Amos Millington

From De Havilland to hospital engineer / Aviation apprenticeship an excellent grounding

The April 2018 HEJ article, looking back at IHEEM’s early history and some of its key milestones, brought back memories for a former chairman of the IHEEM Publications Committee, Amos Millington, whose own NHS career began in 1965 when he started work as the Deputy Group Engineer to the Salford Hospital Management Committee, having cut his teeth engineering-wise during an apprenticeship with legendary British aviation manufacturer, de Havilland.  HEJ’s editor, Jonathan Baillie, spoke to him about his engineering career, some of his most memorable experiences, and the interesting people he met along the way.

Now 77, and living in Manchester (he grew up in nearby Walkden), Amos Millington wrote to me at HEJ in mid-April this year to say how much he had enjoyed reading the article in that month’s issue, ‘Early engineers’ lot was not an easy one’. One significant omission from my article, however, his letter noted, had been any mention of one of the Institute’s early Secretaries, John  Furness who, with the support of his wife, ‘worked tirelessly to successfully improve the status of the Institute and its members’. Amos Millington said: “In those days, the Institute was run and managed by just two people, John Furness, and an able office assistant, Rosemary Hewitt. It was during their tenure that the Institute moved from its London base to Portsmouth, with financial benefit for the Institute, and domestic benefit for John, since, being an ex-naval man, Southsea was his domicile.” (The Institute’s) Council meetings were still held in London, with Amos Millington’s favourite location being the Royal Society of Arts. In recognition of his work as Institute Secretary, John Furness was deservedly awarded an MBE.”

'A driving force'

After I received Amos Millington’s initial letter – he subsequently wrote me a second, containing more information – we had had an interesting telephone conversation, during which we talked a little more about the ‘invaluable work’ done by John Furness, although he admitted his own information on the former Institute Secretary was limited. Former IHEEM President WJ (Bill) Smith had, however, told him: “John Furness was the driving force behind, and formed the core of, the Institute when I joined in 1970.  He worked so hard for it, especially in organising the annual conferences, and was a great supporter of the Branches. I don’t know much about his personal life, except that he came to us from the Navy. The Institute’s headquarters were at his home in Portsmouth for some years, and when we moved to our own premises, it was best to stay in Portsmouth to retain him. He was followed as Secretary by a succession of retired naval officers, all of the rank of Commander. (Any HEJ readers who know more about John Furness and his professional and IHEEM activities are encouraged to write in to me at jonathanbaillie@stepcomms.com).

Presidential 'Roll of Honour'

While fulsome in his praise for John Furness’s work, Amos Millington said he had also enjoyed reading about in the April HEJ article, and subsequently reminiscing on, the ‘Keele courses’ and Eastwood Park visits, as well as the Presidential Roll of Honour that has run in HEJ on a continuing basis in the Institute’s 75th Anniversary year looking back at Past-Presidents. He went on to discuss with me his own very varied career and IHEEM links, explaining that, alongside his professional duties, he was, for about a two-year period in 1982/ 1983, chairman of the IHEEM Publications Committee; the IHEEM journal – at the time known as Hospital Engineering – was published by Mallard Publications in London’s ‘Bank’ in the ‘Square Mile’. He said: “Mallard’s logo was a picture of the famous locomotive, the Mallard. I discovered that the director of the company was a keen locomotive enthusiast; hence the name. For reasons I cannot recall, the contact with Mallard subsequently came to an end, and John and I travelled to Blackheath to interview and appoint a new publisher.”

Apprenticeship with de Havilland

Returning to discuss his own engineering career, Amos Millington explained that, not long after leaving school, he began a five-year apprenticeship with De Havilland in Lostock near Bolton, joining the famous aircraft manufacturer on 1957, where he was tasked with looking after components such as aeroplane propellers and undercarriages for military aircraft, and parts for guided missiles such as the Firestreak. He said: “It was a well-structured apprenticeship at a factory originally established during World War II. De Havilland was acquired by Hawker Siddeley in 1960, but remained as a separate company until about 1963, I believe.” The aerospace apprenticeship saw him gain wide-ranging experience on a range of production engineering equipment. He explained: “I went into engineering after studying locally at Worsley Technical College, gaining both an OND and an HNC.” On successfully completing his apprenticeship, he became a ‘qualified fitter and turner’, and then a Methods Engineer. He said: “I was also given the quite onerous responsibility of acting as a liaison engineer with De Havilland’s chief design offices for aerospace components in Hatfield, from which the Lostock factory received all its design drawings.

A move into the NHS

Having gained ‘excellent experience’ with De Havilland and, subsequently, its new owner, Amos Millington joined the NHS in 1965 as the Deputy Group Engineer to the Salford Hospital Management Committee. He said: “As part of my apprenticeship  training programme I had spent some time maintaining steam-raising plant during annual shutdowns, but, finding myself in a new NHS role in a large hospital group, embarked on a steep learning curve, which continued right through to my retirement in 2000, 35 years later. As chair of the Institute’s Publications Committee, it struck me that my earlier partial ignorance of the workings of a hospital’s engineering services was perhaps shared by other engineers new to the complexity and variety of hospital plant. I thus suggested the Institute consider producing a series of basic information notes dealing in some depth with some of the key plant and equipment necessary for a hospital to function.”

This ‘idea’ was enthusiastically taken up by his successor as Publications Chairman, WJ (‘Bill’) Smith, Regional Engineer to the North Western Reginal Health Authority in the late 1980s, who oversaw the Institute’s subsequent publication of a number of these ‘Basic Information Notes’, A4-sized publications with a cover, illustrated with black and white line drawings / schematics, and photographs, which the Institute marketed for £7.00 (£6.50 for members). See page ??? for an example.

Park Hospital

In 1982, 17 years after first joining the NHS, Amos Millington was appointed District Works Officer to the Trafford District Health Authority; its general hospital was – at the time – known as Park Hospital. “The hospital had the honour to be recognised as the birthplace of our NHS, where, in 1948, Aneurin Bevan symbolically received the keys, signifying that control of hospitals was being wrested from local authorities to the NHS,” he explained. “My predecessor at the hospital was Duncan McMillan, a regular lecturer on the Keele Courses who is pictured, front, centre, in the bottom photograph on page 21 of the April 2018 HEJ. A past Group Engineer at Trafford, meanwhile, was John Bolton, who became Chief Works Officer with the Department of Health, and an IHEEM President. He is pictured front, centre, in the top photograph, again on page 21 of the April 2018 HEJ.

“Sir John Charnley, the renowned orthopaedic surgeon who pioneered hip replacement surgery, was originally the orthopaedic surgeon at Park Hospital. He later moved to Wrightington Hospital in Wigan, where he worked closely with Hugh Howorth (another IHEEM Past-President), developing the Charnley-Howorth enclosure for hip replacement procedures.”

Having read with interest  the April 2018 HEJ article on IHEEM’s early history, and in undertaking some initial ‘fact-finding’ on John Furness, Amos Millington said he had also discovered, among items in storage at his house, some interesting reminders of his own career, including a number of articles.

'Equipment for the disabled'

One, titled, ‘Equipment For the Disabled – A Works Contribution’, that he wrote in the early 1970s while working as Area Engineer for Salford Area Health Authority, describes his own and close colleagues’ work in the design of a variety of equipment for ‘disabled’ or ‘partially disabled’ people. He explains at the start: “It’s a pity that, as engineers employed at either District or Unit level, the opportunities to design equipment for the disabled or partially disabled are all too infrequent. Usually, such specialist equipment is readily available, and only requires involvement by the engineers to determine the mechanical and electrical services necessary for its commissioning.” Noting that, by the early 1970s – with the needs of disabled people having become ‘an automatic consideration when designing public buildings’ – manufacturers had generally modified and extended their ranges accordingly, Amos Millington looks back to a previous era when ‘the ‘range of such specialist equipment was limited’.

For instance, he recalls, in his own ‘area’, were ‘protracted discussions’ on how best to cater for the bathing of geriatric patients in a new 28-bedded Geriatric Ward being built at the Ladywell Hospital in Salford. He explained: ‘Bathing of such patients using conventional methods had always been a difficult and arduous task for staff, because of the strain on nursing staff, and fears and discomfort of patients due to lifting etc’.

'Novel methods' rejected

Several ‘novel methods’ from different manufacturers having been rejected, due either to them ‘involving complicated equipment;’ or being expected to be too costly, he and his Engineering team successfully bid to the ‘region’ for an allocation to finance the design and fabrication of a purpose-built bath. He explained some of the subsequent steps in developing a suitable ‘solution’: “The height of an average chair seat proved to be ideal for nurses to execute long bathing sessions, and, with this in mind, I prepared a drawing depicting an almost conventional bath, but with a door at one end and the whole assembly mounted on a frame so as to attain a bath bottom height of 500 mm. Using a standard tubular frame sanitary chair as a model, a sketch was made detailing a chair which would transport the patient from the bed/ward to the bathroom and then, at the bath, the chair’s seat and backrest would separate from its base and transfer the patient into the bath, still seated. After closing the bath door, water could be admitted at the correct temperature for bathing. To ‘prove’ the design, a company specialising in the manufacture of hospital furniture cooperated and built a prototype of the special chair. By coincidence, an adjacent factory to this company boasted a plastics division, and it in turn produced the bath shell from resin-bonded glass fibre.”

Important details

Amos Millington added that ‘important details’, such as the door seal, ‘easily operated door catches’, and ‘other safety features,’ were decided upon, and the bath and chair to be delivered to the hospital were built. He explained: “The temperature of the water was thermostatically controlled through a locked mixing valve, and a quick response motorised valve was installed after the mixing valve to interrupt the water to the bath should it rise above a safe limit. As the bath needed to be drained before the patient could be removed through the door, a larger than normal waste was incorporated.”

The part of the chair to be partially immersed in the bath water was treated with a silicone-based varnish to minimise water carry-over when withdrawn from the bath. The bath proved successful, being adopted by the hospital furniture manufacturer as standard within its range, and dubbed ‘The Ladywell Bath’, after the location of its invention.

'Pros' and 'cons'

Amos Millington said of the finished bathing system: “Because the patient was held clear of the bottom, and the chair afforded virtually total body surface access, proper bathing could be effected by the nursing staff, who in turn benefited from the ergonomic considerations built into the design. A disadvantage that has revealed itself over the years is that some patients feel uncomfortable at having to remain in the bath while the water is allowed to drain.”

Amos Millington also recalls how, in 1972/1973, a Geriatric Assessment Unit was built at Ladywell Hospital, designed to assess the condition of patients who could be medically discharged from the hospital, but would, in their own environment, either have to care for themselves, or could only expect limited help from their ‘ageing and perhaps infirm’ spouse. Part of the unit included a training area, where patients ‘became familiar once more with the normal household activities of cooking, washing, and ironing etc.’ “However,” he explained in the same article, “for some patients the normal height of fixed domestic appliances was unsuitable, and specialist equipment was asked for whereby assessment could be made by the staff as to what alterations may be necessary at the patient’s home to ensure that worktops, cookers, sinks etc., were at a height to suit the partially disabled person.”

All designed 'in house'

Four such appliances were requested for inclusion in the unit – a stainless steel sink, a cooker top, an oven, and an ironing table. Amos Millington explained that all these units were designed ‘in house’, which ‘provided a novel diversion from the normal drawing board activity’. He explained: “Which method to employ to raise and lower, safely and easily, the sink and cooker units, was solved by observing the equipment used by any gent’s hairdresser – a hydraulic plinth, one each for the sink, cooker top, and oven. The electric cooker top was a Tricity model with controls on a flexible conduit for remote mounting, but a commercial pattern of electric oven was chosen, since domestic models, being rather tall, were not considered suitable for adaptation.”

He added: “The three pieces of equipment were mounted on purpose-designed timber frames with suitable heatshields where necessary, the whole assemblies being bolted to purpose-made steel plates attached to the top of the pedestals on each hydraulic plinth. To ensure stability, each assembly was located in, and ran in, sliding door track runners, attached vertically to the rear wall in the line of travel. The hydraulic plinths were of standard design, as supplied to hairdressing salons. Final connections for piped services such as water and waste to the sink were effected using flexible pipes. Height adjustment of the ironing board was achieved merely by securing a ladder-type assembly to the wall and employing timber brackets on the ironing board itself, which would locate in the rungs of the ladder at any desired height.”

Making a useful contribution

Modestly describing he and his fellow engineers’ efforts in the design and creation of the bespoke equipment described in the article, Amos Millington said: “These designs for the disabled and infirm may seem but a drop in the ocean when compared with what has been, and is being, developed by specialist departments and manufacturers, but hopefully it illustrates that a Works Department can make a useful and practical contribution to designing that ‘one-off’ item which may be needed in the care of the disabled person.”

Another interesting paper that Amos Millington provided to me was co-written by he, Tom Carnwath, and Ted McGuinness of the Trafford Healthcare NHS Trust (respectively, at the time, Estates director, Clinical director, and General Manager, Mental Health, at the Trust), and centred on a new psychiatric unit commissioned in 1992 on a greenfield site within the grounds of the Trafford General Hospital. This article, titled ‘Making Hospitals Safer For Patients’, was published in issue 22 of Psychiatric Bulletin in 1998, and focused on one of the perennial concerns for healthcare estates departments – fire safety; it considered the importance of fire doors being fit for purpose in helping to limit the spread of smoke and toxic gases in the event of fire, while emphasising the need to minimise the chances of parts of self-closing doors being used as a ligature point. ‘

Official guidance of the time

‘During the design stage’, the authors note that ‘reference was made to the appropriate Government documents’ – namely HTM 81 (1987), HBN 35 (1988), and to the local authority and local fire authority for Building Regulations approval. The unit in question was designed to offer a ‘more domestic’ environment than the ‘old’ hospital it replaced, with particular emphasis on landscaping of outdoor areas and internal décor and furnishings, with all patients accommodated in single bedrooms. In line with official guidance at the time, the doors fitted to each bedroom had a 30-minute fire delay rating, and a one-way observation facility. The authors add: “As these were fire-rated doors, the fire authority advised fitting automatic door closures. The devices comprised a spring mechanism attached to the top of the door, connected to the door frame by upper and lower short projecting arms, joined at the end to form a moving ‘V’ shape. Each room also contained an automatic smoke detector linked to the main fire panel.”

‘Two problems’, however, emerged – many patients found the observation facilities ‘intrusive’, and rendered them ineffective by hanging clothes and other items inside their doors, which meant staff had to open the doors regularly for observation, disturbing sleep at night. There was also a risk that the door closure mechanism could be used as – via ligature – as a potential means of suicide. On the observation front, to avoid disturbing the patients’ sleep, night nursing staff began laying a towel between the door and its jamb, but this negated it effectiveness as a fire door.

Fatal incident

The article went on to explain at that, ‘although not considered at risk of suicide’, a patient hanged himself using the top projecting arm of the automatic door closure in a first floor bedroom. Under the weight of his body the arm ‘bent down’ over the door closure mechanism, and effectively jammed the door closed. External access to the room from outside via a window was impossible, since it incorporated a restricted opening mechanism, and it took 45 minutes for staff to get the door open, by which time any hope of resuscitation had passed.

The subsequent hospital review heard evidence that the self-closure of doors was required for fire safety. Potential alternatives to the current mechanism were one internal to the door, or a closure in which the arms folded flat against the door when closed. Replacement with internal fittings ‘would have been very expensive’, and the other type of fitting, the panel was informed, would still provide the facility for suspension of a rope or cord, even though the closure arm would no longer project from the door.

Balancing the benefits with the risks

The report adds: ‘No description of similar events in hospitals was found in Department of Health Hazard Notices or Safety Information Bulletins. The panel therefore took the view that they had to balance benefits and risks, and recommended that the (existing) door-closing devices be retained. Panel members also recommended a ceasing of the practice of keeping doors open with towels.’

Unfortunately, a year later another patient hanged himself in the same way, after which the review panel was reconstituted, and now recommended replacement of all the implicated door closures. This time, however, it was decided to drill a hole through the bottom arm of each door closure, thus weakening the arm when subjected to a vertically applied load, and causing it to collapse immediately, which, it was anticipated, would free up the top arm to bend downwards, ‘and hopefully tear the top arm fixing screws out of the door frame. However, the article explained, ‘as this was unproven, it could not confidently be adopted without much further research’.

Change in guidance pointed out

The authors explain that discussion also took place with the Estates Directorate’s officer responsible for fire advice and Building Regulation standards, who pointed out a change in Government guidance. The new advice stated that ‘with the exception of fire doors to patients’ bedrooms, and doors kept locked shut, fire doors should be fitted with an automatic self-closing device (HTM 81, 1996)’. As a result, and with the fire authority’s authority, the door closures were removed, ‘thus saving the Mental Health Directorate many thousands of pounds, and staff and patients much inconvenience’. The article concludes: ‘In consequence, a suicide risk was removed, and patients could once again be observed without their sleep being disturbed by self-closing doors.’

A 'tightrope to be trodden'

The authors say at the article’s conclusion: ‘Such then is the tightrope to be trodden when planning and equipping a health facility for the mentally ill; managers and clinical staff must take care that one risk does not arise when another  disappears’. Today’s healthcare estates professionals no doubt face many similar challenges.

Amos Millington goes on to explain in his second letter – with which he enclosed a number of interesting ‘snippets’ of information, plus both black and white and colour ‘archive’ photographs taken at various points in his career: “In 2001 I was invited by Sodexo to act on a consultancy basis to prepare part of their PFI bid for the new Royal Manchester Children’s Hospital. My brief was to prepare the technical specifications for the Facilities operation (engineering services etc.) of the new hospital. I worked from home, touching base with Sodexo’s Manchester office on a regular basis. This commission lasted about two years.”

He concludes: “It was very satisfying to be able to use my knowledge and experience gained over the 35 years I worked in the health service. In 1985 I became registered as a Chartered Engineer and a member of the Institution of Mechanical Engineers.

“I still,” he adds, “have the opportunity to put my knowledge and experience to use serving as a member of the Diocesan Advisory Committee (Manchester Diocese), which adjudicates proposals for changes / alterations for C of E places of worship.”

Written by Jonathan Baillie, Editor of HEJ (featured in August 2018)