Dr Tony Berendt, medical director of Oxford University Hospitals NHS Foundation, will be retiring from the trust and the NHS in September. Here, he reflects on his 35 years working in the NHS as this national institution celebrates its 70th birthday.

WHEN I was a clinical student at the John Radcliffe Hospital in the early 1980s, patients who had heart attacks spent 10 days in hospital, first on the coronary care unit and then on the general medical wards.

At the end of that time, those who had survived were put on a treadmill, and exercised – under medical supervision – to see if there were signs that the undamaged parts of the heart were short of blood, in case the patient was at risk of another heart attack.

If a problem was found, the patient might have a coronary angiogram – an X-Ray study of the blood supply to the heart – to see if bypass grafting surgery was necessary; surgery for which there were very long waits.

The consultants I worked with had memories of when the only treatment for heart attack patients was six weeks of bed rest.

In the course of the last 30 years, the treatment of patients with heart disease has been transformed.

My colleagues in cardiology can now place tiny expandable tubes (stents) into the coronary arteries, and do so at the earliest signs of heart attack.

Powerful drugs affecting blood pressure, stickiness and the levels of cholesterol in the blood (and so in the walls of blood vessels) can greatly reduce the risk of a further heart attack as well as helping to prevent one in the first place.

While waiting times are still an issue, they are dramatically less.

It is not just the treatments that have transformed; so have the patients being treated, the staff who treat them, and the systems we have in place to deliver treatment.

Thirty years ago, barely a day went by without one or two patients in their 40s and 50s presenting with massive heart attacks due to blockage of one of the major vessels in the heart.

I looked after them in Oxford, London, and Sheffield.

Public health interventions such as the decline in smoking and the better management of high blood pressure and cholesterol have changed that.

The heart attack patient is now as likely to be someone in their 80s, diagnosed on the basis of some chest pain and a blood test showing damage to heart muscle that may not yet even show on their heart tracing.

Knowing what we now do, that evidence is enough to undertake the coronary angiogram and, if vessels are seen to be critically narrowed, to reopen them with a stent.

The patient may well go home a day or two later.

This transformation in both the treatment we can offer and the population we treat is mirrored in many areas of medicine.

Whether it is diagnosing and treating cancer, extracting clots from arteries in the brain in some cases of stroke, treating inflammatory arthritis before it destroys joints, or dramatically improving safety and recovery in anaesthesia and surgery, many patients can be treated with less invasive procedures, shorter lengths of stay in hospital (or treatment as day cases), and fewer side effects.

Of course in parallel with these changes, the staff and the system have also had to transform. New knowledge and skills are perhaps the easiest part of change.

Redesigning how to work as teams and to organise systems requires much collaboration, negotiation, and relationship building.

In the case of the treatment of heart attack, this has included changes in public understanding, in general practice, in ambulance crew skills and communication with the hospital, and in the systems in the heart centres to diagnose and treat before serious damage or death occur.

These processes demand collaboration between teams of professionals with different skills and backgrounds – clinical and managerial – and attention to all the steps in the pathway of care that starts, and hopefully ends, in the patient’s home.

The need for collaboration with and between teams and organisations has become ever greater.

At the same time as we have improved our ability to treat individual diseases (and to some extent as a result), we are living longer, and acquiring more long-term conditions as we do.

Patients with multiple conditions that might include diabetes, dementia and frailty present their doctors, nurses and therapists with greater complexities and challenges, just as they present their families and neighbours with more worry about how to keep those people healthy and safe.

How to organise and deliver complex pathways of care, to provide the healthcare we all want within the budget we are all prepared to pay for, is one of the greatest challenges the NHS now faces.

So are questions of resource and sustainability, as expectations continue to rise and the gap widens between what is possible and what is affordable or sensible (as Atul Gawande discusses in his book Being Mortal).

Just because we can, does not always mean we should.

As we reflect on the 70th birthday of the NHS, the thing that I will be thinking of is not really the stories of these astonishing improvements in care – improvements that I have been privileged to live through in the course of my career.

Inspirational as advances in healthcare are, more inspirational still has been the commitment made by our whole society, through 70 years of the NHS, to make these advances available to all, and the commitment made by a proportion of our society to work in the NHS – and in social care, which is increasingly linked and important.

I have been extraordinarily lucky to work with colleagues, clinical and managerial, who have worked, and still work, day after day, to deliver for patients, on behalf of us all.