Box-ticking bureaucrats are crippling the NHS... we must give life or death decisions back to doctors: Leading surgeon’s plea as he leaves the health service after 30 years

• 'NHS bureaucracy has made working there feel like swimming in treacle'
• 'Many reorganisations have left a gaping hole at the centre of the health service - leadership'
• 'Ageing population and constant, expensive, technological progress means the NHS will always be in a state of crisis'

By Henry Marsh

Published: 19:41 EST, 15 March 2014 | Updated: 19:41 EST, 15 March 2014

Neurosurgeon Henry Marsh is leaving the NHS after 30 years frustrated at the bureaucracy that he claims is ruining the health service

I have been an NHS brain surgeon for more than 30 years.

Every operation I perform carries grave risks.

The slightest slip can bring paralysis  or death.

I also know that, in many cases, time is vital.

But NHS bureaucracy has made working in the health service feel like swimming in treacle, bringing intense frustration for doctors and danger for patients.

It is only now, as I prepare to leave the NHS, that I feel able to speak my mind.

When I cycle to work in the morning, I never quite know what is going to happen – not only because I can never be certain how well the operations will go, but also because often I do not know whether I will get any operating done at all.

One crucial problem is a chronic shortage of beds.

The other is that the many reorganisations of the NHS have left a gaping hole in its centre – leadership.

We all know effective organisations need leadership.

In the past it was provided – for better or worse – by doctors.

They have now been displaced, but not replaced.

The many thousands of health professionals in the NHS who work so hard for their patients have no real leadership – and that is why the whole organisation seems to be permanently in disarray.

NHS bureaucracy has made working in the health service feel like swimming in treacle, bringing intense frustration for doctors and danger for patients (File photo)

My daily routine illustrates why doctors should be in charge of clinical decision-making in the NHS.

I went in to work one Monday morning to operate.

I was also on call for emergencies.

I knew the hospital was full to bursting and could only hope there would be no emergency referrals.

Three operations were planned – two patients with brain tumours and one with a spinal slipped disc.

The brain tumour patients would need intensive care beds after surgery.

But the last two had been filled with emergencies during the night.

The lives of the tumour patients depended on their being operated on.

If I could not do their operations today,

The ageing of the population and constant, expensive, technological progress means the NHS will always be in a state of crisis (File photo)

I would have to cancel other patients’ operations later in the week, with endless knock-on effects.

The spinal case, who was in severe pain, had already had his operation cancelled twice for lack of beds.

He was very upset when I apologised on the second occasion two weeks ago.

Outside the operating theatres, doctors and nurses looked glumly at a computer.

‘The network has crashed again,’ my registrar Tim told me.

‘I can’t even find the tumour patients,’ my anaesthetist Judith said.

I’d seen them on the male ward but they’d been moved.

Nobody knew where.

One crucial problem is a chronic shortage of beds. The other is that the many reorganisations of the NHS have left a gaping hole in its centre (File photo)

Julia, our bed manager, told me we could do the tumour cases provided we could clear two spaces on the female ward, but that depended on whether we could move some patients back to local hospitals.

I wouldn’t be allowed to start the list until we heard.

In the past, I would jump up and down and shout when we had no beds and we would start anyway.

A bed was always found because one had to be  found.

Now, I would be reported  for bullying.

So we wait until the managerial wheels have ground and a bed has been found.

The end result is the same – emergency cases take priority over non-emergencies.

In the past, doctors could make these decisions quickly and efficiently.

Now, many hours of managerial negotiation are required.

Two hours later, we started operating – it is unusual to start at the official time of 8.30am.

The medical profession has been in retreat for many years, battered by one scandal after another and the rise of the new managerial class. Trust in doctors has been replaced by regulation (File photo)

The first operation was difficult, but once we had finished, Judith sent for the second case.

I was drinking a cup of coffee when Catherine, the registrar taking emergency calls, arrived.

‘There’s a 51-year-old woman with a subarachnoid haemorrhage and acute hydrocephalus.

But there are no Intensive Therapy Unit beds unless you cancel the second tumour op.’ 

I shot off to the anaesthetic room, but the patient had already been anaesthetised.

I either had to cancel his operation or find another ITU bed.

The many thousands of health professionals in the NHS who work so hard for their patients have no real leadership and that is why the whole organisation seems to be permanently in disarray (Pictured is Resuscitation Unit Royal London Trauma Department)

After a 20-minute discussion, we managed to find a bed, which involved moving four other patients around.

Ten minutes later, as I was starting the second operation, Catherine put her head round the theatre doors.
‘They now say there isn’t going to be a bed after all,’ she said.

I groaned.

The spinal case, needless to say, was cancelled for a third time.

In the past, we used to have a waiting list.

My waiting list for spinal surgery was almost a year long (although my offers to come in at weekends and operate free of charge were consistently turned down by management).

The waiting list acted like a reservoir and allowed for the fact that emergencies can come in sudden runs that risk overwhelming the hospital.

But cost-cutting in the NHS demands that we now have no spare capacity and waiting lists are politically unacceptable.

But waiting lists allow surgeons to use their clinical judgment to get through operations in a sensible order.

Patients, politicians and management must accept that emergencies should not have to compete for beds with the routine cases as currently happens.

The central issue the NHS faces – demand for healthcare outstripping its supply – is by no means unique to this country.

The ageing of the population and constant, expensive, technological progress means the NHS will always be in a state of crisis.

The central issue the NHS faces, demand for healthcare outstripping its supply, is by no means unique to this country (File photo)

Re-establishing clinical leadership by doctors will not resolve these problems but it would at least lessen their impact on patients.

The trouble is that the medical profession has been in steady retreat for many years, battered by one scandal after another and the rise of the new managerial class.

Trust in doctors has been replaced by regulation.

Of course doctors need regulating, but so much of today’s regulation is absurd.

In order to be revalidated by the General Medical Council as a brain surgeon, I have had to pass  a test that includes questions about the shape of stool specimens.

My colleagues and I were recently threatened with disciplinary action for wearing wrist watches and not being ‘bare from the elbows’ when merely talking to patients.

Next year, with considerable regret, I will leave the health service after 36 years.

Like most doctors, I feel strongly that the principles of the NHS – free treatment for everybody irrespective of class, race or wealth – are essential to a civilised society.

I intend to spend more time working in Ukraine and other countries where life is much more difficult.

Countries which help you appreciate – despite its many faults and problems – the value of our National Health Service.

Henry Marsh is a consultant neurosurgeon at St George’s Hospital, Tooting. He is the author of Do No Harm: Stories Of Life, Death And Brain Surgery, Weidenfeld & Nicolson £16.99 and ebook £8.99.