Belfast Telegraph

Surgeon's book cuts to heart of the challenges facing our NHS

"Politicians hurl insults at each other while professing adoration for a sanctified service, yet there is no real debate on how to save it amid soaring costs and demand"

By Ian Birrell

Books about brain surgery are not usually best-sellers but I've 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 a searingly honest memoir 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.

David Cameron also read it over Christmas, and has been lauding it; he was moved to tears by the tale of a mother who died of a sudden haemorrhage 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.

Politicians hurl insults at each other while professing adoration for a sanctified service, yet there is no real debate on how to save it amid soaring costs and demand. Instead we just get froth - 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 issues. There's 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. He visits a nursing home outside London filled with badly brain-damaged people, observing, to his dismay, that five names on doors are former patients.

The best way to reduce mistakes is to learn from them, 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 whistle-blowers.

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.

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 - 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.

Marsh questions whether we need to perform many of the treatments that keep people alive, especially if just for a few miserable months or with extreme brain damage.

He shows how operations sometimes 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 later.

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 PM's lead by reading this work. Do No Harm is a good mantra for politicians as well as physicians.

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