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Less than ideal

In the run up to the 70th anniversary of the NHS, the BMA is publishing a number of profiles of leading doctors who will describe the history of the service through their own experiences. The first, to coincide with International Women’s Day, is of orthopaedic surgeon Scarlett McNally. Once mistaken for a waitress at a surgical conference, she tells Kate Youde that the position of women in surgery has changed but there is need for improvement in areas such as less than full-time training

Scarlett McNally wanted Sir Bruce Keogh’s job. She emailed following the announcement of his retirement last April to express her interest and was told she would be informed when the role was advertised. She wasn’t, and missed the deadline for applications. NHS England appointed Stephen Powis as its new national medical director in November.

‘I think they thought I was joking,’ says Mrs McNally (pictured below).

‘I wouldn’t have got it because I haven’t done all the roles in between, but ideally I’d be running the NHS. I think I couldn’t make it worse really.’

You can expect her to take a surgical approach to the role: ‘If you can’t fix it do what you can to make it as good as possible.’

A consultant orthopaedic surgeon at Eastbourne District General Hospital for the past 16 years, she has seen many changes in the profession since she began studying medicine at UCL in 1984.

They include attitudes to women. There were 100 applicants for three places when she applied for her registrar job in 1994, the panel for which was made up of a dozen male interviewers.

‘I was the only woman who applied,’ she says, ‘because everybody was convinced a) that women couldn’t do it; b) that if you did it you couldn’t possibly do anything else; and c) if you did that you couldn’t possibly have kids as well.’

A mother of four, Mrs McNally, 52, has had a career and children. She took 18 weeks off with each child, making use of the BMA’s maternity-leave guidance, and was glad to get back to work.

‘To be patronised by health visitors at home when you’re used to running the show I found really, really hard actually; really depressing,’ she says.

As a woman, she had been ‘put off at every stage’ from being a surgeon, often by people who didn’t realise they were putting her off, owing to unconscious bias. She also missed out on mentoring given in the men’s changing room.

‘I had slip-on shoes and a slip-on dress so that I could be out first, outside the gents ready to go so I didn’t miss the ward round,’ she recalls. It was not her only conscious clothing choice.

After being mistaken for a waitress three times when making her way to the toilet during a dinner at a surgical conference in the 1990s, Mrs McNally stopped wearing black at work. True to her word, she is wearing a red dress when we meet in the lounge at the Royal College of Surgeons of England, where, in 2011, she became only the ninth woman elected to the body’s council.

Today, the situation for women is much improved, she says, with better structures in place and training monitored. Women account for about 30 per cent of registrars and 11 per cent of consultants in surgery.

‘That’s great because it’s like anything else, as soon as it’s normal … things change to accommodate it,’ she says.

However, she says women often don’t put themselves forward for roles – her research has found that women are less likely to apply for the next stage of surgical training although those that do are statistically more likely to be appointed – or are still being put off.

The key to encouraging more women into surgery is skills, adds Mrs McNally, who as a member of the BMA equality and diversity committee between 2005 and 2008 did some work on how institutions might be excluding people unintentionally in their recruitment process.

‘Often women tend to have less confidence than men, so you build up the skills, you build up the confidence,’ she says. ‘You show them what the real job’s like, not this training that is just relentless, and then you support them while they’re doing it.’


Alpha males

Men and women need to be able to take time out and come back less than full time without it being such a struggle which, she suggests, it is at the moment owing to a prevailing ‘superhuman’ and ‘male’ attitude that it is somehow a ‘lesser’ option.

While acknowledging there is no spare money, Mrs McNally would also like to see more funding put in place to reimburse trusts that support people doing focused part-time training in craft specialties including surgery.

In an effort to help ease the workload on junior doctors, she has been leading a research team at East Sussex Healthcare NHS Trust to investigate the impact of a new role of doctors’ assistant – someone who could do some of their paperwork and easier clinical duties – to free up doctors to get on with their training.

Mrs McNally was 14 when she decided to study medicine. She ‘thought it would be like biology but without the rather boring plants’.

The relative financial stability of the job was attractive. Against the backdrop of the recession of the early 1980s, which saw three million people unemployed, she knew that if she became a doctor she would earn enough, because of the low unemployment rate in the profession, and not have to worry.

It was on starting dissection that she discovered her love for surgery. ‘There is a problem, you fix the problem and it’s done,’ she says.

In this way, she sees parallels between surgery and karate, in which she is a black belt and earned a blue while studying the clinical part of her medical degree at Trinity College Cambridge.

‘It’s precision and [a move] doesn’t always work but then you try [again] and you keep trying,’ says Mrs McNally.

She is a keen advocate for having an active lifestyle. The lead author of the Academy of Medical Royal Colleges’ 2015 report, Exercise: The miracle cure and the role of the doctor in promoting it, she co-founded the Bespoke Cycle Group to campaign for improved cycling facilities in Eastbourne.


Sedentary lifestyle

She thinks much of the pressure on the NHS could be solved by getting the population fitter and happier through exercise, nutrition and education, as the majority of its spending is on chronic long-term conditions.

‘I think society needs to understand that that’s why the hospitals are full now – because social care can’t keep up with people that actually, if they had gone for a walk every day, might be able to get up out of a chair themselves and go to the toilet, rather than having to be pushed there in a wheelchair by another person,’ she says. This message needs to come from doctors because they are ‘so trusted’.

Part of the problem is that changes in healthcare during her career mean that doctors now listen too much to patients, she suggests. ‘I think we need to go back a little bit and be a bit more paternalistic, particularly around active lifestyle,’ says Mrs McNally.

‘People who do exercise reduce their risk of getting a hip fracture by 45 per cent, breast cancer by 25 per cent, and we just don’t push that enough. We’re so busy listening to people and taking their agenda that we’re not being firm enough about what they could do for themselves.’

For now, she has missed the chance to run the NHS and put these ideas into practice. But there are other opportunities to pursue.

After we meet, Sir David Behan announces his intention to step down as chief executive of the Care Quality Commission in the summer. Mrs McNally is keen to throw her hat in the ring.

International Women's Day

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