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Carving up the NHS



I am full of admiration for my surgical colleagues. They work long and hard and perform wonders to help put the human body together again. The surgeons I knew and know were and are wizards with their hands, and they perform Herculean tasks to save lives. I have many patients who are walking about today who would be dead or maimed had it not been for the surgeons’ skills.

The oft-repeated adage that a surgeon is ‘a physician who can operate’ has always been wide of the mark. But surgery is glamorous: it is doing something active, and surgeons often deride other doctors with the taunt that all they can offer is ‘pills, promises and post-mortems’. Many young medical students want to do surgery because of this glamour.

Then, sometimes, surgeons stray into other fields of medicine. There are many examples of surgeons who have devoted their time after they have finished doing surgery to developing policy and giving advice – advice that has often been pretty catastrophic for the NHS and their colleagues.

Some examples of this phenomenon:

Liam Donaldson started training as a surgeon, and was an anatomy demonstrator (a frequent step to a surgical career) when I was a medical student.

He subsquently left surgery, went into public health and eventually became the Government’s Chief Medical Officer. He was responsible for advising the Government into restructuring the training of doctors, a system that has been widely acknowledged as to being utterly disastrous. He also presided at the time of the development of the Private Finance Initiative, and the enhancement of the purchaser-provider split. Finally, he oversaw the swine flu panic. Now knighted.

Bernard Ribiero used to be a surgeon who led the Royal College of Surgeons, and was an enthusiastic advocate of the Health and Social Care Bill, that is currently wreaking havoc with the NHS. He now sits as a peer representing the Conservative party.

Ara Darzi is an Armenian-born, Irish-trained, London-based specialist abdominal cancer surgeon who is rightly praised as an intelligent and innovative clinician. He was asked by Gordon Brown to advise the Government on reconfiguring the NHS and suggest ideas to help with this. He came up with an idea of polyclinics – a concept that was impossible and hopelessly ideological. These were pushed through against most people’s advice, and have proved to be ineffective and expensive. He has returned to the thing he is good at – surgery. Now in House of Lords.

Sir Bruce Keogh used to be a cardiac surgeon, and now sits in the Department of Health’s plush offices pontificating about how the NHS should be run.

His latest idea is to suggest that GP surgeries are open seven days a week. So that will be an extra two days, or an increase in opening times of 28%. Has he thought this one through yet, or is he flying a kite?  Will he be able to guarantee that there will be enough extra reception, nursing and secretarial staff to support the extra medical staff required? Where will the money for this idea come from, as it will be much more expensive?

These four surgeons have been active in the last ten plus years presiding over the descent of the NHS into chaos. They apply their surgical mentality to systems, without reflecting or measuring the consequences.

The Jobbing Doctor is a GP in a deprived urban area of England. You can follow him on Twitter @jobbingdoctor.