Many thanks to Brian for sharing his reflections from his years of service to the NHS. Here is his story….
Starting out in a bygone era
No one could say everything’s been hunky-dory for the NHS these last few years. “The NHS is broken … ,” we often hear, yet every day it performs, if not actual miracles, then truly amazing feats that would be the envy of earlier generations.
I began working in the NHS in 1964. Think of the ITV series ‘The Royal’, to know what many hospitals were like at that time. It was the era when matron ruled the roost. Woe betide the nurse – or administrator – who began their lunch before matron arrived for hers. We stood until she was seated!
The arrival of modern medicine
The NHS has come a very long way since 1964. Procedures that were followed by a week or more of post-operative care in hospital, are now done as day surgery or even in outpatients. Life expectancy averages approximately 10 years longer. It is in a constant state of flux, replacing old treatments with new, adapting to societal and demographic change, identifying and treating conditions we might never have known about if it were not for advances in diagnostics. Since 1964 we’ve come to take for granted an alphabet of imaging techniques; CT, MRI, PET, DEXA, US, CM etc. – and a raft of new pathology investigations.
We now have screening programs – immunisation and vaccination from birth (even before in some cases) – IVF – transplant surgery – robotic surgery – genetic medicine – chemotherapy – stem cell therapy and a whole lot more. Thanks largely to Dr (later Professor) Douglas Chamberlain, a consultant cardiologist at RSCH, paramedics are now an established profession in their own right. Illnesses that my parents worried about when I was young, are no longer considered a threat. Premature babies weighing less than 1 kilogram at birth can survive and thrive. With advances in surgical techniques many operations are far less invasive, and recovery times are much shorter.
Over the last decade or so, throughout the NHS, there has been a massive shift towards computerisation, including patients’ records and outcomes, yielding data on a scale not previously available and leading to better evidence-based treatment pathways.
A service like no other: The NHS’s unique mission
Of course these advances aren’t confined to the NHS. However the NHS is unique in being a nationwide, publicly funded institution, with an all-embracing remit to promote good health where it can, to diagnose and treat ill health, and to provide palliative health care when needed. All that for around 10% of GDP, free at the point of delivery, for everyone ordinarily resident in the UK, on the basis of clinical need, regardless of means, status, ethnicity or any other characteristic.
Training the backbone: NHS management in the making
In 1964, I was lucky enough to be given a place on a new training scheme, for hospital administrators. We were among the first tranche of NHS managers to have the benefit of four years intensive on-the-job training and study. Most of my time was spent on secondments to hospitals and other NHS establishments across Kent, Sussex and south east London. I had attachments ranging from portering to working in the then minister of state’s private office. I gained invaluable experience at all levels, in all health sectors, and in nearly every hospital department, before being seconded, early in my twenties, to take over for six months as acting hospital secretary of a small hospital; which really was like The Royal, situated on high, overlooking a seaside town, and with a charismatic, but autocratic, senior consultant.
After training, my first position was at the RSCH where, as part of my duties, I helped with the commissioning of the Thomas Kemp Tower. What a difference it made. Before that the entire A&E department operated from a small area to the right of the entrance to the old Barry Building. I used to cover for the receptionist there in her lunch breaks.
The RSCH had a deservedly high reputation, with several cutting-edge departments, including Medical Physics, led by Brian Keane, whose work was key to the development of Computerised Tomography; the Renal Department, under Dr Tony Trafford (later Lord Trafford) was one of the first to offer dialysis; oncology under the inimitable Dr Jan De Winter; Sam Higgins, whose work as a medical photographer was invaluable to medical science and teaching; and a highly respected team of anaesthetists, whose knowledge and expertise was to help me immensely much later in my career.
Directly opposite RSCH was the Sussex Eye Hospital, with some of the most respected ophthalmic surgeons in the country. The Audrey Emerton Building next door is now an education centre, named after Audrey Emerton (Baroness Emerton) – a former regional nursing officer, chair of Brighton Healthcare NHS Trust, chancellor and chief commander of St John Ambulance, and chair of the UKCC (United Kingdom Central Council for Nurses, Midwives and Health Visitors now the Nursing and Midwifery Council). I came to know her later in my career, during the ’70s and ’80s.
One of the foremost advances in my lifetime has been the dissolution of the large psychiatric hospitals. The services that have replaced them are far from perfect but represent a vast improvement, as anyone who has ever visited one of those heart-rending Victorian institutions would testify. Audrey Emerton, with all her drive and determination, was at the forefront of those changes. She was also a leading figure behind advances within the nursing profession that have helped bring about the career structure that has given us specialist nurse practitioners and the like.
When the lights went out
On leaving RSCH, I was appointed to the position of deputy hospital secretary with responsibility for four small hospitals: the Royal Alexandra Children’s Hospital (RACH), the New Sussex Hospital for Women in Windlesham Road (one of whose founders was the pre-eminent Louisa Martindale), the Sussex Throat and Ear Hospital (Church Street) and the Sussex Maternity Hospital (Buckingham Road). The latter three are all now incorporated within RSCH.
Being based at RACH I was privileged to know Dr Trevor Mann, the consultant paediatrician after whom the neonatal intensive care unit is named. Dr Mann was a consummate professional, and a ferocious advocate for his patients. The work done by him and his team was truly inspirational. There must be many, in middle age now, who owe their quality of life to the level of dedication he and his colleagues brought to their work.
It was a dark era. That was quite literally the case when in the early 1970s industrial action by power workers resulted even in hospitals having their electricity supply cut off. There was little warning and a good deal of panic (on my part for sure). We had a special care baby unit with premature babies in incubators, but no generator! Luckily it was out of season and we were blessed with a highly competent former Royal Navy hospital engineer. As befitting his earlier career, he was a master of improvisation. Being a seaside town, Brighton & Hove had any number of temporarily redundant ice cream vans. In less time than it takes to eat a 99 there were vans parked at the hospital and a spider’s web of cables supplying power to vital equipment. Improvisation was important then, we couldn’t always afford to replace equipment when it failed, and sometimes resorted to make-shift repairs which would be unthinkable today.
It sounds a little defeatist, but we had a saying which I think is still relevant: “The best can be the enemy of the good.” We had to make finite resources stretch to the limit. We couldn’t do everything. What we could do we were determined to do well. Has much changed?
Final thoughts
From where I stand I would say the NHS has adapted and modernised more than any other public service.
It’s almost a cliché to say that the NHS’s greatest asset is its staff. Many who work in the NHS chose to do so because of the principles on which the service is founded, wanting to make a difference where it mattered most. That benevolence of spirit gives the NHS a head start, especially if it has a reputation as a really good employer. Retention and recruitment are key to progress.
We hear a lot about the cost of the NHS, but very little about the immense contribution it makes to our economy. The NHS helps maintain the nation’s economic, as well as its physical and mental health. What could be more important for quality of life and sustained economic output, than good health and keeping people in work?
To anyone wavering about whether the NHS has a future, I would say look at what it’s done for us in my lifetime, and imagine what it might do going forwards. It is a truly amazing institution, not just for what it does seven days a week, 365 days a year, but for its spirit. I saw that every day of my working life, and I still see it in my work today.
The NHS is decidedly not broken. Anyone who’s worked in the NHS can feel justifiably proud of what it has achieved; but it needs us all to support it as a unique national service that, more than any other I can think of, is a vital part of the fabric of this country.
Brian Jones
June 2025
About Brian
Brian worked at Royal Sussex County Hospital from 1968 to 1970 as a higher clerical officer, responsible for the running of the general office and supporting the hospital secretary, he then moved to the Royal Alexandra Children’s Hospital, based then on Dyke Road, until 1972. Brian moved to the South East Thames Regional Health Authority, working on a range of region-wide projects and responsibilities. During the eighties, after the health authority moved its headquarters to Bexhill, Brian headed up the regional legal department, providing legal services and advice across the region (East Sussex, Kent, South East London). More recently Brian worked for the NHS ombudsman and on a number of high-profile enquiries. He is now a volunteer at Worthing Hospital providing dedicated and valuable support to our patients, visitors and staff.