Airedale Hospital is celebrating its 50th anniversary this year . I started writing and researching this article in late January 2020 .  Little did I suspect how the world would alter in the following weeks due to a world pandemic  . I am writing this paragraph in social isolation in late March 2020. I describe below about how much the hospital has changed in the last 50 years and now some of that change has been seismic in the last few weeks. Through all these 50 years Airedale Hospital  has been a central hub for our community and I have never been prouder than I am today to be associated with the amazing teamwork , caring and compassion that has been demonstrated by all the staff in the midst of this crisis.

 

50 years ago I was a medical student in London with no awareness of where my life would take me. I then met my future husband , Micklethwaite born and Bingley bred and my fate was sealed. The Airedale valley has been my home for 47 years and Airedale Hospital has played a central role. I have worked here on 3 separate occasions both as a clinician and medical manager  ,  all the members of my family have been patients here, my daughter was born here , I referred patients here for 36 years , as a primary care medical manager I commissioned services and fought hard for some of them to remain here and I have also been a Non Executive Director on the Board. If I were a stick of rock the words Airedale hospital would run through my entire length

 

I have great memories of working here not  long after Airedale was founded. In 1974 I was a House Office in Medicine ( FY1)  on ward 1 to Drs Jim Fountain and Gwyn Morgan. I lived on site in accommodation that has now been pulled down , I spent hours in the Doctors Mess  on the corporate corridor drinking terrible coffee and watching black and white movies. There was accommodation for all the nurses ,  the Consultant complement was much smaller then ( but there were no women) and everyone knew everyone . Patients with heart attacks were in bed for the first 5 days and often didn’t get discharged for another 5. We treated asthma with intravenous aminophylline (very slowly….) milk drips for ulcers had only just gone out of fashion and stroke patients often stayed in the hospital for years.

 

The reason why I am writing this article is because I have recently read 2 fascinating documents relating to those times. The first is the 1964 Leeds Regional Health specification for ‘ the application of the PGH 600 Project to be sited at Eastburn’ and the second the ‘ Who’s Who for 1974’ for the Hospital which obviously contains the names of all the established staff with whom I worked. It is eye opening to see the changes in the hospital both in the staff and estate over those 50 years. Those changes reflect the way the NHS has evolved both practically and politically, the advances in technology, the recognition of the increased roles of all clinical and non clinical professionals  and the changes in education and expectations of everyone who works in and attends  Airedale . I therefore decided to provide a brief synopsis of the 1964 specification compared with the pre COVID-19 2020 reality and my personal memories from the 1974 Who’s Who. In order to achieve this I must thank all the Directors in the Trust  and AGH solutions (  and their teams) who pressed the buttons to provide the up to date figures . I must also add an instant disclaimer – it was not always easy to compare like with like particularly with changes in job titles and hierarchies so the figures may not be directly comparable but the themes are constant.

 

To paraphrase- it takes a lot more health care professionals  and integral support staff to run a DGH in 2020 than it did in 1970 and there are far fewer beds.

• The surrounding population of hospital was 148,000 in 1964 and is now 200,000.
• In 1965 the annual number of births was 2,500 . It is now 2071.
• In 1964 the projected annual attendance at A and E was 45.000 patients and in 2020 the actual attendance was 70,000
• The bed state in 1963 for the district was 931. This included 355 ‘Geriatric ‘ beds scattered over 4 sites . Skipton Hospital had 60 beds , Harden Bridge 32 , Raikeswood 18 and Bingley Hospital 50. There were also 170 beds for Learning Disability in Castleberg. There were 34 beds for Infectious Diseases at Morton Banks and when the hospital opened in 1970 there were also 12 beds in an isolation unit for infectious diseases situated where occupational health now lives. The only beds now out of the hospital site are the 10 beds for the elderly at Castleberg .
• In 1964 the projected number of beds was 638. Pre COVID 19 the current bed state is 350. However this absolute figure hides the interesting re configuration of beds in an acute hospital over the 50 years .
• In 1964 the plan designated 380 of those 638 beds as ‘acute’ .At that time they excluded maternity , SCBU ( Special Care Baby Unit) and Geriatrics( Care for the Elderly) from this  number .   I have compared the classification used in 1964 with how we care for the equivalent type of acute  patient and added in the Care for the Elderly cohort and we now provide 298 equivalent beds for ‘acute care’ . ( this includes AAU and the ambulatory unit) So the difference is 380/298 and behind those figures lie enormous changes in length of stay , expectations of how the elderly are cared for and profound increases in productivity and efficiency
• The ‘ Care for the Elderly’ complement reflects the rise of Residential Care and Community Care closer to home. When I was a GP in 1980 the definition of ‘Elderly’ was ‘anyone over the age of 80’  As a junior doctor in 1974  I remember caring for older patients on ward 1 who had been on the medical wards for up to 4 years. I suspect the average length of stay was over 6 months .  Currently ward 10 ( 20 beds) and Castlebergh ( 10 beds) cater for those patients who require extra rehabilitation . In 1970 rehabilitation was very different and after their acute episode Airedale often became their home for considerable lengths of time. There was not the capacity in social care that there is now. As a GP In 1981 I also could not admit an older patient acutely , (unless I deemed it an absolute emergency and called an ambulance .)  I always had to contact the Consultant who came out and undertook a domiciliary visit  (not always the same day) before the patient was considered suitable for admission . In 1970 wards 6 , 7 and 8 contained up to 90long stay patients between them  and that didn’t include the ‘outliers’ on the acute medical wards 1,2 and 3 and the surgical and orthopaedic wards. At that time there were also 60 ‘acute’ beds for Care for the Elderly . In 1964 210 of those 638 beds were designated for ‘Geriatrics.’  Currently we provide 60 similarly designated beds though the current demography of acute admission means that there are many other ‘elderly ‘ patients all over the hospital.
• In 1970 the Maternity Unit contained 5 times the number of beds that it does now. Wards 20, 21 and 22 were the Obstetric beds. My daughter was born in Airedale in 1980 and I spent 3 days on ward 21 . There were 50 consultant inpatient beds in Airedale , 20 GP beds in Airedale and 20 GP beds in Skipton Hospital and 20 ante natal beds in Airedale . Special Care Baby Unit had 15 beds . In 2020 we have 15 beds on ward 21 . In 1970 women typically spent up to a week after an uncomplicated delivery and at least 10 days after a Caesarian section .
• In 1964 there were 40 projected beds for Paediatrics, a mix of medical and routine surgical. In 1970 the hospital opened with 2 wards, 17 and 18 , and there were approximately 50 beds. There are now 24 on ward 17 including provision for day case review . In 1970 SCBU had 15 beds – there are now 12.
• What of surgery? In 1970 there were 5 main wards , general surgery , orthopaedics and gynaecology with around 120 beds. We now have 3 main wards with 87 beds and an overspill of 11 beds on ward 19. There was no Day Case Unit which now contains.  X beds. Despite the increase in population the number of surgical beds is probably comparable but the throughput is far greater as  length of stay has reduced – In 1970 hernia patients stayed in for 10 days , prostatectomy 3 weeks , laparoscopic surgery didn’t exist and the orthopaedic wards were full of young men on traction after their motor bike accidents. These men were sometimes in a bed for  6  months and in the summer in some hospitals were wheeled outside to get much needed fresh air. In 1970 there were 5 theatres, (there are now 7) and they were sited along the top corridor between what is now HODU and Radiology . This was convenient for the surgical teams on the upstairs corridor but was a longish dash for Obstetric emergencies – there was a single operating room behind antenatal out- patients for day time emergencies ,  but I can’t remember it being used after hours.
• Coronary Care and Intensive Care were not mentioned in the 1964 specification. The hospital did open in 1970 on ward 16 with a CCU which also doubled up as intensive care. This again required staff to run a distance to crash calls as we were usually working on the floor below on wards 1 2 and 3 . (I  also remember running from ward 24 to  A and E and arriving very breathless. ) Currently a bay on ward 1  has been converted to the CCU and telemetry is also used and ICU now has 7 beds on ward 16,  3 at level 3 and 4 at level 2.
• In 1964 and until the building of the new Mental Health Unit in 19xxx (on the site of my old accommodation) there were 60 designated beds for psychiatric patients spread over wards 4, 12 and 24. This access meant that often there was truly holistic care for troubled patients.
• So what were the projected staff requirements in 1964 compared to now?

Doctors

	1974		2020
CONSULTANTS
Established (including psychiatry )	19	Established (no psychiatry )	121
Visiting	12
Clinical Assistants	14
Medical Assistant	1	Associate Specialists	8
		SST	28
Registrars(including 2 in psychiatry)	6	Specialist Registrars	86
House Officers	6	Foundation 1and 2	45
Senior House Officers	15
		Trust Grade	14

Neither the regional plans in 1964 or the  who’s who for 1974 stipulate the potential and actual number of ‘junior’  doctors then required below ‘registrar ‘ grade and my memory has had to suffice – but as we all worked a 1  in 2 rota in 1973 ( all changed with the European Working Time Directive in 2005) the numbers needed to staff the wards were much less. However the difference in numbers is eye watering and reflects the working time directive and the marked increase in consultant sub-specialisation. Though the 3 medical consultants I worked for had sub- specialisations,  essentially they  all trained as general physicians and did a 1 in 3 rota on call . The same applied to a large degree to the general and orthopaedic surgeons ( and the orthopods were the ED doctors !)  and both the Obstetric and gynaecology consultants did not sub specialise . There was only one consultant paediatrician ,  David Morgan and he covered all aspects of paediatrics from birth to 18 and in retrospect was theoretically always available out of hours with the equivalent of an FY3 covering the out of hours emergencies in the hospital . The established Consultant staff is detailed below.   There were no female consultants. The most senior female medical member of staff was Miss Jo Cummins (in Obstetrics and Gynaecology ) who now would be described as an Associate Specialist but was then described as a Medical Assistant. There was one female Registrar but the only other female doctors were in the equivalent FY1 and 2 grades, there were 2 female FY1s , myself and one other,  and I can’t remember a female FY2!  At that time the female intake to medical school was about 5 %. 

Specialty Consultants	1974
Anaesthetics	Dr. Woods, Dr. Glyn Jones, Dr. Raper, Dr. Truesdell
Geriatrics	Dr. Marshall   Dr. Doshi
General Medicine	Dr. Fountain Dr. Miles Dr. Gwyn Morgan
Obstetrics and Gynaecology	Mr. Phillips Mr. Graham
Paediatrics	Dr. David Morgan
Pathology	Dr. Pyrah Dr. Tinsley
Trauma and Orthopaedics	Mr. Kilburn Mr. Cape Mr. Norton
Radiology	Dr. Pacsoo  Dr. Darnborough
General Surgery	Mr. McAdam  Mr. Shaw   Mr.McCartney

 These clinicians  all gave long and dedicated service to Airedale in a time when a Consultant post was ‘for life’. The work was  service driven and though the hours were potentially longer the pace overall was definitely slower . Despite the lesser emphasis on clinical governance and ‘quality’  I well remember Dr Gwyn Morgan and Archie McAdam being at the forefront of Leeds University research into computer driven AI diagnosis of acute abdominal pain. I also did not have an e-portfolio and my skills and competences were accumulated by the time honoured tradition of ‘ see one, do one, teach one’ . As far as I am aware my only written assessment was contained in the consultant’s reference for my next post. As a junior doctor I  did not carry out any proscribed audit and was not expected to.

 

 Nursing

This has also altered out of all recognition.  In 1970 nursing was not a graduate profession. Student nurses learnt on the wards and in on site lectures and were part of the established workforce. There was a school of nursing based in what is now the post graduate centre . The hospital had a team of nursing educators  for  general nursing, midwifery and paediatrics. It was estimated that there would be 260 nurses in training of which 110 would be in school at any one time.

 

Interestingly the hierarchy below the chief nursing officer and Deputy very much mimics what we have today . There were nine ‘ Nursing Officers’ whose job descriptions in the 1974 Who’s  Who  are almost identical to our current Matrons and associated managers. In addition there was. nursing Officer for Recruitment – the only place recruitment is mentioned. I  combed both the initial specification document and the 1974 Who’s Who but there is no mention anywhere of any department equivalent to today’s Human Resources.

 

	1970		2020
Trained nurses	111	Senior Charge nurse	165
		Staff nurse	415
		Specialist nurse practitioners	76
		Nurse consultant	3
		Advanced Practitioner	1
		Enrolled nurse	2
		Assistant Practitioners	12
		Modern Matrons	13
Nurse Managers	14	Nurse Managers	13
Nurse Educators	6
		Nursing Associates	5
Student Nurses	129	Trainee Nursing Associates	24
Pupil Nurses	34
Midwives	68	Midwives	84
		Consultant Midwives	1
Student Midwives	24
Midwife Manager	3	Midwife Manager	12
Midwife Educators	2
Nurse Auxiliaries	84	HCSW	364
		Health care Assistants	23

• The numbers for nursing and midwifery staff in 1970 are projected with the addition of the nursing management and educators to add up to 441. This figure did include a projected 278 full time and  138 part time workers.
• The equivalent number of nursing and midwifery staff in 2020 is 1258 .(which does not contain the whole time /part time breakdown.)
• in 1964 the projected number of nursing auxiliaries was 84 , we now have 387 equivalent people working in the hospital.
• There was also no mention of nursery nurses in the 1964 specification – we now have 33.
• There was no mention of infection control in the whole specification.

 

 Pharmacy

The needs of pharmacy were described in very few sentences in 1964. ‘ If practicable it should be sited near the Out Patient Department. . All necessary pharmaceutical services should be included; Compressed air , suction of mercury, together with air filtering and heating for an aseptic service; 2 autoclaves, 2 mascarine stills, one 6 cubic foot domestic fridge, one glassware washing machine and one hot air oven. ‘ ( There was no mention of a computer driven robot dispensing service…….)

 

The  planned staffing for the pharmacy department in 1964 was  5. The list of hospital technicians , which numbered 75 in 1964 does not have any mention of pharmacy . There were to be 3 dispensing assistants and it is hard to tell whether these 3 people were extra to the pharmacists or part of the original complement. The world has certainly changed since then! There are now 25 pharmacists working with 58 other pharmacy support specialists  in a department that has long outgrown its original designated footprint.

 

	1964		2020
Pharmacy staff	5	Chief Pharmacist	1
Dispensing Assistants	3	Pharmacists	25
		Pharmacy Practitioner	9
		Pharmacy Technician	44
		Pre Reg Pharmacists	5

Pathology

This Department had a similar one sentence description in the original specification. ‘Provision should be made for a centrifuge, glassware washer, deepfreeze, blood bank, hot air oven, steriliser mechanical extract for fume cupboards and washroom and town gas services.’  No mention of analysers. This specification reminds me of my A level Chemistry lab for the same year. The staffing was equivalently frugal . There were to be 2 consultant pathologists and 14 medical lab technicians. In 1974 this had been fleshed out with a Principal Biochemist and Head Technician respectively called Mr Sanderson and Mr Kay (both men well worth cultivating for their sound advice. ) In 1974 there were no phlebotomists, I had to undertake all the phlebotomy for all my patients. There are now 17.

 

	1970		2020
Consultants	2	Consultants
Principal Biochemist	1	Health Care Scientists	137
Senior Technician	1	Of which Health Care Science Associate	7
Laboratory Technicians	14	Health Care Science Assistant	76
		Trainee health Care Science Associate	2
		Trainee health care science practitioner	15
		Phlebotomists	17
		Biomedical Scientist	2
		Consultant Healthcare Scientist	1

Radiology

In 1964 this was outlined as needing 5 separate rooms with the ‘possible addition’ of a separate unit in accident and emergency . The comparable numbers of support staff are detailed in the table below

 

	1970		2020
Consultants	2	Consultants
Senior Superintendent	1	Radiolology Manager	2
Radiographer trained	6	Radiographer	54
Student Radiographer	6	specialist Practitioner	24

 

Allied Health Professionals

In 1964 there many fewer allied health professionals supporting the specialist teams. There is 1  Speech and Language Therapist in the specification though I know I was working with a team by 1974. A half time orthoptist is listed but no other ophthalmology support specialists . There is 1 dietician on the list , 4 occupational therapists and 15 Physiotherapists  ( plus 2 remedial gymnasts!) All a huge contrast with 2020

 

	1970		2020
Physiotherapists	15	Physiotherapists	76
Manager		Manager	5
		Specialist Practitioners	24
Remedial Gymnasts	2
Occupational Therapists	4	Occupational Therapists	32
		Manager	2
		Specialist Practitioners	5
Speech and Language Therapist	1	Speech and Language Therapists	24
ECG Technician	1
Cardiac Technician	1
Optometrist	1/2
Hearing Aid Technician	1
Dietician	1	Dieticians	12
		Dietician Specialist Practitioners	1
		Manager	1
Psychologist	1	Psychologist	5

 

Accommodation

This took up a huge part of the hospital’s foot print . I lived in one of 4 blocks of medical flats, there were at least 16 separate units housing individuals, couples and occasional families. The hospital was my home for 6 months as it was for all the junior medical staff. The nursing accommodation consisted of 6 flats, 18 flatlets and 127 bed sitting rooms for all the nurses in training. Catering and domestic staff were also given these bed sitting rooms. The boiler men were also all to  have provided  accommodation.

 

There was planning for  743 lockers and ‘appropriate’ changing areas for all non resident groups of staff.

 

Car Parking

In 1970 ‘If possible’  the following facilities should be provided

Car Park                        300/350 ( we now provide 1606 spaces )

Cycles, scooters.           100. ( we now provide 50)

Garages                          20. ( there are now none)

Ambulance Bays.            5  ( there are still 5 )

We now provide 1606 car parking spaces and at times that isn’t enough.

	1970		2020
Medical flats	16	Mews houses	9
		Medical student rooms	36
		S/c flats	3
		On call rooms	2
		General rooms	67
Nurses bed sitting rooms	127
Nursing flats	6
Nursing flatlets	18

 

Corporate Services

In 1970 this was divided into 2 sections , Group Headquarters and Hospital and Departmental Administration. There were 26 people in the corporate corridor , though there didn’t appear to be a finance department of any size, it consisted  of 12 people – which included a shorthand typist. In fact the HQ employed 3 shorthand typists amongst the 26 people . The Hospital Secretary was not considered part of the HQ at that time though he/she had a team of 37 people who included the consultant personal secretaries and another 8 shorthand typists

 

There is no detailed mention of the administrative support that would be required to run out patients, , to support the clinical administration and all the services, the post graduate centre , support the wards, store and manage the clinical notes . In 2020 we have 322 clerical workers ( In 1970 there were 27) and 75 medical secretaries ( in 1970 there were 8) There were no clinical coders , no IT Department . The concept of quality and safety did not exist , clinical governance , audit and research are not mentioned.

 

AGH Solutions  : This was described in 1974  as Hotel and Maintenance Services

It was hard to match the workforce between then and now in all areas because in parallel with the clinical workforce there have been huge changes  . In 1970 all these functions were carried out in house and  out sourcing was unheard of . There are now different technical solutions to all the  requirements to support a  hospital which has again led to big changes in numbers and type of work . In the past 2 years this work has also evolved to be run by by AGH Solutions , a wholly owned subsidiary of the hospital , which now provides ‘ facilities management , estates and procurement services’ phrases which were not found in the original specification .

 

Catering and the kitchens

In 1964 the specification was seemingly class ridden . Meals were to be provided for all wards with central dining accommodation. The cafeteria was said to be for ‘all staff’ but specifically excluded the ‘works department, Boiler House , Laundry and Kitchen staff ‘ The cafeteria was to include ‘ a semi waitress service ‘ for  part of the area – was this planned for the consultants?  . There was to be ‘ a butchery department ‘ on site . More meals a day , 1350 , were planned than the actual in 2020 , 1146.  26 cooks of various grades were specified , but the supporting structure contains much the same number of people as now

 

Laundry

In 1970 all the laundry was carried out in- house and this continued until xxxxxx when out sourcing became the norm across the NHS . The Group Central Laundry ‘is to be provided on the basis of processing 55,000 pieces / week’ . The initial specifications run to 7 paragraphs ,  more than the combined specifications for Pharmacy , radiology and pathology. There was to be a  Laundry Manager, 40 workers and 5 people working in a sewing room.

 

We now send out x pieces of laundry

 

Waste Disposal

 COVID 19 has also increased clinical waste disposal and this is a department also barely mentioned in the 1964 specification. There was one sentence – ‘facilities will be provided for the disinfection of infected linen and bedding and incineration of soiled dressings.

 

 Estates

In 1970 5 boiler men kept Airedale warm 24 hours a day 7 days a week. 4 large boilers were planned. There are now no boiler men .

The Engineering and maintenance team is still there, with a slightly different make up of skills .

There were group and hospital workshops.

We only have 2 more telephone staff than existed in 1970 , 7 in place of 5

The number of porters has increased but the number of ‘domestics’  appears to have reduced. However  titles have changed and there may be equivalent number but with altered designations .

 

			1970		2020
		Domestics	110	Domestics	74
		Porters	29	Porters	38
		Drivers	1	Drivers	13
		Boilermen/stokers	5		none
		Groundsmen	2	Gardeners	3
		Engineers	3	Engineers	16
				of which; Mechanical	8
		Electricians	3	Electrical	5
				Building	2
				Engineer	1
		Plumbers	2		none
		Joiners	3	Joiners	2
		Painters and labourers	4	Painters and maintenance assistants	6/
		Window cleaners	3		none
		Kitchen staff	85	Catering Staff	47
		Of which; Managers/supervisors	6
		Head cook	1
		Assistant head cooks	3
		Cooks	11
		Assistant cooks	11
		Canteen assistants	9
		Kitchen porters	4
		Dining Room and coffee room maids	12
		Kitchen staff domestics	24
		Central wash up	4

What is missing from this 1964 Specification ?

• No Human Resources Department
• No mention of IT ( by 1970 I was using my first computer whilst at University but it was extremely basic )
• No specification for the Emergency Department – other than a projection of potential user numbers
• No mention of a junior doctors ‘mess’ – though there was one in 1974
• No mention of any cafe for patients and visitors
• No mention of potential volunteers or Friends of Airedale

 

So what of my personal experiences 46 years ago. As now, Airedale was a great place to work. Though I have mentioned that there did not appear to be a formal emphasis on clinical governance  everyone took pride in delivering a quality service for our patients. I remember a great deal of teaching on all the ward rounds and in out patients and a great support from my seniors. The weekly lunchtime lectures were already a feature and we were all expected to attend and that  invitation was always extended to my general practice colleagues. The excellent relationship that the hospital has always had with primary care was embedded in those first few years of its existence and has remained until this day. I probably only obtained my general practice partnership because of that trusted relationship. Airedale was my home for the 6 months as the equivalent of an FY1 .

 

I worked a one in 2 rota , was occasionally up all night and still had to go to work for the rest of the day. My time as a houseman coincided with the height of the Yorkshire Ripper – he had possibly attacked a woman in Silsden and consequently I had to be escorted to and from the accommodation after dark when on call or be found a bed in the hospital. The accommodation was situated around a grass lawn and in the summer at weekends we congregated and chatted and in the winter we sat in the doctor’s mess and watched very old black and white movies and drank those endless cups of coffee.

 

I have been a patient several times over the years and want to give a shout out to the cleaners in the early 1980’s who when I was on bed rest for 3 weeks, took the time to cheer me up every day . I wrote a thank you letter to the catering department in the early 2000’s as the food had improved so much in 20 years ! Many years later I then returned the favour by acting as a volunteer on ward 10 and tried to treat the patients with the care and compassion that I and my family have always been treated.

 

As I said at the beginning of this piece Airedale hospital has been a central part of my life and long may it continue to thrive .