Tag Archives: NHS

Universities are a key resource for the NHS. Why are they so underused?

Good public health is central to the success of our cities, nations and regions. It’s an area in which higher education has a key role to play, since working to address local and global health challenges and develop cutting-edge drug therapies is deeply rooted within academic institutions. Yet universities are still an underused resource in tackling local public health problems.

The main obstacle is the absence of organisations that connect universities and the NHS. In the UK, there are just six Academic Health Science Centres, which bring together research, education and clinical practice to translate research swiftly into patient care and ensure that patient interactions contribute to the generation of new knowledge. These AHSCs are not spread evenly around the country: three are in London, and one in Oxford, Cambridge and Manchester.

Part of the problem is that although collaboration between academics is the norm within universities, there is sometimes tension between universities and research institutes. Competition – rather than collaboration – is too often the default setting. A recent report from the King’s Commission on London [pdf], which looked at practical solutions to improve the lives of Londoners, called for better coordination and collaboration across the city’s research infrastructure to reap the benefits of its concentration of expertise and resource.

There are some examples of good practice: in London, the Francis Crick Institute brings together universities and biomedical research centres, while MedCity promotes the life sciences cluster in the south-east. And some institutions are starting to think big when it comes to research partnerships. Pathways to Equitable Healthy Cities is a major new Wellcome-funded initiative running in 10 cities across four continents. It hopes to achieve a step change in urban health, especially among vulnerable populations.


A commitment to ensuring the health and wellbeing of local communities is fundamental to every university’s purpose

Equally, within their communities, universities are on the frontline of local health issues. The University of Liverpool is a lead partner in the Liverpool Obesity Research Network alongside local NHS trusts. Academics from UWE Bristol, the University of Bath and University of Bristol are working with clinicians, commissioners and older people to improve activity and health in later life. Across London, universities’ air-quality research is interrogating the impact of poor air on health, and making real-time data on air quality accessible to Londoners.

Universities also have the potential to improve health through providing expertise that can connect the layers of trusts, providers and commissioners that make up the complex architecture of Greater London’s health service. Linking data across these different layers would streamline interactions and improve patients’ experience. Developing these systems is not beyond the combined brain power of London’s universities. Indeed, this month will see the first phase of investment to establish Health Data Research UK, a £30m fund bringing together six sites, comprising 22 UK universities and research institutes, to make game-changing public health improvements by harnessing data science at scale. Further progress will take sustained leadership from the mayor of London.

While not all universities have medical faculties, a commitment to ensuring the health and wellbeing of local communities is fundamental to every university’s purpose. In the run-up to our 200th anniversary, King’s College London has set out its ambition to be a modern civic university at the heart of London. This recognises the symbiotic value of working in partnership not only with other universities, but with London and Londoners too.

Successful strategies for change require a blend of collaboration and leadership. Universities need to listen to the challenges in their area, and combine academic insights with lived experience to develop lasting solutions. If our cities are living laboratories, then the people within them are not just the subjects of research, they can help create knowledge too.

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Archaic IT is hampering the NHS. But innovation is coming

Panelists at a recent Guardian event outlined the technological problems facing the NHS – and pointed the way forward

Hand reaching for the words login password


‘Some hospitals might have 10 different IT systems for different functions,’ says junior doctor Nadia Masood. Photograph: Markus Brunner/Getty Images/Imagebroker RF

“It’s archaic, slow, fragile and not streamlined.” So says junior doctor Nadia Masood of the chaotic and fragmented state of NHS information technology.

She described the ritual of learning a whole new set of IT systems every time her rotational training takes her to a different NHS trust. “Rotations happen every three to six months and every time there is a new system to learn. Sometimes I spend hours learning things I just don’t need to know.”

Masood is one of the Justice for Health campaigners, a group of NHS workers who took the health secretary, Jeremy Hunt, to the High Court in 2016 over the new junior doctors’ contract. She was also one of a group of high profile speakers and delegates who earlier this month attended Digital disruption: the role of tech entrepreneurs in improving healthcare – a Guardian event supported by Brother and chaired by the Guardian’s health policy editor, Denis Campbell.

Masood said the NHS has a long way to go until it catches up. “Some hospitals might have 10 different IT systems for different functions, such as prescribing, x-rays and blood tests. Much of the tech is from the 1980s. We still rely on pagers, or are hanging on the end of a telephone. That slows us down and it’s really dangerous.”

Doctors and nurses want to innovate but are hampered by organisations that are digitally fragmented, too scared to embrace the new, or who, where a new development bears fruit, want a piece of the action, said members of the panel.

NHS nurse and entrepreneur Neomi Bennett spent years trying to encourage hospitals to buy her new Neo-slip stocking that helps prevent deep vein thrombosis in patients with circulatory problems.

“The NHS is very comfortable doing things it has always done,” she said.

She added that the procedure for getting Neo-slip accepted by the NHS Supply Chain and bidding for NHS contracts was slow and stifling. “The bidding round is four yearly. I just missed the round when I was trying to get Neo-slip into the NHS so I had to wait another four years – which meant I could do a lot more development on my business plan.”

Bennett says innovators need to be certain about who owns the intellectual property (IP) for any invention – especially where development work has been done in the NHS. “Some trusts want to claim the IP and take it to market, meaning the creator loses control – which can be another disincentive to innovate,” she said.

Panellist Dr Ben Maruthappu was an advisor to current NHS England chief executive, Simon Stevens, and now runs Cera – a homecare provider that uses technology to improve services. He felt that comparisons between the NHS and the seemingly faultless IT systems of big businesses are unfair. He said: “We are not in the food delivery or banking business. Healthcare deals with humans and safety, which is what makes introducing new things a complicated maze. It’s a double-edged sword. Innovation needs to go at a pace that is right for patients and helps liberate entrepreneurs.”

Panellists agreed that innovation must be slower than in the commercial world and proceed in step with greater security to head off potential disasters like the WannaCry cyber attack of May last year, which disabled IT systems across the NHS.

Harpreet Sood, a doctor from University College Hospital (UCH) in London and another former advisor to Stevens, is the associate chief information officer at NHS England. He said serious efforts are being made to streamline healthcare IT and join up the dots between hospital, community and social care. He said: “At UCH we have two dozen systems, but work is underway to develop a single system to coordinate them all which will hopefully be launched by April 2019.”

He added that there are 41 trusts across England developing electronic patient records, which will mean that clinicians across the country can access any patient’s medical record. “Lessons learned from their work will be shared across the NHS so that other trusts don’t need to go through the same cycle over and over again.”

According to Sood, the NHS Innovation Accelerator, which showcases innovations to commissioners and so helps speed uptake, the innovation and technology tariff, which removes financial or procurement barriers for innovative products or technologies, and the Academy of Health Sciences all want to nurture new ideas.

Audience member Jackie Kestenbaum, the director and co-founder of data management company Acadiant Limited, warned: “EPR [Electronic Patient Records] is already out of date. We need to look further.” She gave the audience a Zen-like warning not to be obsessed with current technology.

“It’s like when you point at the moon and your dog just looks at your finger,” she said.

Do you work for the NHS? Please take our survey and tell us about your job. It should only take 10 minutes.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs

Archaic IT is hampering the NHS. But innovation is coming

Panelists at a recent Guardian event outlined the technological problems facing the NHS – and pointed the way forward

Hand reaching for the words login password


‘Some hospitals might have 10 different IT systems for different functions,’ says junior doctor Nadia Masood. Photograph: Markus Brunner/Getty Images/Imagebroker RF

“It’s archaic, slow, fragile and not streamlined.” So says junior doctor Nadia Masood of the chaotic and fragmented state of NHS information technology.

She described the ritual of learning a whole new set of IT systems every time her rotational training takes her to a different NHS trust. “Rotations happen every three to six months and every time there is a new system to learn. Sometimes I spend hours learning things I just don’t need to know.”

Masood is one of the Justice for Health campaigners, a group of NHS workers who took the health secretary, Jeremy Hunt, to the High Court in 2016 over the new junior doctors’ contract. She was also one of a group of high profile speakers and delegates who earlier this month attended Digital disruption: the role of tech entrepreneurs in improving healthcare – a Guardian event supported by Brother and chaired by the Guardian’s health policy editor, Denis Campbell.

Masood said the NHS has a long way to go until it catches up. “Some hospitals might have 10 different IT systems for different functions, such as prescribing, x-rays and blood tests. Much of the tech is from the 1980s. We still rely on pagers, or are hanging on the end of a telephone. That slows us down and it’s really dangerous.”

Doctors and nurses want to innovate but are hampered by organisations that are digitally fragmented, too scared to embrace the new, or who, where a new development bears fruit, want a piece of the action, said members of the panel.

NHS nurse and entrepreneur Neomi Bennett spent years trying to encourage hospitals to buy her new Neo-slip stocking that helps prevent deep vein thrombosis in patients with circulatory problems.

“The NHS is very comfortable doing things it has always done,” she said.

She added that the procedure for getting Neo-slip accepted by the NHS Supply Chain and bidding for NHS contracts was slow and stifling. “The bidding round is four yearly. I just missed the round when I was trying to get Neo-slip into the NHS so I had to wait another four years – which meant I could do a lot more development on my business plan.”

Bennett says innovators need to be certain about who owns the intellectual property (IP) for any invention – especially where development work has been done in the NHS. “Some trusts want to claim the IP and take it to market, meaning the creator loses control – which can be another disincentive to innovate,” she said.

Panellist Dr Ben Maruthappu was an advisor to current NHS England chief executive, Simon Stevens, and now runs Cera – a homecare provider that uses technology to improve services. He felt that comparisons between the NHS and the seemingly faultless IT systems of big businesses are unfair. He said: “We are not in the food delivery or banking business. Healthcare deals with humans and safety, which is what makes introducing new things a complicated maze. It’s a double-edged sword. Innovation needs to go at a pace that is right for patients and helps liberate entrepreneurs.”

Panellists agreed that innovation must be slower than in the commercial world and proceed in step with greater security to head off potential disasters like the WannaCry cyber attack of May last year, which disabled IT systems across the NHS.

Harpreet Sood, a doctor from University College Hospital (UCH) in London and another former advisor to Stevens, is the associate chief information officer at NHS England. He said serious efforts are being made to streamline healthcare IT and join up the dots between hospital, community and social care. He said: “At UCH we have two dozen systems, but work is underway to develop a single system to coordinate them all which will hopefully be launched by April 2019.”

He added that there are 41 trusts across England developing electronic patient records, which will mean that clinicians across the country can access any patient’s medical record. “Lessons learned from their work will be shared across the NHS so that other trusts don’t need to go through the same cycle over and over again.”

According to Sood, the NHS Innovation Accelerator, which showcases innovations to commissioners and so helps speed uptake, the innovation and technology tariff, which removes financial or procurement barriers for innovative products or technologies, and the Academy of Health Sciences all want to nurture new ideas.

Audience member Jackie Kestenbaum, the director and co-founder of data management company Acadiant Limited, warned: “EPR [Electronic Patient Records] is already out of date. We need to look further.” She gave the audience a Zen-like warning not to be obsessed with current technology.

“It’s like when you point at the moon and your dog just looks at your finger,” she said.

Do you work for the NHS? Please take our survey and tell us about your job. It should only take 10 minutes.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs

Archaic IT is hampering the NHS. But innovation is coming

Panelists at a recent Guardian event outlined the technological problems facing the NHS – and pointed the way forward

Hand reaching for the words login password


‘Some hospitals might have 10 different IT systems for different functions,’ says junior doctor Nadia Masood. Photograph: Markus Brunner/Getty Images/Imagebroker RF

“It’s archaic, slow, fragile and not streamlined.” So says junior doctor Nadia Masood of the chaotic and fragmented state of NHS information technology.

She described the ritual of learning a whole new set of IT systems every time her rotational training takes her to a different NHS trust. “Rotations happen every three to six months and every time there is a new system to learn. Sometimes I spend hours learning things I just don’t need to know.”

Masood is one of the Justice for Health campaigners, a group of NHS workers who took the health secretary, Jeremy Hunt, to the High Court in 2016 over the new junior doctors’ contract. She was also one of a group of high profile speakers and delegates who earlier this month attended Digital disruption: the role of tech entrepreneurs in improving healthcare – a Guardian event supported by Brother and chaired by the Guardian’s health policy editor, Denis Campbell.

Masood said the NHS has a long way to go until it catches up. “Some hospitals might have 10 different IT systems for different functions, such as prescribing, x-rays and blood tests. Much of the tech is from the 1980s. We still rely on pagers, or are hanging on the end of a telephone. That slows us down and it’s really dangerous.”

Doctors and nurses want to innovate but are hampered by organisations that are digitally fragmented, too scared to embrace the new, or who, where a new development bears fruit, want a piece of the action, said members of the panel.

NHS nurse and entrepreneur Neomi Bennett spent years trying to encourage hospitals to buy her new Neo-slip stocking that helps prevent deep vein thrombosis in patients with circulatory problems.

“The NHS is very comfortable doing things it has always done,” she said.

She added that the procedure for getting Neo-slip accepted by the NHS Supply Chain and bidding for NHS contracts was slow and stifling. “The bidding round is four yearly. I just missed the round when I was trying to get Neo-slip into the NHS so I had to wait another four years – which meant I could do a lot more development on my business plan.”

Bennett says innovators need to be certain about who owns the intellectual property (IP) for any invention – especially where development work has been done in the NHS. “Some trusts want to claim the IP and take it to market, meaning the creator loses control – which can be another disincentive to innovate,” she said.

Panellist Dr Ben Maruthappu was an advisor to current NHS England chief executive, Simon Stevens, and now runs Cera – a homecare provider that uses technology to improve services. He felt that comparisons between the NHS and the seemingly faultless IT systems of big businesses are unfair. He said: “We are not in the food delivery or banking business. Healthcare deals with humans and safety, which is what makes introducing new things a complicated maze. It’s a double-edged sword. Innovation needs to go at a pace that is right for patients and helps liberate entrepreneurs.”

Panellists agreed that innovation must be slower than in the commercial world and proceed in step with greater security to head off potential disasters like the WannaCry cyber attack of May last year, which disabled IT systems across the NHS.

Harpreet Sood, a doctor from University College Hospital (UCH) in London and another former advisor to Stevens, is the associate chief information officer at NHS England. He said serious efforts are being made to streamline healthcare IT and join up the dots between hospital, community and social care. He said: “At UCH we have two dozen systems, but work is underway to develop a single system to coordinate them all which will hopefully be launched by April 2019.”

He added that there are 41 trusts across England developing electronic patient records, which will mean that clinicians across the country can access any patient’s medical record. “Lessons learned from their work will be shared across the NHS so that other trusts don’t need to go through the same cycle over and over again.”

According to Sood, the NHS Innovation Accelerator, which showcases innovations to commissioners and so helps speed uptake, the innovation and technology tariff, which removes financial or procurement barriers for innovative products or technologies, and the Academy of Health Sciences all want to nurture new ideas.

Audience member Jackie Kestenbaum, the director and co-founder of data management company Acadiant Limited, warned: “EPR [Electronic Patient Records] is already out of date. We need to look further.” She gave the audience a Zen-like warning not to be obsessed with current technology.

“It’s like when you point at the moon and your dog just looks at your finger,” she said.

Do you work for the NHS? Please take our survey and tell us about your job. It should only take 10 minutes.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs

Archaic IT is hampering the NHS. But innovation is coming

Panelists at a recent Guardian event outlined the technological problems facing the NHS – and pointed the way forward

Hand reaching for the words login password


‘Some hospitals might have 10 different IT systems for different functions,’ says junior doctor Nadia Masood. Photograph: Markus Brunner/Getty Images/Imagebroker RF

“It’s archaic, slow, fragile and not streamlined.” So says junior doctor Nadia Masood of the chaotic and fragmented state of NHS information technology.

She described the ritual of learning a whole new set of IT systems every time her rotational training takes her to a different NHS trust. “Rotations happen every three to six months and every time there is a new system to learn. Sometimes I spend hours learning things I just don’t need to know.”

Masood is one of the Justice for Health campaigners, a group of NHS workers who took the health secretary, Jeremy Hunt, to the High Court in 2016 over the new junior doctors’ contract. She was also one of a group of high profile speakers and delegates who earlier this month attended Digital disruption: the role of tech entrepreneurs in improving healthcare – a Guardian event supported by Brother and chaired by the Guardian’s health policy editor, Denis Campbell.

Masood said the NHS has a long way to go until it catches up. “Some hospitals might have 10 different IT systems for different functions, such as prescribing, x-rays and blood tests. Much of the tech is from the 1980s. We still rely on pagers, or are hanging on the end of a telephone. That slows us down and it’s really dangerous.”

Doctors and nurses want to innovate but are hampered by organisations that are digitally fragmented, too scared to embrace the new, or who, where a new development bears fruit, want a piece of the action, said members of the panel.

NHS nurse and entrepreneur Neomi Bennett spent years trying to encourage hospitals to buy her new Neo-slip stocking that helps prevent deep vein thrombosis in patients with circulatory problems.

“The NHS is very comfortable doing things it has always done,” she said.

She added that the procedure for getting Neo-slip accepted by the NHS Supply Chain and bidding for NHS contracts was slow and stifling. “The bidding round is four yearly. I just missed the round when I was trying to get Neo-slip into the NHS so I had to wait another four years – which meant I could do a lot more development on my business plan.”

Bennett says innovators need to be certain about who owns the intellectual property (IP) for any invention – especially where development work has been done in the NHS. “Some trusts want to claim the IP and take it to market, meaning the creator loses control – which can be another disincentive to innovate,” she said.

Panellist Dr Ben Maruthappu was an advisor to current NHS England chief executive, Simon Stevens, and now runs Cera – a homecare provider that uses technology to improve services. He felt that comparisons between the NHS and the seemingly faultless IT systems of big businesses are unfair. He said: “We are not in the food delivery or banking business. Healthcare deals with humans and safety, which is what makes introducing new things a complicated maze. It’s a double-edged sword. Innovation needs to go at a pace that is right for patients and helps liberate entrepreneurs.”

Panellists agreed that innovation must be slower than in the commercial world and proceed in step with greater security to head off potential disasters like the WannaCry cyber attack of May last year, which disabled IT systems across the NHS.

Harpreet Sood, a doctor from University College Hospital (UCH) in London and another former advisor to Stevens, is the associate chief information officer at NHS England. He said serious efforts are being made to streamline healthcare IT and join up the dots between hospital, community and social care. He said: “At UCH we have two dozen systems, but work is underway to develop a single system to coordinate them all which will hopefully be launched by April 2019.”

He added that there are 41 trusts across England developing electronic patient records, which will mean that clinicians across the country can access any patient’s medical record. “Lessons learned from their work will be shared across the NHS so that other trusts don’t need to go through the same cycle over and over again.”

According to Sood, the NHS Innovation Accelerator, which showcases innovations to commissioners and so helps speed uptake, the innovation and technology tariff, which removes financial or procurement barriers for innovative products or technologies, and the Academy of Health Sciences all want to nurture new ideas.

Audience member Jackie Kestenbaum, the director and co-founder of data management company Acadiant Limited, warned: “EPR [Electronic Patient Records] is already out of date. We need to look further.” She gave the audience a Zen-like warning not to be obsessed with current technology.

“It’s like when you point at the moon and your dog just looks at your finger,” she said.

Do you work for the NHS? Please take our survey and tell us about your job. It should only take 10 minutes.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs

‘Bullying and being bullied is everywhere now, at every level in the NHS’ | Matthew Barbour

“What can be perceived as harmless banter or acceptable behaviour by some people for decades can actually be deeply offensive, or even abusive,” says Judy Evans, consultant plastic surgeon at the private Nuffield hospital in Plymouth. “We’re now at a point where huge numbers of surgical positions aren’t being filled because millennials don’t want a job in which they think they will be bullied.”

Evans lost her job as an NHS consultant in 2000 after standing up for a junior doctor who had been bullied. “The bullying culture in medicine goes back decades,” she says. “Over 30 years ago, I remember turning up for a surgeon’s exam when I was seven months pregnant and being asked bluntly: ‘What are you doing here looking like that?’ Sadly, that kind of behaviour was seen as something women just had to put up with.

“In the past, surgery used to be just sexist – a hangover from the old boys’ clubs, drinking and playing golf – but that’s not the only issue now. Bullying and being bullied is everywhere now, at every level: consultants, juniors, women, men. It can be incredibly subtle but terribly destructive unless we are all more aware of not just where to go for help, but also that you might actually be a bully yourself.

“I know of surgeons who have considered taking their own lives, others who have left the profession because of bullying surgeons’ bad practice going unchallenged. Of course, the ultimate downside to all of this is patient wellbeing being compromised.”

Evans’s concerns about bullying, particularly among surgeons, are backed up by studies. A quarter of doctors say they have experienced bullying, harassment or abuse from other staff in the past 12 months, according to last year’s NHS England staff survey.One in six trainee surgeons, who responded to a web survey, say they suffer from bullying-related post-traumatic stress disorder that is so bad it can leave them suicidal, according to a paper published this summer in the Surgeon journal.

A 2014 survey of members of the UK’s oldest and largest Royal College of Surgeons, in Edinburgh – with 25,000 members mainly working in England and Wales – found that 40% of respondents had been victims of bullying, and the same number said they had also witnessed bullying in the workplace.

In addition, a 2015 study revealed that 94% of surgeons had observed unprofessional behaviour, including bullying, among colleagues.. Moreover, it directly impacts on patient welfare.

Evans believes the systemic bullying culture was the reason breast surgeon Ian Paterson, who was jailed earlier this year for 15 years, was able to get away for so long with performing unnecessary surgeries on what could be more than 1,000 women. Paterson was described by colleagues as an “arrogant bully whom colleagues feared to challenge”, she says.

“In the airline industry if someone at any level of the hierarchy finds a fault, they are rewarded because passenger safety is everything – in surgery the opposite has been true. Trainee surgeons, nurses and others lower down the team’s pecking order are frightened about speaking out and receiving negative reactions for questioning that something might not be quite right. Tens of thousands of lives have been and will be at risk if the status quo isn’t changed.”

Evans cites the example of airline pilot Martin Bromiley, who has campaigned tirelessly for patient safety after his wife died 10 years ago during a routine operation because a nurse’s concerns were ignored. “That nurse produced the instruments to perform a simple tracheostomy and save Martin’s wife’s life, but she was pushed to one side,” says Evans. “To be effective we have to work as a team and show everyone respect, whatever their role. Bullying strips away self-confidence, so doctors may not trust their own abilities to make life-saving quick decisions.”

Since Evans left the NHS with a large payout she has fought tirelessly to end the bullying culture among surgeons. She is the first woman to be appointed an office bearer of the Royal College of Surgeons of Edinburgh (RCSEd) and has helped to launch its campaign, Let’s Remove It, to encourage healthcare professionals to speak up and stamp out bullying. Its website directs medics to where to get help if they feel they are being bullied, and has a checklist to see if they are showing bullying behaviour.

Anushka Chaudhry


Anushka Chaudhry: ‘A consultant would constantly undermine my professional decisions and insinuate I was workshy, which affected my reputation.’

Backing the campaign is Anushka Chaudhry, 39, a consultant breast surgeon at the Great Western hospital in Swindon. She says she was constantly bullied by a consultant surgeon during her NHS training at another trust – but she kept the bullying and its effects secret for more than 18 months. “I’ve never spoken publicly about what happened to me, and I know many friends and colleagues will be shocked to hear this,” she says. “From the start that consultant surgeon let it be known that women – or ‘girls’ as he preferred to call us – should be grateful to be there. He’d constantly undermine my professional decisions and comment about my workload, insinuating I was workshy and had no work ethic, which amounted to slander and affected my professional reputation.”

Towards the end of that placement she says the bullying had escalated to the point where the consultant told her in front of colleagues and other trainees that she had “never worked for him”. “He basically dismissed me from surgery, refusing to sign me off so I could start the next step of my career, a career I loved. Instead of feeling that he was in the wrong, I felt ashamed that I was disliked so much. I hid what was going on at work from my husband, became withdrawn at work and lost so much confidence, feeling so alone.”

It was only several months later that she heard three other trainees had also been bullied by the same consultant and that he had been dismissed as a trainer and had left the trust. “It was great news, knowing other trainees wouldn’t have to go through what I did,” says Chaudhry, who now mentors trainees.

The RCSEd is working closely with the General Medical Council and the Royal College of Obstetrics and Gynaecology, to run pilot workshops to help doctors recognise and change their behaviour. NHS boards can apply to send people on its courses, the first of which is planned for February. Says Evans: “Prevention is always better than cure, of course, but we need to change the culture so people can be honest and admit they are doing the wrong thing.”

It is also campaigning for the GMC to introduce compulsory training on bullying for trainee doctors.

Dr Alice Hartley, 37, a registrar at Sunderland Royal hospital who chairs the RCSEd’s anti-bullying campaign, says she regularly sees surgeons brought to tears by other colleagues. “It’s an ego thing without any consideration for nurturing the trainee. In my career I’ve seen constant undermining, talking down to people, making both trainees and also consultants feel small and inferior – it cuts across the whole of the NHS and needs to be stopped.”Hartley says she herself has been a victim. “I’ve been in theatre and had a senior colleague fling instruments on to the floor in a rage when I asked a simple question,” she recalls. ”It just makes you doubt yourself and crucially stops you questioning what’s happening and creating a better team to treat patients more effectively.

“It’s the constant belittling, the making you feel like an idiot that slowly breaks you. Surgery has historically been a cutthroat, ego-driven world where you had to tolerate abuse very regularly if you want to move on – either that, or you leave. We’ve got a massive shortage of surgeons coming through now, and we have to address the working environment.”

Danny Mortimer, chief executive of NHS Employers, says: “Bullying is completely unacceptable. All NHS organisations have clear policies in place to deal with reports of harassment or bullying. This requires employers to take clear action to address those concerns. It is not always easy for concerns to be raised, particularly where those carrying out harassment are in positions of power. Many organisations will have specially trained staff in place to help colleagues raise concerns about bullying or harassment, there are freedom-to-speak-up guardians as well as chaplaincy, trade union and HR staff who can provide support.”

Dr Anthea Mowat, the British Medical Association representative body chair, says: “We know from speaking to our members that a combination of factors feed into creating environments which permit and perpetuate bullying behaviour: the organisational culture in the NHS; workload pressure; the strong hierarchy within the medical profession; and the ‘silent bystanding’ which means behaviours go unchallenged and become learned by newer staff. Ending this issue, which means addressing these underlying factors, is a big challenge and the BMA is committed to raising awareness of all forms of bullying and harassment and the consequences for doctors’ wellbeing and patient care. We want to ensure there is a clear understanding of the issues and people are confident to raise concerns and report problems when they occur. The BMA also offers a 24-hour counselling service and the doctor adviser service, Doctors for Doctors, which gives doctors and medical students in distress the chance to speak to another doctor in confidence.”

For Chaudhry, being bullied was such a horrendous experience that, she says, she only really recovered her confidence almost two years later. “I now want to speak up to help others going through something similar.”

‘Bullying and being bullied is everywhere now, at every level in the NHS’ | Matthew Barbour

“What can be perceived as harmless banter or acceptable behaviour by some people for decades can actually be deeply offensive, or even abusive,” says Judy Evans, consultant plastic surgeon at the private Nuffield hospital in Plymouth. “We’re now at a point where huge numbers of surgical positions aren’t being filled because millennials don’t want a job in which they think they will be bullied.”

Evans lost her job as an NHS consultant in 2000 after standing up for a junior doctor who had been bullied. “The bullying culture in medicine goes back decades,” she says. “Over 30 years ago, I remember turning up for a surgeon’s exam when I was seven months pregnant and being asked bluntly: ‘What are you doing here looking like that?’ Sadly, that kind of behaviour was seen as something women just had to put up with.

“In the past, surgery used to be just sexist – a hangover from the old boys’ clubs, drinking and playing golf – but that’s not the only issue now. Bullying and being bullied is everywhere now, at every level: consultants, juniors, women, men. It can be incredibly subtle but terribly destructive unless we are all more aware of not just where to go for help, but also that you might actually be a bully yourself.

“I know of surgeons who have considered taking their own lives, others who have left the profession because of bullying surgeons’ bad practice going unchallenged. Of course, the ultimate downside to all of this is patient wellbeing being compromised.”

Evans’s concerns about bullying, particularly among surgeons, are backed up by studies. A quarter of doctors say they have experienced bullying, harassment or abuse from other staff in the past 12 months, according to last year’s NHS England staff survey.One in six trainee surgeons, who responded to a web survey, say they suffer from bullying-related post-traumatic stress disorder that is so bad it can leave them suicidal, according to a paper published this summer in the Surgeon journal.

A 2014 survey of members of the UK’s oldest and largest Royal College of Surgeons, in Edinburgh – with 25,000 members mainly working in England and Wales – found that 40% of respondents had been victims of bullying, and the same number said they had also witnessed bullying in the workplace.

In addition, a 2015 study revealed that 94% of surgeons had observed unprofessional behaviour, including bullying, among colleagues.. Moreover, it directly impacts on patient welfare.

Evans believes the systemic bullying culture was the reason breast surgeon Ian Paterson, who was jailed earlier this year for 15 years, was able to get away for so long with performing unnecessary surgeries on what could be more than 1,000 women. Paterson was described by colleagues as an “arrogant bully whom colleagues feared to challenge”, she says.

“In the airline industry if someone at any level of the hierarchy finds a fault, they are rewarded because passenger safety is everything – in surgery the opposite has been true. Trainee surgeons, nurses and others lower down the team’s pecking order are frightened about speaking out and receiving negative reactions for questioning that something might not be quite right. Tens of thousands of lives have been and will be at risk if the status quo isn’t changed.”

Evans cites the example of airline pilot Martin Bromiley, who has campaigned tirelessly for patient safety after his wife died 10 years ago during a routine operation because a nurse’s concerns were ignored. “That nurse produced the instruments to perform a simple tracheostomy and save Martin’s wife’s life, but she was pushed to one side,” says Evans. “To be effective we have to work as a team and show everyone respect, whatever their role. Bullying strips away self-confidence, so doctors may not trust their own abilities to make life-saving quick decisions.”

Since Evans left the NHS with a large payout she has fought tirelessly to end the bullying culture among surgeons. She is the first woman to be appointed an office bearer of the Royal College of Surgeons of Edinburgh (RCSEd) and has helped to launch its campaign, Let’s Remove It, to encourage healthcare professionals to speak up and stamp out bullying. Its website directs medics to where to get help if they feel they are being bullied, and has a checklist to see if they are showing bullying behaviour.

Anushka Chaudhry


Anushka Chaudhry: ‘A consultant would constantly undermine my professional decisions and insinuate I was workshy, which affected my reputation.’

Backing the campaign is Anushka Chaudhry, 39, a consultant breast surgeon at the Great Western hospital in Swindon. She says she was constantly bullied by a consultant surgeon during her NHS training at another trust – but she kept the bullying and its effects secret for more than 18 months. “I’ve never spoken publicly about what happened to me, and I know many friends and colleagues will be shocked to hear this,” she says. “From the start that consultant surgeon let it be known that women – or ‘girls’ as he preferred to call us – should be grateful to be there. He’d constantly undermine my professional decisions and comment about my workload, insinuating I was workshy and had no work ethic, which amounted to slander and affected my professional reputation.”

Towards the end of that placement she says the bullying had escalated to the point where the consultant told her in front of colleagues and other trainees that she had “never worked for him”. “He basically dismissed me from surgery, refusing to sign me off so I could start the next step of my career, a career I loved. Instead of feeling that he was in the wrong, I felt ashamed that I was disliked so much. I hid what was going on at work from my husband, became withdrawn at work and lost so much confidence, feeling so alone.”

It was only several months later that she heard three other trainees had also been bullied by the same consultant and that he had been dismissed as a trainer and had left the trust. “It was great news, knowing other trainees wouldn’t have to go through what I did,” says Chaudhry, who now mentors trainees.

The RCSEd is working closely with the General Medical Council and the Royal College of Obstetrics and Gynaecology, to run pilot workshops to help doctors recognise and change their behaviour. NHS boards can apply to send people on its courses, the first of which is planned for February. Says Evans: “Prevention is always better than cure, of course, but we need to change the culture so people can be honest and admit they are doing the wrong thing.”

It is also campaigning for the GMC to introduce compulsory training on bullying for trainee doctors.

Dr Alice Hartley, 37, a registrar at Sunderland Royal hospital who chairs the RCSEd’s anti-bullying campaign, says she regularly sees surgeons brought to tears by other colleagues. “It’s an ego thing without any consideration for nurturing the trainee. In my career I’ve seen constant undermining, talking down to people, making both trainees and also consultants feel small and inferior – it cuts across the whole of the NHS and needs to be stopped.”Hartley says she herself has been a victim. “I’ve been in theatre and had a senior colleague fling instruments on to the floor in a rage when I asked a simple question,” she recalls. ”It just makes you doubt yourself and crucially stops you questioning what’s happening and creating a better team to treat patients more effectively.

“It’s the constant belittling, the making you feel like an idiot that slowly breaks you. Surgery has historically been a cutthroat, ego-driven world where you had to tolerate abuse very regularly if you want to move on – either that, or you leave. We’ve got a massive shortage of surgeons coming through now, and we have to address the working environment.”

Danny Mortimer, chief executive of NHS Employers, says: “Bullying is completely unacceptable. All NHS organisations have clear policies in place to deal with reports of harassment or bullying. This requires employers to take clear action to address those concerns. It is not always easy for concerns to be raised, particularly where those carrying out harassment are in positions of power. Many organisations will have specially trained staff in place to help colleagues raise concerns about bullying or harassment, there are freedom-to-speak-up guardians as well as chaplaincy, trade union and HR staff who can provide support.”

Dr Anthea Mowat, the British Medical Association representative body chair, says: “We know from speaking to our members that a combination of factors feed into creating environments which permit and perpetuate bullying behaviour: the organisational culture in the NHS; workload pressure; the strong hierarchy within the medical profession; and the ‘silent bystanding’ which means behaviours go unchallenged and become learned by newer staff. Ending this issue, which means addressing these underlying factors, is a big challenge and the BMA is committed to raising awareness of all forms of bullying and harassment and the consequences for doctors’ wellbeing and patient care. We want to ensure there is a clear understanding of the issues and people are confident to raise concerns and report problems when they occur. The BMA also offers a 24-hour counselling service and the doctor adviser service, Doctors for Doctors, which gives doctors and medical students in distress the chance to speak to another doctor in confidence.”

For Chaudhry, being bullied was such a horrendous experience that, she says, she only really recovered her confidence almost two years later. “I now want to speak up to help others going through something similar.”

‘Bullying and being bullied is everywhere now, at every level in the NHS’ | Matthew Barbour

“What can be perceived as harmless banter or acceptable behaviour by some people for decades can actually be deeply offensive, or even abusive,” says Judy Evans, consultant plastic surgeon at the private Nuffield hospital in Plymouth. “We’re now at a point where huge numbers of surgical positions aren’t being filled because millennials don’t want a job in which they think they will be bullied.”

Evans lost her job as an NHS consultant in 2000 after standing up for a junior doctor who had been bullied. “The bullying culture in medicine goes back decades,” she says. “Over 30 years ago, I remember turning up for a surgeon’s exam when I was seven months pregnant and being asked bluntly: ‘What are you doing here looking like that?’ Sadly, that kind of behaviour was seen as something women just had to put up with.

“In the past, surgery used to be just sexist – a hangover from the old boys’ clubs, drinking and playing golf – but that’s not the only issue now. Bullying and being bullied is everywhere now, at every level: consultants, juniors, women, men. It can be incredibly subtle but terribly destructive unless we are all more aware of not just where to go for help, but also that you might actually be a bully yourself.

“I know of surgeons who have considered taking their own lives, others who have left the profession because of bullying surgeons’ bad practice going unchallenged. Of course, the ultimate downside to all of this is patient wellbeing being compromised.”

Evans’s concerns about bullying, particularly among surgeons, are backed up by studies. A quarter of doctors say they have experienced bullying, harassment or abuse from other staff in the past 12 months, according to last year’s NHS England staff survey.One in six trainee surgeons, who responded to a web survey, say they suffer from bullying-related post-traumatic stress disorder that is so bad it can leave them suicidal, according to a paper published this summer in the Surgeon journal.

A 2014 survey of members of the UK’s oldest and largest Royal College of Surgeons, in Edinburgh – with 25,000 members mainly working in England and Wales – found that 40% of respondents had been victims of bullying, and the same number said they had also witnessed bullying in the workplace.

In addition, a 2015 study revealed that 94% of surgeons had observed unprofessional behaviour, including bullying, among colleagues.. Moreover, it directly impacts on patient welfare.

Evans believes the systemic bullying culture was the reason breast surgeon Ian Paterson, who was jailed earlier this year for 15 years, was able to get away for so long with performing unnecessary surgeries on what could be more than 1,000 women. Paterson was described by colleagues as an “arrogant bully whom colleagues feared to challenge”, she says.

“In the airline industry if someone at any level of the hierarchy finds a fault, they are rewarded because passenger safety is everything – in surgery the opposite has been true. Trainee surgeons, nurses and others lower down the team’s pecking order are frightened about speaking out and receiving negative reactions for questioning that something might not be quite right. Tens of thousands of lives have been and will be at risk if the status quo isn’t changed.”

Evans cites the example of airline pilot Martin Bromiley, who has campaigned tirelessly for patient safety after his wife died 10 years ago during a routine operation because a nurse’s concerns were ignored. “That nurse produced the instruments to perform a simple tracheostomy and save Martin’s wife’s life, but she was pushed to one side,” says Evans. “To be effective we have to work as a team and show everyone respect, whatever their role. Bullying strips away self-confidence, so doctors may not trust their own abilities to make life-saving quick decisions.”

Since Evans left the NHS with a large payout she has fought tirelessly to end the bullying culture among surgeons. She is the first woman to be appointed an office bearer of the Royal College of Surgeons of Edinburgh (RCSEd) and has helped to launch its campaign, Let’s Remove It, to encourage healthcare professionals to speak up and stamp out bullying. Its website directs medics to where to get help if they feel they are being bullied, and has a checklist to see if they are showing bullying behaviour.

Anushka Chaudhry


Anushka Chaudhry: ‘A consultant would constantly undermine my professional decisions and insinuate I was workshy, which affected my reputation.’

Backing the campaign is Anushka Chaudhry, 39, a consultant breast surgeon at the Great Western hospital in Swindon. She says she was constantly bullied by a consultant surgeon during her NHS training at another trust – but she kept the bullying and its effects secret for more than 18 months. “I’ve never spoken publicly about what happened to me, and I know many friends and colleagues will be shocked to hear this,” she says. “From the start that consultant surgeon let it be known that women – or ‘girls’ as he preferred to call us – should be grateful to be there. He’d constantly undermine my professional decisions and comment about my workload, insinuating I was workshy and had no work ethic, which amounted to slander and affected my professional reputation.”

Towards the end of that placement she says the bullying had escalated to the point where the consultant told her in front of colleagues and other trainees that she had “never worked for him”. “He basically dismissed me from surgery, refusing to sign me off so I could start the next step of my career, a career I loved. Instead of feeling that he was in the wrong, I felt ashamed that I was disliked so much. I hid what was going on at work from my husband, became withdrawn at work and lost so much confidence, feeling so alone.”

It was only several months later that she heard three other trainees had also been bullied by the same consultant and that he had been dismissed as a trainer and had left the trust. “It was great news, knowing other trainees wouldn’t have to go through what I did,” says Chaudhry, who now mentors trainees.

The RCSEd is working closely with the General Medical Council and the Royal College of Obstetrics and Gynaecology, to run pilot workshops to help doctors recognise and change their behaviour. NHS boards can apply to send people on its courses, the first of which is planned for February. Says Evans: “Prevention is always better than cure, of course, but we need to change the culture so people can be honest and admit they are doing the wrong thing.”

It is also campaigning for the GMC to introduce compulsory training on bullying for trainee doctors.

Dr Alice Hartley, 37, a registrar at Sunderland Royal hospital who chairs the RCSEd’s anti-bullying campaign, says she regularly sees surgeons brought to tears by other colleagues. “It’s an ego thing without any consideration for nurturing the trainee. In my career I’ve seen constant undermining, talking down to people, making both trainees and also consultants feel small and inferior – it cuts across the whole of the NHS and needs to be stopped.”Hartley says she herself has been a victim. “I’ve been in theatre and had a senior colleague fling instruments on to the floor in a rage when I asked a simple question,” she recalls. ”It just makes you doubt yourself and crucially stops you questioning what’s happening and creating a better team to treat patients more effectively.

“It’s the constant belittling, the making you feel like an idiot that slowly breaks you. Surgery has historically been a cutthroat, ego-driven world where you had to tolerate abuse very regularly if you want to move on – either that, or you leave. We’ve got a massive shortage of surgeons coming through now, and we have to address the working environment.”

Danny Mortimer, chief executive of NHS Employers, says: “Bullying is completely unacceptable. All NHS organisations have clear policies in place to deal with reports of harassment or bullying. This requires employers to take clear action to address those concerns. It is not always easy for concerns to be raised, particularly where those carrying out harassment are in positions of power. Many organisations will have specially trained staff in place to help colleagues raise concerns about bullying or harassment, there are freedom-to-speak-up guardians as well as chaplaincy, trade union and HR staff who can provide support.”

Dr Anthea Mowat, the British Medical Association representative body chair, says: “We know from speaking to our members that a combination of factors feed into creating environments which permit and perpetuate bullying behaviour: the organisational culture in the NHS; workload pressure; the strong hierarchy within the medical profession; and the ‘silent bystanding’ which means behaviours go unchallenged and become learned by newer staff. Ending this issue, which means addressing these underlying factors, is a big challenge and the BMA is committed to raising awareness of all forms of bullying and harassment and the consequences for doctors’ wellbeing and patient care. We want to ensure there is a clear understanding of the issues and people are confident to raise concerns and report problems when they occur. The BMA also offers a 24-hour counselling service and the doctor adviser service, Doctors for Doctors, which gives doctors and medical students in distress the chance to speak to another doctor in confidence.”

For Chaudhry, being bullied was such a horrendous experience that, she says, she only really recovered her confidence almost two years later. “I now want to speak up to help others going through something similar.”

Brexit could destroy the NHS. This will hurt us all | Jonathan Lis

Of the lies told during the Brexit referendum – and there were many – perhaps the most egregious was the claim that we could spend an extra £350m on the NHS as a result of leaving the EU. It has gained unique notoriety not simply because the figure was demonstrably false, or even because Brexit will shrink the economy rather than free up vital funds, but rather because of its calculated emotional manipulation. We value the NHS more than any other institution. As the defining icon of the post-war consensus and intrinsic component of our national story, it unites Britons across political, geographical and class divides. Crippled by austerity, staff shortages and low morale, our NHS is also on its knees. But far from offering a helping hand, Brexit threatens to bring it down altogether.

A report in the Lancet offers a comprehensive – and bleak – analysis of the dangers. Brexit stands to damage staffing, funding, access to new products and technology, and standards of public health. The softer the Brexit, the lower the harm – but as Theresa May’s speech in Florence made clear, the government still plans to leave the single market, customs union and other EU bodies after a transition ends in 2021, no matter the cost.


Telling NHS workers they can help us, but forget about ever settling or becoming British, may not prove attractive

The key area of risk is also the central plank of Brexit: restrictions on free movement of people. This is no coincidence. While millions of leave voters expressed the concern that immigration was posing an intolerable burden on public services, studies have repeatedly indicated that it in fact keeps them afloat. The NHS and adult social care employs 150,000 EU nationals; 10% of our doctors graduated in EEA countries. The government continually promises that the “brightest and best” will always be welcome, but this elitist and divisive slogan fails even on its own terms. Britain’s most vulnerable patients do not simply depend on EU surgeons, GPs and nurses, but on an army of notionally “unskilled” carers, porters and cleaners who help to keep people alive.

Even if the government prioritises NHS workers in its post-Brexit immigration strategy, grave damage has already been done. This week, a molecular biologist in Madrid told me that London was his favourite city, but its political climate now too hostile to consider returning. The figures bear out the anecdote: while 40,000 nursing positions currently lie vacant, the number of EU nurses registering to work here has dropped by a staggering 96%. While fewer arrive, more depart. About 10,000 EU nationals have left the NHS in the past year.

Britain no longer feels like a welcoming place for foreigners. Let alone the shame, we should also feel profound alarm. We do not have the doctors and nurses that we need as it is; and even if the government was adequately investing in training – which it isn’t – we would still have no time to replace those Europeans who either intend to leave or never even come. To add idiocy to injury, the recently leaked government proposals on immigration specified time-limited work permits, with permanent residency a possibility only for the most highly skilled. Telling NHS workers that they can help us for a few years, but probably forget about ever settling or becoming British, may not prove an attractive offer.

The problem for the NHS is that unlike, say, the single market or Irish border issue, it is not in itself an EU competence and will not be negotiated at the Brexit table. What we do with our healthcare has always been a matter for us alone. But as with so much else in Brexit, problems both predictable and previously unforeseen are threatening key aspects of our national infrastructure.

While remain campaigners stressed the risks to the NHS of reduced immigration and a diminished economy, few mentioned the €3.5bn supplied by the European Investment Bank to the NHS since 2001, or publicised the dangers to cancer patients of leaving the European Atomic Energy Community or the European Medicines Agency. The government, for its part, is so consumed with fire-fighting that it is neglecting to recognise the NHS for what it is: one of Brexit’s key issues, and potentially its most high-profile piece of collateral damage.

Like the ravens at the Tower of London whose departure, in legend, presages the nation’s fall, the NHS’s success – or collapse – is also Britain’s. Brexit’s architects knew that people would respond to appeals to help it; faced with a false prospectus, the public duly chose British hospitals over Brussels bureaucrats. Those same voters may yet punish Brexit’s leaders, but the national consequences will profoundly eclipse any political ones. After all, the risk of deploying your most treasured family heirloom as a political football is not just that it could ultimately land in your own goal – but that in your recklessness, you may irreparably smash it.

Jonathan Lis is deputy director of the thinktank British Influence

Brexit could destroy the NHS. This will hurt us all | Jonathan Lis

Of the lies told during the Brexit referendum – and there were many – perhaps the most egregious was the claim that we could spend an extra £350m on the NHS as a result of leaving the EU. It has gained unique notoriety not simply because the figure was demonstrably false, or even because Brexit will shrink the economy rather than free up vital funds, but rather because of its calculated emotional manipulation. We value the NHS more than any other institution. As the defining icon of the post-war consensus and intrinsic component of our national story, it unites Britons across political, geographical and class divides. Crippled by austerity, staff shortages and low morale, our NHS is also on its knees. But far from offering a helping hand, Brexit threatens to bring it down altogether.

A report in the Lancet offers a comprehensive – and bleak – analysis of the dangers. Brexit stands to damage staffing, funding, access to new products and technology, and standards of public health. The softer the Brexit, the lower the harm – but as Theresa May’s speech in Florence made clear, the government still plans to leave the single market, customs union and other EU bodies after a transition ends in 2021, no matter the cost.


Telling NHS workers they can help us, but forget about ever settling or becoming British, may not prove attractive

The key area of risk is also the central plank of Brexit: restrictions on free movement of people. This is no coincidence. While millions of leave voters expressed the concern that immigration was posing an intolerable burden on public services, studies have repeatedly indicated that it in fact keeps them afloat. The NHS and adult social care employs 150,000 EU nationals; 10% of our doctors graduated in EEA countries. The government continually promises that the “brightest and best” will always be welcome, but this elitist and divisive slogan fails even on its own terms. Britain’s most vulnerable patients do not simply depend on EU surgeons, GPs and nurses, but on an army of notionally “unskilled” carers, porters and cleaners who help to keep people alive.

Even if the government prioritises NHS workers in its post-Brexit immigration strategy, grave damage has already been done. This week, a molecular biologist in Madrid told me that London was his favourite city, but its political climate now too hostile to consider returning. The figures bear out the anecdote: while 40,000 nursing positions currently lie vacant, the number of EU nurses registering to work here has dropped by a staggering 96%. While fewer arrive, more depart. About 10,000 EU nationals have left the NHS in the past year.

Britain no longer feels like a welcoming place for foreigners. Let alone the shame, we should also feel profound alarm. We do not have the doctors and nurses that we need as it is; and even if the government was adequately investing in training – which it isn’t – we would still have no time to replace those Europeans who either intend to leave or never even come. To add idiocy to injury, the recently leaked government proposals on immigration specified time-limited work permits, with permanent residency a possibility only for the most highly skilled. Telling NHS workers that they can help us for a few years, but probably forget about ever settling or becoming British, may not prove an attractive offer.

The problem for the NHS is that unlike, say, the single market or Irish border issue, it is not in itself an EU competence and will not be negotiated at the Brexit table. What we do with our healthcare has always been a matter for us alone. But as with so much else in Brexit, problems both predictable and previously unforeseen are threatening key aspects of our national infrastructure.

While remain campaigners stressed the risks to the NHS of reduced immigration and a diminished economy, few mentioned the €3.5bn supplied by the European Investment Bank to the NHS since 2001, or publicised the dangers to cancer patients of leaving the European Atomic Energy Community or the European Medicines Agency. The government, for its part, is so consumed with fire-fighting that it is neglecting to recognise the NHS for what it is: one of Brexit’s key issues, and potentially its most high-profile piece of collateral damage.

Like the ravens at the Tower of London whose departure, in legend, presages the nation’s fall, the NHS’s success – or collapse – is also Britain’s. Brexit’s architects knew that people would respond to appeals to help it; faced with a false prospectus, the public duly chose British hospitals over Brussels bureaucrats. Those same voters may yet punish Brexit’s leaders, but the national consequences will profoundly eclipse any political ones. After all, the risk of deploying your most treasured family heirloom as a political football is not just that it could ultimately land in your own goal – but that in your recklessness, you may irreparably smash it.

Jonathan Lis is deputy director of the thinktank British Influence