I opted to review this book in part because I was intrigued by the idea of a Dermatologist doing anything so large scale as saving the NHS. The speciality has figured very little in my career – I got next to no instruction in it during my clinical training at UCH, none of my fellow trainees went on to take up the speciality; and the only time I had any contact with it was when I had a biopsy of a pigmented lesion that I thought, wrongly, might be a melanoma.

This is in fact a very readable and interesting book although improving NHS dermatology services would be a more appropriate title than saving the NHS.

It is a very unusual book in that the 34 chapters – all quite short – are not in a logical time sequence. Chapter 1 deals with incidents in 2017, Chapter 2 relates to 1789-1860 but the last Chapter does bring us up to date or almost so, to 2021.

As forecast in the Foreword, Dr Anstey takes the reader at breakneck speed across his 40 year very varied career jumping from the present to the past to show how his work built on his previous experience.

As someone who is currently writing their own autobiography I had not thought of this approach but it is one that could be used with any autobiography for the same reasons because Dr Anstey interweaves his own biography with fascinating historical insights and profiles of influential medical thinkers. When I discovered that one of the latter was Julian Tudor Hart I knew that I was doing the right thing in reading and reviewing the book as Dr Hart was a very influential influence on me as a practising public health specialist and as a politician.

Cutting to the quick, Dr Anstey describes his successful efforts to make his clinical practice a laboratory for clinical research with active involvement of the patients; and his efforts to integrate his hospital clinical practice with that of the local general practitioners as a means of improving and speeding up the care of patients. I do not think that in doing these he did anything very original or revolutionary but very importantly and, unusually in my experience, having concluded that these efforts would be valuable he actually went ahead and implemented them. This is what I call the engineering approach to practice – in the vein of Dick Strawbridge of Escape to the Chateau fame and of course of Julian Tudor Hart – which is remarkably rare.

On the research issue I have always assumed that as doctors are scientists by training they would all realise that every contact with a patient provides information that should be recorded and regularly reviewed to see if it advances knowledge of the aetiology, natural history and treatment of the relevant condition. And if so, this knowledge should be broadcast to the relevant medical / scientific community. I had imagined that this was a commonplace of clinical practice but it would appear this is not the case, shamefully. And I have to confess that I did not adopt this approach myself except occasionally, in the course of my career and regret this greatly.

On the integration issue it was a tragedy that general practice opted for independent practitioner status at the inauguration of the NHS and thus created a huge barrier between them and their activities and staff and those in their local hospital services to which they referred their patients. It is very unfortunate to put it mildly that it has taken so long for inroads to have been made into this barrier by the likes of Dr Anstey to the great benefit his patients and to the effectiveness and efficiency of his local hospital service.

Anstey rightly castigates governments of both persuasions for interfering with the NHS by proposing so called reforms purely for electoral purposes when in fact they are patently ignorant about how the NHS works and succeed only in creating chaos and confusion in the Service and wasting vast sums of money. One of the best examples of such a reform which I took advantage of directly was the introduction of general management in the mid 1980's on the assinine assumption that the NHS operated like a supermarket. As one of the new fangled District General Managers I proved to my own satisfaction that the scope for what would be recognised as management action was totally constrained by the bureaucratic structure of the Service and the conservatism of its health authority members.

Looking at what needs to be done for the NHS to survive Dr Anstey cites the LSE-Lancet Commission's 7 recommendations which are fine as far as they go but miss the key point which is that the NHS, by some new constitutional arrangement, needs to me made independent of the government while remaining ultimately accountable to Parliament. The NHS belongs to the people whom it serves and the people who provide its services and this must be reflected in a new constitution and structure. We can no longer have ignorant politicians tinkering with it at whim and invariably undermining and impoverishing it.

I am very conscious that I have inevitably focused on issues that particularly interest me and in no way done justice to all the pearls in the book, The short case histories of patients who presented to the author in outpatients I found fascinating and there is much else of great interest too including the author's travels abroad.

In summary, a very interesting and well written book that I recommend to all interested in the NHS and its wellbeing. Its idiosyncrasies are part of its charm.

A quote I could not resist highlighting “ I survived Eton but was determined to take a career path with as few Etonians as possible; Medicine beckoned.”

Paul Walker