ARA DARZI: AN INNOVATIVE SURGEON WHO LED REFORMS OF UK’S NHS
Sarah Boseley

The Lancet
September 26, 2009 – October 2, 2009
UK

When Ara Darzi was summoned to the UK Prime Minister’s office in June,
2007, he thought he was going to get a slap on the back for his radical
ideas for the National Health Service (NHS) in London. Gordon Brown,
to his astonishment, asked him to be a Health Minister. Darzi recalls
how "I couldn’t keep a straight face. I did laugh. I didn’t know if he
was serious". But Brown was serious and told him to take a few days to
think about it. Darzi, however, says "I came to the conclusion that
this is not something I wished to do. I had at that stage built a
very strong academic department of surgery which was internationally
competitive and I didn’t see myself giving all of that up at my age
to go and pursue a career in politics. That was the first reason. The
second reason is I always did what I knew I could contribute to and
politics wasn’t an area that I had any knowledge in and it wasn’t an
area that I could describe was on one of my lists to do in life."

But when Darzi went back to Brown to say that he could not give up
medicine, Brown said he could do both, although the clinical work
must be unpaid.

If Darzi was a reluctant minister, he was nonetheless a dedicated
one with an impressive work ethic. He maintained a normal
surgical workload, operating all day Friday and Saturday on major
cancer cases and visiting the ward on Sunday. By 0630 h on weekday
mornings he had seen patients and was on to his academic and clinical
paperwork, finding time to peer-review for The Lancet before going to
Whitehall. He assiduously read his red box and went to official dinners
most nights-"that’s the bit I least enjoyed", he says. Others suggest
Darzi, who says he has no political persuasions, did not relish his
role as a Labour spokesman.

But for Darzi, the job was a focused, challenging project: to
undertake a review and put in place reforms to embed quality as
the fundamental organising principle of the NHS. The frustrations
came not from political colleagues and civil servants, but from his
general practitioner (GP) colleagues at the British Medical Association
(BMA). "I didn’t expect that", he says. He was particularly concerned
because the biggest area in need of reform was primary care, requiring
investment and the kind of technology dear to Darzi’s heart, such as
imaging and computer-linked diagnostic tests. He was disappointed
by petitions against the closure of GP surgeries generated by the
BMA. A doctor, Darzi says, must "never, never exploit an individual in
need…I felt it was exploitation based on fear". And his opponents
were wrong to portray the fight as a surgeon against GPs, he adds,
"My whole thinking and philosophy was to support primary care."

After a year of "hard, hard work", the NHS Next Stage Review
was published in June, 2008, to acclaim. For the first time,
NHS organisations must publish quality accounts. Institutions
and individuals will be rated by how well they perform, not
just how many patients they process. Professor Sir Bruce Keogh,
cardiothoracic surgeon turned NHS Medical Director, says he thinks
Darzi’s contribution to the quality agenda has been huge: "What he
has done very effectively is change the mindset." Niall Dickson,
chief executive of the King’s Fund, says although it is early days
to judge the reforms, Darzi "has challenged in a very public way the
idea that clinicians’ performance is universally good and recognised
that we need to measure it". But Dickson adds that "his report was
written before the financial wheels came off" and sees a danger that
managers and doctors will slip back into old ways as balancing the
books becomes harder. After publication of his review, Darzi saw
his job as mostly done, but stayed for a further year to steer the
implementation of his reforms. Never having intended a long political
career, he resigned in July.

49-year-old Darzi has pursued quality and innovation throughout
his career as a world leader in minimally invasive surgery and
robotics. He jokingly calls himself "a failed engineer"-his father’s
profession, which he resisted entering. One of the happiest of his
many accolades has been an honorary fellowship of the Royal Academy of
Engineering. Darzi grew up in a Christian Armenian community in Iraq,
a descendant of those who fled genocide from the Ottoman Turks in World
War I. Aged 17 years, he moved from his Jewish school to study medicine
and surgery at the Royal College of Surgeons in Ireland and became
fascinated with minimally invasive surgery at a time when it was viewed
with suspicion and persuaded others by his results. After moving to the
UK as a consultant surgeon at the Central Middlesex Hospital, in 1991,
he wrote a seminal paper of his first laparoscopic colorectal cancer
resection in 1992. By 1994, he was an honorary consultant at Imperial
College and the Royal Marsden. Knighted for his services to surgery
in 2002, he then became the Paul Hamlyn Chair of Surgery at Imperial
College and professor of surgery at the Institute of Cancer Research.

Although he enjoyed his ministerial experience, Darzi says he can now
concentrate on his passion for advancing the revolution in robotics
and image-guided surgery, together with engineering colleagues at
Imperial and abroad. "We push the boundaries", he says. His group
has developed robots that can operate guided by the surgeon’s gaze
and a wireless body sensor network to monitor a patient’s recovery
from abdominal surgery at home. But politics may never completely go
away. On his resignation, Darzi was appointed UK Global Ambassador for
Health and Life Sciences, and during his summer holiday in Portugal,
he found himself writing a rebuttal of US criticisms of the NHS.