James Palmer - Medical Director & Consultant Neurosurgeon Derriford Hospital

Their Say...
Plymouth Herald - 05/07/2008

AS A neurosurgeon, I often see patients. who are frightened and anxious. Fear is often irrational but those of us who have been seriously ill know its strength all too well.

I remember the fear I felt when I was ill as a child, a time spent in and out of hospitals, having had heart and lung surgery in my early years. Perhaps this is why I chose a medical career. My memory of that is varied; many people along the way helped me to the good health I experience today.

The first fear was of the physiotherapist; with multiple respiratory infections, I had my chest pummelled and shaken when I was in pain, tired, and poorly. The second was a fear of death. As a child I had always thought I was invincible, even though I knew the inside of hospitals so well. Then, when I was about 14, I found myself on a cardiac care unit, my heart not beating to the rhythm it should.

Pretending to be asleep (a good way of finding out the truth) I listened in to the conversation at the end of the bed. The two nurses were discussing my outlook and it all looked very grim; words like 'cardiac arrest' and 'resuscitation' hung in the air. The picture was complete as my mother, visiting later that day, told me my school had prayed for me that morning.
Within hospital, a simple, unguarded conversation, an off-hand comment, a failure to give clear advice, can all amplify a patient's fear. No-one comes into hospital without some apprehension, patients and staff alike.

After medical school in London and training in surgery around the country, I found my first few weeks as a 35-year-old, newly-appointed consultant neurosurgeon in London terrifying. I was afraid I would forget something important, make the wrong decision; I was even afraid to leave the hospital in case something happened to my patients. The weight of responsibility was something I was not prepared for.

Fast-forward a few years. In January 2008 (now with many years' experience and a few grey hairs), I started a new job. I am now Medical Director at Plymouth Hospitals. I am still a neurosurgeon, I still see patients and operate, but I also have a role in leading and managing medical services at Derriford Hospital, the Royal Eye Infirmary, the Child Development Centre and Mount Gould.

This has thrown a whole range of new issues at me, but now I feel prepared, ready to do my best, because I believe so much in the future of Plymouth Hospitals: and I believe passionately that together with GPs and health professionals in the community we can lead the country in raising the bar for the standards that can be provided in health.

There is already much to be proud of. I am determined that we achieve further improvements by focusing on the quality of care we provide: not just in terms of results of surgery or infection rates, but how all our staff learn to provide care in a respectful way and encourage patients to share in the decisions about their healthcare.

As we celebrate the 60th birthday of the NHS today, I am grateful for and proud of the NHS. I'm too young to have been around in 1948, when the NHS started. From that date everyone was entitled to receive free healthcare, regardless of whether they could afford to pay. We all still have fears when we become ill, but now we struggle to understand how, when there was no National Health Service, people with little money faced and feared the prospect of illness with no way of paying for it.
The last few years have seen an unprecedented rise in funding for the NHS, and it is true that the funding of our healthcare system is closer to the average across Europe. As taxpayers, we still pay far less for our healthcare than European leaders such as Norway.

In terms of more general measures of the nation's health, the UK does not fare very well. The current latest review of the NHS, called 'High-Quality Care For All' and led by Lord Darzi, has encouraged everyone involved in healthcare to shift the focus onto helping people to stay healthy, rather than only continuing to spend money on those of us who get sick. The aim is that, to afford the healthcare system of the future, we need to reduce the demands on it, by encouraging people to be healthier. This change of focus is only possible because of huge improvements in hospital care: for example, waiting lists brought down from two or three years to just 18 weeks from being referred by your GP. It is my job to fight for the resources we need in hospitals to ensure we offer a full range of services, and to use those resources wisely. By doing this, we can make sure everybody who needs our services is able to access all the care that we know will be of help. To get the resources, we must make sure we can provide care as efficiently as possible, keep patients in hospital only for the time needed, cut out waiting and attain levels of quality care that appeared out of reach just five years ago.