British Cardiac surgeon
Professor Sir Bruce Edward Keogh, KBE, FMedSci, FRCS, FRCP ( ; born 24 November 1954) is a Rhodesian-born British surgeon who specialises in cardiac surgery. He was medical director of the National Health Service in England from 2007 and national medical director of the NHS Commissioning Board (NHS England) from 2013 until his retirement early in 2018. He is chair of Birmingham Women's and Children's NHS Foundation Trust and chairman of The Scar Free Foundation.
Early life.
Keogh was born on 24 November 1954 in Salisbury, Rhodesia (now Harare, Zimbabwe), the son of Gerald and Marjorie Beatrice Keogh (née Craig). His father held a senior position in the Civil service, having been Chief Inspector of Public Services for the Federation of Rhodesia and Nyasaland while his mother was a Hansard reporter in parliament. He attended the private Catholic boys school St George's College, Harare.
Clinical medical career (1980–2007).
Prior to becoming full-time NHS Medical Director in November 2007, Keogh practised as a cardiac surgeon with a special interest in reconstructive mitral valve surgery.
He earned a Bachelor of Science degree and MB BS degree from Charing Cross Hospital Medical School part of the University of London in 1977 and 1980 respectively.
He was a demonstrator in anatomy at Charing Cross Hospital Medical School before training in general surgery in London and Sheffield and gaining his FRCS in 1985. He then opted for a career in cardiac surgery, returning to the Hammersmith Hospital as a registrar. During this time he spent a year as a laboratory-based British Heart Foundation Junior Research Fellow which led to the award of the MD higher degree in 1989 for research into laser coronary angioplasty. He was appointed as senior registrar on the West London training rotation where he spent time at St George's Hospital and the Harefield Hospital training in cardiac, pulmonary and oesophageal surgery. He was subsequently appointed a university Senior Lecturer in cardiothoracic surgery at the Royal Postgraduate Medical School and honorary consultant surgeon at the Hammersmith Hospital between 1991 and 1995. He then took an NHS consultant position in Birmingham where he became the 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.
In 1994 he established the National Adult Cardiac Surgical Database and as a consequence, he is perhaps best known for his work promoting the measurement, analysis and public disclosure of clinical outcomes. But he has also published numerous peer-reviewed scientific articles on coronary artery vasomotor tone, the effect of cardiopulmonary bypass on gut blood flow and function, myocardial protection during surgery, surgery for patients with poor left ventricular function and the effects of social deprivation on cardiac surgical outcomes. He has co-authored a book on the Evidence for Cardiothoracic Surgery (2005) and another on Normal Surface Anatomy (1984). While at UCL he brought the national registries on adult and pediatric cardiac surgery, myocardial infarction, coronary angioplasty and pacemakers into a new National Institute for Cardiovascular Outcomes Research.
His work with Paolo Camici using PET scanning to identify hibernating myocardium in people with heart failure in the mid 1990s helped transform surgery for heart failure worldwide. He performed the first successful transabdominal, off pump gastroepiploic artery bypass graft to the heart in the UK and was among the first to adopt minimally invasive, direct coronary artery bypass surgery, thoracoscopic mitral valve surgery and warm blood cardioplegia for myocardial protection.
Keogh has been active on many medical and professional committees. He has been secretary and president of the Society for Cardiothoracic Surgery in Great Britain and Ireland, Secretary General of the European Association for Cardio-Thoracic Surgery and president of the Cardiothoracic Section of the Royal Society of Medicine and served on the Council of the Royal College of Surgeons of England and the board of directors of the Society of Thoracic Surgeons in the US. He is an elected member of the American Association for Thoracic Surgery and a Fellow of the European Society of Cardiology. In addition, he has served as a member of the Civil Aviation Authority Medical Advisory Panel, and on the trustee board for the National Confidential Enquiry into Patient Outcome and Death and the Board of the Picker Institute. He has sat on the editorial boards of Heart and the Journal of the Royal Society of Medicine. He has been a British Heart Foundation junior research fellow, senior lecturer, member of the Research Grants Committee and Council member.
Prior to becoming medical director of the National Health Service, he served on the National Coronary Heart Disease Taskforce, the NHS Standing Medical Advisory Committee, and was chairman of the NHS Information Taskforce on Clinical Outcomes for the Department of Health. He has also served as Commissioner on the Commission for Health Improvement and the Healthcare Commission, where he chaired the Clinical Strategy Group.
Given his long-standing interest in measuring and publishing clinical outcomes as a driver for improving quality, in 2007 he was asked by Patricia Hewitt, then Secretary of State for Health, to assist Tim Kelsey in establishing a new health website, "NHS Choices". Keogh's role was to ensure credible clinical content. He chaired the clinical advisory group and subsequently went on to chair the NHS Choices Board.
NHS Medical Director (2007–2013).
As medical director of the NHS (2007–13) he was a director general in the Department of Health where he led the Medical Directorate, which had oversight for clinical policy and strategy in the NHS. This included the work of the National Clinical Directors and their associated strategies such as those for coronary heart disease, stroke, cancer, respiratory disease, renal disease, liver disease, trauma, and transplantation. He established the Healthcare Quality Improvement Partnership (HQIP)a joint venture between the Academy of Medical Royal Colleges and the Royal College of Nursing to develop and run the national clinical audits.
Keogh's role also included oversight of the medicines supply chain into the UK, policy relating to the pharmaceutical industry, drug pricing, prescriptions and the role of pharmacy in England and sponsorship of the work programmes of the National Institute for Health and Clinical Excellence (NICE), the NHS regulator the Healthcare Commission and the National Patient Safety Agency (NPSA), including the National Confidential Enquiries and the National Research Ethics Service. Through sponsorship of Medical Education England (MEE) a product of the 2008 Darzi review of the NHS, he had oversight of postgraduate education of doctors, dentists, pharmacists and clinical scientists, but this was superseded by Health Education England (HEE) in 2012 to ensure a balanced and integrated approach to all healthcare professionals.
In 2008, Keogh succeeded Matthew Swindells as Interim Director General for Informatics in the Department of Health. During this time he set out a vision for NHS IT and Informatics that would learn from successful GP systems and inform future direction for the National Programme for IT. This review recommended the development of essential functionality that would create a pull effect from clinicians by ensuring NHS IT was useful in conducting day-to-day business. The idea was to create a create a ‘tipping point’ in the acceptability and demand for strategic IT systems. The five key elements (the ‘Clinical 5’) for secondary care were: a Patient Administration System (PAS) with integration with other systems and sophisticated reporting; Order Communications and Diagnostics Reporting (including all pathology and radiology tests and tests ordered in primary care; letters with coding (discharge summaries, clinic and Accident and Emergency letters); scheduling (for beds, tests, theatres etc.); e-Prescribing. This set the NHS on a path to electronic health records.
He also recommended a National Quality Framework based on clinical metrics. The lack of a national set of clinical outcome and quality measures had impeded progress towards a culture of continuous quality improvement.
On handing over to his successor, Christine Connelly, Keogh emphasised 3 priorities for NHS IT. The first was the need to focus on the £12.4 billion worth of contracts within the National Programme for IT in the NHS. The second was the need to get the technology right for clinicians who use it. The third was the need to focus on the patient, saying “Most importantly, we must not lose sight that the technology is about underpinning the interaction between citizens of this country and health and social care services.” 
As Medical Director he opposed the establishment of the Cancer Drugs Fund which he believed would undermine NICE and the quest for an evidence based NHS. He was subsequently responsible for drawing together NICE, cancer charities and the pharmaceutical industry to lay the groundwork for a revised evidence driven CDF which went live under NICE in 2017.
Keogh's team was responsible for implementing the majority of the recommendations from Lord Darzi's review of the NHS "High Quality Care for All" published in 2008. This review has been credited with refocusing the NHS on quality of care. Keogh's team also developed the Quality Framework for the NHS (based on the work of Sheila Leatherman) and included in Darzi's review. The principles were simple: Define what is meant by quality, measure it, publish it for everyone to see, reward those who do well, regulate for minimum standards, promote and develop leadership for quality within the NHS and promote research and innovation within the NHS, by drawing on and linking with the best British universities and biotechnology companies in to form academic science networks. The resultant definition of healthcare quality based on the provision of effective care, safe care and a positive experience became widely accepted and was subsequently enshrined in the Health and Social Care Act (2012).
In 2011, after the collapse of the British Association of Medical Managers, he established the Faculty of Medical Leadership and Management under the jurisdiction of the Medical Royal Colleges in order to ensure access to all doctors, not just those in leadership or management positions. He subsequently asked the Faculty to administer the National Medical Director's Clinical Fellows Scheme which had grown out of the Clinical Advisor Scheme in the Department of Health, thereby ensuring a long-term home for the programme. The following year, he helped to establish a shadowing period for new Foundation Trainees.
NHS England (2013–18).
Following the election of a coalition Government in 2010, he was tasked with making clinical outcomes the currency of NHS business. In response, his team developed the NHS Outcomes Framework which was based on the observation that all healthcare systems should do five things well: Firstly, the NHS should stop you dying prematurely from things they could influence through treatment or prevention through immunisations e.g. stroke, heart attacks, measles. Secondly, the NHS should look after you well if you have a long-term medical condition such as diabetes, asthma, arthritis. Thirdly, the NHS should treat you effectively if you need a short episode of care e.g. broken leg, an operation or infection. Fourthly, the NHS should treat you well. The experience should be as positive as possible, ranging from participation in decisions about your treatment to decent customer service. Finally, the NHS should treat you safely. All of these are measurable at different levels. They also dovetail with the definition of quality in the three domains of effectiveness, safety, and experience.
The five domains of the NHS Outcomes Framework have formed the basis of the Government's Mandate to NHS England and NHS England's planning guidance for the NHS where they give clarity of purpose and direction to the NHS in a way that was previously undefined. He has argued that the role of NHS England is to "turn taxpayers money into good clinical outcomes".
Following the Lansley reforms of the NHS, he was appointed National Medical Director in NHS England from 2013, where he is responsible for promoting a focus on quality, clinical leadership and innovation. To facilitate these aims he was responsible for overseeing the establishment of Academic Health Science Networks, Strategic Clinical Networks and Clinical Senates. He put clinicians at the heart of NHS England through the Chief Pharmaceutical, Dental, Scientific and Allied Health Professions officers, a primary care deputy, a medical director for specialised commissioning, regional medical directors and pharmacists, area medical directors, over 20 expert national clinical directors and junior doctors, pharmacists and dentists through the National Medical Director's Clinical Fellowship Scheme. In 2015 he established and chaired the NHS National Innovation Acelerator to help innovators