Most surgeons don't get involved with politics - they are too busy working and life in the NHS has bred a certain cynicism about policy shifts that come with changes of government. But there are two notable exceptions: Lord Darzi of Denham, the Health Minister, and Sir Bruce Keogh, the medical director of the NHS.

Sir Bruce took one step, becoming an adviser at the Department of Health, and Lord Darzi went a step farther, going down the party political route.

“We're astonished,” says John Black, new president of the Royal College of Surgeons of England. “It's a very unusual career move but we are extremely pleased."

Having two of their own at the top doesn't mean that surgeons have no complaints. Breaches cause most trouble on the shop floor: when cases are about to ruin a waiting-list target and managers allocate the patients to an available surgeon. “Surgeons have lost control of their own waiting lists,” Black says. This inability to follow through patients is a “considerable cause of frustration”, he adds. “Everybody, every doctor, everywhere, just doesn't like this.”

Knives get everybody nervous

Hospital staff dismayed that new legislation could make them legally required to report knife wounds to the police

Background

• Cutting edge champion

• Benefit help for council staff

• What worked for us

• Public opinion: Campbell Robb

Related Internet Links

• Public sector jobs

• Snakes & Ladders

It is also a professionalism issue, since it goes against the desire of doctor and patient to form a relationship that lasts throughout the hospital episode. “An independent, prop-erly trained, confident consultant is the best advocate of the highest standards of patient care on an individual basis. In the hospital, if something isn't going right with your care, a bloody-minded old geezer like me is far more likely to get it put right than the domestic services manager, that's a fact.”

The importance of surgery seems to have been forgotten at some levels - namely in the organisation of cancer services and funding of research. That cancer services are organised around oncologists - who administer radiotherapy and anti-cancer drugs and deal with leukaemias and lymphomas that are relatively rare - is an irritation for surgeons when it comes to the common, solid cancers of the bowel, breast and lung.

“The common cancers that have a one-in-five chance of killing any of us are dealt with by surgeons. There is a reasonable input from radiotherapy, but the input from all these anti-cancer drugs, which cost vast sums, is very marginal.”

To put it into perspective, if all breast cancer patients were given the best surgery alone, seven in ten would be alive in ten years. Add in everything else - radiotherapy, the latest drugs - and it would increase to eight in ten. “I'm not saying they shouldn't have [the other treatments], but the primacy of surgery has never been recognised,” Black says. Bringing all surgical results up to the best would produce greater improvements than those achieved by chemotherapy.

Black emphasises that it's not about making surgeons more skilful, but about knowing what is the best kit and technique to use. For some conditions, the jury is out as to the best operation. A trial to find out is costly - though not compared with the millions spent on developing anti-cancer drugs. “Tiny amounts go into actual technical surgical research. We think the improvement that could be brought about by technical advance is at least as great. And squillions are spent on anti-cancer drugs that might give you six more weeks in the hospice. That sounds a bit cynical and brutal, but it's true.”

As for publishing surgeons' results, as competitive animals they welcome it. But some surgeons specialise in difficult cases and it's important not to discourage that. “You might say that it's terrible if you die, but where operations carry a risk, the disease carries a much higher risk than the operation, otherwise nobody would do it. People forget that.”

Born: February 13, 1944, in Wallsend, Tyne & Wear
Career: Appointed consultant general surgeon in Worcester in 1978; first medical director of Worcester Royal Infirmary; president of The Royal College of Surgeons of England since July 2008.
What he says: “The NHS can be very slow to introduce new techniques - a classic example being laparoscopic [keyhole] surgery for colorectal cancer. We lag behind the rest of the developed world.”
Little-known fact: When he was 8 years old he met Aneurin (Nye) Bevan at his parents' house in Wallsend. Black's father was a local politician.

Explore Public Sector

• How to get a job

Times Recommends

• Inspirational leadership
• How to get a new job
• The reluctant CEO