Thomas Dyke was Medical Officer of Health for Merthyr Tydfil from 1848-1894. He was born in Merthyr in 1816, apprenticed to the surgeons at the Cyfarthfa Ironworks before completing his training in London. He served the community for all his working life, surviving an attack of cholera in 1849. He strived to introduce sanitation to the town, working against the resistance of nearly all the Iron Masters. It took fifteen years to get the Penybryn waterworks built, the first source of healthy water for the workers and their families.

His life story has a number of contemporary resonances. He was a Merthyr lad who returned to the town to work as a doctor. A Victorian essayist writing about the doctors of Merthyr Tydfil commented: “Merthyr was the nursery ground of many men of ability who afterwards settled down in other towns”. He went on to report that nearly all of the other doctors working here had “arrived from elsewhere”. Nothing has changed.

Every year, between five and ten of our brightest young people leave Merthyr to train to become doctors. In my twenty eight years working here, I am aware of only three who have returned to work in their home town. Some have returned for some of their postgraduate training, some have settled in other Valleys communities. Where have the rest gone? What has kept them away?

The former Archbishop of Liverpool, David Sheppard described the inner cities of England in the 1980’s as “communities of the left behind”. I was reflecting on this with a patient who replied: “anyone with get up and go has got up and gone”.

How can today’s men and women of ability be encouraged or challenged to contribute to the health and wellbeing of the communities that nurtured them?

UPDATE:  

As soon as I had uploaded my first ever blog I noticed flaws in my thinking! Lots of the ‘brightest young people’ choose other careers. It seems that those who choose nursing and teaching for example do return and work locally. Do people who do not have the resilience required to continue living in a community like Merthyr choose certain professions, perhaps thinking of them as a way out?

But if junior doctors are working fewer hours then we need more of them, and we are already precariously short.  

Coupled with the new rules, Wales is struggling to attract trainees from across the Severn Bridge.  And on top of that the UK as a whole is now bound by stricter immigration laws on recruiting from outside Europe which is putting further strain on NHS Trusts, also desperately short of middle grade doctors

The Assembly Government has set in train a significant expansion in places at medical schools in Wales and last month offered junior doctors free accommodation if they come to Wales to train.

These are good long term strategies but they should have been in place long ago. NHS Trusts now need immediate solutions.

During a recent session of First Minister’s questions Rhodri Morgan said “backfilling” from India was no longer an option and even went as far as to say it was “the lazy way out”.

But desperate NHS managers in Swansea have confirmed they are looking for front line staff in India to plug gaps.

Governments have had 11 years to prepare themselves for today. Too little action may now have left them with two unappealing options -  agree to the Conservatives call for an emergency delay on the directive or apply to Immigration and Customs for leniency.