Professor Sir George Alberti

National clinical director for emergency access
Appointed: September 2002

My achievements

I have been a national director for just over a year. I perceive my role as:

Acting as a link with the medical profession in acute trusts and primary care and at national level,
Bringing messages back from "the field" into our branch in the healthdepartment,
Acting as a clinical "reality check" in the department,
Working with clinicians (nurses and doctors) in the department on clinical issues,
Looking at long term needs of emergency care,
Advising trusts and health authorities when asked to do so,
Helping ambulance trusts develop new ways of working, and
Promulgating new aspects of emergency care nationwide.

It is hard to summarise the achievements to date. I have certainly communicated with very large numbers of clinicians and managers, having visited more than 50 trusts and health authorities. I have advised on problems and their solutions.

I work very closely with colleagues in the department and bring messages about emergency care to the top team. I have developed ideas for a long term strategy for emergency care.

However, it is difficult to single out particular personal achievements. I work as part of a closely knit team, and together we have raised the profile of emergency care. I feel we have helped improve the timeliness and quality of emergency care. I would certainly not single out any achievements as mine alone.

What others say

John Heyworth, president of the British Association for Accident and Emergency Medicine: When the announcement of a tsar for emergency care (the "trolley tsar") was initially proposed, there was a cautious welcome from specialists in emergency medicine. Although the post represented a much needed and long overdue focus on the complex issues surrounding emergency care, at that time there was "tsar appointment frenzy" and concern that the approach was a political panacea of cosmetic benefit, with little chance to deliver real change. Could a political appointee also be an advocate for clinicians? Another understandable reservation concerned the appointment of an internationally renowned diabetologist to a field that perhaps had not been a primary area of interest in his career. His learning curve on current issues in emergency care must have been vertiginous.

However, so far the appointment has been hugely successful. It became clear from the outset that Sir George did not get where he is today without having superb political skills, particularly as a listener to the various lobbies and a cajoler in areas of resistance to change. His previous appointment as president of the Royal College of Physicians afforded him the prestige and contacts to address senior figures in the medical and political hierarchy on at least equal terms, enabling him to convince them of the importance of emergency care and the need for change.

In particular Sir George�s early recognition of the fundamental role of emergency departments confirmed his astute insight into the core issues and the areas where maximum progress could be made, given adequate support.

But there is much work still to do. The government is committed to a 100% target of four hours for patients attending emergency departments, and concern is increasing about whether such an absolute target is either desirable or achievable, particularly within the timescale set.

Overall, this has been an excellent appointment, and emergency medicine and our patients have acquired an invaluable ally. We look forward to continuing our close working relationship in allowing emergency medicine to fulfil its potential at long last.

Peter Bradley, president of the Ambulance Service Association: Professor Alberti has been a huge breath of fresh air. I�ve met him on about a dozen occasions, and he�s made it his business to find out what each bit of the emergency care system does. He�s spent time working shifts on ambulances in London and the North East, and he is encouraging emergency department staff to go on ambulances so that they can understand what ambulance work is all about.

He�s such a good fellow, because he can talk to anybody at any level. Because of his standing in the medical profession more people listen to him than would talk to us. He�s made a huge difference in breaking down barriers and in questioning traditional roles and responsibilities. Maybe ambulance services have been put to one side until now�we didn�t have as much of a say in how emergency care was provided. But Professor Alberti makes a point of ensuring that primary care trusts and health authorities don�t forget us.

Our greater profile means that ambulance service managers are beginning to lead the local emergency care networks that organise out of hours care�this is happening in Greater Manchester, for instance.

Professor Alberti is considering radical ideas such as ambulance staff working in emergency departments and emergency care centres and having the remit to treat more people at home and to prescribe drugs such as antibiotics. These ideas may have been talked about before, but they hadn�t had so much support from the top. He�s also trying to make sure that people with minor injuries have access to emergency care centres across England.

He�s pushing for higher education and greater clinical skills for ambulance staff. Rather than local ambulance services having to find the money for education of ambulance staff, he�s pushing for the health department to fund such training centrally.

The next step is to prepare the ground to make sure that ambulance services really do make a difference in the reform of emergency care.

Dr Saxon Ridley, president of the Intensive Care Society and director of critical care services at Norfolk and Norwich University Hospital: I�m sure that Sir George has spent a huge amount of time and effort on improving emergency departments and ambulance trusts. This is probably in response to the government�s concentration on reducing waiting times in emergency departments. With regard to critical care it is a little more difficult to identify his contribution.

The main government led improvements in critical care have been through the Modernisation Agency, which has put money into critical care and the critical care networks. There has been a big push for the development of outreach teams, sharing best practice and standardising care across units.

While the health department has given critical care about £300m ($560m; €430m) since 2000, it has enhanced high dependency beds in preference to intensive care beds. This has led to a continuous shortfall in the provision of intensive care. Normally the summer months are quiet, but this year there has been no respite. This persistent high level of activity makes us extremely concerned for the winter and the expected flu epidemic.