Tom Sutcliffe — rich legacy of multitalented first head of the Western Cape Health Department

The imperative to reform arose with the incoming national government’s policy to redistribute financial resources equitably across nine newly established provinces. The Western Cape had to reduce its health expenditure by 27% over five years. At the same time, there was a legitimate expectation from previously underserved communities for better access to health services in the townships and rural areas of the province. 

A strategic management team set up by Sutcliffe and then health MEC Ebrahim Rasool identified the unfettered public access to expensive tertiary care as the source of greatest inefficiency in the provincial health service, and designed a far-reaching health reform plan that strengthened primary healthcare as the entry point and the foundational base of access to healthcare. More than 100 clinics and community health centres were built and staffed within the first few years. 

The plan also proposed the shift of specialist services and training to smaller hospitals throughout the province. Hospitals in the Cape Metro and Paarl, Worcester and George were substantially upgraded to fully fledged regional specialist hospitals. The strengthening of the primary and secondary levels of the health service created the reasonable conditions to downscale tertiary services; decanting patients needing primary or secondary care to the upgraded lower levels; resulting eventually in the closure of almost 1,000 tertiary beds. 

These reforms brought the provincial health service within budget while expanding services to more than a million residents of the Cape who had previously had little access to health services.

Scaling up primary and secondary care was received with great acclaim by the public and the health fraternity alike, but the closure of tertiary hospital beds and the relocation of specialist training posts to smaller hospitals was met with scepticism from many quarters and outright resistance from others. 

Sutcliffe’s stature among the academics in the universities and tertiary hospitals was key to bringing them onto the side of a radical reform agenda that, on the face of it, appeared like a loss of teaching, training and research capacity. Under Sutcliffe’s leadership over the next seven difficult years, almost all of the plan was meticulously implemented, and the direction of travel was set for the provincial health services for the next 20 years. These reforms, implemented in the initial years of the post-democratic era, contributed immensely to the relative stability of the health service in the Western Cape. 

The health services in the province acquired the right size and shape of primary, secondary and tertiary services with credible management capacity at all levels. Thousands of people benefit every day in the province’s clinics, community health centres and hospitals because of this formative work under Sutcliffe’s leadership. 

The Western Cape Health Services continued to improve under subsequent heads of department. Its structural integrity and system strength came to the fore during the Covid pandemic, when the province showed its ability to withstand the immense pressure the system came under. The ability of the health service to withstand the shocks of the pandemic is testament to the strong foundations that were built during Sutcliffe’s time at the helm.

Sutcliffe dug deep to find wisdom and integrity, and proved a steady hand when the province had to develop a response to the Aids crisis that began to overwhelm the health service in the late Nineties with a catastrophic rise in deaths of newborns, children and adults. 

The crisis took an unexpected turn when the phenomenon of Aids denialism from the very top of government reared its ugly head, and a decision was taken by the National Department of Health and the Presidency to deny dying patients antiretroviral treatment against all the medical evidence. 

Sutcliffe’s team bucked the national instruction, teamed up with the Treatment Action Campaign and raised hundreds of millions of rands in donor funding to roll out treatment, first to pregnant women and then to children and adults living with HIV. This was an intense period of conflict and controversy. Sutcliffe, delicately and with great diplomacy, managed the fallout with his national counterparts, while leaving no doubt in the minds of his team that they were correct in their resolve to provide treatment, indeed had a moral duty to do so, and that his total support and protection would not be found wanting on the issue. This work led eventually to the national roll-out of treatment and changed life expectancy in the country by more than 10 years. Sutcliffe’s role in this epic battle should never be underestimated.

After his decade-long stint at the helm of the provincial health department, Sutcliffe established and ran the province’s mental health review board, which has become an exemplar of how the age-old problem of institutional abuse of mental health patients should be prevented and monitored. His deeply caring personality made it a compelling task to ensure the rights and dignity of the mentally infirm are protected. His work in this area and the skill with which he approached every individual psychiatric admission in the province’s hospitals led him to be awarded an ad eundem Fellowship in Psychiatry by the Colleges of Medicine of South Africa, the only one ever given. His concern for the vulnerable led him to dedicate a significant amount of time to the Red Cross War Memorial Children’s Hospital Trust, where he was a highly valued member providing leadership and guidance and much time and effort fundraising for the hospital. 

Sutcliffe grew up in Johannesburg and schooled at St Stithians College where he excelled academically and on the cricket pitch as opening batsman for the first team; retaining a love for the classical stroke play seen only in the five-day game. There was talk of him playing county cricket in England, but level heads prevailed, and Sutcliffe relocated to Stellenbosch to study medicine. It was here too that Sutcliffe started a serious career in fly fishing in the crystalline streams of Jonkershoek, Stellenbosch, and the mountainous regions of the Cape, developing his love of nature and an interest in ornithology. He especially loved the Karoo and the Eastern Cape. 

Over the next few decades and after having fished the trout streams of most parts of the country, and many iconic fly fishing destinations in the world, the Sutcliffe name became synonymous with fly fishing in South Africa. He has published seven books on the subject. His Hunting Trout was so popular among fly fishing folk that it had to be printed three times. His monthly newsletter, The Spirit of Fly Fishing, was read in 92 countries. The literary skill of his writing was matched by a demonstration of his mastery over his subject matter. Sutcliffe illustrated his books with his own sketches of the flies that he had tied (incredibly colourful and elaborate imitations of all types of insects that a trout might mistake for a meal), drawings of trout seen or photographed and landscapes of the mountains, rivers and farmhouses that he had come across on his countless fly fishing expeditions.

If Sutcliffe’s two worlds of living out the beauty of life through fly fishing and the compelling calling of medicine and health administration had been dogged by the irreconcilable tension of these two worlds, they were joined by his character and personality across both. In medicine and health as in fly fishing, one always left an encounter with Sutcliffe feeling enriched, having been shown a thing of beauty or smiling at the thought of another Sutcliffe homily.

Sutcliffe showed integrity and honesty in his dealings at the office, calm strength, and infinite patience in the face of dispute or discontent and an ability to treat every person with respect and dignity. He had the gravitas of a natural leader, much humility, and a warmth for the people around him. 

Great men and women come and go unnoticed. Sutcliffe may well be one of them. And yet he smiles on a life lived to the full and in the satisfaction of the part he played, wondering still of the brilliance of the one that got away.

Sutcliffe leaves behind his wife Kathy and his five children Theresa, Victoria, Anne, Robert and Alison. DM

A former colleague of Sutcliffe’s, Fareed Abdullah MBChB, FCPHM was the head of the Strategic Management Team and Deputy Director-General in the Western Cape Health Department from 1994 to 2006. He currently works for the South African Medical Research Council.