Surgeons' leader is beginning to think the unthinkable: the NHS can be transformed

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The government's controversial proposal to limit private practice by NHS hospital consultants receives unexpected backing today from the president of the Royal College of Surgeons.

The government's controversial proposal to limit private practice by NHS hospital consultants receives unexpected backing today from the president of the Royal College of Surgeons.

In a move which will split the medical profession, Barry Jackson, who heads the country's 6,000 consultant surgeons, signals his support for the plan in an interview with The Independent.

As recently as April, Mr Jackson was was frankly sceptical about the Government's proposed rescue mission to save the NHS. He thought the six teams of advisers appointed to help draft the plan unwieldy, the timescale too short and the challenge too great. In April, he told the New Statesman: "I would like to think it can be done but I am not confident it can be... If the Government's strategy does not work out then alternatives will have to be faced... three or four years down the line, one is inevitably going to have to look at another system."

Now, with the plan published and 25 leading players in the health field, including him, signed up to its core principles, his tone is boldly upbeat. "I think it is an astonishing feat to have put this together in three-and-a-half months. If everyone in the health service pulls together I think it could make a dramatic difference to the health service and set it on its feet again."

More nurses, more consultants, more beds, more cash - suddenly everything the surgeons have been demanding for years they have been granted. Even so, the task ahead is immense. Hundreds of thousands of extra operations will have to be carried out over the next five years if the central pledge in the plan is to be met: a cut in waiting times to a maximum of six months (the current maximum is 18 months). Can the surgeons deliver?

On the answer to that question hangs not only the fate of the NHS, but that of the Government and the Prime Minister. Tony Blair took charge of the NHS plan - and he will take the rap if it fails. The surgeons, it is fair to say, now hold Mr Blair's political life in their hands. Mr Jackson knows how tough it is going to be. He challenged some of the waiting time targets but was persuaded that the staff and resources necessary to meet them would be made available. "The key to the whole thing is staff. Unless we can get the extra staff into the system the plan won't work as envisaged. My belief is that the Government has recognised that."

His optimism however, comes with a warning. "I am only confident it can be delivered if everyone pulls together. If we don't get the commitment of pretty much everyone who works in the health service the plan will fail."

And there is the rub. The GPs are already in revolt over what they see as an unfairly small boost to their numbers - a 7 per cent increase over five years, compared with the planned 30 per cent increase in consultants. The consultants are angry, too, over proposals to tighten their contracts and, worse, ban them from private practice for the first seven years of their careers, a proposal instantly attacked by the British Medical Association as "vindictive".

Dr Peter Hawker, chairman of the BMA consultants' committee, said such a ban would not help patients and would unfairly penalise consultants. "Consultants are already more than fulfilling their contractual commitments to the NHS, working an average 50 hours a week in the NHS. If they have fulfilled their contractual obligations to the NHS why should they be prohibited from using their spare time as they wish?"

The right to carry out private practice was the price the BMA and the consultants extracted from Aneurin Bevan 52 years ago to set up the NHS. It has been regarded as inviolable ever since. Surgeons are the biggest earners, with six-figure incomes on top of NHS salaries of £60,000-plus no longer exceptional. So they have most to lose, but Mr Jackson, surgeon to the Queen and with a private practice of his own, will not be weeping into his kidney dish.

At first, he fends off questions about private practice, saying it is a matter for the BMA. But when pressed for his personal views, he pauses. "This is straying into ethics. I think it is very difficult. I am sympathetic to the view that there should be three phases to a consultant's working life. The first phase should be devoted very heavily to the NHS in service terms. In the second phase they should be able to relax a bit and take on private practice. In the third phase they should be easing back very considerably from night work and emergency work and taking a greater role in teaching, examining or perhaps medical politics."

In one respect the proposal will suit senior consultants such as him. The restriction on private practice will only apply to new consultants. Existing ones will have their rights protected. "Trainees will inevitably see it differently," he admits.

Mr Jackson is a gentle reformer, with an impeccable bedside manner - courteous, concerned and with a readiness to listen uncommon in a surgeon. His rounded vowels belie his background as an Essex boy who left school at 16 and took medicine as a mature student.

His election to president of the college two years ago caught him by surprise. He was, according to colleagues, the compromise candidate of whom little was expected. But he has proved a popular choice and a safe pair of hands.

He is also fully behind the NHS. "I am absolutely, unequivocally committed to it," he says. He recognises that on private practice and other issues - such as the proposal for nurses to take on more of the role of doctors, including some surgery - the NHS plan will be opposed. "I am quite sure there will not be 100 per cent support from all the fellows [of the college] for the plan. But I would like to think the majority will support it. The contractual areas are the most likely sticking point."

The test of whether the plan will work will come, he thinks, in the next few months. That will be long enough to see whether the necessary collaboration between all the staff will be forthcoming. "If you interview me in nine months' time I should be able to give you a much clearer idea of whether the plan will succeed," he says, with the rueful smile of the realist who knows that winning the support of the rank and file is not going to be easy.

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