Can we face the truth about the NHS?

Published by The Independent (5th January, 2015)

Books about brain surgery are not usually best-sellers. But when the newspapers did their annual Christmas round-ups for readers, I noticed one book on this esoteric subject being repeatedly mentioned by critics and celebrities. So I bought Henry Marsh’s Do No Harm, devoured it in two days and now understand all those eulogies for the veteran neurosurgeon.

It is an astonishing memoir, a searingly honest book from a senior doctor that offers intense insights into life and death. With candour and compassion, Marsh draws the reader into agonising decisions over delicate, microscopic surgery that he compares with bomb disposal work, such are the catastrophic consequences of mistakes. A brilliant and unforgettable work, it fully deserves all the praise.

David Cameron also read it over Christmas, as he revealed in interview with the Mail on Sunday. Like me, he has been lauding it to friends and colleagues; he told one that he was moved to tears by the tale of a heavily pregnant mother who died of a sudden hemorrhage after the delivery of her child and seemingly successful surgery to remove a brain tumour.

Yet what a contrast this physician offers to the puerility of political discussion on the National Health Service, especially as the election campaign kicks off. Politicians hurl insults at each other while professing adoration for a sanctified service, yet there is no real debate on how to save our health system amid soaring costs and demand. Instead we just get froth, such as Labour’s pathetic posters implying the Tories want to eliminate the NHS or Nigel Farage’s repulsive attack on foreign staff.

The doctor’s book raises important and timely issues. For a start, there is the need for honesty – something sorely missing from most political discussion on healthcare. One astonishing aspect about Marsh’s memoir is his admission of mistakes that “wrecked” lives. At one point he writes about visiting a nursing home outside London filled with badly brain-damaged people and observing, to his dismay, that five names on doors are former patients.

The best way to reduce mistakes is to learn from them, to accept human fallibility, while extending transparency and speeding up compensation when needed. Jeremy Hunt, the Health Secretary, has referred to the model of the Virginia Mason hospital in Seattle, which transformed services following a fatal bungle by encouraging staff to report mistakes with no fear of repercussion. Yet the NHS clings to a culture of cover-up despite the deadly mistakes of Mid-Staffordshire – still hounding whistleblowers rather than listening to them.

Marsh is unusually responsive to patients trapped in terrible predicaments, influenced by the trauma of his own son needing brain surgery at three months old. Years later he watched another child bleed to death in the same operating theatre, having the same operation performed by the same surgeon. He appreciates the need to respect fearful patients and relatives, even when anxiety turns to anger. And he knows the huge difference made by decent hospital environments, comparing them to prisons and creating a small roof garden at his own unit.

The surgeon takes his scalpel to the NHS’s bumbling bureaucracy as he highlights ignorant edicts, daft targets and operations delayed by box-ticking and bed shortages. The anecdotes are revealing: this top surgeon wastes time hunting down patients lost in his own hospital, patients are pointlessly shunted between hospitals and endless computer problems impede work. Visiting Ukraine, he finds a neurological hospital with 400 beds compared with 50 in his own unit – which is one of Britain’s biggest.

He tells how his chief executive – “the seventh since I became a consultant” – issued a 22-page dress code and threatened disciplinary action against consultants who wore ties or wristwatches. Marsh insists there is no evidence that such items contribute to infections, then discloses that the CEO took these points so seriously he started dressing as a nurse and following them on ward rounds. Such attitudes have driven him from the NHS.

There need to be regulations and management, not least since one key cause of failure has been the arrogance of all-powerful doctors. As Marsh points out, he grew wiser and less hasty with age; he even questions if some great surgeons are psychopaths such is their lack of concern with botched procedures. But international studies show the best managers are those with clinical training, while there is no doubt red tape, misguided targets and poor management continue to curse the NHS.

Marsh also questions how greed drives some consultants to carry out unnecessary private operations. Yet the biggest questions he raises are whether we need to perform many treatments that keep people alive, especially when it is just for a few miserable months or with extreme brain damage. He shows operations can take place because doctors and families are afraid to confront reality or hold painful discussions, and says what may seem a “successful” operation can look more like “a human disaster” several years down the line.

On the surface this is merely the elegant memoir of a brain surgeon. Yet an extraordinary work raises issues of profound political and societal importance that are the legacy of an ageing society, technological advance, twisted attitudes to disability and the skills of those such as the author. More politicians should follow the Prime Minister’s lead by reading this work; some might even be spurred to entering a debate suffering severe paralysis. “Do no harm” is a good mantra for politicians as well as physicians.

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