Imagine a retired professional man waiting for an elective operation. He has been told that the outcome data for individual consultant surgeons is available. He consults his nephew a statistician who tells him that based on the data, there is not much to choose between the seven surgeons working at his local hospital. So he chooses a surgeon whose name looks familiar.

Come the day of the operation, he is disappointed when he is told that the surgeon of his choice is off sick and that his operation is going to be performed by a locum. This is not a far-fetched story. The availability of this data is unlikely to guarantee the best treatment for the patient. What the patient needs is confidence in the system which will effectively deal with all possible eventualities. This can only be provided by an effective head of surgery.

When you come to think about it, the outcome of the operation would be influenced by the anaesthetics (given by the anaesthetist), the surgical technique (wholly controlled by the surgeon), theatre discipline (team effort), operating room air standards (team effort) and post –operation care (team effort). The only person who can control most of these factors is the head of service.

He/she will be in charge of recruiting and training staff working in that department. With some assistance from the director of finance, he/ she will manage the departmental budget. He /she will also organise a seven day service so that in the unlikely event of that elderly patient coming back with unexpected complication on a Saturday, he will be in safe hands. Outcome data including complications with proper interpretation can be best produced by the head of service.
A successful outcome also depends on other well run departments including blood transfusion (in case he needs blood for his operation), microbiology (in case he gets an infection) and Imaging to mention but a few.

Building such a department needs a special person whose recruitment needs to be robust and transparent. That is what will give confidence to the above mentioned patient and all of us. What our government can do for us is to make sure that such a system is in place by underpinning it with legislation. Once that is done, the professionals should be trusted and given time to build such departments. I am speaking from experience as a retired consultant microbiologist. I have put this and other issues in my autobiography, ‘The bugs doctor with a passion for music.’