LABOUR'S FAVOURITE DOCTOR PRESCRIBES STRONG MEDICINE, BUT PATIENTS AND HIS COLLEAGUES MAY NOT SWALLOW IT
The surgeon Ara Darzi likes to listen to Pink Floyd while he wields his scalpel. After a year-long operation, the music stops tomorrow when he publishes a review of the NHS that aims to revive the ailing patient on its 60th anniversary.
One of Gordon Brown's first acts as prime minister was to call on Darzi to undertake the task. He was duly ennobled as Lord Darzi of Denham and made a health minister. Brown's request "gobsmacked" the 48-year-old clinician, but stranger things had happened to Darzi.
Born in Iraq to Armenian parents and raised in the Russian Orthodox faith, he went to a Jewish school before studying medicine in Ireland and becoming an internationally renowned pioneer of keyhole surgery in London. His robot-assisted techniques have earned him the nickname "Robo Doc".
His years in Dublin have left him with an Irish lilt that marks his affable manner. Courteous, brainy and driven, Darzi has done nothing to embarrass his patron, unlike Brown's other coopted "outsiders" such as Alan West, the security minister, Mark Malloch Brown, the foreign minister, and Digby Jones, the trade minister.
He achieved heroic status last November by helping to save the life of Lord Brennan, a Labour peer, who had a heart seizure after attacking the Human Fertilisation and Embryology Bill in the Lords.
"I could see from the corner of my eye Lord Brennan was not very well," Darzi recalled on Desert Island Discs last week. "He collapsed. You just forget where you are. So I started jumping on top of benches and ended up doing a mouth-to-mouth and heart massage to see if I couldn't get him back." After several minutes of futile attempts, Darzi called for an electric defibrillator ("I used the F-word") and revived Brennan. "As I was shocking him I saw the Archbishop of York doing his prayers."
Darzi continues to perform operations on Fridays and Saturday mornings in London: he is honorary consultant surgeon at St Mary's hospital, professor of surgery at Imperial College and chair of surgery at the Royal Marsden. The rest of the weekend is set aside for his wife Wendy and children Freddie and Nina.
Having left political meetings abruptly when summoned for emergency operations, he is clear where his priorities lie. He does a humorous impression of aghast expressions in Downing Street when he raced off to treat a colleague. "From day one I told them: if one of my patients [needs attention], that comes first."
Darzi seemed in need of pastoral intercession himself last October when the interim report of his NHS review proposed 150 polyclinics or "super-surgeries", open all hours and partly run by private enterprise, which would bring together family doctors and specialist consultants. Amid talk of a mass walkout from the health service and calls for Darzi's resignation, fears were raised that the innovation could spell the end of small practices run by family doctors, replacing them with a wasteful, bureaucratic system.
The clamour has increased in recent weeks, with the British Medical Association's "save our surgeries" campaign raising 1.2m signatures. Scaremongering, protested Darzi, who accused doctors of "breaking their professional vows" by urging patients to oppose the plan. In last week's Sunday Times he singled out some doctors as "laggards", so intent on protecting their "professional boundaries" that they obstructed new treatments.
Since Darzi mooted the idea of polyclinics, all 31 London health trusts have submitted plans for the super-surgeries.
Tomorrow's review is expected to guarantee minimum standards of care, setting out the rights and responsibilities of patients - although plans to force people to lose weight or give up smoking in exchange for healthcare have been rejected. Darzi also proposes to give a bigger role to nurses.
Under his slogan "localise where possible, centralise where necessary", Darzi believes doctors and nurses must treat patients as customers, inviting them to grade the quality of their care so others can shop around: "When you go to a restaurant you look at a website and find out exactly what people said about that restaurant."
He visualises the NHS structured like a pyramid with, at the bottom, patients receiving more care in the home - and being allowed to die there, if they wish - while the top tier would consist of centres of excellence along the lines of the Royal Marsden. Complex surgery and critical care for serious illnesses would be provided by big hospitals serving a million or more people.
Critics say aspects of the plan smack of John Major's "patient's charter", introduced to little effect in 1991. They also cast doubt on Darzi's avowed reluctance to take on a political role ("I had sleepless nights thinking about this"), claiming he was used as a pawn by the government in the 2004 Hartlepool by-election to reinforce its reassurances that the town's University hospital would not be closed.
His detractors point to a telling remark by Alan Johnson, the health secretary, on Brown's appointment of nonpoliticians to his "government of all the talents", known by the acronym "goats". Johnson told The Guardian in January: "We don't have a goat problem in this department. Our goat is tethered."
Darzi was born on May 7, 1960, into a family that had fled to Iraq from the genocide of Armenians by Ottoman Turks in 1915. His father's work as an engineer, developing power stations, often took the family abroad, but Baghdad was then a stable cosmopolitan city in which Saddam Hussein had yet to appear.
Darzi's Jewish school was highly disciplined: "Very academic, not even a playground. There was no such thing as sport, really." At home he studied Armenian and served as an altar boy in church. He was expected to emulate his father's career, but while in hospital with a life-threatening case of meningitis, his doctor planted the idea of medicine.
His parents had friends in Ireland, which they considered safe for his studies, so at 17 he was packed off to Dublin: "Rain, cold, miserable." Soon he began to fall in love with the place, visiting little towns in a sailing boat and frequenting Durty Nelly's bar in Limerick, which he had been told had the most beautiful girls. Friends called him "Dara Darcy, the dark Paddy".
To his mind there was a curious parallel between the conflicts in Ireland and Iraq: "Most of the troubles back in Iraq were between the factions of the Shi'ites and the Sunnis. In Ireland, is was between two factions of Christians. That had no logic to me. I found that quite challenging."
As a student at the Royal College of Surgeons, Darzi took to hanging around hospitals to see if he could make himself useful and experience the reality of being a doctor. After conducting his first appendix operation, a year before qualifying, he said: "It was the most exciting day of my life."
He met Wendy, the Protestant daughter of a dentist, at a college function. Their subsequent marriage in 1991 posed interdenominational problems: "We had to find a church in Ireland to get married, and also to have an Armenian patriarch to come and give us a blessing."
Darzi first encountered keyhole surgery in Dublin. "Surgery in those days was a big cut - the bigger the cut, the more macho the surgeon was." Enthused by accounts of less invasive techniques, he did his first keyhole operation and was struck by the patient's quick recovery time. "The same day we had done an open operation on the patient next door. It was like chalk and cheese."
Moving to England to gain experience, he encountered resistance to keyhole surgery from his superior, who pronounced the procedure dangerous, until Darzi won him round by conducting an operation with him. "Very quickly we realised this was the tip of the iceberg." The medical director of St Mary's hospital was so thrilled by the publicity that he offered Darzi a consultancy at the youthful age of 31. The student decided to wait until he had qualified a year later.
Showered with awards, in 2002 he was knighted for services to medicine and surgery; in 2003 he became a British citizen.
Darzi says his review of England's healthcare is like no other, incorporating the views of 2,000 medical experts. His watchwords are courage, innovation and best practice. "I am a great believer in bottom-up. When I want to change something in a ward environment, I go and talk to the student nurses on the ward, because they know exactly what is happening on the ward."
It sounds invigorating, but whether doctors can surmount their "change fatigue" and give Darzi a sympathetic hearing seems open to doubt.
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