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AMIC’s Info-Flash
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A special issue of AMIC Newsletter, May 2010

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Info-Flash is reproducing below the full text of an interview made with Lord
Ara Darzi. The interview dates from January 2010 and the “reporter” is Dr.
Sonia Wartan, member of the “Great Britain Armenian Medical Association.” We
remind our readers that Lord Darzi was the main speaker during AMIC’s Xth
Medical World Congress held in New York in July 2009 (July 1-4, 2009.)
Info-Flash in its issue of September 2009, made a short presentation of the
communication given then by Lord Darzi on “Robotic Surgery.”

We are certain that all our readers will read with great interest the
following interview.

Interview with Professor the Lord Ara Darzi
Dr. Sonia Wartan reporting

Professor Lord Darzi was born on 7th May 1960 to Armenian Parents. He was
appointed as a consultant Surgeon at the age of 31. Darzi joined Imperial
College London in 1994, obtained his Professorship in 1996 and became the
Chair of Surgery and Head of Department in 1998. Darzi holds the Paul Hamlyn
Chair of Surgery at Imperial College London and the Institute of Cancer
Research. He is also an honorary consultant surgeon at St Mary’s Hospital,
and the Royal Marsden Hospital. He has held many senior administrative
appointments within the Faculty of Medicine at Imperial College, Research
Council, Editorial Board of Scientific Journals, and medical royal colleges.

Darzi’s main clinical and academic interest is in minimal invasive surgery
and allied technologies in which he and his team are internationally
recognized. He leads a team of researchers covering a wide spectrum of
engineering and basic sciences research topics including Medical Image
Computing, Biomedical Engineering, Clinical Safety, and Robotics. He has
published more than 450 peer-reviewed papers and published 7 books.
His work has received international recognition including many awards. He
has also delivered many prestigious and named lectures around the globe.
On 29 June 2007, Darzi was appointed Parliamentary Under-Secretary of State
(Lords) at the Department of Health by the Prime Minister, Gordon Brown. He
was created a life peer on 12 July 2007, as Lord Darzi of Denham. Lord
Darzi was asked to carry out a “wide-ranging review of the NHS”. His
review, High Quality Care for All along with High Quality Workforce were
published on 30 June 2008, which sets out how the findings relating to the
NHS workforce will be taken forward, and a consultation on a draft NHS
constitution.

Sonia Wartan

Thank you for taking the time in your busy schedule to talk to us.
I would like to start with the following:
I believe our readers will be very interested to know any new and exciting
surgical technologies in robotics that you are leading at present.

Ara Darzi

There are plenty, some of them were presented in the AMIC’s meeting in New
York. Robotics as we know it now is the tip of the iceberg, best described
as the first car ever on the road with breakthroughs coming at an ever
increasing pace. So its applications at present are very limited, but it
has opened a completely new platform of computer assisted surgery, this is
primarily because you are bringing the computer chip into the operating
theatre. Robots being used not just into the cavities like chest or
abdominal cavities but robots used intraluminaly through the mouth, nose,
transrectaly and the potential to do much more not just minimally invasive
but certainly what we call natural orifice trans-endoscopic surgery. We
have been involved in developing ‘snake like’ robots, funded by the Wellcome
Trust. There are also a number of other concepts in robotics that we are
very excited about and will materialise into the clinical use in the next
2-3 years, they are very much at an experimental stage.

SW
With your experience during your time as health minister, what are your
views on the health system that our children (and us during our retirement)
will be using? Would it be more or less like the present National Health
Service or would it be different? And how?

AD
In the United Kingdom the National Health Service has been with us for the
last 61 years. I do not envisage that ever changing and in actual fact I
think it is much more relevant post Obama than it has been before. Many
people here do not necessarily appreciate what we have in the UK as the NHS
has been with them their whole lives. Look at the debates in the United
States where 40-50 million people are un-insured with no access to care, I
think we have a very sound health system but at the same time we understand
that our system itself has challenges in improving the quality of care it
provides and we are tackling them. So I still believe that we have the best
system right here where we are. However, we need to start working on it
because there are still areas where we can significantly improve the quality
provided.

As far as society and the problems we all face getting older, I think the
challenges are different than the ones that faced the system when I was back
in training or in my early years working in the NHS. One interesting
statistic shows that most of us are living up to five hours a day extra.
Life expectancy when the NHS was created in 1948 has increased by 10 years.
That is because we embraced innovation, technology, new devices and new
treatments. I think we will see more of that, but there are challenges that
arise through the technology and science that has added years to our lives.
We have to start thinking whether we are also adding life to the years,
because older people might not have the quality of life that they are
entitled to and this is a real challenge. That is one example, the other is
long-term conditions. I do not think the future is a service entirely
focused on hospital provision; the future has to also be in community and
primary care, to build that service we need to see more resources and invest
this more in primary care and community services.

SW
Polyclinics featured as the way forward for an efficient primary care
delivery in your report on the NHS. This will give easy access to the
service that is available 8am to 8 pm and during the weekends. How
successful the implementations have been so far and are any lessons to be
learned from the experience?

AD
In London I have opened seven polyclinics and I am sure more are open now.
I think if we look at all the challenges facing us; aging population, long
term conditions, well being, prevention, all of those cannot just be
delivered in the large hospital setting. This has to also be in the primary
and community health care sector. There is plenty of evidence for this
argument. Starting with what we have at the moment, we have one of the best
primary care systems in the world. This primary care system has two
functionalities; firstly a treatment service, which is more or less what 80%
of the population needs, and it has a gate-keeping role, which is the
referral role. There is a tension between those two because to be a
gatekeeper you have to have a small number of general practitioners who know
their population well if you want to expand the treatment role. I strongly
believe that we should expand the treatment role in primary care because
there is no difference between somebody who qualifies from Imperial college
medical school London becoming a general practitioner or a surgeon because
they are equivalent. I think we need to give more diagnostic capabilities to
primary care, to enhance their ability in this area.
Lots of patients come to hospitals to see a specialist unnecessarily, a lot
of that could be done in primary care settings, but to do that you need a
larger population base because you can’t invest in diagnostics if you are
treating a list of 2000-3000 people. You need to come-up with a way, keep
the right size of population, small enough to keep the familiarity, but
expanded for the diagnostics. That is the concept of polyclinics.
Polyclinics are not single buildings, a lot of polyclinics we described are
a federated model where 5 practices come together and invest in a core
facility in diagnostics. Diagnostics is one arm, well-being, prevention,
social services, community services and schooling come under a holistic
approach and that is what a good community is all about. If you translate
policy into implementation you are always challenged, you will always get
different lobbies and people with different agendas. There are fantastic
federated models, G.Ps doing surgery and interventions. On the other hand
what I will not tolerate are these small single-handed practices in small
premises. One has to acknowledge that these people have done a lot of good
in their time for patients and for our communities but things have moved on,
even in my practice I am one of a team of 4 consultants and 2 nurses
specialist and a stoma specialist.

SW
As a professional, academic and international intellectual figure with
Armenian parents, I am sure our readers will be interested to hear about any
contributions to the Armenian health care system.

AD
I have been there twice and have operated on sick patients and I get a lot
of Armenian patients here. We have a PhD student from Armenia with us. That
was our idea to build a capacity of academics to go back to Armenia.
We are also contributing to training and we have done some live links with
university officers, skills training, sent virtual reality simulators for
training purposes, which I understand, is been actively used. I think more
could be done there in this respect.

SW
In your reviews “high quality care for all” and “High quality workforce” you
emphasis on quality in the NHS. In the present economic environment, how
would you envisage the delivery of high quality care with fewer resources?

AD
Well, I think you are right; we have made a fairly bold statement. Quality
will be the organising principle of the NHS, but at the same time quality
becomes more relevant in economic downturn. It is unlike other sectors; in
health quality may be cheaper. If you do something right from the first
time, it is much cheaper than treating some of the issues that will arise
later. Quality reinforces and also provides a greater momentum in an
economic downturn but it can mean different things to different people.
Quality is not just the consultation between the patient and me, quality is
all about the patient’s journey, and quality is also what the customer
thinks not just what the doctor thinks. As doctors we have to think about
the patient’s pathway of care as a whole.

SW
I enjoyed listing to your episode of dessert island discs on 22 June 08. I
very much enjoyed the very 1st and the last piece of your music choice.
They were Yekeghetsin Haikakan, sacred choral music by Vahan Tekeyan and the
logical song by “Supertramp.”

Would you share with our readers the reason for your choice?

AD
The first choice was because it reminded me of my childhood as a choirboy in
the Armenian Church; I had to listen to that every Sunday. The thing about
desert island discs is that you don’t just choose your favourite seven
songs; you need to pick-up songs which remind you of different decades of
your life. To be fair that is one of my favourite songs as well. Not many
Non-Armenians know about it and I think that Kirsty Young, the presenter of
the programme, was also quite touched by it.
The other song was the logical song, I pick it up in the context of what I
was doing at the time where a lot of things might not be logical to people
at the time but become very logical later. You need to invest in the
future.

SW
I note that you are the 1st surgeon ever granted an honorary fellow of the
Royal academy of engineering.
How important was this accolade to you?

AD
I am not sure whether many have been appointed since then but yes I was the
first one. It was an honour for me; I was always, up to the year before I
entered the medical school, very much geared up to becoming an engineer
because I came from a family of engineers. Engineering was more relevant to
me; I enjoyed visual and tactile tasks rather than being a prescriber.
However, I decided to do medicine and most of my research is in engineering,
computing and computer science. The honorary fellowship was a great
privilege to receive; it had a great value for me as it was from the
Academy.

SW
With your duties, do you have any hobbies or spare time?
What hobbies help you relax?

AD
I like boating; I enjoy the water when I can. I still go to Ireland for a
bit of boating. I like cooking but I find Armenian cooking much more
difficult than others. Cooking is fun and makes you switch off. I enjoy my
holidays with my family. I also do some exercise to keep fit.

SW
Do you have any favourite books?

AD
Yes plenty, probably the most relevant is “Yes Minister.” This is
interesting because it is not just a book. I was given this book at my
leaving party for my ministerial position; it was signed by all the civil
servants who I had worked with over the years at the Department of Health.

Dr. Sonia Wartan
MB ChB, FCARCSI
Consultant in Anaesthesia and Pain Medicine
Royal Gwent Hospital, Newport, Gwent, UK