I work as the Clinical Director of the Millwall Match Day Medical Service. Millwall F.C., located in Bermondsey, South East London, is one of the 92 clubs in the English Football League. I was the first registered nurse – indeed the first woman – to lead such a service. Most Match Day Medical Services are run by physicians – the majority of whom are male.
Our team is made up of different health care agencies and healthcare professionals. We have doctors and nurses. We have paramedics from the London Ambulance Service and volunteers from the St. John Ambulance. The number of people we have on the team varies depending on the risk of the game. The stadium is quite small, only holding about 23,000 people. If the stadium is full and the police have deemed the game to be high risk, then we need more people. So, depending on the game, we can have between 10 and 30 people on our team. We also do emergency planning and participate in public health initiatives, for example, prostate cancer or mental health awareness campaigns.
I never expected to embark on a career running a match day service for a football club. But in 1997, I was first asked to help someone out at the club on a locum basis. I ended up being the clinical director of the service in around 2008. When I began working for the football club, I was working in thoracic oncology. I am now a professor of health care modeling at the London South Bank University and the University of Southeastern Norway.
In football, clinical match day services really began with the Hillsborough Stadium disaster in 1989. Until about 2001 football medical services were organised primarily around disaster management. When I started to lead the service, my team and I began to collect data on the kinds of problems that we dealt with on match days. The majority of people we treated had exacerbations of chronic disease or minor injuries. They would have heart attacks or strokes, or epileptic seizures. They would fall down and get injured. About half of the things we see are problems that arise from pre-existing conditions.
However, post-Hillsborough, services were still organised around disaster management. The rules said that you had to hire emergency people on your team. They also said that you could hire a doctor as long as they had a three-day course from the Football Association. We found that, despite doing this course, doctors were not prepared for the work. We documented that this wasn’t meeting demand because most of the problems we see do not stem from disasters but from exacerbations of chronic conditions or minor injuries. We knew that we had to change the make-up of the team.
My scientific background in healthcare modeling and mathematics helped us conduct the research and mount some robust arguments for change.
Our data clearly showed policy makers that the configuration of the services needed to be revised and that we were running an unnecessarily high risk by not having the right people with the right skills in place. In fact, we had some near misses. The most important thing was to document that the policy of the regulator was not optimal, and the rules didn’t work in real life.
Although we knew that change was needed, it was a very contentious thing to do. Some people were supportive but there were areas of resistance. But by gathering evidence and making a case, we were able to change the national policy of the English Football League, regulated by the Sports Ground Safety Authority. That change in policy meant that we were able to transform our team. We dispensed with the crowd doctor role and started to hire more general practitioners and nurse practitioners. We also work closely with senior paramedics, who have the best skills for managing an emergent disaster. A lot of the things we were seeing were better suited to that workforce.
I am at the stadium every time there is a match. Although the service meets demand better, we are never complacent. With a wide range of skills on our team, we are now well prepared for the routine work of dealing with emergencies like a cardiac arrest as well as disasters and mass casualties. And we are also constantly anticipating the next challenges. You never know where the next disaster is coming from. The world has changed and we now face threats not only from issues such as disorder but also from terrorism. We have to prepare for the routine as well as for these new threats. One of the ways we do this is by involving our supporters in all our initiatives, service redesign, and delivery. Every year we look at our service and review it to make sure it is still meeting the need and we do this with the input of our supporters.
Although I never expected to be in this role, I discovered that it is a very good opportunity for nurses because a lot of my work is in leadership. And leadership is a hidden facet of nursing.
Professor Alison Leary MBE
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