Lord Darzi responds to questions of citizens on a variety of issues related to NHS reforms
Moderator says: Welcome to today's webchat with Lord Darzi. He's just arrived, so we're going to let him settle in and get a cup of tea before we begin.
peter williamson: ideas are good we can all brainstorm what we would like in our NHS I have worked for 24 years in the nhs and my wife 18,what you dont see is the quality cannot be put in place if you do not have the staff to implemement that quality.With staffing a crisis points how are you going to get the staff to do those things you require.
Ara replies: Peter - that's why we also published on Monday the Workforce document. It's well worth a read. We already have tens of thousands more staff than we did a few years ago. The NHS needs to invest now in high quality education and training of all staff. The Workforce document explains what we will do nationally to help enable that to happen.
Alan Cormack: Given the title of the Report is "High Quality Care For All", it was particularly disappointing to see only one mention of learning disabilities - and that was a footnote.
The Department of Health, the Disability Rights Commission and the Healthcare Commission all have reported upon the inequality of health treatment for people with learning disabilities as evidenced by the Cornwall and other abuse enquiries.
Those disabled people and their families must feel let down by the regrettable absence of any comments in your report to improve the support and care they should expect from the NHS.
Improvements are promised but your Report could have lent considerable weight to those promises.
Ara replies: The ten vision documents published in May and June by the strategic health authorities set out the kind of care they envisage for people with learning disabilities. Mental health too was one of 8 areas of care that the SHA visions focused on. My national report is intended to enable all areas of care to be improved. You are right that personalised care means little to people with learning disabilities if the local NHS does not do more to reach out to those who may find it harder to access services. But that's not something we can direct from Whitehall. We need local services to do that. There are some really good examples of local services that do that, e.g. I visited a really good health centre in Oldham that did exactly that, and I met some really good staff and patients with learning disabilities.
Daryl Mullen: Are polyclinics additional capacity or intended to replace existing services?
Ara replies: Daryl - health centres in every PCT will be additional capacity. There is £250 million extra to fund them. The reason we want to expand capacity is to provide patients with more choice. All the health centres will be open from 8am to 8pm, 7 days a week.
Ed Jacobs: How can we ensure that over the next 60 years, the NHS turns itself into a service which is as much concerned with preventing conditions such as sexually transmitted infections as it is to reacting to ill health?
Ara replies: My aspiration is for the NHS to change from being primarily a sickness service to being a wellbeing service. We've announced a number of policies, including a Coalition with other government departments, industry and the third sector with the goal to promote wellbeing at individual, family, community and society levels.
db: Will the private sector have more of a role as a result of your plans?
Ara replies: NHS care will be provided through a family of providers, which include organisations such as the one I work in, the private sector and the 'third' sector. My report highlights that these decisions are made locally by commissioners of care, and also by patients exercising their free choice on where they wish to go for care, based on information.
Gary Kirk: Does Lord Darzi agree that considerably more could be done to improve patient welfare in hospitals, including the total removal of same-sex wards and free car-parking facilities?
Ara replies: Gary - we can always improve patient welfare in hospitals, and having single sex accommodation is a priority, based on principles of dignity and respect which lie at the heart of my report.
stephanie boland: What will be the forum for sharing good ideas and best practice nationally?
Ara replies: My report announced that NICE will run a new 'NHS Evidence' service which will be an online portal that everyone can access to find out what the best evidence is in all areas of care. As a practising clinician, I expect this service to help me base what I do on the latest evidence, and learn from the best of what is being done elsewhere in the NHS.
Claire - Therapy Zone: Do you envisage Complementary Therapies being integrated into the NHS to help patients from a holistic approach, as patients are now seeking out other forms of treatments available to them due to services provided by NHS sometimes being disappointing?
Ara replies: I believe that we should do what the evidence says we should do. During the consultation for my review, I met a number of people, including a colleague of mine who was in my year at medical school, who have a great interest in this field and suggested that evidence in this area will come to light in due course.
Stephen Phillips (ADNE representative): How do you percieve the role of the District Nurse in the 21 Century given your vision for the health service ?
Ara replies: The local SHA visions all spoke about the potential of nursing to play a bigger role in helping to prevent ill health and treat people closer to home. My report announced that nurses working for primary care trusts at the moment will be able, if they wish, to apply to set up social enterprises in their own right and keep their NHS pensions. I heard throughout the last 12 months that some nurses want to be freed up to get on and provide the high quality care that they wish to.
Sara: Dear Sir,
I'm a Finnish origin and moved to UK 5 years ago.
First I was really surprised to see all nurses in the tube and busses wearing their uniforms.
This would never be allowed in Finland.
There you're not allowed to leave hospital wearing your uniform.
This also keeps all the nasty bugs away.
In Finnish hospitals they have locker rooms for staff where they can change into their uniforms (including shoes).
Clean uniforms they can get from laundry department.
I cannot understand why this shouldn't be a rule/law also in this country.
Especially when you're trying to fight against MRSA.
Ara replies: Nurses and doctors should not wear uniforms outside hospital settings. We're doing everything to tackle MRSA, and I'm delighted to tell you that rates have gone down by about 30%.
Peter Moore: Health care is not just about clinical nursing excellence, it is about delivery through operations management. Productive ward is a start but there does not seem to be a national standard / agreed way forward for supply chain / patient pathways / logistics. What is the direction from the DH? Surely operational excellence needs to spread to primary care also.
Ara replies: The NHS Institute for Innovation and Improvement have been doing some excellent work in this area. But yes, operational excellence should spread to all areas of the service.
Nick Hartley: How will you measure standards of care? I work in a Clinical Psychology department. The nature of therapy can be challenging and upsetting and people, who are not ready for therapy, may disengage from the process. Even though therapists are working from a strong evidence-base, and providing optimum care, might this type of scenario reflect badly on the department?
Ara replies: Professionals who provide care are best equipped to know the metrics that should apply in measuring safety, clinical outcomes and patient experience. None of us knows if we are providing high quality care until we measure it and are able to compare ourselves with others. Then we can work out how to improve. That's what this is all about.
ajb: Does the evidence confirm that private healthcare companies provide value for money in the NHS?
Ara replies: The priority is high quality care, and value for money is part of that. In my report I say that these decisions should be for local commissioners and by patients exercising their choices.
Sandra Reynolds: Why do we need these 'local health centres' if the local population as evidenced through patient surveys is more than 80% satisfied with their current GP provision - why not use that money to help existing GP practices expand their services and hours?
Ara replies: We have worked with existing GP services to extend hours. We also wish to provide choice so that everyone is able to access GP services from 8am to 8pm, 7 days a week.
Rob: The reforms look good. I am however worried about the continued influence politics plays on the NHS. I accept there is a necessity for this - but will this review amount to nothing if there is a change of government in 2 years time?
Ara replies: The whole of my review was about a local review away from politics. But as I said in my report, it is important that the Government can be held to account through Parliament for the £100 billion of taxpayers' money that we invest in the NHS every year. The NHS Constitution which we are now consulting on will make sure that patients, public and staff understand clearly their rights and responsibilities and who makes the decisions on our behalf.
simon browning: Why is this report so incredibly narrow. As with all things in the NHS it is assumed that the NHS consists merely of hospitals doctors and nurses. Yet again Lord Darzi refers to priomary care when he really means GP care in a primary care setting. What hope is there when those incharge seem so far behind the times in understanding what primary care is and still cling to such a outdated view of what the NHS is. I am an optometrist and a former PEC chair and despair when I see yet another report with such an incredibly narrow minded outlook. Surely the NHS can only move forward when we have truly innovative thinkers heading up the service?
Ara replies: Simon - I agree that primary care is very different from how it was even a few years ago. Take a look at the Primary and Community Care strategy that we are publishing today.
Graham Tyers: Given the massive success of the smoking ban in terms of public health, would you like to see the NHS having more influence over public health initiatives? And if so - what legislation might you promote.
Ara replies: The smoking ban has been a great success. I would be happy to look at any proposal where the evidence shows there could be a positive effect, although we have to balance that against wider issues.
stephanie stanwick: Please could you provide an interpretation of the term 'continuity of care' as the shift in focus seems to be towards the term personalised care and yet continuity of care is seen as extremely important to patients and carers in the care of people with long term conditions
Ara replies: Continuity of care is extremely important. And for those patients that need it that's what personalisation means. The new Care Plans, personalised budgets and other proposals will help with that.
Ara says: I've had a wonderful morning. Thank you very much. I hope you will continue to get involved in improving our national health service.