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 have to say, I am not very concerned about polyclinics. To me it sounds like a grandstanding idea with little basis in reality that, had I been a GP, I would have been minded to say "very nice Lord Darzi, run along now dear [head pat]" as I don't see how contractually they could be enforced on any real scale.

Personally I think they're a good idea in certain circumstances for certain areas. Example: I live and work in Leeds. I am healthy, my dh has a chronic condition. I have no need to see the same GP twice and would benefit from being able to see a GP outside business hours. My dh absolutely 100% must see the same GP each time, there is no electronic equivalent to a personal knowledge of the patient in case Lord Darzi wanted to suggest the Summary Care Record would remove that need. It can't and shouldn't attempt to.

For me, therefore, a polyclinic in Leeds city centre would be great. For my dh it would be catastrophic and we need the local surgery. I would hope that Leeds PCT, Yorkshire and the Humber SHA and ultimately the government would recognise that and provide for a flexible model. If it can't, I would prefer the status quo of course. Could Lord Darzi offer an assurance that current incentives towards polyclinics will not have an adverse effect on patients with chronic and acute conditions? And if so, how? I note that National Carers Week is upcoming and so would welcome his comments also this year's theme, which is "Carers Can't Afford To Be Ill".

What do you think that Aneurin Bevan ("creator of the NHS") would make of todays provision of services?

Athene - you seem to keen to find out how many hours a GP works. I'm sure it varies.

However my Dh is a GP and he currently works 4/5 time so he works 4 days out of 5. On the 4 days he works he works at least an 11 hour day with very little break. One thing that is often forgotten about GPs work is the nature of the job. For several hours at a stretch a GP sees a patient approx. every 10min. Each patient is different, some may need to be told bad news, others will be argumentative and difficult to deal with and since most of the routine work is now dealt with by nurses, there is much less of the pleasant or easy work such as ante-natals or pill checks. During his day, my DH usually eats his lunch at his desk while making phone calls to patients. In the gap between surgeries he does visits and attends meetings. On the end of the surgeries they may have as many as 20 extra patients who considered themselves to be urgent enough to need seeing on the day. It is a high stress job without any break. Many jobs have at least some time where colleagues chat to each other during working hours or where the actual work becomes less stressful. I nkow many jobs have long hours but they are not always such intensive hours with a lot of contact with people, some of whom could be upset. To then add evening surgeries onto a day like this is too much to ask IMO.

Plus I don't want my husband to work flexible hours - my kids are at school in the day, not the evenings. Even if my Dh could swap surgeries in the week for Saturdays and evenings, he wouldn't see the children. He wouldn't be able to help out with the local football team on a Sat morning.

Anyway sorry that came out as a bit of a rant. It wasn't meant to be personally directed at you. But I am fed up with the proposals because I can see it eroding our family life.

Hi Lord Darzi,
As you have children of your own i would think this might mean something to you.
I am a mother of four beautiful children , unfortunatley my eldest who is 9 yrs and my youngest who is coming up 5 months have Plagiocephaly...also my youngest also has CMT congental muscular torticollis.
Now unfortunatley my eldest couldnt be treated for it as Cranial Remoulding Helmets were not in the UK at that time but my youngest had his fitted at the end of May.
His measurements at the start were a C.I. of 92% & 16mm plagio he has been in his helmet just short of 2 weeks and his measurements have gone down to 90% & 9mm which is amazing results.
I knew there was something not quite right at birth because of the way he held his head on a side and to a tilt (referring to his CMT) i had to do my own research via the internet to discover my son had CMT.
At his 8week check i mentioned to my family GP that i thought he had CMT and she dismissed it so i stood my ground and demanded a referral to a paed cons who then confirmed it upon when we had our conversation she didnt even bring up the fact about the plagio that i could go down the helmet route i had to bring that up myself! and her response was 'do you really want to put your child in a helmet for 23 hours a day?'...my response was YES because of my eldest been teased at school also the fact he gets frequent headaches!
Like i said Kaen my youngest has been in his helmet less than 2 weeks he is very happy in it ,it has not hindered any developement progress and i have the proof these helmets DO WORK.
It annoys me that it is a postcode lottery that some areas the NHS will fund the treatment and unfortunatley ours doesnt , we had to do our own fundraising to get the funds and i felt like a 'beggar'.
All this topic needs is more awareness and advise on 'repositioning' signs to look out for if it is the case of CMT a SIMPLE leaflet of which anybody can obtain from PLAGIO UK to photocopy and hand out to mums in the maternity wards also to educate health visitors and this could become a thing of the past.
But all the health professionals say is 'it will round out on its own' well ive been fobbed off and i have the proof that it doesnt always!
Please please please raise this issue then alot of us mums wont get into debt by having to fork out nearly £2000 to correct our childrens head.
Especially when they will give a heroin abuser a detox program when they have brought it on themselves.... did our babies ask for this ...NO and its not fair.

Lynn Mawdesley

All I said was that I liked longer opening hours. That doesn't mean I think one person should work all of them. It seems it would be reasonable if a GP worked late one night of the week and perhaps another one worked Saturdays. Or have some kind of rotation system where they work late every other Thursday or whatever.

I'm not against the GPs. I'm just interested to know what the issues are really.

Around 50% of infants now have some degree of 'flat head'. The Back To Sleep campaign clearly needs to be followed to minimise SIDS, but please can we train midwives and health visitors to raise awareness and importance of:

1)Tummy time
2)Repositioning whilst asleep

In order to bring this statistic down. Many Mums are being fobbed off with 'they will grow out of it' or 'hair will cover it', but this isn't always the case.

Why does the NHS not make new Mums aware of the need to reposition and tummy time whilst awake whilst their infants are very young and their skulls are still soft enough to respond? Surely this would be a cost effective way of dealing with this increasing condition?

these women asked for smear tests but were told they were too young now two of them have terminal cervical cancer www.dailymail.co.uk/health/article-1025334/I-told-I-young-smear-test-I-dying-cervical-cancer-just-24 .html What will you do to prevent this happening to others?

Test Message

What is the plan for the development of an NHS constitution?

Is there an official NHS policy on a patient's right to choose a hospital? I see countless stories of women who are forced to go to a hospital they are not happy with. When I was pregnant I refused to go to the hospital which my GP tolkd me I had to go to. He told me the government tells us we have a choice, but really we don't and would have to go to St. Peters in Chertsey. I changed GPs and stood my ground and ended up at Queen Charlotte, which was lovely. But not everyone is as successful as I was at choosing my hospital. Do patients have a right to choose their hospital/doctor?

What is the NHS doing to reduce it's costs? I often see comments on this website about how the NHS is underfunded and I wonder if it is underfunded or if it is just spending all it's resources as efficiently as it could. What is your view? Is there too much waste or not enough funding? (or both)

Could I ask Lord Darzi to look at a few of the messages that we wrote to Alan Johnson regarding the care of women undergoing miscarriage, ectopic pregnancy and molar pregnancy ? Its an area in which only a small amount of money (relatively) needs to be spent to make a huge difference to womens lives.

I'd also like to hear his thoughts on the failure of the government to stick to Evidence based medicine - for instance the backtracking on Herceptin funding. Does this not undermine the whole point of NICE as an independant body who make decisions solely on the criteria, rather than on who shouts the loudest or has the best marketing campaign ?

Having always been a patient at large GP practices, two of which were/are based in community hospitals, I can see how well polyclinics can work, and I fully support the need for routine appointments outside normal working hours. I find it especially annoying that all childrens services assume that the mother doesn't work and must be available in school hours.

Does the ban on top up care mean that a woman who shows up in labour with an independant midwife will not be entitled to have the baby at an NHS hospital?

What about a pregnant woman who pays for treatment which is offered by a neighboring PCT but not her own? (for example a nuchal scan) Is she now not entitles to any maternity care on the NHS.

Does Lord Darzi think that perhaps what the NHS needs most is a political commitment to simplifiy the bureaucracy of the NHS?

I wonder if he agrees that it seems as if successive UK governments have taken a "pic 'n mix" attitude to reforming/modernising the NHS. They seem to borrow ideas for modernising parts of the system from other parts of Europe, or from examples in the USA, or from the imagination of some well-meaning civil servant/politician and instead of having a clear, well considered and structered approach to creating a healthcare system that deals with the particular needs of a large, densely populated island, what we end up with is a hodge-podge of systems, levels of care, initiatives etc that create frustration amongst the "clients" of the NHS and, indeed, amongst the many hard-working professionals within the Health Service?

My message/query is along the same lines as nappybaglady - I am a medical registrar, nearing the end of my training, currently on my second period of maternity leave. I have been qualified for 11 years and have worked hard, including through two pregnancies. I love the NHS, it used to feel like family, I'd been brought up in it and never thought I'd leave it. But sometimes I don't recognise it any more.... But anyway.

Women in medicine - not a minority any more. A highly motivated, highly skilled majority. How are you going to retain the >50% of medical graduates, particularly in hospital medicine? What can you do within this restructure to ensure that they are not marginalised, and that women working flexibly can take on positions of responsibility too without having to essentially work full time for part time pay?

The colleges have faffed about with this for years, and the people on the front line are getting frustrated. Please, please try and make some provision for flexible training and working, bring back the hospital retainer scheme, improve on site childcare especially for rotating registrars and send a message to the thousands of female graduates who could be the hospital doctors of the future that things are getting brighter.

Otherwise they will keep saying to me 'I like working in hospital but I don't think I could do it AND have a family....'

Polyclinics - rubbish. Don't foist London-centric practically private solutions on the rest of us. Stupid extended hours - if you're that ill you'll be off work anyway....

Ditto centralised hospitals - most of us only require a GOOD CLEAN local hospital - not ultra super high tech we can repair you with nano technology.

Don't continue down this ridiculous road of backdoor privatisation - WE ARE NOT STUPID - and even those of us who don't work in the NHS can see what you're up to!

All I really want to say is that the government needs to stop closing maternity wards. My nearest maternity ward is Scarborough which is about 45 minutes to an hours drive away. It is further for some people I know who that live in the small villages around her. This could be solved by re opening Malton maternity ward and many many others around the country.

Hi all and welcome

There've been heaps of advance questions and I know Lord Darzi has been working hard to prepare some answers, so I'll save time on the intro and just say over to you ...

Hello everyone and thanks for taking the time to send in your questions.

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.

Many of you have sent in questions and I?m going to try to answer as many as possible in the next hour.

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.

Dearbeatrice, Sidge and Edam 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.

Ara

I had a question last week from MissChief who was concerned about a demoralised workforce being hit with more reorganisation.
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?

oooo look at you with your bullet points !

They work if you copy and paste.

Thanks!

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.