Emergency access czar Professor Sir George Alberti has spent his career as an outspoken agent of change. Here he reveals how he prefers to eschew politeness and tackle controversy

Emergency access czar Professor Sir George Alberti has spent his career as an outspoken agent of change. Here he reveals how he prefers to eschew politeness and tackle controversy

Professor Sir George Alberti may appear the epitome of the British establishment but the national director for emergency access says that from an early age he has not readily accepted authority and has never fully integrated into the establishment. Perhaps the disruption to his early life may go some way to explaining why.

His Jewish parents fled from Germany in 1939 and his father, having re-established his paper goods business in Newcastle, was interned on the outbreak of war. This left Sir George's mathematician mother to manage the business while he and his older brother were evacuated to Wakefield.

Sir George wanted to be a doctor from an early age and flippantly comments that he was influenced in his decision by observing the quality of life enjoyed by the local GP. He won a school scholarship to Oxford where he was academically sound rather than brilliant, viewing himself as somewhat idle and preoccupied with the non-academic pleasures.

A career in academic biochemical medicine and diabetes followed, which he describes as successful on the basis of hard work rather than brilliance. 'I don't look on myself as an outstanding academic,' he says. 'I think I'm good in terms of practical applications of research and in helping others.'

He did not achieve the significant research breakthrough he wanted and he considers this his biggest career disappointment. However, he is not one for looking back, saying he reached an age when he had to accept the limit of his own capabilities.

Never quite getting on with authority has probably served Sir George well. His five-year period as president of the Royal College of Physicians is characterised by changing its image from Victorian establishment to modern institution.

He has always been a powerful advocate of the need for the profession to change but believes isolated incidents like Shipman have been grossly distorted so they become the principal reason for change. He concedes that until the recent changes to regulation, the medical profession presented a self-satisfied image.

The emergency access czar would like to see other changes being considered: postgraduate training, for example. He believes there is the need for stronger mentoring of postgraduate doctors in training to help them adjust to becoming consultants at a much younger age than their predecessors. And he is unequivocal about the new consultant contract, describing it as 'a catastrophe because it removes professionalism by spelling out almost hour by hour what doctors are supposed to be doing. I look on that as deeply insulting.'

He sees many consultants working fewer hours as a result - or disaffected working extra 'unpaid' hours - and would rather see a firmer approach to job planning not linked directly to salary.

When RCP president, Sir George drove through internal changes on an inclusive basis, a personal style he continued when appointed national director for emergency access in 2002. He is seen by NHS colleagues as one of the most accessible czars and is good at balancing his discursive and inclusive approach with clearly expressed firm views. In short, he is an effective influencer.

He decided about 25 years ago that he had tired of being polite all the time.

'I decided that I wanted to be honest and to say what I thought, which at times I know is uncomfortable for me and others. I don't go out of my way to be deliberately rude or hurtful but there is no point in bullshitting.'

No stranger to controversy

Sir George's style is deliberate but not without principle or purpose. He is driven by a strong personal desire to see a much more integrated and multidisciplinary-based system of healthcare and for his own profession to change the way medicine is delivered.

He illustrates this by referring to his time in Africa when he saw large numbers of medical assistants and nurses supported by fewer doctors. The doctors, he said, 'were frequently a nuisance because they had strong professional expectations'. His subsequent work with practice nurses in the UK has convinced him that these alternative practitioners have much to offer.

He believes so strongly in integrated healthcare that he would have preferred to see foundation health economies created rather than foundation trusts. He believes the foundation trust policy, with its emphasis on organisations, works against the optimum organisation of local clinical services and patient-focused care. Healthcare, he says, should be organised on a network basis spanning primary and secondary care and with a disregard for organisational boundaries.

He is no stranger to controversy, once being the focus of a media tabloid story about an alleged disagreement with a former health secretary about the number of doctors required in accident and emergency departments. The media was on his side then and he hopes it will be again with his campaign to persuade the public, and undoubtedly many in the NHS, too, to support reconfiguration.

Hospitals have inherited the iconic status that local churches had in the 19th century and he is keen to stress that reconfiguration is not about complete hospital closures. He wants to see 24/7 regional specialist centres within networks spanning big geographical areas. This will not only guarantee higher-quality care but also remind the medical profession that clinical services exist to serve populations rather than hospitals. He strongly supports decentralised care closer to home, a policy with the potential to also increase the size of the local NHS workforce. This, he says, would dispel any arguments about increases in local unemployment as hospitals change.

'The public aren't idiots'

He accepts these are hard messages to get across to both public and backbench politicians. The real task, he says, is to get the professions and the public used to a programme of continuous improvement, which is difficult when people are tired of change but his optimism shines through.

'The public by and large aren't idiots; they trust doctors more than they trust many other professions such as politicians and journalists. So if we have a good story to tell about improvements in health we are more likely to be believed.'

Optimism is all very well but surely change may have to be forced through in some parts of the country? 'We need to remember that in recent years we have made significant changes to hospital services. Look at the changes to mental health hospitals, for example. These experiences, as well as those that have already taken place in the acute sector, tell us that if we produce a good quality alternative service then people quickly forget about the change.'

Sir George accepts MPs are still nervous about what happened at Kidderminster but he thinks there may have to be other incidents of political upset if safe, good quality, sustainable health services are to be provided.

Although Sir George acknowledges the challenges facing managers he urges them to think more about the future direction of local clinical services and how to achieve the change. It is, he says, terribly important to have a clear sense of direction as the basis for short and longer-term decision-making. He cites a recent example of a decision to cut the number of consultants in a local accident and emergency service, which he describes as a short-term panic.

It is therefore not surprising he wants managers to operate with greater sophistication and political astuteness. But he also urges doctors to support managers because a strong relationship between the groups is a powerful force for change.

So why, at 69, does he continue to push himself rather than spend more time in his beloved Lake District? Although his three sons are established in their careers (one is a doctor), his wife, a professor of diabetology, still works. He is clearly driven but maintains that work remains fun.

He is not deeply reflective but has a simple religious belief based on doing good in this life without worrying about the next. Sir George says he would like to be remembered for being a nice bloke, someone who was not boring and made a little bit of a difference to medicine and patient care.

If the idealistic and optimistic emergency access czar achieves the changes he is championing there is little doubt he will be remembered, and for a lot more than that.