My first job at Lewisham

The first place I was every paid for working as a doctor was Lewisham Hospital.  On August 1st,1986, I started my medical career as a houseman in general and orthopaedic surgery.   Things were a bit different in those days. We came to work in long white coats, and when one of my colleagues went off sick I spent two months working one in two, something that would be unimaginable for training doctors today (thank goodness). My boss, Lord McColl, had the unusual distinction of having consulted on healthcare systems for both Mrs Thatcher and Colonel Gaddafi.  So I was interested to hear that the casualty department at Lewisham Hospital is now the subject of service reconfiguration. It is clear that people in Lewisham feel the way this has been done, in response to funding difficulties in a neighbouring healthcare trust, is unfair.  But the truth is that one way or another we do need to change the way we deliver healthcare. Apart from anything else, the way we are currently organised does not provide a good service to older people. Too many of them get caught in delays in our emergency departments, and are left waiting unnecessarily in hospital to go home.

Senior managers in the NHS in England are now engaged in a national debate on quality of care and service reconfiguration. There is no doubt that this debate will be sharpened with the publication of the Francis Report this Wednesday. This week's British Medical Journal contains a response to an interview with the head of the new NHS Commissioning Board which was recently published in the Independent newspaper.  Marion McMurdo, the Professor of Ageing and Health in Dundee, wrote in (www.bmj.com/content/346/bmj.f453) with a view that I thought captured the challenge to healthcare providers so well I’ve reproduced it here in full:

“Let's fix our health care system to make it responsive to the needs of the patients who require it. Let's change training and education to ensure that its staff possess the skills to manage people with multimorbidity, including older people. Let's enable prompt diagnosis and invest more in downstream systems designed to allow old people to leave hospital when ready to do so. Let's have equity of access for all patients who require it, and begin the overhaul of the NHS to make it fit for the 21st century.”