"Fifty years in the NHS doesn’t feel like very long…”
Hugh Millington started working as a doctor in the NHS in July 1968. While his early training was surgical, he switched to A&E medicine soon after it started as a separate specialty in the 1970s. In 1979 he was one of the first three A&E medicine trainees appointed in London. Mr Millington was appointed as a consultant at Charing Cross Hospital in 1982, and he’s been here ever since. To celebrate the 70th anniversary of the NHS – and his 50th anniversary with the NHS – Mr Millington shares some reflections on how the specialty has evolved over the years, what has kept him at Charing Cross Hospital, and why he’s still working at age 73.
My job and emergency medicine have changed so much since I started at Charing Cross Hospital in 1982 that I have never felt the need to go anywhere else for a new challenge. My specialty has gone from casualty to A&E and now, to emergency medicine. Charing Cross Hospital’s A&E attendances have risen from around 42,000 a year in the early 1980s to over 80,000 a year. I have seen many changes and, due to NHS reorganisations, had four different employers.
When I was appointed, our A&E department was effectively three large rooms. I was the only consultant overseeing a team of five junior doctors. Essentially we looked after minor injuries and anyone, medically or surgically, who required further assessment was admitted to a ward, which was easier then. In 1983 we moved into a new purpose-built A&E department, where we are today. This enabled us to assess and treat patients in the department instead of admitting them for further management. Our staff steadily increased and we took on more responsibility for patients who arrived by ambulance and on foot.
The way we work has changed dramatically. Emergency medicine is now practised in multi-consultant emergency departments with many junior doctors, nurses and allied health professionals. At Charing Cross we now have 12 consultants on our rota and most work at St Mary’s as well. We also have 28 junior doctors who just work at Charing Cross. We can do so much more for our patients than when I started. The department is busy 24 hours a day, seven days a week.
A good example of how medicine has changed is how heart attack patients are managed. When I was a medical student in the 1960s, I remember being told that it was just as safe for GPs to look after their heart attack patients at home as to admit them to hospital. By the 1990s, thrombolysis, which dissolves the blood clot causing the heart attack with an injection of a drug, had been introduced and we were doing it in the A&E department. One of the most rewarding experiences I’ve had in medicine was watching the patient’s ECG, which monitors the heart, and watching the irregularities disappear soon after I had injected the thrombolytic drug into the patient who was having a heart attack. Now the ambulance paramedics rush people with suspected heart attacks directly to specialist heart attack centres – there are eight in London, including one at Hammersmith Hospital – rather than to A&E.
Changes at Charing Cross Hospital
Over the years at Charing Cross Hospital, I’ve worked with colleagues in the hospital and the community to change the A&E service to meet the needs of patients.
When I started here in 1982 the department was rarely full and nights were so quiet that one junior doctor, with myself on-call from home, could manage the workload after midnight.
In the 1980s we added an elderly care nurse, an occupational therapist and a physiotherapist to our A&E ward team. They enabled us to assess the elderly patients properly and discharge them home safely, rather than admitting them to a main hospital ward. It was a forerunner of our current frailty service.
In the 1990s, working with community services, we opened two minor treatment centres, one alongside the A&E department and the other at Parsons Green. At these centres, nurses managed the increasing numbers of patients with minor illnesses and injuries. We rebadged these as walk-in centres when they were introduced. Then we added GPs to the Charing Cross Hospital walk-in centre and created the forerunner of the current urgent care centre.
In 2004, as patients were waiting too long to be seen in A&E departments, the government introduced the four-hour A&E target, meaning patients had to be admitted to a ward or treated and discharged within four hours of arriving. The focus on the target and investment has helped my specialty develop and improved the emergency care of patients.
Now, patients who arrive at A&E are either seen in the emergency department, with its critical care and assessment areas, in the urgent care centre or, increasingly, in our ambulatory emergency care unit which offers same-day specialist assessment, diagnostics and treatment without needing to be admitted to a bed. There are also services immediately behind these frontline services, such as the clinical decision and frailty units, where we transfer some patients for further specialist assessment.
Improved outcomes – and increased pressures
The changes in the NHS since I started have certainly improved the outcomes for patients, with fewer requiring long hospital stays, but everywhere seems to be busier. Too many patients wait too long in our A&E departments and it can be difficult for staff to do their jobs as well as we would like. We can struggle to admit patients to hospital beds because wards often aren’t able to safely discharge their existing patients promptly if they need additional help at home or in a community facility. This puts a huge amount of pressure on the emergency department.
The Charing Cross A&E department is about to start its fourth major building project since 1982 to enable it to cope with the increasing demand. I hope the latest investment will mean a much better experience for patients and for staff.
Retirement
I did retire briefly, just before I turned 70, but our clinical director asked me to stay on part time. July 2018 will mark 50 years in the NHS for me, so I thought I’d stay on to see this milestone. I currently work three days a week in the clinical decisions unit, where I see patients who are stable but need further assessment before a decision can be made about the next step in their care. It’s not the adrenaline-fuelled work I did when I worked full time in A&E but I still get enormous job satisfaction from helping the patients and staff. I have no trouble getting up in the morning to come to work – I still really enjoy it. I’m due to revalidate – the five yearly check that doctors are clinically up-to-date and fit to practice – next year, which will give me a few more years to continue winding down my work as a doctor before I retire for good.
Fifty years in the NHS doesn’t feel like very long to me, though the health service and my work has changed a lot in that time. Now we can do so much more for patients that they live well into their 80s and 90s and even past 100. That’s what the health service has achieved – we’re keeping people alive and out of hospital much longer. That’s why I’m still working – I’m only 73!
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