Henry Marsh: ‘Today's NHS makes me angry. I'm not sure I could be a neurosurgeon now'

Telegraph

20 hours ago

In April last year, the celebrated neurosurgeon Henry Marsh was pushing his bicycle home from St George's Hospital in south-west London when he heard someone call out his name. In itself, this was not unusual. In his long career, during which he has been a world pioneer of operating on the brain while his patients remained awake and communicating, Marsh has removed so many life-ending tumours that he is often recognised and thanked. But this was different.
Coming across the road to meet him was Tina, the mother of Max, whom Marsh had operated on as a four-year-old almost 30 years ago. The consultant had removed what he thought was a benign tumour; it turned out to be a rhabdoid teratoma – a rare, aggressive form of cancer occurring mainly in young children – which grew back within weeks. Its progression was rapid. Max died shortly after his fifth birthday.
In a new Horizon BBC documentary, Confessions of a Brain Surgeon, Tina remembers Marsh back then as 'quite gung-ho about everything, quite arrogant, really', and describes how her 'hate' for him had lived with her for 29 years. 'Henry didn't do what we thought he was going to do, which was save Max,' she says simply. Marsh remembered Max instantly.
'It was a very moving experience to meet her,' the 74-year-old tells me from Norfolk, when we catch up over video call. In the documentary, they meet in a pub to discuss how when Max grew sick after the operation, Marsh refused another scan until the evidence that the cancer was spreading became irrefutable. 'I was a young, self-important, arrogant consultant,' he recalls. 'I made some bad mistakes and learnt some bitter lessons.'
It's hard to equate this with the warm, approachable figure talking to me now. The word 'hate' did not shock him at all, he tells me. 'It's a very emotional relationship.' He hopes that Max's mother understands now that his blunder would not have altered the outcome; the cancer was too aggressive and Max would have died anyway, but he says, 'I handled it very badly, and in a sense, they were right to hate me, even though I wasn't responsible for the child's death.'
In the documentary, Tina describes their meeting as 'a weight lifted'. Marsh talks of how 'if you make a mistake, you've no right to ask for forgiveness, but I have sometimes been forgiven, and it's one of the most moving experiences you can have'.
Acknowledging failures
He revisits other failures too, such as Tanya, a girl he brought back from Kyiv to operate on in London after one of the many visits he has made to Ukraine as a neurosurgeon since 1992. She had a benign tumour – 'one of the largest I've ever seen' – that was affecting her brain stem, causing physical disability, though not mental impairment. The surgery proved torturously difficult – 'The tumour was tangled up with the brain's blood vessels,' Marsh recalls.
After a second operation, Tania had a stroke that left her brain-damaged. She remained in intensive care for six months before being moved home to Ukraine, where she died a year later. 'It was a disaster,' Marsh says. 'I look at it with complete horror. I really find it very distressing… very painful.'
Yet, Marsh says now, 'I didn't regret it.' It had been 'overambitious', he says, yet he believes 'so much of neurosurgery is knowing that the operation is bad but doing nothing is even worse'. Tanya, he is certain, would have died either way, sooner or later.
Marsh is internationally admired for his contribution to neurosurgery, the author of three books on his life and work, including Do No Harm (2014), and the subject of three documentaries, dating back to BBC One's Your Life in Their Hands in 2004. He retired as a surgeon in 2017, yet he has continued to teach the generation that follows him and has been a tireless advocate for greater honesty in medicine, of the necessity for acknowledging when failures happen. He carries his own with him, always.
'I think any surgeon will tell you, they all recognise the inner cemetery,' he says. 'How much it troubles them is going to vary from person to person.' The public's idea of the 'stereotypical surgeon', he notes, 'is sort of an unfeeling, technical psychopath. And that's actually very unusual. I've known one or two surgeons who had psychopathic traits, by which I mean they didn't actually seem to get very upset when patients came to harm, but most of us do. How we deal with it, whether we talk about it, whether we learn from it, that's another question.'
He believes that the main lesson for him was to let go of the desire to appear infallible and 'on a really long, difficult brain tumour case, to do it with a colleague, somebody you treat as an equal and trust'.
'We all know surgical departments where some of the surgeons hate each other and there's lots of friction, because they often are prima donnas, and they end up thinking they really are as good as their poor patients desperately have to think they are,' he says.
'Horror beyond horror'
Marsh has, since the very beginning, understood what it is like to be on the other side of the surgical equation. As a newly qualified doctor, aged 29 and still to decide which field to specialise in, he experienced the agony of seeing his first child, William, diagnosed with a brain tumour at three months old.
'I couldn't cope with it at all,' he says in the documentary. 'It was a complete nightmare, horror beyond horror.' William's life was saved by surgical intervention (he's still alive and well, 45 years on). Soon after, Marsh made the momentous decision to train as a neurosurgeon.
Although twice wed – he's now married to the social anthropologist and author Kate Fox – with three children and four grandchildren, he unhesitatingly describes his profession as 'the love of my life'.
It wasn't until he was diagnosed with advanced prostate cancer five years ago that Marsh came to understand just what a 'humiliating, demeaning, frightening experience' cancer can be for a patient. 'I was really very frightened, and more upset than I expected,' he says, 'although rationally, I knew that to have prostate cancer by the age of 70 is no big deal.
'I'd spent all my life dealing with cancer and people dying. So when it was my turn, I couldn't say, 'Why me?'' A more apposite question, he says, might be, 'Well, why not?' After being treated with radiotherapy and hormone therapy, the cancer is in remission, though Marsh has to be tested every six months to check that it has not returned.
Support for assisted dying
As a patron of the end of life charity My Death, My Decision, he has long been a passionate believer in medically assisted dying, and he considers it a possibility for himself if the cancer returns. 'I must have operated upon hundreds of old men like me, where it spread to the spine and is causing paralysis,' he says. 'You might delay the paralysis, and they may then die from organ disease, but if I ended up paralysed, doubly incontinent, in a hospital bed somewhere, I think I'd say, 'This is boring. I'm going to die anyway. I want to get it over with.''
He welcomes the passing of the Terminally Ill Adults (End of Life) Bill in the House of Commons, although he favours a 'less restrictive criterion' than a prognosis of less than six months to live. 'I think it should be intractable suffering, as you have in Holland and Belgium and Switzerland, [but] it is better than nothing,' he says. 'And hopefully, as it beds down, the law might be made a little bit kinder.'
He accepts that one can't hope to influence those who oppose assisted dying on religious grounds, but he says the arguments of some of its most vociferous opponents – that there will be coercion and that palliative care will suffer, for example – are 'simply not borne out' in the many countries where assisted dying is available. 'The evidence is clear that there is not terrible coercion or bullying or things like that.'
His views are informed by experience. He is 'horrified by the idea of dementia ', he explains. 'I watched my father, who was a very brilliant man, become profoundly demented.' His father, the eminent legal reformer Norman Marsh QC, died in 2008 at the age of 95.
'Strong sense of moral duty'
Norman met Marsh's mother, Christel Christinnecke, in Nazi Germany before the outbreak of the Second World War. Unlike her sister (an ardent Nazi and member of the girls' equivalent of the Hitler Youth – the League of German Girls) and her brother (a future Messerschmidt pilot), Christinnecke vehemently opposed Hitler's regime. And after being denounced to the Gestapo for making anti-Nazi statements, she fled to the UK, where the couple married in 1939.
Both were heavily involved in the foundation of the UK-based human rights organisation Amnesty (now Amnesty International) and Marsh says they played an 'enormous' role in shaping his own sense of morality. 'I was brought up to understand very clearly that we are here to make the world a better place,' he says, 'to help others, not just to make money'. They were also 'terrible snobs', he adds. 'They disapproved of businessmen driving Jaguars and television aerials. But there was a strong sense of moral duty.'
Marsh grew up in Oxford, the youngest of four siblings, including the architectural historian Bridget Cherry, the editor of the Pevsner Architectural Guides for many years. It was partly out of rebellion against his father that Marsh decided to abandon the politics, philosophy and economics degree that he had begun there – the famous (or infamous) PPE course which has been the conduit to political power for so many, from Harold Wilson and Edward Heath to Peter Mandelson, Liz Truss, Rishi Sunak and Rachel Reeves.
Marsh had also fallen 'madly in love with an older woman' – a family friend – 'who led me on a bit', he says, which had made him so unhappy that he couldn't cope. Feeling suicidal, he spent a brief period in a psychiatric hospital. 'I'm very emotional. I'm not a manic depressive; the medical phrase is cyclothymic, which means I go up and down a lot. It's not as bad as it used to be. My mother told me I was like that from a very early age. So I'm very intense, very driven. I get frightened easily. I get excited easily, but at the same time, I can be very determined and apply myself.'
What helped him was going to stay with a friend from the north-east of England, whose girlfriend's father was able to get him a job as a cleaner and porter in an operating theatre. Serendipitously, it turned out to be the inspiration he needed to escape the trap of 'writing self-destructive Sylvia Plath-style poetry'. 'That was it,' he recalls – 'there was medicine.'
He was 21. After taking a year off, he returned to Oxford and 'worked like mad to get a good degree to make it easier to get into medical school'. He studied at the Royal Free Hospital in north London, qualifying in 1979. His decision to specialise in neurosurgery, after seeing how it had saved his son's life, was also partly down to how exciting it seemed. He gained his FRCS (Fellowship of the Royal College of Surgeons) in 1984, and then became a consultant in 1987.
'Frustrated and angry' at NHS management
In his early surgical career, he focused on treating aneurysms, which he calls 'bomb disposal work'. He has witnessed 'profound changes in the NHS' since he began working in medicine. In fact, his decision to retire from practising neurosurgery when he did was influenced by how 'increasingly frustrated and angry' he had become with management interference. 'It is extraordinary just how inefficient the department I used to work in has become over the last 20 years,' he wrote recently.
The cost of the extra managerial layer 'in terms of lost productivity and commitment from NHS staff', he suggests, is enormous. He's not even sure that he would have ventured into his chosen field under the present circumstances. 'For a very high-risk, high-responsibility speciality like brain surgery, the fact that doctors have lost so much agency and autonomy, I think, makes it very difficult,' he says.
He doesn't know if Labour's decision to abolish NHS England will help. 'It's easy to dismiss all management and bureaucracy as a complete waste of time,' he notes. But he acknowledges that the NHS has unprecedented challenges. This summer alone it faces strike action from resident (junior) doctors and a looming nursing strike – clear signs of increasing workforce dissatisfaction.
Is he worried about its future? 'I am,' he says. Junior doctors, he believes, are treated 'more and more like assembly line doctors. They're pushed and pulled by the management; when they complete medical school, they've virtually no say in where they will go to work. They're treated as expendable units in a production line. No wonder they're demoralised.
'So I feel deeply sorry for them,' he says, 'although I have very mixed feelings about their going on strike. I supported the earlier strikes. Now, I'm less certain, but I think the problem has a lot to do with alienation and bad management.'
Yet the biggest issues facing the NHS are 'worldwide', he believes. 'All healthcare systems are under strain. I think that is particularly bad in the NHS because there's been almost 20 years of relative underfunding.'
'I worry that the NHS will struggle more and more,' he adds, because of the continuing pressure on the Government over taxation. 'You have to pay more taxation if you want good-quality healthcare. In Europe and the Scandinavian countries, they accept higher levels of taxation, and on the whole, have more effective universal healthcare. There are many different ways of funding it, so it's very complicated, but this country is not doing very well at the moment.'
He continues to believe passionately in Nye Bevan's concept that 'a country can't call itself civilised if the quality of your healthcare depends upon how much money you have. That principle,' he says, 'remains very true.'
He suggests the solution may be a 'hypothecated tax' – ring-fenced to fund healthcare – 'though the Treasury hates it', or for wealthier people to pay to use the NHS, or to have some kind of hybrid insurance system. 'But you do need to be honest with the public that healthcare is very expensive. To say it's all a question of reform and AI and more efficiency is not true.'
'Absurdly long hours'
A recurrent theme in Confessions of a Brain Surgeon is the impact that working 'absurdly long hours' had on Marsh's home life. 'I was either on call all the time, seven days a week, seven nights a week, 48 weeks a year, or every other night, every other weekend,' he says in the documentary. 'So I basically had no life outside medicine at all. You went into neurosurgery 40 years ago, those are the hours you worked, and your family had to lump it.'
He describes how he dealt with the stress of his job by developing a 'mania' for home improvements. He would spend hours of his time doing building work on the family home. 'I should have spent more time, particularly with my children, but I put myself first because I was so obsessed and stressed all the time about my work.'
It led to the intense and painful break-up of his first marriage; although he has since remarried, and adds: 'I'm on holiday in Norfolk with my three children, my four grandchildren, my first wife, my current wife.' He's quick to criticise his past self, he admits, but 'it's worked out all right'.
He still hasn't quite conquered his desire to work with his hands at all times. 'Even now, I find it very hard not to do all my plumbing and electrical repair work. A few months ago, I spent a day on my knees working on the kitchen plumbing, and I now need a knee replacement.'
In the film, he describes how 'everything we are, our feelings, our personality, our thoughts, fears, our hopes are all part of our brain. So when I operate on a brain, it's as though I'm holding a human soul in my hands.'
He's not religious, so does he believe in the theory of the brain as the basis of personality? 'Yes, I do,' he says. 'As a neurosurgeon, you see many people over the years with damage to the front of the brain who suffer profound personality change … When you see people's sort of moral, social nature changed by physical damage to the brain, it's hard to feel that we are more than our brain.'
Talking to Marsh, one thing is clearer than any other. 'I was totally in love with my work with neurosurgery,' he says, 'and I still am, in many ways.' Ultimately for him, it comes down to caring about what happens to your patients. 'What makes surgery exciting,' he insists, 'is your concern.'