A conversation with surgical pioneer, Dame Averil Mansfield

Early in her career as a surgeon, Averil Mansfield was given a huge bouquet of chrysanthemums by an older man she had recently operated on. Many of the other patients in his ward thought this was the proper way to thank the “lady doctor” and Averil found herself overwhelmed by flowers. It was just one of many amusing episodes that she experienced as the patients learnt that they were going to be – or had been – operated on by one of the handful of female surgeons in the UK.

Averil went on to enjoy a stellar career. Before her retirement, she was one of the UK’s leading vascular surgeons and is acclaimed for her role in the development of operations that saved lives and limbs and prevented strokes. She championed the role of women in the profession, founding the organisation Women in Surgery in the early 1990s. She was awarded a CBE in 1999 and a damehood for her services to surgery and equality in medicine in 2023.

Born in Blackpool in 1937, Averil describes her background as “very working class” with no professional role models in her family. However, her parents always encouraged her academically and she qualified from Liverpool University’s School of Medicine in 1960. It required more than a decade of further training, and gruelling hours, before her appointment as a consultant surgeon. This included several stints in the US, where the specialism of vascular surgery was more advanced than in the UK.

Averil clearly stood out from the crowd: she estimates that just 2% of consultant surgeons were women when she started her career. However, she does not feel that her gender put her at any disadvantage. “It was always about the work,” she says reassuringly. Averil is of course aware that not all women have been as fortunate – especially in the field of surgery. She saw evidence of this while serving on a working party looking into discrimination for the Royal College of Surgeons in 2021.

Imaginary barriers?

Even today, just under 20% of consultant surgeons are women – despite the fact that women generally account for slightly over half of UK medical students. Surgery faces particular challenges when it comes to attracting and retaining women. This is not a minor area where the problem can be overlooked: surgeons account for almost 20% of the NHS’ 132,000 hospital doctors, according to data from NHS Digital.

Averil identifies early medical careers as one point where women may face discrimination. “I do think there is still an issue of women – and others from non-traditional backgrounds – being told they can’t make it in surgery, simply because they don’t fit outdated ideas of who can do what kind of medicine.” These narrow-minded perspectives can become internalised, leading people to rule out a hugely rewarding field without giving it proper consideration.

Family life is perceived as another obstacle: “You can’t easily walk away from an operation,” she explains. “So sometimes your personal life takes a bit of a backseat.” However, she is adamant that this should not mean that women avoid surgery. “It is now perfectly feasible, if hard work, to be a surgeon and have a normal family life. It’s definitely not one or the other.” The NHS can and should be doing more to help. Making it easier for women to come back to surgery after taking time off while their children are young would make a big difference.

Motivation

Averil knew from childhood that she wanted to be a surgeon. She was inspired by books on anatomy and medicine that she discovered in her local library. She also suggests that her mother’s experience of thrombosis pushed her towards the specialism she eventually chose. At the time, the only available treatment was weeks of strict bedrest and Averil recalls the episode being part of the “family’s folklore” when she was growing up.

One of Averil’s first breakthroughs was treating young women who developed blood clots as a side effect of the contraceptive pill. Early versions of the pill contained excessive levels of oestrogen, meaning that this landmark in the battle for equality came with serious health consequences for many women. Averil pioneered a treatment that involved using X-ray and a balloon catheter to remove the clots. Her subsequent specialization in vascular surgery meant that her patients were more likely to be men, who are more prone to diseases of the arteries.

What ultimately motivated Averil is patient care. “I still cherish the personal contact between doctor and patient more than anything else.” When asked about the operations she is proudest of, it’s not technical breakthroughs that come to mind; it’s the former patients who have been in touch to tell her about the extra years of life she has given them.

The NHS today

Averil applauds the recent Budget changes, which removed the Lifetime Allowance on pensions, a particular headache for senior medics. More generally, though, she is concerned about the outlook for the NHS. “Over the years, I have thought that a major revamp of the health service was best avoided. But now I think it’s necessary,” she explains. “We can’t go on with the situation we’ve got at the moment. We need a big rethink. We’ve been running on the goodwill of staff to paper over the cracks…and that goodwill is now running low.”

Averil remains hugely enthusiastic about surgery as a career choice. “I have loved every minute of it,” she says. Whatever field they may be interested in, the lesson she wants young people to take from her career is to follow their passions – even if it leads them in unconventional directions. “I always encourage people to look at what they would like to do in life and to accept the fact that it is possible to do things. If you set your heart on something and you have the ability, the energy and the commitment, then you can achieve it.”

Averil is a client of Cazenove Capital. Her autobiography – Life in Her Hands – was recently published by Penguin Books.