Webchat with Lord Darzi
Lord Ara Darzi joined Mumsnetters for a webchat on June 10th 2008 - this is an edited transcript of the session.
Introductions | Polyclinics | Constant reorganisation of NHS | NICE (National Institute of Clinical Excellence) | Non attendance at booked appointments | Health care acquired infections | NHS relationship with patients | Medical records access | Paediatric service vs adult service in hospital | The NHS constitution
Mumsnet: Lord Darzi is a Professor of Surgery who joined the Department of Health in 2007. Since last July he has been working on a review of the NHS, talking to NHS staff and patients about how they think it should be reformed. He's already set out plans for new health centres to be open 7 days a week, which will complement GP practices and offer an extra way to see a doctor. His final report will be published at the end of June 2008.
Lord Darzi still works in the NHS as a consultant surgeon two days a week and is married with two children.
This is a very exciting and busy time for the NHS. In the last month each regional strategic health authority has published its vision of how healthcare will be delivered in the next ten years. If you haven’t seen your SHA’s vision go to their website and take a look. I think you’ll be pleasantly surprised at the ambitious plans they set out. Doctors, nurses, allied health professionals, patients and voluntary sector workers in each SHA have spent the last seven months looking closely at how they deliver care across the NHS and how this could be improved. These plans are ready to be rolled out and you will start to see a difference soon.
DearBeatrice: I'm very concerned about the proposed 'multi-GP' polyclinics which I understand the Dept of Health has instructed each Primary Healthcare Trust to open, or at the very least to consider. The financial incentives to open a polyclinic are huge and therefore the PHT's will strive to do this regardless of the need for the existing GP services. My local GP centre serves a village community consisting of a large amount of OAP's. It is a real lynchpin of the community, and as a first time Mum I've received superb (continuity of) care from the GP's. I'm very concerned that successful and necessary surgeries such as mine will attract 'mobile' patients to these 365 day /24 hour centres, and consequently lose their budget. Nobody, but particularly pensioners and pregnant ladies / new mums should not feel coerced into travelling much further afield to recieve anonymous treatment, when an excellent service is already provided in the immediate vincinity. Would you please give further consideration to this issue?
Lord Darzi: A lot of you have asked about polyclinics. It is not our policy to introduce polyclinics across the country. Last year I carried out a review of the NHS in London and polyclinics were one proposal to meet London’s specific health care requirements. Since then we have been able to fund 150 new GP services around the country using £250 million extra cash. This was our response to what I heard at a large number of local deliberative events where I met patients and members of the public to find out what they wanted to happen. They all suggested extended hours and this is why we suggested that these should be open 7 days a week from 8 til 8.
AtheneNoctua:Where are the polyclinics planned? I live in Sunbury and work in Chiswick. I would much prefer to nip out to a clinic in Chiswick at lunch time then have to leave work early to drive back to my local GP (who is in Hampton, not Sunbury). When I was pregnant I would have loved ante natal appointments near work, but they were not on offer.
Lord Darzi: - The new health centres will allow you to attend near work if you wish without having registered advance and without having to give up your local practice near home
AtheneNoctua: Yay! Will there be one in Chiswick?
Lord Darzi: It's not up to me because it's got to be locally planned. But please have your say.
Bundle: Does everyone need a polyclinic? How can you discriminate between problems which you see your GP about, those you go to a hospital about, and those a polyclinic will pick up?
Lord Darzi: Your first entry point will always remain the GP, whether that's your local GP or the GP in the polyclinic or health centre if there is one in your area and that's where you choose to go. In due course, patients and public will know and decide what types of services are available locally. Flexibility around what patients actually need is the whole point of my Review. The new GP-led health centres will provide over 2.5 million extra GP appointments a year for a start, and my final report will say more on how we will make services more flexible.
AtheneNoctua: In my experience, what you are offered is all about what PCT you live in. If you try to cross the boundaries, they say "Sorry your not in our catchment. Bugger off." So, who will be in charge of developing these polyclinics, and can they discriminate against who can use them?
Lord Darzi: Athene - very good point about cross-boundary access and I'm definitely looking at that.
Sidge: The NHS saved the life of me and my second daughter. I have nothing but praise for the dedicated and caring staff that saved us, care for us now, that we see regularly due to her condition. BUT I also work in primary care and have the following concerns: Why are GP services being eroded and polyclinics being pushed so heavily? I fear the loss of the incredible continuity of care that GP surgeries offer and I know that most of our patients fear the loss of the service as it is now.
Lord Darzi: You were among many who expressed their concern that we were underestimating the value of community GP practices. I know exactly what you mean and it is not my goal at all to spoil successful local GP practices. On the contrary, I want to see the best possible GP services. Every part of the country is different and what might be right for a big city like London might not be right for a small rural town or village. So I look to PCTs to find out what local people want and what the clinical evidence shows leads to the best care, and get on and make it happen in the best way for local people.
MissChief: How is the NHS going to cope with a largely demoralised workforce, fed up with constant re-organisation and new policy (and so much money being wasted in this area)
Lord Darzi: NHS staff don’t like upheaval and rightly so, but I don’t accept that they’re tired of change as long as the change is for the right reasons. If we think about it, innovation in clinical care and scientific developments are always moving on, so we are always going to have to change the services we provide and the way we provide them over time in order to give patients the best possible care. I think we have to apply 5 principles whenever we want to change services in the NHS:
• Change will always be to the benefit of patients
• Change will be clinically driven
• All change will be locally-led
• You will be involved
• You will see the difference first
What do you think?
cmotdibbler: The other important point is that change should not just be driven by the clinicians and nursing staff, but also by all the professions allied to medicine - who are often overlooked as minority groups.
Lord Darzi: I agree with you. The whole clinical team and all professions and managers need to be involved in making services better.
BigEmma:There's a feeling I think that in recent years government has made changes to policy in the NHS and in education too often and often in response to the latest Daily Mail tirade in attempt to look like they are doing something - and instead it looks like they are meddling. I think it's important that we give any long term proposals time to succeed - hard, I know, with an election looming - but your principles seem like the right ones to me.
Lord Darzi: We need to make sure the principles are followed in practice for just the reason you give. Change should happen for its own sake. These principles have sprung out of the local clinical work rather than something invented in Whitehall.
cmotdibbler And what will happen to ensure this ? As I mentioned earlier, we've seen the govermnent overrule NICE decisions for no good economic reason, but based on media coverage and pharmaceutical company campaigning.
Lord Darzi: I understand your point about NICE and it's something I'm looking at in my Review.
ggglimpopo. Do you have any ideas for tackling the problem of non-attendence at booked appointments? When I worked in the NHS, no shows were a huge problem - as many as one in three at some clinics. It's a terrible waste of time and resources.
Lord Darzi: Non-attendance at appointments is a big issue, you are right. It would be wrong to somehow try to force people to attend - in the end it's up to them - but there are things that the NHS can do, like sending reminders and making sure people understand the implications of not turning up on other patients. Also, many non-attenders are vulnerable patients who may have good reason for not attending, and it's important we remember t
ggglimpopo:My children see a specialist here in France whose secretary sends a text message, 48 hours before the appt. It works on two levels - as a reminder and secondly, it seems so personal - one wouldn't dare miss the appointment!
tribpot: ggg - some hospitals here do the same thing using NHS Mail. Not quite as personal but effective I think.
Sitdownpleasegeorge: A relative has recently died after a stay in hospital during which she contracted a HAI. It was not mentioned on her original death certificate and to be fair there were already 3 other items listed as having contributed to her death. The certificate was however re-issued on the insistence of the deceased's niece to include the HAI.
Clearly the NHS is still trying to minimise the data count statistics relating to HAI and actions like this, and here I'm speaking from experience of having worked within the NHS, are usually as a result of following guidelines issued from on high. Do you feel that it will take elective patients getting themselves privately but professionally tested for MRSA/C. DIFF etc before admission and then suing the NHS if they contract a HAI before discharge to get infection control taken seriously ?
Given the level of infection in NHS hospitals are staff being regularly and routinely tested and treated for such infections ?
Lord Darzi: The NHS shouldn’t need directions from on high to tackle problems like MRSA and C Diff. It should be done because it’s the right thing for patients. I would like to see every clinical team taking pride in the service they provide and doing everything possible to tackle infection because they want to provide a service that is among the best. Some of the top hospitals do screen staff, e.g. the Royal Marsden in London where I work.
VeniVidiVickiQV: Aren't 'patients' referred to as 'clients' now?
Lord Darzi: Patients are clients, customers, consumers, users - call them what you like. But in the end they are the people who should decide how services should be set up to meet their needs. It's good that we have transparent reporting of the quality of care - that's how change happens - because patients can exercise choice based on information.
Big Emma: I tell you what I don't think my receptionist at my local GP sees me as a client or customer - more like an irritation!
VeniVidiVickiQV: Agree BigEmma. Having experienced NHS receptionists and having been a receptionist in a private hospital, the gap between service provision is HUGE in my opinion. The hospital was cleaner (and the cleaning staff weren't better paid or had better hours and there never seemed to be enough staff on duty), but, the service provided was better. Do you think there is a malaise in the NHS and it's workers?
Lord Darzi: Veni - I don't know about a malaise but I do know that the way you are welcomed in the health service is very important and could often be improved and I'm working on this.
VeniVidiVickiQV :Why is there such a discrepancy in service, waiting times, cleanliness, hygiene and performance across the country, and even across boroughs? I was also interested to know how the results of a recent survey conducted on maternity services at my local hospital - Chase Farm - had come back with 4 stars (out of 5 I think), and yet anyone I've EVER spoken to who has had a baby at Chase Farm has always had a less than positive experience, or has in fact had a very negative experience? I've had two babies there (no choice to go elsewhere - other hospitals were 'full' at booking in) and I was disappointed with my treatment both times. Surely this isn't a coincidence? Is someone fudging the figures or aren't the right people being asked? Where is the transparent reporting?
Lord Darzi: There is some transparent reporting already and it is possible to see the information on the NHS Choices website. But we need much more transparent information about the quality of care in its various aspects and I am looking at how we can get that and then get it onto the Choices site so that everyone can see it.
AtheneNoctua: What about the medical records, can the usual GP access records from the polyclinic? For example, if I get a prescription filled at the polyclininc, will my GP know about it? When I was pregnant with my second child in 2004, I tried to get my medical records from Epsom Hopsital of my emergency caesarean in 2003. They asked my to send them £50, and then they would let me know if I needed to send them more money. I w/te/1.gifas astounded that I had to pay anything for MY records and amazed at the price they thought was reasonable. I said forget it and just told Queen Charlotte my version of the events. I find it unbelievable that this information is not readilty available to all across the nation (although I work in Information Management so perhaps my standards are higher than the average patient).
LordDarzi:I am looking at the possibility of enabling patients to access their own records in a secure way perhaps online. Would this be of interest to you?
artichokes: Part of me is very tempted by the idea of access to my medical records online. That ease of access would be great. I would have concerns about teh security of my inforamtion though. The Government does not have a great record at keeping electronic personal data safe! If safety could be guaranteed then free electronic access to records would be desirable.
AtheneNoctua: Yes, Lord Darzi, I would love to be able to access my records online. Did I mention I work in Information Management? I can help you (for a price)
Lord Darzi: Thanks for the kind offer!
ggglimpopo:I live in France where women hold their own maternity records - from first booking through to delivery and discharge. Brilliant
cmotdibbler:I think it would be great to have just one medical record that the patient could view - when I saw my maternity notes just before discharge they were factually incorrect (in that at one point they stated that my baby had been transferred to SCBU from the ward in midafternoon, when in fact he had never been to the ward and was transferred at 6am immediatly after birth). I couldn't be bothered to get a copy to complain, partly as I'd already complained at that hospital after my recurrent miscarriage fiasco, and not got much joy. But if the patient had access to their full notes they'd know exactly where they stood with everyone.
VeniVidiVickiQV:I'm not sure online access would be secure! I know that a vast amount of money was spent investing in the new computerized systems for the NHS - far more than ought to have in the circumstances. I don't think I'd like to see more money wasted trying to find a way for patients to access details online. I must say, the last 2 years it has been vastly easier to get an appointment at my local GP clinic. Can't fault them at all actually. They are brilliant. Well, except for the locums....and the people who regularly seem to lose specimen samples......I digress
Lord Darzi: Online access would have to be very secure indeed. Delighted to hear of your good experience with your local GP clinic.
artichokes: I have thought more about putting records online. It is a nice idea but it would be expensive and time consuming. The NHS has very limited resources and I would much prefer those resources to be used on emloying more midwives, doctors and nurses. I would prefer money to be spent on incentives to hospital cleaners to acutally clean (unlike the one who took 5 hours to clean the blood from the floor of my hot ward in St Thomas' hospital). The NHS needs less radical new thinking and more effort spent on getting the things it already does right.
LordDarzi: I think we have enough money being invested in the NHS now (£100bn+) and we need to make sure it's spent as well as possible, to improve the quality of care and the patient experience.
VeniVidiVickiQV: I hate visits to the hospital that you'd rather not have to make, only to be greeted by a miserable old trout, or someone who makes you feel like you are an utter pain in the arse/incredibly stupid because you don't know what you are supposed to do/where to go. I've experienced better service in all Paediatric clinics though.
LordDarzi: What is it about paediatric clinics that you find good? We need to learn.
VeniVidiVickiQV:Well, the majority seem to understand that a child might be nervous or anxious or upset and they work to deal with that. They talk to the child in a sympathetic manner, and they tend to be more reassuring to the parent. Only one experience recently where i had to intercept as the guy making a mould of DD's ear for her hearing aid just went ahead and started doing without explaining what he was about to do etc. I had to jump in quickly and pre-warn DD what was about to happen (cold gunk to be squirted in her ear!).
But, I think its normal for ALL patients to feel like child patients. A great many folk havent been to hospital before. They dont know the layout, they dont know what to expect at the appointment and it can be very disconcerting - that WITHOUT the added worry about whatever health problem it is that they are going for in the first place. Yes, most of us are not daft, but, that's not the point really, is it?
AtheneNoctua:What can you tell us about plans for an NHS constitution? What will be in it? When will it be published?
A LordDarzi: The PM announced in January that there will be an NHS constitution. I can't say what will be in it yet but I'm expecting to publish a consultation paper on it with my final report. Do you think a constitution will be helpful to patients?
AtheneNoctua:Yes, I would like a constitution. My hope is that it will define what the NHS does so that doctors can know what they are meant to deliver and patients can know what they can expect to receive. Communication is always a good thing, in my opinion.
dearbeatrice: The constitution will only be helpful if a copy can be seen by all NHS users -but more importantly if it's actually stuck to by the NHS and all who work for it. Plus of course, if a vast amount ISN"T spent on branding it etc.
cmotdibbler: What will a constitution actually achieve ? We all know what the NHS is there for, and what the principle is, so I don't see the point. What the NHS needs is less words, more action - and more centralised administration so that what is effectively a huge company isn't left under the management of non professional managers with huge replication of administration.
Lord Darzi: Mumsnetters - I've got to go now. Thanks for your comments - good to chat. Have a good day.
AtheneNoctua:This has been a really good chat. I wonder if there is somewhere we can contact Lord Darzi if we want to follow up any of things covered here? MN Towers, can you point us somewhere???
Carriemumsnet: There's a website where you can post questions/leave comments - it's Our NHS