‘Health shouldn’t be commercial’ | Coptic Medical

‘Health shouldn’t be commercial’

As Sir Magdi Yacoub leaves the NHS, he says that bureaucracy is stifling the health service.

Professor Sir Magdi Yacoub is not easy to pin down. He refuses to carry a bleeper, and the mobile phone that his son bought him is lying unanswered on his desk. He rarely gives interviews, and I am starting to think that this one is doomed when, 45 minutes past the appointed hour, he shuffles through the door.

I know, because his secretary has told me, that he has come from talking to the parents of a desperately sick child. Some members of his team want to operate; Yacoub believes that to do so would have fatal consequences.

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His large, brown eyes are weary but his manner is courteous and unhurried. He has the enviable knack of making whomever he is with feel that they have his undivided attention.

From this week, for the first time in more than 30 years, Yacoub’s working day will not be dominated by life-and-death decisions. At 65, the world’s foremost heart surgeon has been forced to retire from the National Health Service. He will still practise privately but will deal with NHS patients only if colleagues call upon him for advice. Nor will he be able to conduct the heart and heart-lung transplant techniques that he pioneered — transplant surgery in the UK is almost exclusively an NHS service, and thus will fall outside his sphere.

That Yacoub has clung to his NHS post until the last possible hour (his 65th birthday was last November but, under the rules, he has been allowed to stay on until the beginning of the academic year) suggests that he is leaving with some reluctance. Dr Gavin Wright, a consultant anaesthetist who has worked alongside him for 15 years, says: “Harefield (Hospital, part of the Royal Brompton and Harefield NHS Trust) owes a huge amount of its current status to him. To be king one day and the next day be told that you cannot operate here is hard. I think he is going to be very sad not to be able to do what he is so capable of doing.”

Yacoub prefers to play down any feelings of indignation. “I resent it slightly, but not badly,” he says. “I will miss my NHS patients because it is a sort of love relationship that I have had with them for a long time. But I have so many articles to write, so much research to do, so I won’t be working less in any way. I am just changing direction.”

Yacoub will go down in history as one of the most innovative surgeons of his generation. Cardiologists from around the world have vied to join his team, but only those who shared his inexhaustible work ethic and hunger for progress made it. A man of phenomenal stamina who never sleeps more than five hours a night, he is, according to those who know him well, stubborn, demanding, hopelessly disorganised and a poor delegator. But he is also gentle, unflappable, logical and audaciously persistent.

Most good surgeons are essentially good technicians,” says Dr Rosemary Radley-Smith, who has known him since they trained together as junior doctors. “Magdi has amazingly quick hands, but he also has ideas. He has always wanted to challenge boundaries.”

Ministers and academics from around the world court his opinions. In his native Egypt he is arguably more famous than President Mubarak. Diana, Princess of Wales, idolised him; she had observed him operate, befriended his patients and was about to accompany him on a charity mission when she was killed.

Despite being held in such reverence, Yacoub is genuinely and intensely shy. His colleagues at Harefield were so anxious that he would not turn up for his own “change of direction” party last week that they stole his car keys from his jacket pocket while he was in theatre. “It was the only way of preventing him from leaving the building,” says Radley-Smith. A few days earlier I had watched him at a reception for supporters of The Chain of Hope, the children’s charity that he established. His entrance was so low-key that it was several minutes before those waiting to see him realised he was there.

This reticence can be traced back to boyhood, when the young Yacoub would sometimes go for days without speaking to anyone. His worried parents considered taking him to a psychiatrist. “They didn’t, but I remember being frightened at the suggestion,” he recalls. “I was much bigger than my peers, so people expected more of me. I was the boy who would sit at the back of the class and say nothing, because who was I to say anything? I was too reflective.”

When he speaks it is with a heavy accent that makes him sound more sombre than he really is. We are in his office at the Royal Brompton Hospital, an untidy room where every surface is piled high with scientific papers, and unanswered letters spill on to the floor. His late father, who was a surgeon in Egypt, once told him that he was too chaotic to make it in medicine, a remark that served to spur him on.

His interest in heart surgery stemmed from family tragedy. When he was seven he witnessed the death of his 22-year-old aunt from mitral stenosis, a narrowing of the heart valve. His father told him that the condition was treatable elsewhere, but not in Egypt. This fact had a profound impact, both on his choice of career and on his decision to found The Chain of Hope, whose raison d’être is to introduce routine life-saving treatment in countries with no cardiac facilities.

Yacoub studied medicine in Cairo and later spent a year in Chicago, where he nearly stayed. But the brash US style did not suit his natural reserve. “I interacted with the intellectual milieu in England, it was my type of thinking, my philosophy, everything here suited me,” he says.

Within a week of his arrival at Harefield Hospital in Middlesex in 1969, it was obvious to everyone that the new chief cardiac surgeon was going to change things. “It was like having a turbo charger installed in a poop-poop engine,” says a former colleague.

Christiaan Barnard had performed the first heart transplant two years earlier and Yacoub was convinced that it was an operation whose time had come. But a series of subsequent disasters made the Government wary. At one point, after a baby boy died on his operating table, heart transplants were banned indefinitely. It was 1980 before he conducted his first successful heart transplant. The first heart-lung transplant came three years later, in December 1983.

The early triumphs were beset by financial difficulties, with no NHS funding at all for the first three years. The cash was raised by plant sales at the local church, hefty donations, and by Yacoub and his team delving into their own pockets, often handing over fees from foreign patients to buy crucial equipment.

And yet, Yacoub says: “I am a total believer in the NHS. I have seen many healthcare delivery systems around the world, and I believe firmly that the NHS is the best — as a concept.”

He would like to see the Government spend more, and regularly lobbies the Health Secretary, Alan Milburn. But he accepts that there have to be limits. “They are trying very hard, I do believe that. But now that I am reflecting, I can say what I want, and the other thing the NHS needs badly is co-operation between administrators and doctors and nurses. There is resentment and mistrust between the professionals and the administrators, and even the Government. It is counterproductive.

Rather than being vindictive and saying we will have regulations on either side, separate groups running the NHS, there must be more co-operation and dialogue. To a degree this is happening, and I hope it will develop more, rather than being led by the book, as happens now.”

He believes that unless the situation improves, trust between patients and doctors is in jeopardy. “In terms of the doctor/patient relationship and the NHS, that trust, that dialogue — I am worried about it,” he says. What is his worst-case scenario? “That health becomes a commercial thing that you buy, and you expect something in return. I saw that when I was in the States. People felt that they bought your services.” And that compromises healthcare? “I am sure of it.”

His own career at the cutting edge has depended heavily on the trust of his patients. Inevitably, he has failed them many times. “You see that there is a solution and then somebody says ‘But this has never worked before’. Of course it has never worked before, but without experience there can be no progress. They say ‘show us the figures’. And I say ‘I can’t show you the figures, but I can show you reason, and I can show you that if you don’t do anything, this patient will die’. The learning curve is painful but you just have to work through it with your colleagues. Eventually you reach a point where the risk of not operating is higher than the risk of operating. But you will never get the risk level down to zero.”

Perhaps the greatest vindication of Yacoub’s work is the “switch” operation, which he developed to cure babies born with the main heart vessels connected the wrong way round. The first three patients he operated on died. But, convinced by the logic of the technique, he persisted. Today the “switch” is more than 90 per cent successful and has saved thousands of children from a slow and inevitable death.

His success has earned him detractors. “A lot of people are jealous and exasperated by his antics,” says Wright. “They don’t understand that his ideas are often good, that he is seeing the future while they are living in the present. His enemies will miss him more than they realise.”

Surgeons are notoriously flamboyant as well as competitive and, despite his modest demeanour, Yacoub does have some extravagant tastes. He keeps an old Lamborghini and shares a Ferrari with his son, Andrew, an airline pilot. “I like the mechanical efficiency. It is not just a flamboyant thing,” he says. He is also passionate about orchids. “If I go into my orchid house late at night, I switch off completely.”

He and his wife, Marianne, also have two grown-up daughters: Lisa, who works for The Chain of Hope, and Sophie, a doctor. They are clearly a close family but there is no chance that, having dispensed with his NHS workload, Yacoub will be spending more time at their Ealing home. “It is a sore point. My wife is very outspoken, but she gets over it,” he shrugs.

His diary is already bursting with commitments. He will increase his Chain of Hope missions from three to nine a year (as well as bringing children to the UK for treatment, the charity dispatches volunteer medical staff to poor and war-ravaged countries to perform operations and to train staff in local hospitals).

His other focus will be the Harefield Research Foundation, which he set up in 1993. Also called the Heart Science Centre, it houses 60 leading scientists from around the world and is about to undergo a £5.5 million expansion. Successes so far include the development of the artificial heart and molecular research that is helping to reverse heart failure. Yacoub is its driving force. “He co-authors all the articles and knows as much as the researchers. He is not just a figurehead,” says the chief executive, Ray Puddifoot.

Physically, Yacoub knows that “I cannot do things I used to do”. But his quick mind has not deserted him. “I forget names of people, but the science I remember, every bit. I can say that in 1965 something was published somewhere and put my finger on it. That gives me great joy. Experience compensates for tiredness.”

If his predictions are correct, within a generation his research team and others will have identified the causes of heart and lung disease, thereby making many of the surgical techniques he pioneered redundant. “People talk of the golden age of cardiac surgery, but I say the golden age is now. What is happening today is massive,” he says. “I just wish I was starting out all over again.”

Donations to The Chain of Hope can be sent to Emma Scanlan at The Royal Brompton Hospital, South Parade, Chelsea, London SW3 6NP; 020-7351 1978

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