Once ensconced in an ivory tower of medicine, any new incumbent must be tempted to pull up the drawbridge. Sir Peter Morris has resisted this urge. In the few months since he became president of the Royal College of Surgeons, he has sidestepped the plush red carpet of clubbish networking, preferring lino corridors and a meet-the-members trudge round English hospitals. As Nuffield professor and chair of surgery at Oxford University, as well as a vascular and transplant surgeon, Morris had thought himself attuned to NHS blight. What he discovered on the road shocked him.
"Things are in such a mess, much worse than I would have imagined possible. I'm hearing over and over again that there aren't enough beds. In some places, elective surgery has just about stopped. Often a surgeon has an anaesthetist and surgical and nursing teams ready - only to find that they are all stood down because there isn't a single patient and nothing to do. It is dreadful." Surgeons, he says, are "miserable, depressed, frustrated". Patients who have urgent operations cancelled are frightened. The situation, he says, is mostly "desperate".
If Morris were eager to heap scorn on the government, then Tony Blair might have less cause to worry. But in a profession still deemed overstuffed with prima donnas, Morris fits no autocratic stereotype. Instead, he is a benevolent, white-haired man of 67, whose looks and manners suggest an off-duty chain-store Santa. He trained in Australia, worked in the US and used to tell everyone that he would always rather be treated by the NHS than any other system. It gives him no pleasure to revoke that view.
We meet, by a coincidence of timing, on the morning after Gordon Brown's pre-Budget report. This is Morris's first major interview since his election in July and the first intervention by a Royal College head on the new health agenda. Rumours of cabinet rivalries are rife. Derek Wanless, less wan than first supposed, is denying that his Treasury report ruled out alternative funding. Among media guesses on what reaching average European spending might cost, the top bid is £37bn a year.
Morris thinks that Blair's (quickly fudged) pledge of parity with Europe by 2005 is impossible to achieve. "I just cannot see it . . . All we are doing at the moment is trying to catch up. Things have gone downhill so much over the past ten years that we'll spend two or three years just trying to get back to where we were then. It's a matter of catching up to a situation where most of the public and most of the profession are reasonably happy that something is being done. I don't think one can be more ambitious than that. As to whether there will be enough money: again, I suspect not."
Despite opposition from the Treasury, he thinks increased tax should be hypothecated. "The public likes the health service. I think if they knew extra tax was being ring-fenced for the NHS, they would accept it." As for alternative funding, such as social insurance, he keeps an open mind. "We need to be thinking about other possible means of funding. But we've had so many changes, and every one is unsettling. That's what I would be nervous about, particularly since there will be more change anyway. Alan Milburn has said we can't just keep pouring money in, and I couldn't agree with him more about that."
The consensus may stop there, much as Morris lauds Labour's intent. "I think they are genuinely desperate, from Tony Blair down, to get it right. It's not just a political thing. I see from my meetings that they are very anxious to get the show on the road." Those meetings are limited. Unlike his predecessor, Morris does not sit on Blair and Milburn's modernisation board, forged to implement last year's NHS plan.
He was not asked to, he says, but it seems clear that he would refuse to risk locking himself into government policy. Does he see himself as a thorn in the flesh?
"No. I'm very much on the side of what they're doing. But it's better to have some degree of independence. It would be very hard for me to speak up if I were unhappy about something, having been involved in confidential discussions. I have a whole lot of unhappy constituents out there."
Apart from a shared belief that the centralised monolith of the NHS must be broken down, the Morris wish list for reform seems radically to differ from Blair's. "There are some big, nasty bullets to bite," he says. The first, in his view, is that small district hospitals will have to close. "I cannot see how they can survive. That will cause local outcries. But I don't believe they can get a critical mass of junior doctors. Plus, there is the ever-increasing shortage of nurses."
First, "you'd have larger hospitals where the specialties would be concentrated. Then the district hospitals might become glorified diagnostic centres, with day surgery and patients admitted for three or four days. This does, of course, mean a change of attitude for surgeons. It's not a very attractive prospect for a trained consultant surgeon." Nor is it likely to please the government. Does Morris think ministers have accepted radical restructuring? "No, not publicly. Privately, they are aware, I think, that it will have to happen. But the political aspect, closures and so on, is perhaps more than any politician would care to contemplate."
Hospital closures are, however, the less contentious part of Morris's vision. Meddling politicians, he believes, should no longer run the NHS at all. "They can't resist interfering or trying to interfere. That concerns me . . . I wonder whether we don't need a health service that is funded by government but independent of it." So Milburn has his finger in far too many pies? "Yes," Morris says. Milburn, he concedes, "has worked pretty hard for the NHS, but . . . nothing gets time to settle down without some new, radical change."
Plus, there are new tensions, such as the rivalry between the Health Secretary and the Chancellor? "Yes, exactly. We have a chief medical officer [Liam Donaldson] and Nigel Crisp, who is the chief executive officer and also the permanent secretary. But they are very much under ministerial control. Maybe they should be running the health service together, without this interference."
Would Crisp and Donaldson, whom Morris does meet often, like to take over from the micromanagers of government and run the show? He hesitates. "I have no idea," he says, before adding, with sudden firmness: "Well, I guess they wouldn't be in those jobs otherwise. I suspect they would like that opportunity . . . It [the health service] is all too influenced by political pressure."
Morris is uneasy about primary carers buying operations (the regions should do it) and about PFI schemes. "I am very concerned that, in ten years' time, we will be in desperate trouble because of the money needed to keep them going. There are other problems. They always try to cut down beds. Because the people who put up the finance have to make money, they are always cutting corners."
Doctors, he says, must change, too. Morris took up his presidency at a time when the profession's standing was very low. Lone cowboys, such as Rodney Ledward and Richard Neale, and the systems failures of the Bristol children's heart scandal cemented the idea that surgeons were often inept and mostly overbearing. Morris is all for scrutiny. He believes the Kennedy report on Bristol will change the culture of surgery for ever, and that arrogance is waning. Its demise, he says, will be helped once medical schools stop selecting only the brightest. "That may not be the way we should pick medical students. You need an academic cadre for the future, but you don't have to be a rocket scientist to be a good doctor. You have to like people."
He is wholly lacking in bombast. He is also anxious. Although he keeps stressing that he eagerly seeks out the (few) remaining good things in the NHS, he thinks the Charles Clarke view, endorsed by Blair, that some aspects have worsened under Labour, is too flattering. "Almost in general, things have got worse."
On his own patch, in Oxford, elective patients awaiting serious operations are now kept in hospital for days on end, at vast cost, waiting for an intensive-care bed to come free. If it does, then a surgeon will turn out to operate, on a Saturday or Sunday, at whatever hour. While consultants still hardly rate as the oppressed of the earth, they may not be the quick beneficiaries of the improvements that a Micawberish government predicts. In particular, Morris does not buy buoyant forecasts of more surgeons, doctors and nurses.
"By all the best predictions we can make, there will be a shortfall of 2,000 surgeons by 2009. New students will eventually provide the numbers needed, but you're looking at 12 or 15 years down the line." On hiring foreign staff, Morris says his view on likely numbers is less bleak than that of most colleagues. "But it will still be a long way short of what is required."
Does he think that health could be the Tories' last chance, and the downfall of this government? "It's near the top of public concerns. So yes, if in three years the health service wasn't obviously improving. Whether the Conservatives could come up with any alternative, I doubt."
I ask him for a worst-case scenario, and he says: "People talk about the health service collapsing completely. I don't think it will happen. It will bumble along as a second-rate system. That is the worst case. But I have always been an optimist."
And that is what should trouble Blair. As a hopeful sympathiser, Peter Morris wishes for progress. As a demotic president, he monitors the heartbeat of the NHS. When such a reluctant critic decries a Labour government as unfit to run the health service, it is time for revision and for shame.