Live chat with Lord Darzi about the NHS - June 10th 1-2pm

[carriemumsnet]

Hi All

Lord Darzi will be joining us on Monday June 9th to talk about the NHS and its future, and to hear your views on how you think it could be improved. 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.

Lord Darzi still works in the NHS as a consultant surgeon two days a week and is married with two children.

As always, if you can't make it on the day, please post your advance questions here and we'll try and get as many as possible answered. Otherwise, we'll see you Monday lunchtime.

I am a first time pregnant mum to be and I've been shocked by the lack of information and advice given to first time mums.
A simple fact sheet given to newly pregnant (i.e. as soon as a pregnancy test is done) mum would prevent a lot of anxiety and medical problems. For example I was unaware of the risk of varicose veins due to the extra blood in a pregnant womans body and the effect of pregnancy hormones on the vein valves. If I had been told to wear compression stockings at the outset, then I would not now have painful and extensive vein damage in my legs which will cause me health problems and therefore NHS money for the rest of my life.
A simple factsheet outlining sickness, veinal issues, nutrition and exercise along with some solutions would prevent a lot of unecessary GP visits and hospital treatment later on.

So many questions - the majority of which would probably get my message deleted and me banned from MN...

So, Lord Darzi, I believe your background is surgical, and you seem totally out of touch with the reality of General Practice - how much time have you spent actually in a general practice and seeing what it's like, rather than relying on what appears to be a wealth of misinformation? And not just an inner-city practice, but enjoying the spread of different challenges faced by practices all over the country.

People have already made good points about polyclinics - particularly the dotctor-patient relationship. I work in a small rural general practice. I don't pretend to know all of my patients, but I do know a lot of them. I know who a person's family is, what their social circumstances are, what their health problems are. I know a lot of them well enough that I know if something's bothering them when they walk in the room, or pass them down the street. This sort of knowledge means I can instantly place a person's problems in context, and have a massive advantage when it comes to holistic treatment. One of the reasons I was attracted to a career in general practice was the cradle to grave idea. It attracts a lot of people to general practice. Do you think Virgin Polyclinic Faceless Corporation will offer the patient or the doctor/nurse/AHP enough to offset the complete loss of this unique perspective? Is it not simply the first step to total privatisation of primary care, to rid the NHS of a chunk of what costs it so much to run each year. And a large part of the GP-bashing going on at the moment is a part of the government making us as unpopular as possible to smooth that privatisation process. We all know that the NHS is massively over-stretched, but don't you think that there are a lot of ways where money can be saved without chopping off one of the things that makes the NHS what it is - the envy of a lot of countries? You can't put a price on the quality of care that primary care provides.
The demoralisation of GPs might serve a purpose. Maybe we will get so narked with the whole thing that we throw our hands up and say sod it. We'll work for the polyclinic. We'll become employees, not employers. We will lose the stress, the paperwork, the responsiblity. And you can be damn sure we will also have much less loyalty to the business for which we work, we will clock on and clock off, we will work to guidelines and protocols and have no place for the sixth sense (based on our knowledge of our patients) that saves lives all the time, and we will not go the extra mile for those patients who we have known for years, and care about, and push the boat out for. And you can also be damn sure that there is one person who will suffer: the patient.

That makes me sound like I think a lot of myself: I don't. But I think a lot of my job. And I think a lot of my patients, and I think that they deserve a lot better than polyclinic anonymity, government headline-grabbing initiatives, and inappropriate avenues for money-saving.

I'm sure there was a question in there somewhere... Try this: Lord Darzi, what the hell are you thinking??!

Lord Darzi

Obviously you are focussed on NHS England and none of the other UK countries. Have you done any consultation with NHSScotland, NHSWales and NHSNorthern Ireland to ensure sharing of ideas?

What are your views on the proposal to put the management of hospitals in NHSEngland under private companies when they are deemed to be 'failing'? And what if the private companies are then seen to be 'failing'.

Do you think there are too many absolute targets which can lead to manipulation of data e.g. waiting times?

Amen to abolishing simplistic targets that just lead to gaming.

I agree with some of your recommendations - for example some aspects of polyclinics. I think the out of hours care in urban areas like London is out of date. Of course your proposals threaten vested interests and therefore will never be universally popular. Some of those vested interests will have valid concerns about alternative provision of healthcare.

Equally I can see that some patients are better treated at tertiary centres where the expertise lies. If I become very, very ill, I want to survive as a preference to being treated locally. However, this is not the case for all hospital care.

Paediatrics is an example where local can be good. A non-life-threatening condition treated locally must be preferred because of the logistic difficulties of visits and care.

However, although the solutions you propose are appealing, what I don't see is a strategic plan for how we are going to get there from where we are now. I hope that the plans don't destabilise the current system before a replacement can be implemented.

Can I ask who had the brilliant idea of choose and book for referrals to hospital because having very recent experience of this fiasco - I can report that I neither got a choice nor did I get a reasonable standard of care.

I have been told that I have to accept the one appointment that is available out of 4 hospitals in the next 3 months or I have to go to the back of the queue.

Where is the progress in that - and why is it in my interests to travel 30 miles to a hospital when there is one (with a clinic run by the same consultant) less than 4 miles from my home. The explanation I received was that the hospital hadn't updated the computer system and they were sorry but the website the recorded message was directing patients to was down for servicing.

I am now forced to go private for a routine appointment and pay for the medication that I would receive free if I could get an NHS appointment.

Dear Lord Darzi,

I am becoming increasingly concerned about the disparity of resources in our NHS system. It very much feels that money is heavily invested in the specialty that is in vogue. For example that currently seems to be cardiac surgery. I work on an upper GI ward where big advancements are being made in the battle against GI cancers and the surgery required to correct it, including many procedures being undertaken laproscopically. However we struggle to care for these patients in cramped and under resourced wards. I struggle to understand how there can be such disparity of investment in different areas - surely the whole principle of the NHS is equal treatment for all. I would argue that this is not the case as certain areas receive more funding, equipment and not in my opinion in direct relation to the amount of patients treated. I would be very interested to learn how you feel about this issue having had such a wealth of experience in the surgical field.

I am a nurse.

I am concerned about the plans from PCTs to build lift centers costing millions without any idea of what to put into them. Much of what is going in seems to be provided elsewhere and will be confusing to patients such as urgent care centres, diagnostics and polyclinics whilst the A&E department is also open and has a primary care centre.

What are you going to do to support A&E departments who survive because they treat minor injuries which pay for services under payment by results?

How are we going to staff all these disparate services?

Lord Darzi with the greatest respect for your surgical career, how can you even begin to feel that you are qualified to both comment on and then rip apart primary care services.

Have you considered that you are simply being used as a figurehead by the government to push through these poorly thought out changes, which are quite frankly only a prelude to privatisation of the NHS.

Remember that politicians come and go but people will always need good healthcare outside the latest soundbite or catchphrase.

CLEANLINESS: Bring back in house cleaning, and cleaners that belong to particular areas and work there every day which means they are part of a team, the sister would be managing them, they would have more pride in their work and dedication to that team.

MONEY: Start charging people who waste NHS time, those people who just fancy a trip to hospital in an ambulance, have their observations taken and then go home feeling fine. Time wasters and DNA's would be decreased greatly if there were a charge. The public need to realise that the A&E units are not there for you to pop in if your GP is closed or too busy.

NURSES: please pay us more, lets have less managers, less ridiculous jobs (welsh language translator anyone??) and give some mooney to the people at the front of healthcare providing care for patients.

And please can you explain why health authorities have such disparate funding priorities? For instance, in one area a breast cancer patient is prescribed a certain life-extending drug, in another refused it due to it being too expensive. I have a rare lung condition that requires intensive physiotherapy; in my previous HA I was assigned a respiratory physiotherapist, but when I moved to this one was told I couldn't see a physio because they weren't funded for my condition, despite it being identical in the chest aspect to cystic fibrosis. Since moving here my condition has worsened considerably. This disparity of funding is frankly wrong in the extreme. What is going to be done about this?

STOP PRESSSTOP PRESS

This chat is now on TUESDAY 10TH JUNE - same time 1-2pm. We'll try and get the title changed, but it might be Monday before that happens and wanted to warn folks in advance.

Sorry for mix up

1. I have worked in the NHS and Social Services since 1992. In that time I seen countless mergers, reorganisation and change. Does Lord Darzi agree that there has been too much change within the NHS already and explain what plans there are to allow any changes enough time to actually take effect???

2. Why is Shrewsbury Hospital allowed to refuse to tell a mother the sex of their baby at routine antenatal scans and ask them to pay privately for another scan? (The scans cost £100, are only well off people allowed to know the sex of their baby in Shropshire? In other parts of the country it they just tell you.

3. My mother had to have a knee operation at a hospital 44 miles away from her home. If you had to drive a round trip of 88 miles to see your mother every day for 2 weeks would you then be annoyed that you have to pay parking charges?

4. I gave birth at Chelsea and Westminster hospital and stayed as an inpatient with my baby for 8 days. I was induced, there wasn't a bed in the labour suite so I was in full labour on the antenatal ward. The cleaner mopped around me whilst I was having contractions. During that time I saw a different midwife at every shift, 3 shifts per day for all 8 days which meant I had to explain the feeding situation to them everytime. I saw a different paediatrican every shift. The midwives wanted me to breastfeed. The Peads said that I should formula feed. There was no joint working. No one cared that I had had NO SLEEP in the 8 days and that I was incoherent with sleep deprivation. When I asked if my husband could help feed my baby they wouldn't let him on the ward before 9am yet they wouldn't help me either. The nearest toilet was blocked for the entire time I was there, with blood and feaces smeared aound. I got fed rotten carrots and there was broken glass under my bed for three days.

Why can't hospitals be clean?
Why can't midwives stay with the same woman as much as possible and actually offer practical care instead of sitting around the nurse station listening to the radio and gossiping ?

Why is the government so keen to sentence cancer patients to death by refusing NHS care to people who have the temerity to sell their houses and cash in their savings to buy the lifesaving drugs their NHS consultants tell them could save their lives?
Do you not realise this is the kind of issue that could lose you an election?
What next? Should anyone who has private physio after having their lymph glands removed due to head cancer be refused NHS treatment? Anyone who treats themselves with paracetamol bought over the counter? Will kids who get private help with dyspraxia be refused a state school place? And if not, why are these cases different?

I'm personally booked in for a private breast scan as they are not available on the NHS. If it turns out I have cancer, will I be turned away by the NHS?

the goverment has effectively coerced gps into working longer hours for the same money. Gp's now have to offer evening and sat appts, they are not allowed to drop any other time during the week, thus making hteir working week longer, for no extra money , i would like to see my MP at 8 oclock at night or on a saturday as i cannot see them during the week because i am a bloody gp at work ! now i actually do think we should offer routine appts in the evenings on some days for working people and i for 1 would happily "man" this but only if i could have the morning off in leiu. Please could Lord Darzi explain how this situation is fair and how on earth it fits wiht the current goverment's work/life balance and family friendly working practises ??

mummydoc, I don't understand. Can't some dcotors at the surgery cover the evening whilst others cover the morning or saturdays with some form of rotation so not one has to work 15 hour days.

As a patient, I LOVE the evening and saturday appointments. My GP has recentctly started haveing one day a week when she is open until 7:00pm and I am delighted with it. (She might not be, but I am)

And, just curious, how many hours per week does a GP work?

Why are there so many tiers of administration? It really isn't necessary and wastes a lot of time and resources.

What is this ridiculous new system of consultant referrals, where one has to 'request' an appointment - the GP gives you a form to fill in, you post it off, another form arrives through the post telling you that you want an appointment, giving you a telephone number and a silly password, you phone up, no one is there (lunchtime), you phone again (all the lines are busy) - repeat a few times - you give up, another letter arrives reminding you that you want an appointment, you ring up lots of times again, eventually get through, get an appointment (if the system isn't down - otherwise you have to ring another time). Why is this considered helpful? To whom - other than the new layer of staff you have employed in the 'Choice' booking department? It is silly.

(By the way, the second letter won't have your password on it, so don't lose the first, as no one - except the person at the GP surgery who is currently on holiday - can tell you what your password is and they won't make an appointment for you if you can't tell them the password.)

I have ms. It is very important to me that I see the same doctor. I am very concerned about polyclinics and continuity of care. I do not want to have to keep explaining or elaborating or reminding an endless stream of doctors of my medical history, and no, patient notes are not sufficient.

athene - in answer to your question ...the goveremtn made that against the rule, i would happily give up one or 2 evenings a week to run later surgeris if i could then have say friday morning off , but the rules are you cannot cut the time the gps already do so basically gps now have to work longer hours for the same money or lose approx £6000/ yr . i want Lord Darzi to justify this and the fact that i cannot see my mp in the evenings or saturdays

I understand that in the West Midlands that some specialist emergency services for strokes and heart attacks are to be concentrated in one or two key centres.

Are you aware that patients from rural Mid Wales already have long journeys to local hospitals? (25-40+ miles)

The Ambulance Service in midwales is already short staffed and often are not meeting their targets to reach a patient in an emergency.

How is centralising those services in the West Midlands going to affect the people of mid-wales?

The air ambulance in mid-wales is being funded by local people raising money for it's charity. Will the government commit to funding the air ambulance in midwales on a permanent basis?

My husband is a consultant.

He worked over 100 hours a week and studied in his spare time for 12 years after qualifying as a doctor in order to be a consultant.

This was back in the days when anything over 40 hours per week was paid at one third of the basic rate.

Since becoming a consultant he has consistantly worked around 70 hours per week.

Until a couple of years ago, he was paid for 56 hours a week. Then he was told by management that he now only works 40 hours a week, and would therefore take a paycut.

This was achieved by altering the paperwork, but no attempt was made to actually reduce the work load.

His pension will be reduced accordingly, after all those years of studying and unpaid overtime.

I just hope and pray he will live long enough to retire and not have a heart attack or a stroke.

Now that the junior doctors' hours are being reduced, guess who is picking up the slack?

There is a bullying management culture in the NHS, which is bad enough when it is aimed at the staff, but is much, much worse now that it is aimed at the patients - as you can see if you read all the posts on here from people who have had appalling treatment.

Mummydoc, don't have a legal right to apply for flexible working. And the the NHs has a legal right to consider it. And it surely can't be said that it's being considered if there is a blanket policy that says no one can have it.

So, how many hours a week does a GP work?

I personally work about 55, and I think that's enough. (although I'd work more if some offered me a big fat raise... but it would have to be big and fat)

Oh jeez, sorry about the terrible typing.