Profile: Ara Darzi

The Sunday Times
June 29, 2008

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.