Dr No started his medical career in a surgical specialty (O&G), and in many ways, he still thinks like a surgeon. Physicians, with their pills and potions, and frock coats and baffling cardiac murmurs, were and still are quite beyond him. So he naturally expected that he would understand the Royal College of Surgeons stance on the Health and Social Care Bill. But instead he finds today it is the RCS’s position that is baffling him. If ever surgery was called for, it is a for a wide resection of the malignant tumour that is the Health and Social Care Bill. Yet the RCS wants to not just leave the tumour in place, it wants to encourage its growth. Dr No is indeed baffled.
Many surgical mistakes follow from making the wrong diagnosis. Could it be that Dr No’s former colleagues, now installed the top drawers of the RCS, have made the wrong diagnosis? Could the surgeons believe – or perhaps their pathologists have reported – that the tumour was benign? This seems hardly credible. The cardinal features of malignancy, of invasiveness, metastasis and destructiveness, and of rapid unregulated growth and poor differentiation to function, are already, even before the Bill has been enacted, plain for all to see. There can be no doubt about the malignant nature of the tumour, except to perhaps the most blinded eye, and surgeons are not blind.
So the surgeons must know the true nature of the diagnosis, and that makes their refusal to operate, to excise the tumour, even more baffling. Could it be that they believe the tumour has spread so far that we are now beyond any hope of curative excision; that ‘heroic surgery’ might harm, or even kill, the patient?
There is evidence this might be part of their thinking. In his latest President’s Newsletter, Professor Norman Williams writes: ‘to stop the bill at this late stage, even if that were possible, would create chaos. Structural changes have already been implemented on the presumption that the bill will pass; to stop now would result in uncertainty and a severe disruption in services.’ The argument, it appears, is that the tumour has got such a hold that to excise it now would do more harm than good.
That is as may be. But, even if true, it begs the question: what were the surgeons doing when the tumour was at an earlier stage, that is, when it was still operable? The answer – it appears – is first looking the other way, and so allowing the tumour to grow, and then actively encouraging its growth.
A year ago, at the time of the Bill’s publication, the College demurred on the broad question of implementation, and called instead for detailed amendments. One might suppose the policy was one of jaw-jaw rather than war-war, even if that policy, a year later, has borne but the feeblest of fruit.
By last October, however, the College position had shifted to one of rapid implementation. A briefing to parliament said: ‘The College has recommended that the plans laid out in the Health and Social Care Bill should now be implemented without any unnecessary delays, otherwise we believe that delays to this process will ultimately be to the detriment of patients.’
So – the College demurred, and then urged rapid implementation of the Bill, with only tinkering amendments. This does seem extraordinary, given that an early survey, albeit with an embarrassingly low (9%) response rate, suggested that the majority of the profession – and presumably that includes a good number of jobbing surgeons – are opposed to the Bill.
It seems even more extraordinary given that the weight of considered professional opinion is that the malignant tumour that is the Bill will, if not halted, lead to untold harm. And no right-thinking surgeon could possibly want the patient – the NHS – to get iller still – could they?
Dr No remains as baffled as ever.