LORD DARZI: YOU ASK THE QUESTIONS
The Independent/UK
Published: 12 November 2007
The minister with responsibility for improving patient care answers
your questions, such as ‘Are doctors paid too much?’ and ‘Will we
ever find a cure for cancer?’
How many hospitals do you think should be closed? Dan Inson, by email
My review of the NHS is not about closures – it’s about delivering
high-quality patient care. Any changes to services should be about what
is best for patients and based on the best clinical evidence. These
decisions need to be determined by people locally – clinicians, the NHS
staff, patients and public. Medicine is constantly changing – more and
more is being done to detect people’s health problems earlier. These
advances mean patients who previously required hospital treatment can
more frequently be cared for in their homes. As part of my review of
the NHS, I’m focusing on ways to improve the care patients get as they
move through the NHS. It’s not going to be about buildings or closures.
Should we bring back matrons? Patricia Niblock, by email
We already have. After an absence of 30 years, the Government brought
back matrons in 2002. There are about 2,000 matrons already in post
and we aim to recruit an additional 3,000 next year. Leadership and
accountability is very important in the health service – whether a
matron or anyone else on the clinical team.
Have you always been a Labour Party supporter? John Swaine, Oxford
I’m a clinician not a politician but I was honoured to be asked to
take on this role. I am proud of the unprecedented investment into
the health service we have witnessed over the past 10 years of this
government. It has helped transform the NHS for both patients and
staff. I am now pleased to be part of the team delivering further
improvements and hope my work will ensure clinicians have a clear
voice within the Government.
You want to shift work out of hospitals and into GP surgeries – but GPs
complain of being overworked. How will you square that circle? Simon
Mills, Windsor
GP practices are the front door to the NHS and where most care already
takes place. Increasingly, work that used to take place in hospitals
can now be done nearer to where people live – in their communities or
even their home. That’s good for patients and helps hospitals focus
on the specialist care they need to deliver. As we transform how care
is delivered, we will need to be more creative about deploying our
clinical specialists better.
This isn’t just about GPs. I would like to see more of a role for
nurses in helping to support people with long-term conditions such
as diabetes. And I’d also like to see consultants going out into the
community and holding local clinics..
Do you want to see more private companies providing GP and hospital
services Fiona Hamilton, Acton
I’m keen to see services improved for patients. Who provides the
service doesn’t matter – as long they deliver services to NHS standards
and provide good value to the taxpayer. Competition in the health
service can be a good thing – I’ve seen it help drive up standards
and offer patients increased choice.
Had you been in charge five years ago, with the benefit of hindsight,
what single change would you have made that could have created a
stronger NHS?
Kate Pearse, Ashford
While a lot has been done to improve the NHS over the past decade,
it is clear more could have been done to engage staff. Some of the
changes have not been fully supported by medical professionals, because
government has focused on the means, and not the end – the quality of
patient care. We know that for change to be truly effective requires
clinical engagement and leadership. Part of my role is to ensure we
place clinicians at the heart of the decision-making process.
More conditions are treated with drugs or minor interventions instead
of surgery. Will there ever be a time when surgeons become redundant,
Andy Mason, Hampstead
As a practising surgeon, I certainly hope not. Even with innovative
developments in drug treatments and care moving closer to people’s
homes, there are certain conditions that will always require surgery.
My team and I have developed techniques for less invasive procedures –
such as keyhole surgery – which is better for patients but actually
requires greater surgical expertise. While the role will continue
to change, there will always be an integral role for surgeons in
our system.
Why are medical jobs being given to those from overseas when there are
qualified British doctors who are unable to gain employment? Ashwin
Ramamurthy, by email
Overseas doctors have made and continue to make a huge contribution
to the NHS over the years. Indeed, for most of its history the NHS
has relied upon the contribution of doctors who trained outside
Europe. However, we have a responsibility to ensure qualified
British doctors are able to gain employment and this is something
the Government are looking at carefully.
You work at a university. Do you think the new electronic system for
assessing new doctors is flawed? John Brewin, Cambridge
While the principles that led us to modernise medical careers were
absolutely right, there were some veryserious issues with how the
scheme was implemented. I know it’s been very difficult for junior
doctors – I saw some of my brightest students struggle to get the
jobs they deserve. The Government was right to apologise for the
distress caused.
Do you think everyone should automatically be an organ donor, unless
they opt out? Francis Walker, London
We know there is a shortage of organ donors and the Government is
trying to improve the situation. We have the organ donation task
force to look at the issue of presumed consent. They will be taking
into account as many different views as possible.
With the news that cancer can be avoided by a good lifestyle, should
the Government do more to make people lead healthier lives Henry
Anderson, Hounslow
While a lot is down to the individual, the Government has a role in
supporting people to make healthy choices. That is why we introduced
a smoking ban and are working on an obesity strategy. I’ve also asked
the clinicians working with me to look at how we can help people
stay healthy.
In the battle against MRSA, isn’t deep cleaning hospitals missing
the point?
Neil Moreton, by email
For the fight against MRSA to be effective requires a multi-faceted
strategy. The deep-clean programme is part of a wider range
of measures, such as screening patients before they come into
hospital, that we are asking all hospitals to take to ensure we
reduce healthcare-acquired infections and improve the safety of our
patients. The NHS is taking this issue very seriously and we will
work with all our hospitals to ensure we reduce infection and increase
patient confidence.
What is the main complaint you hear from patients about the
NHS? Richard Baker, Farringdon
Patients have told me that they sometimes feel like a number in the
system rather than a person. We need to make the patient experience
as personal as possible and I have made this a priority.
At £110,000 a year, are GPs being paid too much? Jeff Porrit, by email
I think GPs do a vitally important job and deserve to be well rewarded
for their efforts. A significant proportion of their income is now
related to the quality of care they provide and that can only be a
good thing. We will continue to tie GP income to patient experience,
and we are working with GPs to ensure that at least 50 per cent of
practices extend opening hours.
You were born in Iraq. What do you make of the current state of
the country?
Maajid K, London
Although I was born in Iraq, my family are Armenian and I was raised
in Ireland. Progress has been made in bringing security and stability
to the country – but clearly there is more to be done.
For someone with connections to Iraq, did you support the
invasion? Chris Bute, by email
I was not privy to the information that led the Government to support
the invasion. Clearly this was a complex situation where decisions
had to be made. I think the key now is to support the Iraqi people and
help them to develop their country into an economic and viable state.
As medicines become more expensive and varied, isn’t the NHS
doomed? Shaun Barlow, SE14
It’s an interesting point. I’m a passionate believer in a universal
tax-funded healthcare system, free at the point of need. Clearly,
the NHS needs to consider how it keeps pace with the ever increasing
number of technologies and medicines. Innovations can sometimes
offer significant savings. Statins, medicines which reduce the risk
of heart attacks and strokes, are a good example.
In 1997, Tony Blair said he’d get rid of the internal market in the
NHS. He didn’t. Should it be removed now? P Foucault, by email
The internal market was a top-down system driven by price competition,
where patients followed the contracts negotiated by strategic health
authorities or GP fundholders. I would argue it has been replaced with
a fairer system in which there is no negotiation over price, care is
provided according to national standards and funding increasingly
follows the choices made by patients, who tell us they want better
quality and faster access to services.
Most people have a bad impression of the NHS, but good personal
experiences of it. How on earth can that be changed? Dr G Waters,
by email
It’s really good that nine out of 10 patients who use the NHS rate
their care as excellent, very good or good. Unfortunately, that
doesn’t always translate into a wider sense of enthusiasm about the
service and there is a greater appetite for bad news about the NHS
than good. We all need to challenge that – patients, public, staff
and the Government. Through my work, I encourage staff working in
the service to be proud of its successes and be ambassadors for the
good work being done.I also want to get more patients talking about
their good experiences.
Are there too manymanagers and not enough nurses in our
hospitals? Frank Jenkins, Cardiff
There has been a significant increase in the numbers of staff across
the NHS, which has helped transform the service. I used to be the
only colorectal surgeon in my hospital. Now I am one of a team of
four surgeons working with colleagues including two full-time stoma
nurses, two specialist nurses and a nurse consultant. Many people don’t
realise how essential managers are in ensuring that patients receive
the care they need. There are far fewer managers than people think;
they make up less than 3 per cent of the total workforce.
New Labour has spentbillions on the NHS and nothing seems to have
improved.
Where’s it gone? Sophie Williams, by email
There have been many improvements. Back in 1997, the NHS was in
relatively poor health. Investment levels had varied considerably over
previous decades, hampering proper planning. I only have to look in
my own experience to see the progress that has been made – there are
more staff in my team, our patients do not wait as long for operations
and their care is of a higher quality and much more personal.
Is it right an unelected person has so much power over the future of
such a huge public institution? Philip Barry, London E3
I’m part of an elected government and it was a great honour to be asked
by the to join the team. I am a practising clinician, seeing patients
two days a week, and thus much of my working life is, and will continue
to be, centred on patient care. I intend to draw onmy experience in
clinical practice, research and teaching to ensure I add value.
If you could make everyone do one thing to improve their health,
what would it be? Val King, Richmond
Take regular exercise.
Do you listen to music during operations? Linda Edwards, Brighton
Yes, sometimes. My preference is Led Zeppelin and Pink Floyd and
occasionally Capital Radio.
Will we ever have a cure for cancer? Dave R, by email
We are making great strides in treatments, some of which we could
not have imagined. We may eradicate some specific cancers but it is
unlikely we will eradicate cancer altogether.
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