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

The NHS clearly needs a huge cash injection.. the vast majority feel over taxed and underwhelmed with government provision of public services... so what is the answer?

people already feel they are taxed too much and supporting a crumbling healthcare system that is unable to provide adequate, never mind good service, a lot of the time...

my particular area of interest is maternity services, where it seems acceptable/ inevitable that women and babies are being compromised, daily, nationwide, due to lack of midwives.

botched deliveries and post birth trauma will cost the NHS more in surgical repairs & c.sections, SCBU for babies who are compromised, psychological treatment for mothers

money seems to be key, yet there is not enough of it !

what is your take on this?

thank you

how 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)

how to bring the failing NPFIT programme round without wasting even more money

how to reduce the burden of long-term conditions on the NHS. What preventative measures are really going to work and be acceptable to the public?

how to continue to provide quality, locally-based GP practices in rural areas when national policy seems to be pushing towards polyclinics

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 ?

What are we doing to screen migrants to the U.K. for chronic diseases such as T.B. and other infectious diseases as soon as they arrive and refusing entry to those who pose a public health risk ?

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? In particular I note on the tender documents available to view that the privately managed polyclinic "MAY" provide enhanced ante-natal care. I know I"m not the only mum who was unable to make long journeys when pregnant. If the polyclinic in my area is established, and they choose to provide the enhanced ante-natal care it will force women to swap GP to this centre to receive better funded care, despite a longer journey and all the risks / hassles that go with it. Please do not underestimate the value of a community practice - wind it down and you change a community too - we need to preserve communities, not make things even more anonymous. I'm going back to work and am willing to go to the GP's when they are open rather than swap to a centre which is open 24/7. Successful GP centres need protecting, not 'shaking up'.

just privatise it, you want to, don't you

In a society where we are constantly being told that children don't get enough attention from their parents, why are you insisting that GP surgeries open at evenings and weekends meaning that the doctors will have to work even longer hours than before and reducing the time they have to spend with their families? My husband is a GP and he already works around 11 hours in a day (with very few breaks, which are constantly interrupted by phone calls etc.) This means he goes out soon after the children get up and comes back just as they are going to bed. There are only 4 doctors in his practice and so to cover evenings and weekends they will all have to do many extra hours.

In addition I think you completely underestimate what the local surgery offers to a community if you think it could be replaced by polyclinics. Patients do not want to travel to see their doctor and they value the continuity of the same doctors at the same practice. Even from a purely political point of view, I cannot see that this is not going to be a vote-winner. At the moment, patients in my husband's practice complain about having to travel 4 miles for a local hospital appointment or to see the out-of-hours service. They will not appreciate this type of journey for a routine appointment. I think that if you axe local GP surgeries we will lose something that is greatly valued in this country and that the rest of the world doesn't really have. We will not be able to return to the old system and it will be like the Beeching rail cuts - something that is bitterly regretted for many years later.

I work for the NHS as a nurse in the community, i wonder what you think about the move towards the NHS operating as a business with commissioners and providers?

In my PCT we have all been given set targets we have to meet around how much patient contact we have in our working week. I spend most of my time inputting into computer systems and completing paperwork.

I feel that we are moving towards privatisation fast and that it is quantity rather than quality of patient care that counts.

In light of the interim report of the Bercow Review, what does the government propose to do to improve paediatric speech therapy services? My own experiences (and I suspect they are representative of many Mumsnettters) is of difficulty getting the referral, long waiting lists once we have the referrals, and of assessment after assessment rather than any actual therapy beign given.

I am lucky enough to have an amazing Gp practice, Elizabeth Ave in Islington. You can call Mon- fri at 8.30 and get an appointment that morning or if you're just a bit anxious you can call the doctor or nurse and they will call you back. Even the receptionists are helpful not grumpy. Surely these 7 day a week centers are going to cost a fortune and wouldn't the money be better invested in making the current system work properly for everyone, making more money available for out of hours doctors, bringing all GP practices up to scratch? People need continuity of care and the Gp practices are best placed to offer this, so let's support them.

I would like to report that we have always received fabulous care from our local NHS (South Lincs)
This covers maternity/homebirth/homebirth emergency transfer. One ectopic pregnancy, one appendicitis during pregnancy and one laproscopy.
Two of these surgeries saved my life.
Also my daughter has a rare genetic condition - Noonan Syndrome. From her consultant paediatritian to her orthoptist/opthalmologist/cardiologist/geneticist/physiotherapist/othotics/speech/therapy/visual impairment assistance. The trestment and support for her and us has been better than money could buy.

I know there are aspects under huge strain.
But just wanted to let Lord Darzi and others know that in some areas, some people are very very grateful and happy with their level of NHS care.

I am from NZ where paying for your care started a decade or more ago.

I cannot say that service was any better.

Lord Darzi I am a Gp working in an average sized practice.We are as general practitioners constantly battling demand with providing a prompt, efficient and yet caring and holistic servcie.Our patients appreciate continuity of care which they seem to get more readily from their GP then secondary care.You are now planning to totally deconstruct and demolish this excellent system to set up polyclinics where Doctors and nurses will be salaried and have set hours and eventually continuity of care will be eroded. Why are we trying to emulate other western healthcare systems when they (eg USA, Australia) are desperately trying to convert to our system.
Do GP's threaten the governments plan to totally rule over all doctors?
We work FOR our patients, WITH our patients whilst at the same time running a samll business.I think we do an excellent job considering the limitations of the NHS.When will the Government stop interfering and allow doctors and patients to start making decisions?

Rant OVer!!

Although I have always received fantastic care from the doctors and nurses in my local hospital in London, my experience of poor hospital cleanliness has eroded my confidence in the service.

I am concerned that although we are told about survey results and reviews of cleanliness in hospitals, little is improving at ground level. We all know that stringent cleanliness and hygiene are absolutely key to minimising the spread of MRSA and C diff, as well as other viruses and infections, so why is it taking so long for improvements to be implemented?

Try visiting a hospital toilet and check how many times it has been cleaned thoroughly in 24 hours. In my experience, it is usually less than local public toilets. Having been on a ward (a London hospital) one month ago with one windowless toilet and no fan, shared between 6 women (and their visitors), for 2 nights, I can tell you that the toilet was cleaned once in 24 hours and used frequently by all. This was not enough for a shared toilet for expectant mothers, 3 of whom were bleeding. There was noone in charge to monitor and enforce additional cleans. The clean done was a ?surface clean? and not particularly thorough. You cannot put this down to a one off experience either. I have seen it in A&E and hospitals where I have visited family undergoing other treatments this year.

It seems that only when poor hygiene levels in a particular hospital hit the headlines, is ?a deep clean? ordered eg Ealing Hospital. This one off clean is surely not a long term solution. The norm is ?a surface clean? which is seen as an acceptable level of cleaning and all that is expected from hospital cleaners. It is not going to help stop the spread of infection.

I have seen doctors and nurses travelling on public transport and sitting in cafes, wearing the same clothes they were in when they were on the ward attending to patients. Surely if all hospital staff change clothes as they enter and leave a hospital, it would cut down the possibility of spreading infection?

Issuing guidelines on hand washing and taking in feedback about cleanliness from patients and staff is a step in the right direction however there has to be a manager of some sort enforcing the guidelines. If investment is chanelled towards enforcing strict cleanliness rules, the cost of care will be eventually be reduced as less patients are infected, and furthermore, public confidence in hospital care will be restored.

Resolving the cleanliness issues, I have been appalled at the lack of cleanliness in my local childrens hospital. Children crawl on floors and lick things. Washing up was put away dirty in draws after being washed by hand. Bins were overflowing. Beds weren't clean properly when patients left. Things weren't moved. The hospital staff were unconcerned although they work in the environment every day. If they work in an unclean environment and don't take issue and raise concerns they are just as responsible. Washing hands alone is only one measure, keeping the place clean in the first place is so obvious. It's unacceptable that we kill so many people in this way and no one to taking responsibility. Standards are appalling.

I would prefer to pay privately for my healthcare and have a good service.

Overuse of painkillers and antibiotics needs to be looked at particularly where children are concerned.

Doctors salaries are far to high and is an appalling mismanagement of the NHS budget. It's an insult to nurses and other vital hospital staff not to mention the tax payer.

Out of hours care is poor and there seems to be no home visits anymore from local practices. Why are doctors being flown in from Europe?

Cenralised call centres for emergencies do not work it's dangerous, this should be managed locally.

Local hospitals and facilities should not be closed if at all possible. They are a valuable local service. Move more people from the larger hospitals to smaller units rather than cramming and overloading already over stressed hospitals.

Well, apart from asking why I can't get my hideous and painful varicose veins (more than happyto post vomitagious pic on profile) treated under NHS so that I may wear Boden skirts...

What is happening to improve partnership working between health, social services and other bodies and how is access to appropriate mental health care to be improved.

Why does it take months or even years to receive this treatment when it can be as life threatening as Cancer or Heart disease?

I must say I have always had very good experience of the NHS.

I am worried about cleanliness though. My step father and my mother-in-law both contracted MRSA from hospitals

Can it really be that hard to implement a proper cleaning programme?

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.

Why are nurses being pushed into virtually replacing junior doctors? If ambitious nurses want to extend their role then fine, but it seems to me that the drive for nursing to become a graduate profession is inherently dangerous and risks alienating good, competent nurses.

Why are patients given so many rights and so few responsibilities? The system seems to be swinging too far the other way now and is increasing inefficiency (ie DNA - did not attend - numbers rising, no penalty to patients, increased pressure on services).

There are too many managers in the NHS who have no clinical experience and so no real understanding of the grass roots system. We need more clinical managers and matrons and less office-bound management.

Why is healthcare becoming so target-driven, and why are trusts being measured on spurious performance indicators that don't take into account the population they serve?

Lord Darzi, I am concerned about two aspects of the NHS.

Firstly, the move towards centralising care. In my (rapidly expanding) town you can no longer have your baby in the local hospital. If you have a major accident you have to travel 12 miles to the latest mega hospital etc etc.
Local, where possible, is better.

Secondly, why do we have to pay parking charges for hospitals? It's wrong and the charges themselves are outrageous. Two pounds (sorry pound sign not working) for 2 hours, 4.50 for 3 hours. We're not there by choice!
Charging the staff who work there is beyond the pale.

On the plus side, I've always been happy with the standard of care and cleanliness that I've come across in hospitals.

Second the concern about polyclinics - he says they won't be imposed but have heard that before a thousand times. Central government policy initiatives tend to happen even if they aren't officially 'imposed'. Why is the government imposing a secondary-care led model rather than listening to patients and GPs who know about primary care?

What is Darzi/are other ministers doing about abuse of the elderly in care homes? Inspectors say they are told by their managers to rate 'poor' homes as 'good' because there aren't enough people to work with all the poor homes.

What are they doing to ensure staff CAN blow the whistle? Current policies just aren't working - I can think of two horrible situations where nurses are desperately concerned but either too afraid to complain or have complained and been threatened as a result so the issue has been hushed up. That's just in my social circle - there must be thousands more.

I have had generally great service from the NHS, however at the moment I am on a waiting list for treatment for a mental health problem. Having tried to commit suicide I got brilliant immediate help, however, now I have a diagnosis of my problem it turns out that in my area it is a 6 month wait list for treatment.
I have the fear of God inside knowing that at any time this could all go wrong again. The psychiatrist I have seen keeps checking that I will call him before acting on my thoughts.. well in rational moments I can say of course... but suicide is not rational behaviour.
Waiting lists for mental health issues are as important as other problems, if I had a broken leg I would not be expected to wait 6 months before I could have an operation to fix it.

I know there are many areas that need help I just wanted to share the frustrations in the particular area of the NHS system that I am currently involved.

The medical profession is facing a staffing crisis. MMC/MTAS chaos has driven many good doctors overseas. The changes in immigration laws have restricted the ability of many non-EU doctors to underatke some training (and provide a high level of service) in this country. The European Working Time Directive, although unavoidable, willl cause further damage to continuity on our wards as junior doctors become even less available. UK medical schools have >50% female students and, as we know well on MN, it's the girls who have the babies. Yet the NHS is doing NOTHING about part-time working. The old flexible training scheme has been decimated. MMC has created further problems with part-time training. Then, when one has finally reached consultant level, part time posts are like gold dust

I am a part-time consultant physician. I am exhausted, demoralised and at the very end of my tether. I have an appraisal next week which will be make-or-break in terms of whether I can continue to do this job which I have worked so hard to achieve and the taxpayer has funded.

Please tell me - truthfully- what plans the doh has to retain the large number of medical working mothers within the workforce to help deal with this staffing crisis. For 60 years many consultants doing private work have worked part-time for the NHS yet those of us who work part-time as mummy and part time for the NHS are vanishly rare and extremely unsupported. Posts are not advertised and job plans, when they are available, are desperately unrealistic.

I have so much to offer the NHS. Please let me.

Also, having gone through miscarriage in both the UK and in France, why was the UK experiencing so gruelling in comparison? I received treatment under the reciprocal care scheme in Europe and so wasn't benefiting from any private health cover and yet my experience was of a comparatively thorough, compassionate and hygienic service which did not see me on a maternity ward with new mothers, did not leave me begging for pain relief, did not leave me pondering what was going on for hours and did not see me walking across blood streaked floors to get to the toilet.

.

You will be aware that over 25,000 deaths a year in England are due to VTE (Venous thromboembolic disease) - More than the total number or deaths from breast cancer, HIV AIDS, MRSA and RTAs.

Thousands more patients suffer pain and disability as a result of this condition. I have known patients who have lost their jobs and even their homes as a result.

Many of these thromboses are hospital acquired.

The NICE guidelines for Surgical patients are supposedly in force.

The NICE guidelines for thromboprophylaxis for medical patients will come in in 2009, the CMO has written to every CEO in England and Ireland, yet only 1 in 3 acute trust are doing anything about it.

I work in a trust that simply refuses to take this issue seriously.

We are desperately understaffed in the area of thromboprophylaxis and thrombosis management.

How can Trusts get away with ignoring evidence based guidelines, ignoring advice from the CMO, ignoring advice from their own specialist staff?

I will be at work when this discussion takes place, but I will look for feedback when I get home.

Thank you
What is the point of issuing guidelines for best practice, if there appears to be no need for Trusts to comply?

I am extremely concerned at the move to "walk-in" and poly-clinics, so undermining the GP-Patient relationship. At my surgery we are ALWAYS encouraged to see the same GP wherever possible to ensure continuity of care.

The nGMS contract makes no allowances for the excellant services provided for OAPs, depression, palliative care - home visits etc, and these new surgeries are just not providing that. A new surgery in Berkshire is not doing ANY home visits - how is that good patient care?

I believe all surgeries should offer non-urgent pre bookable appointments at a varity of times, but only urgent cases should be seen "Out of hours" after say 7pm and the present Out of hours service covers this. Why force the GP's to stay open all hours??