The first episode with "Smiler".
Smiler's name is Clem Hemingway.
Smiler Stephen Lewis would not be a regular cast member until the season 12 episode A Landlady for Smiler (1990) 2 years later and would stay with the series until the season 28 episode Sinclair and the Wormley Witches (2007) until ill health forced Lewis to leave the series in 2007.
The porter in the lift with the patient, was also a regular background /supporting artist in Only Fools and Horses.