Following a distinguished career as a cardiac surgeon, Bruce Keogh has been at the heart of NHS policy development and implementation for many years, promoting openness, quality, clinical leadership and innovation. Knighted for services to medicine in 2003 he has repeatedly been ranked the most influential clinician in the English NHS by the Health Service Journal and has been named as one of Britain's 500 most influential people in the Sunday Times/Debrett’s list.
Born in Zimbabwe, Bruce attended the Catholic school St George's College, Harare. Political unrest led him to leave for England with a rucksack, £250 and no university place. After 19 medical school rejections he was admitted to Charing Cross Hospital Medical School through clearing, gaining a BSc and medical degrees from the University of London.
General surgery posts in London and Sheffield saw Bruce gain his FRCS in 1985. A British Heart Foundation Junior Research Fellowship allowed him to spend a year in the lab at London’s Hammersmith Hospital and he received an MD in 1989 for research into laser coronary angioplasty. As a senior registrar on the West London rotation, Bruce trained in cardiac, pulmonary and oesophageal surgery at St George's and Harefield Hospitals.
From 1991-1995 he was a British Heart Foundation senior lecturer in cardiothoracic surgery at the Royal Postgraduate Medical School and honorary consultant surgeon at the Hammersmith Hospital. Moving to an NHS consultant position in Birmingham, he became clinical service lead for cardiothoracic surgery and associate medical director for clinical governance at University Hospital Birmingham before being appointed professor of cardiac surgery at University College London and director of surgery at the Heart Hospital in 2004.
As a surgeon and scientist, Bruce has a track record of fruitful collaborations and a vast publication record. His work helped transform surgery for heart failure worldwide and he has pioneered approaches to bypass graft and mitral valve procedures, alongside new ways to protect the heart during surgery.
Bruce is also noted for promoting the measurement, analysis and public disclosure of clinical outcomes. He was responsible for establishing the National Adult Cardiac Surgical Database and bringing the national registries on adult and paediatric cardiac surgery, myocardial infarction, coronary angioplasty and pacemakers into a more coherent National Institute for Cardiovascular Outcomes Research.
Bruce’s appointment as Medical Director of the NHS, in 2007, followed his close involvement with several influential bodies: the National Coronary Heart Disease Taskforce, the NHS Standing Medical Advisory Committee, and as chairman of the NHS Information Taskforce on Clinical Outcomes for the Department of Health. He also served on the boards of the Commission for Health Improvement and the Healthcare Commission where he chaired the Clinical Strategy Board.
As NHS Medical Director, Bruce had oversight of clinical policy and strategy. This included the UK medicines supply chain and the pharmaceutical industry, drug pricing, prescriptions and the role of pharmacy. His teams were closely involved in professional development and training for doctors, clinical scientists, dentists and pharmacists, including the introduction of revalidation for doctors, at which point he became the responsible officer for all NHS doctors in England.
Bruce sponsored the work programmes of the National Institute for Health and Clinical Excellence (NICE), the National Patient Safety Agency and the Healthcare Commission for the Department of Health. He was responsible for establishing the Healthcare Quality Improvement Partnership between the Academy of Medical Royal Colleges and the Royal College of Nursing, to develop and run national clinical audits, and ensured extensive publication of hospitals’ and surgeons' mortality and procedure-related complication rates. He was also instrumental in the creation of the "NHS Choices" website, where he chaired the clinical advisory group and the board.
Bruce led quality improvement within the NHS, notably taking forward Lord Darzi's recommendations from his 2008 review of the NHS "High Quality Care for All.” Bruce was a fierce defender of its principles, from the need to define what is meant by quality, measure and publish it, to promoting leadership alongside research and innovation, by drawing on and linking with the best British universities and biotechnology companies. The ensuing definition of healthcare quality based on the provision of effective, safe care and a positive experience was subsequently enshrined in the Health and Social Care Act (2012).
Bruce’s tenacity when he feels decisions to be unwise was seen in his opposition to the Cancer Drugs Fund (CDF), which he feared would undermine NICE and an evidence-based NHS. Instead, he drew together NICE, cancer charities and the pharmaceutical industry to lay the ground for a revised CDF, enabling patients to access new treatments much earlier than before.
In 2010, Bruce turned in part to developing the NHS Outcomes Framework, based on the observation that all healthcare systems should do five things well: stop you dying prematurely from things they could influence through treatment or prevention; look after you well if you have a long-term medical condition; treat you effectively if you need a short episode of care; ensure you are always treated as well as possible, and treat you safely. These domains formed the basis of the government's mandate to NHS England, giving clarity of purpose and direction in a way previously undefined.
Bruce has said that the role of NHS England, where he became Medical Director in 2013, is to "turn taxpayers’ money into good clinical outcomes." Responsible for promoting quality, clinical leadership and innovation, he oversaw the establishment of Academic Health Science Networks, Strategic Clinical Networks and Clinical Senates. He moved the roles of Chief Pharmaceutical, Dental, Scientific and Allied Health Professions officers from the Department of Health into NHS England, and substantially increased senior clinical leadership in the NHS by creating new clinical roles including a primary care deputy, a medical director for specialised commissioning, regional medical directors and pharmacists, area medical directors, and over 20 expert national clinical directors. He created the National Medical Director's Clinical Fellowship Scheme to introduce junior doctors, pharmacists and dentists to management and policy-making. Several hundred have now been through the Scheme.
Bruce left NHS England in 2018, becoming chair of Birmingham Women's and Children's NHS Foundation Trust. He joined the board of the Cell and Gene Therapy Catapult, the board of NICE and took up several private sector chair, independent director and advisory roles in biotechnology, diagnostic and investment companies. He chairs The Scarfree Foundation, a medical research charity, the British Heart Foundation Clinical Research Collaborative, the Birmingham Women's and Children's Hospitals Charity and a trust supporting his former school in Zimbabwe.
Alongside such roles, his passion for the NHS is strong. Writing in the Guardian in 2021, Bruce said “The pandemic has shown us all how much we depend upon the NHS. In this dark year, it’s worth remembering that the health service was founded during a similarly intense period of hardship following the second world war. It was the most ambitious social insurance project in history and became an icon of Britain’s social conscience. Our task now is to ensure its resilience for the future.”
Bruce’s contribution to this great British institution cannot be over-emphasised. The Academy of Medical Sciences welcomed him as an Honorary Fellow in 2020.