These are extracts taken from one of the 1993 Editions of the Medical Society Newsletter

Sadly, all the very well known contributors have passed away but their viewpoints are eye opening
particularly taking into account the current state of affairs in the health service in general and Kidderminster in particular.

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Recollections of Mill Street Hospital

I came to Kdderminster in 1957 having been appointed as orthopaedic and traumatic surgeon to the Mid Worcestershire group of hospitals. At that time there was very little in the way of facilities at Mill Street Hospital where I was employed for three sessions and I remember arriving at the upper car park and looking at the main theatre above it. This was a small room which doubled up for operating theatre. Sisters office, changing room and sterilising room.  The whole building seemed forbidding. There were never more than two or three cars parked in the car park. A 'blister' was next to the theatre which became sister's office and changing room and it seemed to me that there was much risk of this falling out onto the car park. The laundry was downstairs next to the board room and the nurses used to run downstairs for towels and gowns for our lists.

The wards were pleasant though very over crowded. Downstairs were the male wards -Samuel Stretton occupied by general surgical and trauma patients. Towards the present X-ray department down the corridor was the William Adam ward, this later became a day room. Past the X-ray department the corridor carried on to the children's ward, Stanley Baldwin named after the Prime Minister.  Upstairs there were three female wards, Faith, Hope and Charity. The total bed compliment of the hospital was in the region of 75 -80 beds and this included of course medical patients as well, although as far as I remember, most 'medical patients' were treated at home.

 The two surgeons, Mr Gibbins and Mr.Doran, covered Bromsgrove and Redditch like myself and it is difficult to understand how this was done in those days as we could not possibly have been in three different places at once. There was always a first class resident surgical officer at both Bromsgrove General Hospital and at Mill Street , and Mrs Ball who was one of them will undoubtedly remember them all. Of course the work load was very light by today's standards, all three towns were really not very much larger than a very large village and the population growth all round has been quite astounding Similarly, there was very little traffic on the roads at first although we did have a number of motor cycle accdents, especially late at night. Some horrific accidents kept us up at night fairly often until the local young men gave up their motor cycles and took to four wheels.

There was only one portable X-ray machine at Mill Street and no facilities existed for developing and printing X-rays in the operating theatre. This made things difficult for hip pinning. The fracture was reduced and Harold, the theatre porter,  skilfully held the limb in position while the X-rays were taken. The radiographer had to be very fit as she had to dash down the stairs, around four corners to the X-ray department and then back to the theatre. Before I retired we were blessed with smooth anaesthesia, an orthopaedic table to hold the reduced fracture and a large image intensifier for these cases. It was surprising how well the patients did at Mill Street ; perhaps they were made of tougher stuff although life was certainly more peaceful in those days as a whole.

John James

PRE-NATIONAL HEALTH SERVICE
REMEMBRANCE OF TIMES PAST

I came to Kidderminster in August 1946. Rumours about Nye Bevan's intentions for a heath service were rife, and it seemed important to get settled before one was posted to darkest Lancashire . Ken Beatty had just bought a half share in the Church Street Practice and offered me the other half. We had worked together in the Army so knew each other's weaknesses. I borrowed £500 and bought the goodwill and equipment. This precluded any hopes of raising a mortgage and I was lucky to be able to rent 25 Church Street . next to the surgery for £60 per annum. We also rented the surgery at number 24

The practice was mostly panel patients (working men) and the club (their families). The Club paid 6d. a head per week (£1/6/0d per annum) for free medicine. visits and consultations. This brought in hard cash every week which was extremely welcome! We also had a fair number of private patients. Some of these deserted immediately they found out the practice had changed hands and their goodwill did not usually extend to settling their unpaid bills. I still see one socially who owes me £30. In 1946 this would have paid Tim's school fees at the 'Knoll' for a year.

There were 14 doctors practising in Kidderminster ; 8 were in Church Street , 4 were single handed and the rest 2 - man practices. In spite of competition, all were on good terms with each other socially and professionally, as we were with the consultants and the hospital. We each did 13 surgeries a week. including 3 on Thursday (market day) and 2 on Saturday. In addition, we held a sick parade every day (7.30 to 8.30 am) at the Pay Corps camp at WoIverley and Polish camp at Drakelow, and at a displaced persons (Anglo - lndian) camp up on Birchen Coppice. Astonishingly, I used to do occasional post mortems for the coroners office as well !

The pattern of disease was different - diphtheria, polio, whooping cough and TB were fairly frequent. Coronaries were usually treated at home without the benefits of an E.C.G.  machine. The patients never complained and the thought of being sued was inconceivable. Treatment was minimal, most patients ending up with a bottle from the stock Winchesters in our dispensary. Early diagnosis was the challenge!

Midwifery was badly organised and largely domicilliary. Most of the patients could not afford the £5 we charged for total care, and ante-natal care was at the local authority  clinics run by the MOH. The result was a call to an obstetric emergency to a patient one had never seen. Most midwives were adept at dripping on the chloroform for POPs .

In all, they were the bad old days for the patients but exciting and interesting work for the doctors. Ken Beatty and I changed things fairly rapidly in our practice, but the biggest and best change came with the advent of the NHS.

Sam Wadsworth

KIDDERMINSTER GENERAL HOSPITAL

A PERSONAL VIEW OF THE FUTURE

Being within sight of retirement the invitation to write about the future of hospital services in Kidderminster places me in a dilemma. My natural reaction is to look back and say that the best has passed. In the 1970s money was available and the hospital service within the NHS was blossoming. Patients no longer inevitably died from chronic renal failure, endoscopy became available as a routine, cardiac investigation and surgery advanced dramatically and at Kidderminster we became a proper District General Hospital .

But I must look forward. On the wider front, cancer, multiple sclerosis and rheumatoid arthritis are still to be conquered not to mention HIV infection. Thus we have to harness medical services (and that simply means money) to care for patients as best we can and to exploit advances in prevention and treatment quickly and efficiently. Government's aim to make money follow the patient is basically sound but as there is no more money available, in real terms, this means that resources have to be redistributed. Now this appears to be all to the disadvantage of the hospital service Indeed, many things must be cheaper done in General Practice and the community than in hospital.

Potential cripplers for the hospitals are capital charges, loss of Crown Indemnity and the financial responsibility for legal claims of all sorts. Reduction in junior hospital doctors' hours has to be accommodated without compromising the service or their training and experience and without further stressing consultants who, contrary to popular belief, do not spend NHS time (or much of their own time) on the golf course or with private patients Thus NHS hospitals will be forced to reduce or amalgamate services that are expensive in medical manpower for relatively small numbers of patients.

We have already lost in-patient ENT services. We have never had in-patient radiotherapy, invasive cardiology, renal dialysis or neurosurgery. Will we be able to keep in-patient ophthalmology and oral surgery for example? The development of our own obstetric service is a tremendous bonus for local people but it is against the trend.  Perhaps the Nurse Practitioner grade will reduce the need for on-call junior doctors in every speciality. The reduction in junior medical staff involvement in out-patient clinics must be accompanied by increased formal training and audit sessions that at the moment are impossible. With more consultants, this may become realistic.

I believe that there will be a Kidderminster General Hospital for the foreseeable future. Geography and the loyalty of our patients and General Practitioners are all on our side. The quality and commitment of our new generation of consultants are paramount The enthusiasm and interest of our newest junior doctors is a constant reassurance to me for the future.

Richard Taylor

FROM MILL STREET TO BEWDLEY ROAD

When I was appointed to Kidderminster General Hospital at Mill Street in 1949, it was in the group of Mid-Worcestershire Hospitals which included redditch, Bromsgrove and Tenbury.

In 1951, Bromsgrove General Hospital was opened and I was then working at Redditch, Bromsgrove and Kidderminster . For the next decade the Group Management Committee directed most of its energy and resources to developing that hospital with the result that Kidderminster got very little attention or finance for its development.

My only surgical colleagues at Mill Street were John Stretton. General Surgeon and Ken Forsyth (1947 - 1975) ophthalmologist. Walter Dunsby (1939 - 1980) was running an excellent pathological service virtually single handed. Sadly, John Stretton died suddenly in 1953. Soon afterwards. F.S. Doran joined me on the staff from Bromsgrove and for the next five years Doran and I looked after the general Surgery including emergencies at the four hospitals. At that time. the RSOs at the two general hospitals were only partially trained surgeons which put a considerable strain on us.

This situation was relieved in 1958 when we appointed Mr. Chitty as consultant surgeon to the group. Unfortunately. he died after two years and after doing a locum for six months Douglas Tooms was appointed in his place. During this lean time, the orthopaedics was in charge of T. S. Donovan from Birmingham and N. Scrase helped out with the trauma. In 1957, John James was appointed as consultant in orthopaedics and trauma for the group.

Pam Ball - our first RSO with the FRCS - was appointed in 1958. and as you can imagine, the tempo at Mill Street increased. She established an ITU in the boards room and John Ball came on as House surgeon. Mr. Laljee followed soon after as RSO in 1961 and stayed with us for two years, returning later as SHO in the Casualty Department. During this time the medical staff were Dr. Malins from Birmingham , Dr. Pat Thorne who served the hospital well from 1954 to 1966 and Dr. Lurring, a GP Physician. In 1961 we started infiltrating the wards at Blakebrook hospital, the old 'poor law' hospital. Two wards were vacated on the old 'A' Block for surgical recovery patients from Mill Street and were looked after by Dr. Pat Campion and later by John Ball. In 1962 an extension was built on to the casualty theatre at Mill street to enable us to use six trolleys for day patient minor surgery. During the 1960s the Regional Hospital Board envisaged a large general hospital at Prestwood. five miles from Kidderminster . This was to cover the districts of Kidderminster, Stourbridge, Dudley and Wordsley. The plan was dropped but by then the plans had already been made to build on the Blakebrook site a subsidiary hospital to Prestwood.

These plans were enlarged, we had numerous meetings with the AHB and finally evolved a three phase building plan. Dr. P. H. Beves who had been appointed consultant anaesthetist in 1966 was largely responsible for the design and equipment of the ITU. We also worked together on the design and layout of the operating theatres. In 1967 a minor operating theatre was constructed in the kitchen block at Blakebrook and we started doing intermediate and minor surgery there using the wards on 'A' block. A year later a new I casualty department had been built on its existing site. In 1969 the new twin theatres were completed along with the nurses tower block, residents accommodation, dining room, kitchens and administration office, so we were now ready to move the surgical work over to Bewdley Road using the two wards on 'A' block (now demolished) and the new theatres and X-ray, the latter under the direction of Dr Macnamara In 1971 the new 'C' block for surgery was opened and the patients transferred from old 'A' block. Their place was taken by the medcaI patients and children from Mill Street .

In 1972, 'S' block was found to be unsafe, it could be shored up but ,after two years would have to be demolished. The medical patients were temporarily  accommodated in 'C' block but the children  were allowed to stay on the ground floor until a 'porta cabin'  type children's ward was established on a different site. This apparent disaster was a blessing in disguise. By an astute move, our then District manager Stuart  Dickens, persuaded the RHB to build us a new medical block in those two years. The  present 'A' block was opened in 1980.  In the meantime, '0' block was under construction as part of a Worcestershire project with Worcester District to provide in-patient and day places for psychiatric patients attached to general Hospitals. Dr Robertson was appointed Consultant in psychiatry. The pathology and physiotherapy departments  were split between Mill Street and Bewdley Road .

With the opening of 'C' block and the new Post Graduate Medical centre, the hospital began to take off.  Dr. Peaston had been appointed consultant physician in 1969 and Drs. Taylor and Murray came in 1972. Walford Gillison was appointed Consultant Surgeon in 1973 and when Dr. Peaston left in 1975 Dr. Stephen Booth was appointed in his place. Dr. Eales returned to Kidderminster as pathologist after some absence at Dudley Road Hospital to join Martin Lewis, the haematologist.

Since I retired in 1979 many changes have taken place with new consultants and a large increase in junior doctors. The new 'E' block (phase V) is catering for paediatrics, geriatrics and maternity and the newest block (phase VI) will provide the surgical beds, theatre and ITU along with maternity, geriatrics and a complete new outpatient department. Mill Street will then be closed. This will complete the development of one of the best District General Hospitals in the Region.

R.E. (Bob) Gibbins

THE FUTURE OF PERSONAL CARE IN THE WYRE FOREST

Although the NHS rarely seems to run on an even keel it has, fairly consistently sustained and improved health care in this locality. The relationship seems likely to continue, so to look forward to our future locally we must first read the National Health tea leaves! I believe the future direction of challenge is clear. The rate of change is less so, being driven politically and economically by a heady mixture of aspiration and expedience.

 For the future, affordability will be 'the ticket', finance being the main determinant. Given the economic status of the country and taking into account future probabilities it seems fair to conclude that the major rationale on the future health service will be financial realism. What we see now is an overpowering need to remodel the health care system so that it will in the long term be consistent with our likely resources, economically used. This will require a series of mutations by which the National Health Service will be translated from a total health care provision into a much more selective system mainly based on providing core services. Its value and effectiveness will be monitored by a body such as the Audit Commission.

With considerable difficulty but for! overwhelming economic reasons the I government will have to jettison various parts of the political baggage of the NHS - like a comprehensive service, free at the point of use. What will emerge will be a range of services confined to a national menu of approved clinical options and therapies. This will, in effect be a 'health formulary'. It will consist of practices, procedures and potions which are both affordable and of proven efficacy. Within the next decade, the evaluation of all therapeutic processes will have become a major speciality in its own right, driven by the health purchasers, nationally and commercially.

Because of established trends in recruitment and retirement the majority of doctors will be women in 20 years time, most of them being the generalist service. In terms of total manpower the National Health Service will no longer be the largest employer in Europe (currently 1.25 million employees) but will become a very small and concentrated framework. It will identity key health policies and titrate the range of health service provision in the light of them. Secondly, it will be directing and managing subsidiary modules of relatively independent health care businesses. The latter will include substantial elements of fairly autonomous professionals whose overall pace and direction will be determined by the national financial allocations.

At the point of consumption of health care there will have been equally significant changes. Patients expectations will have continued to rise and the variety of health options will have continued to expand dramatically - the continuing achievement of one medical miracle a month will for example leave no stone unturned ! The combination of rising expectations and ever expanding options will mean that the range of services that are possible will widen and weaken remorselessly. As medical science continues to press forward on the theoretical frontiers of medicine in pursuit of the ultimate there will, in the NHS, inevitably have to be a much more rational use of personal skills and abilities by everyone. So that all health care workers and indeed patients will need to contribute selectively at the upper level of their personal ability but to no lower clinical standard. Not only will super specialisation progress dramatically but the organisation of care, recognising the benefits of concentrating skill and experience, will progressively limit the range of activity of individual clinicians and establishments in the pursuit of effectiveness, safety and as a defence against litigation.

Many distinctions will become blurred. Primary and secondary care will be difficult to distinguish as isolated clinical activities inevitably become a matter of the past. Virtually all care will be aggregated on to single sites providing a co-ordinated delivery on a 'one-stop-shop' basis. The Wyre Forest will have one medical 'Carrefour' for the sake of convenience, efficiency and integrated activity. This will be closely linked with neighbouring hospitals and provider units and each of these can be expected to concentrate on complimentary areas of clinical activity to a much greater degree than at present. The planning and provision of specialist clinical care will be largely based on levels of turnover and clinical experience, the attainment of clinical standards being ranked above issues such as availability and access. What will also be impressive will be the relative absence of in-patient facilities, with the establishment of linked but independent 'hotel-care' accommodation for those patients where some continuity is necessary.

The supermarket analogy will however not stop there. The major provider conglomerates, in terms of their style and modus operandi, will lean more and more on the commercial philosophies rather than follow the old patterns of Whitehall . With the, result that for example a wide range of non NHS services will be promoted on the back of  basic NHS provisions (just as happens in the , practice of eye care today). For example, a visit from the local hospital's gynaecological marketing director will be no more surprising  tomorrow, than' a call from today's pharmaceutical representative.

Organisationally the key health care framework will be a lean one supporting a series of integrated modules responsible for providing a selected range of services. Within the modules the specialist professionals and their staff will largely be self employed in direct contract with the provider units for the basic NHS services and they will provide. within the same framework. private services beyond the range of NHS core items.  'Ah,' you say 'what about the patients?' Well, hopefully the General Practitioner will continue and provide an independent personal care service and the crucial patient advocacy - but then we mustn't be too optimistic must we?

John Ball