Other NHS hospital staff (Part 2)

 In the last post, we looked at all the different types of nurses who work in NHS hospitals. In this post, we’ll concentrate on the other clinical staff you might run into.

Midwives (aka Madwives)

I didn’t include midwives in the previous post because most midwives today aren’t nurses. Midwives have actually been regulated, independent medical practitioners in their own right since The Midwives Act, 1902. However, at the inception of the NHS in 1948, the nurse-midwife model dominated, in which most midwives first qualified as nurses before specialising in midwifery. Certainly, as a callow trainee anaesthetist, most of the midwives I worked with had previously been nurses. During the course of my career, the model shifted to direct-entry midwifery training programmes. The rationale was that birth is a normal physiological process and that the relationship between an expectant mother and her midwife is not a nurse-patient relationship. Expectant mothers are not patients. It was further argued that a nurse’s knowledge, mindset, and skill set were not optimally suited to managing a labouring woman.

I am going to rashly stick my head above the parapet now and risk incurring the wrath of midwives up and down the country. I quite liked it when the midwives I worked with as a junior anaesthetist were also trained nurses. I do agree that birth is a natural physiological process, and labouring women, perhaps, shouldn’t be viewed as patients needing to be nursed (or doctored). However, in the real world, pregnancy and giving birth are sometimes pathophysiological processes: major haemorrhage from placental abruption or placenta praevia, hypertensive disorders of pregnancy, pre-eclampsia and eclampsia, gestational diabetes, anaemia, DVT and pulmonary embolism, amniotic fluid embolism, sepsis, and so on. Labouring women also request epidurals, a major medical intervention in anyone’s book. Labours obstruct. Unborn babies exhibit fetal distress necessitating emergency caesarean section. There are loads of other reasons why a labouring mother might need a section.

Anaesthetists aren’t involved in the birth of a woman undergoing ‘natural childbirth’. My presence was only demanded if she requested an epidural or if the shit was hitting the fan in any of the ways suggested above, or in ways I neglected to mention. In these latter circumstances, I tended to feel that it was better for the patient (as soon as I became involved, a labouring mother instantly became my patient, whatever designation she held beforehand) if the midwife assisting me had received nurse training. I somewhat regret that this is no longer the case.

There, I’ve said it. Hard hat on and wait for the flak.

More than a bit scary to most junior doctors, and some consultants, midwives actually do an amazing job under tremendous pressure. The shortage of midwives in the UK is even more acute than that of nurses. It is a significant contributory factor to concerns that obstetric units across the UK may be failing to deliver the highest possible standard of care. In the last ten years, at least seven major national enquiries have been launched, three of which are currently ongoing. They have concluded, or will conclude, that maternity care is suboptimal, resulting in avoidable baby and maternal deaths. They have declared, or will declare, that better systems, processes, training, clinical audit and performance review are required to achieve better outcomes. I am sceptical that the conclusions and recommendations of all these enquiries stemming from the ‘lessons learnt’ will ever be successfully implemented without an appropriate injection of monetary resources. From a bloody large syringe!

Radiographers

A large set of biophysical technicians that most of us have encountered at one time or another, radiographers are easily identifiable because they glow in the dark from accumulated exposure to X-rays. In addition to X-ray examinations, they perform CT and MR scans, as well as other imaging investigations, including ultrasonography. They are second only to consultant radiologists in their ability to diagnose from X-rays or scans.

Other Medical Biophysics Technicians

A heterogeneous group, they include laboratory technicians, microbiologists, ECG technicians, echocardiographers and phlebotomists. The first two don’t get out much, so patients seldom encounter them. If an ECG technician introduces themselves and connects a bunch of ECG leads to your chest, the indigestion you thought you were suffering from could well be a heart attack. Echocardiographers perform ultrasound scans on pregnant women to date pregnancies, assess fetal growth and check for fetal abnormalities. They also scan your gallbladder if you’ve been suffering from flatulent dyspepsia or biliary colic, your liver if you’ve turned yellow recently, your kidneys if you’ve noticed blood in your pee, your heart if you’ve been getting increasingly breathless and your ankles have swollen, your breasts if you’ve noticed a lump, and just about every other organ and tissue in your body as required.

Physiotherapists (physios)

These are the people to see when you’re recovering from a hip or knee replacement, have a frozen shoulder that needs defrosting, suffer from chronic back pain, are learning to walk again after a stroke, or need help coping with a host of other neuromusculoskeletal calamities. They make you mobilise whichever bit of you would benefit from a spray of WD40, no matter how agonisingly painful it might be. ‘Cruel to be kind’ is their motto.

Occupational Therapists (OTs)

If you need help performing certain activities of daily living to maintain your functional independence, whether from physical or mental illness, you need the services of an occupational therapist. These activities range from simple things like washing, dressing and cooking to more complex work-related tasks.

Speech and Language Therapists (SALTs)

They provide treatment and support for people with difficulties communicating verbally, eating, drinking and swallowing, often as a result of a stroke. As an ICU consultant, I was very reliant on SALTs to assess whether it was safe to orally feed ventilator-dependent patients and patients with tracheostomies.

Dieticians

Their input is invaluable if you have specific nutritional needs or dietary intolerances. Critically ill patients in the ICU usually meet the criteria for the first group, so I used to see a lot of our hospital dietitian. She always used to pitch up at the end of her working day and would then spend hours assessing every patient, writing reams of dietary advice in the notes. I’m not sure if she had a home to go to because she was often still hard at it long after eight o’clock.

Orthoptists

My younger sister was diagnosed with a lazy eye when she was only four or five. She had to wear an eye patch over her good eye to encourage her lazy eye to do a bit. My brother and I found this most amusing and used to shout words of encouragement at Lazy Eye: ‘Go on, you can do it!’ ‘Try harder!’ ‘Wake up!’

 I didn’t realise it at the time, but my sister had seen an orthoptist. Experts in diagnosing and treating squints, eye movement disorders and binocular vision, orthoptists could be described as eye physiotherapists. I think they’re all brilliant, and not just because my sister’s lazy eye became a prodigiously hard grafter after a few sessions with her orthoptist – one of my daughters is one.

Organ transplant coordinators

I couldn’t do their job. As an intensivist, I managed critically ill patients all the time, many of whom ended up dying. Afterwards, I had to speak to the family members. It was stressful and upsetting stuff. Even so, most of the patients I admitted to the ICU survived, and so the good karma outweighed the bad. Now imagine if all your patients died. Every single last one of them. Imagine having to speak to all those deceased patients’ families. Not to tell them you did everything you could to save their loved ones, but to ask them for a few of their organs.

Organ transplant coordinators play an essential role in ensuring that as many people’s lives are saved, or at least radically transformed, by receiving an organ transplant, be it a kidney, a liver, a heart, a pair of lungs, both heart and lungs, whatever. To achieve this goal, they act as intermediaries between the ICU team, the transplant surgical team and the deceased’s family. It’s a delicate task that requires the very best communication skills, empathy, patience and kindness. Organ transplant coordinators also have to be extremely well organised and willing to work day or night, seven days a week.

Sadly, there is an insufficient supply of organs for donation to satisfy the demand from patients dying of kidney failure, heart failure, respiratory failure, liver failure and the rest. The total number of people needing an organ transplant in the UK in 2025 was about 8,000, more than half of whom were waiting for a kidney transplant. Against this backdrop, about 1,400 people received a transplant from a deceased donor in 2024/25 (a 7% decrease on the previous year), and just under 1,000 people received an organ from a living donor (usually a kidney or part of the liver). Meanwhile, hundreds of people on the transplant list die every year waiting for a donor.

An opt-out scheme has existed throughout the UK since 2023 to maximise the availability of organs for transplant. The scheme presumes that everyone consents to the donation of their organs after their death unless they specifically and formally object. In addition, there is an NHS organ donor register, which everyone is encouraged to sign up to, to make it abundantly clear and obvious to your nearest and dearest that you positively would like your organs to be donated in the event of your untimely death. So why the shortfall?

The biggest reason is that only about 1% of everyone who dies does so in circumstances that allow their organs to be donated (such people are usually diagnosed as being brain dead while in a deep unresponsive coma on a mechanical ventilator on the ICU after a severe head injury, brain haemorrhage or other catastrophic acute brain injury. I’ll be discussing brainstem death (BSD) in a later post, so I won’t expand further here. In addition, even under the opt-out law, assent to retrieve organs in these utterly distressing circumstances is still routinely sought from the deceased’s next of kin. If it is not forthcoming, organ retrieval does not proceed. Family members can therefore veto organ donation, and around 40% of all potential organ donations are lost because of this. Crucially, it makes a massive difference if the deceased’s explicit wishes are known (because they have previously registered on the organ donation register or discussed the subject with their family). When they are known, the family refusal rate is only 10%. Where they aren’t, it’s 90%.

So, if you haven’t already, please discuss your views on organ donation with your husband, wife, mistress, partner, or dog. And if you agree with the concept, consider signing up. You can do this easily online at https://www.organdonation.nhs.uk/register-your-decision/donate. If you have the NHS app, you can also record your decision by going to Profile > Personal Details > Health Choices > Organ Donation Decision.

Anaesthesia Associates (previously known as Physician Assistants (Anaesthesia))

I am reliably informed that, like nurse consultants, these do exist. However, they are even rarer and much harder to spot (there were only 186 on the official GMC register as of January 2026). If you do see one, award yourself 100 I-Spy points. ‘But I’m too young to remember the I-Spy series of books published in the 1960s,’ I hear you cry. Well, bully for you. I’ll take my 100 points back.

Anaesthesia Associates (AAs) aren’t anaesthetic nurses. Nor are they ODPs. They have only been around for about twenty years, having been introduced into the NHS as some mad professor’s hair-brained scheme to address a predicted shortfall in medically-trained (proper) anaesthetists. I know I risk upsetting any AAs reading this, but seeing as there are so few of them out there and only about a dozen people and a cockapoo actually read this blog, I’ll take the risk.

What do AAs do? I had to crib this. They administer anaesthetics for straightforward, low-risk cases under the direct supervision of a consultant anaesthetist. One consultant may supervise two AAs simultaneously. I’m not sure how I feel about them. Strike that. I do know how I feel. I think they are the wrong solution to the problem of insufficient numbers of medically-qualified and trained anaesthetists.

Hospital Chaplains

Chaplains are a precious source of strength, comfort and succour for many patients, as well as their friends and relations, when things are not going too well. The final step in the ICU treatment algorithm, if the clinical situation was desperate, was to ask: “Is the patient a no-hoper?” Answer = No: start again from the top and hope it works this time. Answer = Yes: call for the priest.

And it would have been a priest or another Christian minister when I first started practising. Nowadays, it is recognised that patients belong to all faiths or none, and the chaplain on-call rota includes RC priests and Church of England vicars; Methodist, Baptist and Pentecostal ministers; rabbis and imams; religious leaders of the Hindu, Buddhist and Sikh faiths; as well as humanist and secular chaplains. For the same reason, the hospital chapel has given way to the multifaith prayer and meditation room.

I know that some of my colleagues sometimes felt uncomfortable when a critically ill patient’s loved ones sent for the priest or the rabbi or whoever. I think they took the view that the relatives had lost faith in us, the medical carers, and had now turned to God to make the most of a bad job. If not to effect a miracle cure, then at least to ensure an unimpeded passage after death into the heavenly afterlife. I think some of my colleagues also thought that having a priest on the ICU, throwing holy water about the place, might be bad for the morale of other patients on the unit who were conscious and aware of their surroundings.

My own take is that in the game of Life, you need all the help you can get if you find yourself in hospital at death’s door. Chaplains do a great job and can be an immense source of strength and hope to patients and relatives alike.

Two previous patients stand out in my mind for being slightly weird. One professed himself a Jedi Knight, and the other an adherent of the Surakian faith (think planet Vulcan and Mr Spock). The Jedi Knight was sent on his spiritual way with a wave of a lightsaber and the words, ‘May the force be ever with you.’ The Surakian shuffled off his mortal coil with the exhortation to ‘Live long and prosper.’

I’m all for hospital chaplains, but I do draw the line when the doctors themselves get involved in the religious side of their patients’ care. Before I specialised in anaesthesia, I worked as a medical SHO for two years. One of the cardiology consultants was a fervent Christian, either a Baptist or an Evangelical. It was not unusual for him to kneel at the bedside of a patient who wasn’t particularly chipper, make the sign of the cross, and pray for his patient. The look on some of those patients’ faces was a sight to behold.

Ancillary Staff

The unsung heroes of any hospital, porters, electricians, plumbers, catering and domestic staff keep a hospital ticking over. They work incredibly hard for a pittance yet somehow maintain a perpetually cheery disposition. I always tried to make a point of greeting ancillary staff with a wave and a smile whenever our paths crossed.

That’s it for this post. It’s been a bit of a slog trudging through all the different people who work in a hospital. The more perspicacious among you will have noticed that I’ve omitted one of the largest groups, namely hospital managers. Don’t worry, they get a blog post all to themselves and will be making an appearance in due course. However, over the next few posts, I want to discuss a few clinical conditions that are often misunderstood. Stay tuned to find out the difference between a heart attack and a cardiac arrest in the next post.