was exchanging supportive emails with his colleagues until a few days before his death just four weeks later. He leaves a wife, Kerri, a step-daughter, Rhiannon, and step-son, Russ, as well as a son, Huw, and daughter, Ruth, from his first marriage.  

Julian Costello MB BCh MRCGP FBCS FFCI, GP and clinical informatician, b. 2 December 1954 in Coventry, d. 24 January 2021 in Derby, of carcinoma of the head of pancreas.

Please see tributes to Julian from Faculty members below. We will continue to add to these as we receive them. 

If you’d like to donate, please visit the JustGiving page which has been set up in Julian’s memory.

"Everyone in the Primary Care and Assurance team only have fond happy memories working with Julian, always referring to his kind, considerate and ‘calm’ nature. You couldn’t help but admire Julian’s dedication and ‘cheerful enthusiasm’ for Primary Care Informatics, specifically his vast knowledge and expertise in the field of Clinical Terminology, which has contributed hugely to the advancement of Healthcare IT in Wales. His role in the development and adoption of the Welsh GP record meant the success of this work and contributed to the safe care of millions of patients. He was a key part of the patient safety agenda in NHS Wales Informatics Service and will be missed."

Peggy Edwards

"I first worked with Julian just after my time in SCHIN when I started working with BT in the National programme for IT, and he was the GP adviser for IDX, the initially selected US EHR provider for London. His job was to tailor IDX functionality for English General Practice, and so we spent many hours working together, opposite UCLH in the Euston Road. Despite the impossible task, he worked in a great team, and we became good friends. Since that time Julian became increasingly involved in informatics nationally, and was there in most national activities. SNOMED CT became one of his special areas of expertise and he became a Welsh representative on many projects and committees. He was also a participant in the legendary Alpine Health Informatics Summits held in Montalbert courtesy of Phil Koczan, where much hard work was peppered with light skiing, good food and fine wine, and camaraderie."

Nick Booth 

"Having only been part of the GP IT community for 8 or 9 years, I didn’t know Julian as well as many others, but I have an enduring memory of Julian being one of the first to welcome me as a newbie informatician to my first Joint GP IT Committee meeting. I recall his easygoing conversation in Mabel’s after meetings, his head clearly bursting with ideas and enthusiasm. He was well respected and well known and has worked tirelessly on the fine detail for 25 years to make NHS IT better."

Marcus Baw

"I’d probably known Julian for the last 7 years or so when via the RCGP Health Informatics group he became involved in work I was also doing via the Scottish Clinical Information Management in Practice Group on Dose Syntax (making the instructions given to patients about how to take their medication into something that computers could understand and process). Since then I’ve met him on multiple occasions at Joint GP IT Committee meetings, and over the past few years over our joint involvement with the Professional Records Standards Body. He was always friendly and sociable as well as being supportive and having a great understanding of medical informatics terminologies. More recently during the pandemic he was a stalwart supportive face in video calls for the informal clinician led collaboration that occurred between the 4 UK nations to discuss Shielding and related topics. It will be hard to measure the extent to which he has contributed to various projects and helped people of the years."

Ian Thompson 

"I knew Julian for over 20 years, the first major project was while we both worked at SCHIN Newcastle university.  This involved developing SNOMED concepts for a drug ontology.  Our relationship continued ever since often involving primary care clinical systems and terminology development.  Culminating in the last year in the delivery of SNOMED in primary care project.  The work with Julian involved attending many meetings, where we discussed/solved informatics problems well into the early hours."

Neill Jones

"Julian was part of the Meditel gang I got to know in the early 1990s. In 1996 he and I were appointed as medical consultants along with others to Meditel thanks to Glyn Hayes. It was all too short lived but I recall a very jolly stay at a hotel at the companies expense, followed by terrible presentations to the directors the next day as we were all a little worse for wear!  He was one of those I often met and whose company I enjoyed at the user group conferences, and when we grew up the PHCSG and of course the committees JGPITC etc.. He was certainly ubiquitous. I believe we worked together on a GP Subset for SNOMED more than 10 years ago and we were all disbanded for suggesting perhaps they could make it look like READ! In 2016 along with John Williams and I , he was appointed as a senior clinical adviser to NHS Digital as part of the Expert Reference Group (ERG). We spent many hours on teleconferences working through the mapping from READ supported by proper NHS digital clinicians like Neill! We have continued in that role and were working on a number of different projects together right up to the end. Typically he wanted to carry on working as long as he could."

John Robinson

"From my perspective Julian has just always seemed to be ‘there’ for a long time in and around HIG and JGPITC and the many related things that we have been involved in.  UK SNOMED Terminology Committee was one example.  More recently I had the great pleasure to be working with him on the SNOMED CT migration ERG and most recently at the start of the pandemic when we worked out some basic COVID-19 coding advice and tried our best to make it ‘four country’.  Widely knowledgeable, unassuming and quietly contributing to many things with a smile and sense of humour, we shall all miss him."

John Williams

"I have only had the pleasure of working with Julian in recent years. He was always warm and welcoming and generous at all times with his wisdom and his friendship. Recently, when he moved to Derbyshire we had developed plans to go walking together when the Covid-19 situation improved. Plans that sadly will now not be fulfilled. I will miss him greatly."

Geoff Schrecker 

"Much like all of the contributors, I met and worked with Julian through the informatics part of his career. Initially through meetings with the British Computer Society we learned of Julian’s determination to ensure that whatever he was involved with it would be of benefit for both the patient as well as the clinician. He did this tirelessly and gently injecting, of course, his own uniquely Welsh take on both the issues and the solutions. I also worked with him over the course of the National Programme for IT through his role in the London cluster. Sadly, due to COVID and the closed Australian border, I did not manage to get to see him in his new Derbyshire home. I was hoping for a walking partner. I’ll miss his contributions, friendship and good humour."

Michael Bainbridge

"I only really came to know Julian when he joined the PHCSG Committee, though had met him at meetings before then.  He was a lovely man, extremely patient with the failure of BCS to let him onto the Discuss List, and a splendid dinner companion at the Christmas dinner.  Great organiser will miss him so much."

Roz Foad