Lord Darzi addresses questions from the citizens discussing access to health care, older people, access to treatment for terminally ill people as well as the NHS review itself.
Jill Robson: The Government are pushing ahead with extended access to GPs even though the survey states 84% of people are happy with GP Opening hours. I can get an appointment with a GP generally when I want however, why is it that access is only mentioned in a primary care setting, if I have access to a GP say to 9pm why can I not see a consultant in a hospital at 9pm instead of 10 - 2 3 days a week, it is harder to see a consultant than a GP, the DOH may have access the wrong way round!
Ara replies:
Good morning!
Although I agree we need to look at access to health care provision more generally, including access to hospital provision, from a patient prospective they do see primary care as the entry point to their care. Although you refer to the recent access satisfaction survey, the NHS next stage review consultation has reinforced that although the public and patients are satisfied with the quality of primary care, they are much less satisfied with the access to that care.
I have also picked up from these engagements that the patients and the public intermittently refer to access as both access of extended hours and urgent care provision which I agree we need to look at both with colleagues at both primary and secondary care. The inflation rates we have currently seen in A&E attendance is also something that concerns me as it is not sustainable in the long term without addressing access in primary and community setting.
Mrs M Wild: As a senior citizan i feel that G.P's and hospitals are not interested in my age group. Would it not benefit and be cost effective to the NHS to have clinics for the elderly to prevent serious health problems before they become debelatating. This would free a lot of beds and waiting lists.
Ara replies: I am grateful for your thoughts. Firstly, dignity and respect should be at the heart of services for older people. This is why we have launched a national dignity campaign and asked the Healthcare Commission to make dignity central to its inspections.
As a clinician working in the NHS, I am fully aware that the bulk of the care that the NHS provides is for our elderly users. I hope through the NHS next stage review, which tackles clinical models of care, care for the elderly at all levels - primary or secondary, health or social care - should be designed to deliver the best care to our senior citizens. That care qualitatively should also be underpinned with respect and dignity to our patients.
Gloria Middleton: Dear Lord Darzi,
As National Chair of the Institute of Healthcare Management (IHM) Primary Care Sector, I have had numerous members approach me regarding your engagement of Clinicians & Staff to redesign the best models of care. It is the believe of General Practice that they are not being consulted and their views sort. It is very much from the patient point of view and the Trusts point of view with the exclusion of the people who are at the forefront of patient care. I appreciate that this avenue of communication (live webchat) is available, however I would be grateful if you could inform me of any individual practices that you have consulted with directly. General Practice would like the opportunity to have a forum to consult and discuss with you our views, and be a part of Our NHS Our Future. The PCT's/Trust outlook is their interpretation, which, is not always mirrored by General Practice in our attempts to re-design / shape the future in the interest of our patients and the NHS. Feedback would be very welcoming to our members. Gloria Middleton
Ara replies:
I totally agree that both engagement and a significant contribution from primary care is vital in the NHS next stage review. I have instructed all the SHAs (Strategic Health Authorities) and the PCTs (Primary Care Trusts) in the nine regions that all the clinical working groups I have set up as part of this review (covering birth; staying healthy; children; planned care; acute care; long term conditions; mental health; and end of life care) should have a signfiicant representation from clinicians working in primary care, including general practice and community and social services.
I have also requested that chairs of some of these clinicial working groups should be primary care clinicians. At a national level I am working with the Royal College of General Practitioners and the NHS Alliance in seeking their views about the tremendous opportunities that exist in primary care in the future.
Catherine Heaton: I was disappointed to read that the consultations with the public being undertaken by Lord Darzi, Gordon Brown and Alan Johnson, appear to involve cash payments to those members of the public who 'contribute'.
We are told these consultations will influence the future of the NHS. How can Lord Darzi be confident that these purchased opinions are impartial or even representative? I feel deeply uneasy with the concept of payment (of taxpayers' money) for opinions.
Ara replies: This consultation is one of the largest of its kind undertaken by the Department of Health. It is vitally important that we talk to the public and listen to the public if we are to design the best health care system for the future. It is also very important that we attract patients and public from all sorts of different backgrounds and age groups. The money was paid to compensate for their time and loss of income and I feel it is their right. The idea that this is going to influence their thinking is absurd.
Ella: How is this review different to the 'Our Health Our Say' consultation held by Patricia Hewitt?
When are you going to tell us what you have done in direct response to what the public, patients and professionals have already said?
Isn't it time to have an honest debate which says that the NHS cannot provide all things for all people so it is time we had an open transparent debate on priorities and funding?
Ara replies: This review builds on 'Our health, Our say' and also on previous reviews such as the NHS Plan. In my view it reflects why we should have a constant and open dialogue with the patients and the consumers of health care to allow us to design and prioritise their needs and aspirations.
As a clinician working in the NHS, I can say it is the best healthcare system around the globe. If you compare us with the debate currently occuring around healthcare across the pond there are 50 million Americans who have no access to health care at all. In this country we have seen a significant investment in the NHS and our spending in the NHS is now approaching the European average.
Sharon Baxter: i am a patient with breast cancer which has now spread to the liver , what id like to ask is why is it necessary for some of us terminally ill patient to have to go through the ordeal of fighting in the courts in order to have health authorities pay for and allow life lengthening treatments , new drugs are around in other countries which are used to prolong life ,why is it we cannot be allowed these drugs which have already been triialed and tested in other countries ,this is our lives we are talking about ,surely we should be offered and allowed every option possible to prolong our lives .
regards
s baxter
Ara replies: Through the NHS next stage review, our aspirations are to provide the highest quality care for patients with cancer.
We have achieved tremendous amounts in cancer management, as I know in my own practice being a surgeon with an interest in bowel cancer. We need to ensure that all therapies are based on evidence of effectiveness whether its a drug or a surgical treatment. We have an independent organisation (National Institute for Health and Clinical Excellence (NICE) ) which looks at the effectiveness of all new technologies and advises us, as clinicians, what are the proven treatments that we should be providing. I feel this is one of the strengths of the NHS. However, I also sympathise that it can take time before a new drug is brought in and its effectiveness proven. In these circumstances it should be at the discretion of the clinician, the hospital and the PCT, in consultation with the patient, to address the patient's need.
Greg Fell: given that most credible international (and UK research) -including Wanless - commissioned by then treasurer, now PM - highlights that health care contributes to about 10% of health outcomes - what will this review do to address the huge underinvestment and underimplementation of preventive interventions and health promotion. What will the role of clinicians be in this?
Ara replies: I could not agree more with you. We have to change our thinking from a service that treats sickness to a service that prevents illness and encourages wellbeing. I have requested that the next stage review, 'Staying healthy clinical working groups', will have a wide representation to include clinicians, allied healthcare professionals, pharmacists and local government to address and design the best models to deliver this important agenda. We all agree prevention is better than cure.
Karen McGuire: Will these proposed changes to the delivery of healthcare in London be sustainable given the fact that a lot of Trusts are in financial difficulty and are undergoing organisational change as a result?
Ara replies: You raise an important point and I feel one of the reasons why some healthcare organisations in London are in financial difficulty is because we have failed to address the issue of clinical reform. By this I mean we have not made the changes that are based on quality and evidence base.
London is the best known capital city in the world and enjoys competitiveness and excellence in business and in research and development. It is imperative that it's healthcare system should also be of that level.
It may come as a surprise but increased spend doesn't always mean better care. For example, nationally we spend as much on stroke care as many European countries. But we don't have the same outcomes. This is because we have not designed the best models of stroke care. It is anomalies like this that I will be looking at in the next stage of the review.
Rupert Millard: Lord Darzi, as a man who is always photographed in a suit, do you think wearing a suit is an important part of looking professional? I am a medical student and pride myself on maintaining a high standard of appearance in hospitals for this reason. I was most disappointed to hear of the new "bare below the elbows" policy on Monday. Where's the evidence that this will have any effect on rates of hospital infection? If there is any, why was it not in the "Uniforms and workwear: an evidence base for developing local policy" document? Alternatively, if it is a public perception matter, then why not address other image problems identified in that document, such as staff coming to work/doing their shopping in uniform, by providing changing rooms and a uniform laundry service in hospitals?
Ara replies: When I was at your stage in medical school buying a new suit was the highlight of the year. My second aspiration was to wear a white coat when I became a doctor. Once a doctor, my next aspiration was to wear surgical scrubs while I was in theatre. Then I recognised that in our profession, unlike bankers and ministers (which I now am between Monday and Thursday), when I am in hospital it is not what you wear that is important, it is the quality of care that your provide.
There is very strong evidence that washing your hands is one of the most important actions in preventing infections and cross-infections. Bare below the elbow encourages more effective hand washing and therefore reduces the risk of infections. From my patients perspective, without any doubt in my mind, their preference is reducing infections rather than what I wear.
Sarah Airey: I attended the 'citizens jury' in Birmingham 18th Sept and was wondering why very little mention was made of Mental Health Services - especially in light of the figures regarding the rising age of the population. Are Mental Health Services being taken as seriously within government as A&E/GP services seem to be? Are the NHS going to stop focussing onover- treating Metal Health Problems with drugs and work with the patients to discover and help with underlying issues?
Ara replies: I have estabilshed clinical working groups across the country covering eight pathways of care. Mental health is one of these pathways and therefore could not have any greater importance within this review.
Joanne Chamberlain: Lord Darzi,
as a community nursing sister of some years I have weathered many organizational changes through the whims of governmental policy at the time. How will you ensure that the NHs to some extent will have an apolitical future where it is protected from "vote attracting manifestos" that rarely materialise and are detriemntal to patient care and staff moral.
Ara replies: When I received the phone call from the Prime Minister I felt that he was giving a clear message that he wanted clinicians and frontline staff to lead change in the health service. This has been reinforced by this call for the next stage review which is also very different from the previous review as it is going to be clinically led, evidence based and patient centred. I very much hope that you will join or contribute to this process. There is no national blueprint for this review, this is going to be designed based on local needs and apsirations through a massive consultation with clinicians and patients and the public. As a clinician I also believe that any design of a healthcare model should be done in consultation with the users of the service.
Mandy Pegman: Does the Govt not realise that using lesser - trained nurses to do the job of better - trained doctors causes more expenditure in the end since they investigate unnecessarily and expensively far far more often ? Would not a less short-sighted approach, other than just saving on salaries, be more prudent?
Ara replies: This review allows us to re-design the models of care through which we will have a better idea on workforce needs in the form of frontline staff delivering service. In my own experience specialist nurses underpin a significant number of services and provide excellence in quality of care.
Let me give you an example. In most A&E departments a specialist nurse is the first person that the patient sees on arrival. In the vast majority of cases the specialist nurse not only diagnoses but also instigates a treatment plan. We should be very proud that we have such a multi-disciplinary approach to care and should celebrate it.
Fiona o'neill: Do you think there is enough transparency and accountability for the quality of education and learning that gets deliverd in the NHS? How do I as a tax payer know that my local teaching hospital is dleivering the best educational experiences for student professionals that will prepare them to be excellent and humane practitioners?
Ara replies: You raise a very important point on a subject that is very close to my heart. We need a more transparent and better commissioned education and training systems for all healthcare professions. I plan to address this at a national level with all stakeholders as part of the review. at Policy Exchange.
This conversation was originally published on the No. 10 Downing Street website.
