RCP clinical vice president Dr John Dean reflects on 75 years of the NHS through the experiences of four generations of doctors in his family.
I am the third of four generations of doctors in my family to work in the NHS. How has it changed, and what can we look forward to?
My grandmother Eileen Brereton (nee Deane) was childrens’ medical officer for Cambridgeshire in 1948. When she graduated in medicine from the University of Glasgow in 1924, she was one of just a handful of women in her medical school year. Medical officers worked alongside children’s nurses and midwives and were employed by local authorities. She was only employed by the NHS towards the end of her career when in 1974, the NHS Reorganisation Act established area health authorities to integrate healthcare and work collaboratively with local authorities.
She established one of the earliest antenatal clinics in the country in 1930, supervising midwives, and was involved in the first national vaccination programme for influenza in 1961. Her main responsibilities were the health and wellbeing of children with special needs. A single mother of three children, she worked full time until the age of 68 so was clearly a determined woman. Perhaps it was in her genes as her aunt Maud Chapman, also a single mother of three adopted children, was a rare female surgeon in the early 1900s who founded South London Hospital for Women in 1912.
Moving on to the next generation, my parents Denis and Iona Dean graduated in medicine from Birmingham Medical School in 1952. After only 6 months as resident medical officer in Walsall Manor Hospital, Denis started a brand-new general practice in a purpose-built surgery on the Shard End Estate in Birmingham. There was a flat above the surgery for the GP to live in. My mother joined him as GP partner six months later. These replica GP surgeries were built on a number of new council estates, to provide local care and to attract GPs. He was a founding member of the Royal College of GPs, and one of his proudest professional moments was when he became a fellow of the college.
In the 1960s they introduced new innovations, including booked appointments and receiving patients in their own home with the district nurse from the ambulance after day case surgery. They took a sabbatical in 1963 to run a mission hospital in western Nigeria, a year which changed their lives and thinking. Having both decided that they needed extended skills for this, my father obtained MRCP following attachments with local physicians, and my mother gained obstetrics skills for caesarean sections and other procedures. Denis also developed a special interest in dermatology, and published on the subject. The practice had grown to seven partners by the time they both retired – earlier than they would have wished because of poor health. There is no doubt that as the local GPs they were a core part of the local community.
Focusing on my own experiences, I graduated from the University of Leicester in 1982 – a new medical school established to expand medical student training, and placed in an area where health services needed significant development to address inequalities. We were exposed to general practice from the first year, as one big aim was to attract doctors to general practice, which required significant expansion. After an itinerant postgraduate training in Leicester, Kettering, Sheffield, Cardiff and Manchester I was appointed as a consultant physician with an interest in diabetes at Bolton Hospitals in 1994.
I was a single-handed diabetologist on appointment, though working in close partnership with my colleague Paul Baker, a geriatrician with an interest in diabetes. We established a town centre Diabetes Centre off the main hospital site in 1995, and also worked with and in GP surgeries as well as the hospital to develop care close to home integrated with primary and community care. The department now has five consultants. Similarly emergency medicine had two consultants when I started, and now has 13. During my time as clinical director we also established only the third acute medical unit in England. I took a 12-month sabbatical to the Institute for Healthcare Improvement in Boston, Massachusetts in 2005/6, which has defined my subsequent career. I was a lead contributor to the RCP’s Teams without walls report in 2008.
I moved to East Lancashire Hospitals in 2011, partly as a result of NHS reorganisation, in order to further my leadership career, leading service change across the health and care system, including aspects of our response to COVID-19. This led me back to the RCP through the Future Hospitals Programme, and other leadership roles to my current role of clinical vice president.
Turning to the fourth generation, my daughter Stephanie graduated from Bristol Medical School in April 2020, where women made up 70% of the graduates. It was brought forward so she could work as an FiY1 in response to the pandemic. Following foundation training in Manchester, she is now working in Brisbane, Australia alongside many of her UK colleagues.
So, what have been enduring features in the NHS’s 75 years seen through the lens of our family, and what has changed? There is much from the past that we recognise today. It seems reorganisation has been a recurrent theme, as has the desire for integrated care, and GP shortages are nothing new, though the training rather more substantial. The workforce has grown dramatically as need and available treatments have increased. Many of today’s challenges were also yesterday’s challenges.
We mustn’t take for granted some everyday aspects of care and support, such as vaccination, antenatal clinics for everyone, appointment systems, day case surgery, acute medical units or even royal colleges. Although they still require improvement, the opportunities for women in medicine have changed dramatically. We all benefit from time away from the NHS and it can be life and career defining, but these opportunities are rare and not without risk and sacrifices, particularly from families. Unless conditions for doctors in their early careers improve, they won’t return to or stay in the NHS.
And what can we look forward to? Certainly new treatments and practices, and hopefully a more integrated system of health and care will at last be achieved, not just in small pockets of innovation and excellence, but ‘designed in’. Care must remain free at the point of delivery, and professional lives can continue to be affirming. Undoubtedly, Stephanie and her peers will balance their working lives with other interests more than previous generations. I hope she will continue to have the varied opportunities that her forebears had, feel she has the resources to guide the care her patients need, and enjoy being a valued member or leader of the teams she works in.