Sir Anthony Grabham: Surgeon who transformed the fortunes of the BMA

As elected president of the British Medical Association, he said that he was 'a child of the NHS', but criticised the service’s chronic underfunding

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The Independent Online

Sir Anthony Grabham was a medico-politician to his fingertips. In his professional life – he became a surgeon at 34 – he was, as he called himself, “a middle of the road surgeon” doing abdominal, breast, thyroid, vascular, urological and paediatric surgery in Kettering with only two other surgeons. But it was in the committee room and at the negotiating table that he excelled, as I witnessed many times when I reported on medical politics for the British Medical Journal.

Born in Newcastle in 1930 and raised as a Roman Catholic, he was the son of a police inspector and grandson of the head of all the fire brigades in the north-east. He studied medicine at the Royal Victoria Infirmary in Newcastle upon Tyne then spent two years as a regimental medical officer in the army in Germany and Libya before taking up the post in Kettering.

Frustrated at the BMA’s poor performance, Grabham decided to do something about it. He was elected chairman of the Central Committee for Hospital Medical Services in 1975, the council of the BMA in 1979 and the Joint Consultants Committee (JCC) in 1984. The JCC is made up of representatives of the BMA and the medical royal colleges and negotiates with the government on all hospital matters, except pay and terms and conditions of service. The committee had always been chaired by someone from the royal colleges; Grabham was the first BMA person to fill the role.

A major highlight of his career came in 1975. Harold Wilson’s government published a consultative document on the separation of private practice from the NHS. The BMA described this as “perhaps the greatest threat to the independence of the medical profession since the controversy associated with the introduction of the NHS 30 years ago.”

Grabham helped to put together an alliance of the BMA and 15 other medical and dental organisations. They hired Lord Goodman, who arranged a meeting with the prime minister. Lord Goodman advised that although Grabham was the junior member of the alliance only he should speak at the meeting. A compromise, known as the Goodman proposals, was reached: private beds would not be phased out of NHS hospitals where there were no adequate private facilities close by. Threatened sanctions and industrial action were averted.

Barbara Castle said that negotiating with Grabham was like being “shot at with silver bullets” and that, although he was greedy and arrogant, he was “the best negotiator I have ever dealt with and a huge force in committee meetings.” In her diary she wrote. “Grabham made all the running. He is by far the ablest (and toughest) negotiator they have got.”

When they sat next to each other at a dinner 10 years later she said, “You’re the Tony Grabham?” When he agreed that he was, she retorted, “You were a bugger.”

Barbara Castle was not the only minister to cross swords with Grabham. When the Conservative government planned to radically reform the NHS in 1990 some members of the House of Lords feared the reforms might harm patient care. So the Health Secretary, Kenneth Clarke, set up the Clinical Standards Advisory Group to explore alternatives, but he specified that the group should not include the BMA, particularly the JCC chairman, whom he regarded as “one of the cleverest and most difficult negotiator he had ever come across.” But the President of the Royal College of Surgeons, Sir Terence English, refused to take part unless the BMA was involved.

A second highlight came in 1979 when Grabham was persuaded by leading general practitioners to stand as chairman of the BMA council against the incumbent, James Cameron, another general practitioner. He won at a time when the membership of the association had fallen to about 50 per cent of British doctors. Under his leadership the BMA introduced regional services and industrial relations officers to help doctors in their disputes with employers. Membership increased to 75-80 per cent of doctors, and the largest increase in membership of the association came while Grabham was council chairman.

He illustrated his financial acumen by starting BMA Services, which helped members with their financial affairs. This tied in members, who lost the services if they resigned. BMA Services was eventually sold for £500m. He was a business leader manqué.

Grabham was a member of the General Medical Council for 20 years, running twice unsuccessfully for president. In 1993 he became chairman of the journal committee of the BMJ Publishing Group. Thanks in part to his business knowledge the group’s turnover rose from £12m in 1991 to £55m in 2004.

In 2002 he was elected president of the BMA. In his presidential address he said that he was “a child of the NHS”, but criticised the service’s chronic underfunding. He said that a third of the NHS was of the highest quality, a third reasonably good, and a third verging on Third World medicine. Although he knew that it was against BMA policy he suggested looking at other healthcare systems rather than relying on a tax-based healthcare system.

Grabham loved foreign travel, particularly to Egypt and the Caribbean. He was interested in antiques and enjoyed good food. Some colleagues and opponents found him arrogant and ruthless, but he was always polite and dignified. He and his wife, Pam, who was a staunch supporter throughout his medical and political careers, were kind and thoughtful. Their first child, Sarah, who has Down’s Syndrome, always came first when they were making travel or social arrangements. Even after he developed spindle cell sarcoma last year they found time to send me flowers after I had had an operation.

Anthony Herbert Grabham, medicopolitician, born Newcastle upon Tyne 19 July 1930; Kt 1988; married Pamela Rudd (two daughters, two sons); died Bath 22 February 2015.