Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Asylum Seekers and Refugees
- RJ Harwood (16 November 2007)
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Reform fatigue
- Neville W Goodman (16 November 2007)
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Problems at the interface between health and social services
- Andrew J Stanners (16 November 2007)
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Out of Hours patient access to care
- Naeem Toosy (16 November 2007)
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patient satisfaction
- nigel konzon (16 November 2007)
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question for Lord Darzi
- Chris S Wayte (17 November 2007)
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incentives, reform and markets
- stephen black (17 November 2007)
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Personal care
- Patrick Beauchamp (17 November 2007)
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Key clinical questions regarding the UK health services.
- William G. Pickering (17 November 2007)
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Junior Doctors Training
- Sanjeeve Sabharwal (17 November 2007)
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Paediatric Neurodisability Services
- Michael A Absoud (17 November 2007)
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Innovation- is it a realistic vision in today's climate?
- Kishor A Choudhari (19 November 2007)
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Medical Education
- Zahir B Mirza (19 November 2007)
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Questions for Lord Darzi
- Steven Ford (19 November 2007)
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Question for Ara Darzi
- Philip A Hall (19 November 2007)
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Darzi reforms
- Robin Chung (19 November 2007)
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Lord Darzi, How do you think that the NHS will different in 20 years?
- Wendy W White (19 November 2007)
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Ara Darzi
- John M Plumb (19 November 2007)
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streamlined patient pathways
- richard j butterworth (19 November 2007)
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Fruit Money For Pregnant Mums
- Paul P Fogarty (19 November 2007)
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darzi questions
- christina m faull (19 November 2007)
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Qualifications
- benjamin dean (20 November 2007)
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Chronic Diseases
- Brian J Karet (20 November 2007)
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Privatisation
- jonathan e masters (20 November 2007)
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Questions to Ara Darzi
- Hans-Joerg Paul (20 November 2007)
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Facharzt
- Amur Amur (20 November 2007)
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Institutionalised racism
- muhamed albaghdady (20 November 2007)
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Future of Medicine in NHS?
- mamta pathak (21 November 2007)
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Why La Poly-Clinic ?
- Makhan Thakur (21 November 2007)
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Objectives
- Francesca Carter (22 November 2007)
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What percentage of the reports are Darzi's original ideas?
- Clive Peedell (22 November 2007)
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Mobile Phones: do they cause cancer
- William A H Tenison (22 November 2007)
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Quality Improvement: Should the Theory Work in Practice and What Price to Pay?
- Rubin Minhas (23 November 2007)
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HIV-specific Public Service Agreement Target
- Joe C Murray (23 November 2007)
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Ask Ara Darzi
- Swati Patel (23 November 2007)
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Medically Fit For Discharge
- Josie E Mouko (23 November 2007)
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GP Opening Hours
- Felix A Udoh (23 November 2007)
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family occupation of GP practices
- Pervaiz A Waraich (23 November 2007)
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Start at 20
- ASHRAF KHAN (23 November 2007)
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Questions for Lord Darzi
- Norman P Briffa (23 November 2007)
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How will you address the postcode lottery and widespread inequalities in radiotherapy provision?
- L Tho (23 November 2007)
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commitments
- Alexander J Hills, kapil sugand (23 November 2007)
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Return to the UK
- thomas Hopkins (24 November 2007)
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Ask Ara Darzi
- Sheo B Tibrewal, London SE10 4QH (25 November 2007)
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What Value Professional Selection?
- Andrew p Thompson (27 November 2007)
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NHS Dental Care Aches
- M Samer Abdalla (27 November 2007)
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What is a sustainable population for Britain?
- Pip Hayes (27 November 2007)
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Question for Lord Darzi
- Michael Jameson (27 November 2007)
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Achieving public health outcomes with devolved commissioning -an oxymoron?
- Mary CM Macintosh (28 November 2007)
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BMI as a screening tool for hospital malnutrition
- Regis HANKARD, Marie Alphonse, Médéric Roncheau, Elise Mok (28 November 2007)
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Question To DARZI
- charles Wynn Jones (29 November 2007)
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HEALTHCARE AT THE DOORSTEP
- MOHAMED AMIN (29 November 2007)
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Health Discriminations
- Betsy Aidinyantz (29 November 2007)
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What makes
- Stephane G Watteeux (30 November 2007)
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Question for Lord Darzi
- Angus Macdonald (30 November 2007)
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Decentralised commissioning may serve general services well but threatens the survival of small specialist mental health services. Would you intervene or allow them to close?
- Diana E Menzies (30 November 2007)
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Future of NHS - elective and acute
- William R Smith (30 November 2007)
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An interesting development...
- Steven Ford (1 December 2007)
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Experience In General Practice
- mark palmer (1 December 2007)
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"There is no health without mental health"
- Christopher. L. Manning (2 December 2007)
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A Question for Lord Darzi
- David R Warriner (2 December 2007)
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Polyclinic
- L Sam Lewis (2 December 2007)
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What experience of primary care do you have?
- john sharvill (2 December 2007)
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Maternity Leave Reimbursement - Question for Lord Darzi
- Jasmine E Salih (2 December 2007)
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Junior Doctors Training
- Amir Nisar (3 December 2007)
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Respecting the wishes of Elderly Citizens
- Pushpa Wijetilleka (3 December 2007)
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Welfare of SAS doctors
- Pushpa Wijetilleka (3 December 2007)
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The London Review
- Sati Ariyanayagam (3 December 2007)
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Managers in NHS
- Paul E Watkins (3 December 2007)
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C diffile control
- David Mitchell, Dublin (4 December 2007)
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Why are GPs excluded?
- Wendy-Jane Walton, Shrewsbury SY2 6DL (4 December 2007)
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Re: Managers in NHS
- john L OGLE, TA5 2HB (4 December 2007)
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Should non-EU British medical school graduates be allowed to compete with UK/EU nationals for specialty posts?
- Mohammad Farhad Peerally (5 December 2007)
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Engineering complex systems
- David P Kernick (7 December 2007)
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surgical training
- peter s barling (7 December 2007)
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Re: "There is no health without mental health"
- Philip Seager, Foundation Trust S10 2JF (14 December 2007)
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RJ Harwood, Medical student Newcastle University NE1 7RU
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What do you think about the government's plan to deny asylum seekers free primary care? Kind regards Rebecca Competing interests: None declared |
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Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB
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As Rudolf Klein wrote in his "The new politics of the NHS", "there is no magic formula for health care reform and... any attempt to devise one inevitably turns into a conflict between conflicting claims and interest". We have already had more "reforms" than we need, and they have provided plenty of evidence that Klein's statement is a wise one. So why do you think that your reforms will be any more effective than what has gone before, and will last any longer? Competing interests: None declared |
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Andrew J Stanners, Consultant Physician for Older People Pinderfields Hospital WF14DG
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I would be interested to hear what Ara Darzi proposes for the interface between Health and Social Services. The current system is not one that benefits its clients since it creates a barrier between the two sides. This barrier is unduly bureaucratic and encourages the different organisations to argue over funding for care and often to dispute and then duplicate eachothers practises. Competing interests: Geriatrician currently struggling at the interface of Health and Social Services |
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Naeem Toosy, Specialist Registrar - Emergency Medicine St. Marys Hospital
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Though the interim report 'Our NHS, Our future' has encapsualted many of the legitimate concerns of patients and practioners; I was surprised at the mixed response it got from the Emergency Medicine community. This was highlighted at a regional Specialist Registrar training day dedicated to the report as well as a national conference of the specialty. I wondered what the highly respected Professor felt about letting the GPs carry on with Primary Care (albeit with better access and better coverage in deprived area) while letting those who have chosen Emergency care as their vocation manage all unscheduled care (which might not be in A&E departments as per the report's recommendations). My ideas emerged after analysing the needless death of Penny Campbell last year (which was covered extensively in the media) and inspired me to vent my feelings in a letter to the Independent on the 16th of November 2007(http://comment.independent.co.uk/letters/article1876667.ece). Would this not satisfy all the professionals; GPs and A&E Specialists? Competing interests: None declared |
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nigel konzon, general medical practitioner london, SW9 7SE
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Below what level of patient satisfaction (if his unit has bothered with one), would Lord Darzi expect his clinical unit to be closed and amalgamated with an alternative so called 'centre of excellence' at another site? Competing interests: My interest is in a comprehensive health care system, free at the point of delivery, funded by general taxation, that is patient centred. I am not interested in the tunnel vision of ideologically inspired laporoscopists |
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Chris S Wayte, GP Bath BA2 3JZ
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As well as my GP work I also do a day a week as a Clinical Assistant in our local hospital. I received an e-mail from Lord Darzi recently in my Clinical Assistant (hospital)e-mail inbox, about his proposed reforms. Surprisingly I didn't receive an e-mail at my GP e-mail inbox (maybe it got "lost in the post"). If I was being sceptical I might think this means that Lord Darzi isn't very interested in communicating with GPs, but I'm sure this isn't true. I wondered if Lord Darzi could be asked why his e- mail apparently just went to hospital doctors and not GPs? Competing interests: None declared |
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stephen black, management consultant london sw1w 9sr
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I have several questions (I hope that is OK): What can the government do to prevent patient choice being throttled by overly dominant and monopolistic acute providers? How can a department so sensitive to bad news (eg hospital deficits) preserve any incentives for providers to improve efficiency? How can a healthcare system be designed so that medics and hospitals improve their rate of innovation (eg developing new services) rather than the inefficient process of some central body having to tell than how to change? Competing interests: None declared |
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Patrick Beauchamp, Retired GP HR2 8AL
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Do you use private health care or are you prepared to use the NHS - without fast tracking ? Competing interests: None declared |
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William G. Pickering, Doctor 7 Moor Place, Gosforth, Newcastle upon Tyne. NE3 4AL.
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Key clinical questions regarding the UK health services. Dear Editor, You ask: ‘Do you have a question for Ara Darzi?’ Here are two: 1. Re: Can Gerry Robinson Fix the NHS? broadcast on BBC TWO in January 2007. Please put any or all of the following quotes to him for a response. "Not having them (operating theatres) running on Friday afternoons was effectively cutting out 10 per cent of the hospital's work time. Not only was it wasteful in itself ……..” “Institutionalised thinking” “If the consultants don't want to do it, then it won't happen, as simple as that.” "In what other organisation would that be allowed to happen?" [One of many refs: http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2007/01/09/ngerry06.xml ] 2. Why is there no clinical accountability in the health services? That is, why when GPs or consultants break rudimentary clinical ground rules (as intermittently happens daily nationwide), is there not the slightest chance of their being stopped and questioned? [Motorists and patients will understand this question]. Is it not any wonder that serial disasters can happen when single errors pass without remark? A medical student or postgraduate doctor can fail their exams for making a basic clinical error. Accountability is thought elsewhere to improve quality. Why not in daily clinical medicine? Yours faithfully, William G Pickering wgpi@hotmail.com 17.11.07 Competing interests: None declared |
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Sanjeeve Sabharwal, Foundation Year 2 Doctor Royal Berkshire Hospital, RG1 5AN
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Sir, Junior doctors have faced an uncertain year adapting to an ill thought out and hastily conceived new training scheme. With the recent publication of the Tooke Report, MTAS will hopefully be a thing of the past and whatever replaces it should ensure that the consultants it produces have the same skills, broad experience and opportunities that your generation had. In a organisation driven by targets that need to be met and boxes that need to be ticked, there will inveitabily be a clash between the training of doctors and service provision. In the NHS of the future, the NHS that you envisage, how do you see our training being affected by measures being taken to provide better patient care in a more cost effective way? What measures do you think need to be taken to make excellence in training paramount despite this sometimes not being conducive to balancing the books in the NHS? Competing interests: None declared |
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Michael A Absoud, Padiatric SPR Neurodisability John Radcliffe Hospital, Oxford OX3 9DU
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How would you improve access to specialist neurodisability services for children with disability and ensure better patient care for his group of patients in the next 5 years? Competing interests: None declared |
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Kishor A Choudhari, Consultant Neurosurgeon Royal Victoria Hospital, Belfast BT12 6BA
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Your interim report mentions creation of an Innovation council that will lead our way to making NHS a world class service by the care we provide. Developing and adopting new methodologies into clinical practice is a challenging task. Neither the current NHS culture nor the funding (allocated in Consultant contracts) encourages contemporary NHS consultants to be innovative. Would you not be afraid of trying a new laparoscopic procedure that is not yet approved by NICE or that might attract criticism of colleagues? How do you propose to address the limitations which are forcing the Consultants to practise defensive medicine instead of allowing them to be innovative? Competing interests: None declared |
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Zahir B Mirza, Final Year Medical Student Warwick Medical School, CV4 7AL
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Are tomorrow’s doctors sufficiently equipped for a career in medicine when perhaps too much emphasis is being placed on social aspects of disease, at the expense of medical sciences, in undergraduate curriculums? Competing interests: None declared |
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Steven Ford, GP Haydon & Allen Valleys Medical Practice
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1/ Would putting one of the nation's most esteemed Admirals in charge of the Air Force be thought a promising move? 2/ Your putative reforms and their logical extensions, as presently understood by me, seem likely to strip primary care out of rural areas entirely. In this area, Northumberland, there are thousands of square miles of country with merely a handful of GPs - nowhere near enough for even a micro-polyclinic. Metropolitan plans always fail in rural areas - or didn't you know that? 3/ All volume hospital services should be accessible to all patients within less than thirty minutes travel. When services are reconfigured they should be reconfigured for the benefit of patients and not politicians, managers and accountants - discuss. 4/ Every patient and their illness is unique. All services and goods provided by major commercial organisations are identical. Forcing the one into the other is self-evidently bound to fail. Commerce cannot care (in the proper sense of the word) - except for the shareholders. Why is this fatal flaw not apparent to you and the government? 5/ In your planned future for the NHS what happens to the holistic care of patients? The physical, psychological and social elements of their presentation are inextricably bound together. The pastoral aspects of care are not less important than the simple physical parts. 6/ Fragmenting care is such a desperately backward step that it is difficult to even imagine how the discussions went that have led to it. Primary care is best provided by fully integrated, multi-disciplinary, autonomous teams that can deliver coherent, seamless, timely and minutely tailored care to individuals at home. Why has such an incomprehensible, uncivilised madness gripped the government that they want to destroy primary care? 7/ Whereas we used to have a badly funded system that would have worked brilliantly if the funds had become available, we now have vast funds and 'reforms' that will take years and scores of billions of pounds to repair. Failure of that which is proposed is inevitable and in the meantime the damage done to people, government and professions is horrible to witness. Where did it all go wrong? 8/ Should all those driving the 'reforms' be held legally accountable for the harm done? Yours enquiringly Steven Ford Competing interests: I am a GP |
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Philip A Hall, staff grade, independent hospice St Margaret's Hospice, Taunton, Somerset, UK
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If, rightly, we have to practise evidence-based medicine, when is the NHS going to follow evidence-based management and organisation instead of politicians' Big Ideas? What is the evidence base for Prof Darzi's ideas? Competing interests: ex-GP, now working in palliative medicine |
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Robin Chung, Research Fellow Royal Brompton Hospital, SW3 6NP
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Dear editor, I would like to pose two questions to Professor Lord Darzi: (1) Who will pay the bill for financing the new treatment centres? Will it be a re-hash of PFI to mortgage our NHS with shiny new capital infrastucture that looks good on the election manifesto yet hides off-balance sheet expenses for the DoH and Treasury? (2) What of training contracts for our juniors? Will peers shuttle between Bluewater and Whiteleys for MMC version 2.0? What works in Sweden or the USA may not be the solution for the UK. It seems persuasive to recruit as health minister a surgeon who practices privately, but important questions remain for which the present government remain accountable. Yours faithfully, Robin Chung Competing interests: None declared |
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Wendy W White, Student BN7
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Lord Darzi, How do you think that the NHS will different in 20 years, especially as you have just spent so much money on pay rises that there will be no further money for NHS improvements? Competing interests: None declared |
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John M Plumb, Retired GP NP77HY
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There will surely be unintended consequences of the reforms Ara Darzi proposes. Has he anticipated what some of these might be? I can imagine that there may be a huge surge in private, and alternative, medical practice as patients opt out of a perceived iron curtain type of poly clinic staffed by poorly paid and disgruntled staff. Competing interests: None declared |
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richard j butterworth, consultant neurologist milton keynes general hospital & john radcliffe hospital, oxford (mk6 5ld & ox3 9du)
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Dear Lord Darzi I was interested in your recent interview on the BBC's Today Programme in which you highlighted that it was ridiculous that non specialists such as GPs could not order specialist investigations such as MRI scans. I am a neurologist and in the last couple of years (in line with many consultant colleagues) have seen patients in whom wrong diagnoses are given when MRI scans are ordered by non specialists (often through diagnostic centres). In these examples very often a 'distant' radiologist gives a very defensive report listing a whole range of diagnostic possibilities which the non specialist is not able to decipher. A typical example if that patients are told they might have Multiple Sclerosis following flimsy symptoms and over reporting of a scan or told wrongly they have a brain tumour. My question to you is that if you truely believe that non specialists should have equal access to investigations and treatments etc. (given that we are all skilled professionals with many years of mutual training as you mentioned in the radio interview), then I assume you are fully comfortable for non specialists to book patients on to your non urgent operating lists (e.g. for hernia repairs) without the need for you to see the patient first. Competing interests: None declared |
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Paul P Fogarty, Consultant Obstetrician &Gynaecologist Ulster Hospital, Belfast, BT16 1RH
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Sir It is with amazement that the government continues to pursue the incredible naive step of paying mothers up to £200 to buy fruit and vegetable during their pregnancy. Although it sounds wonderful you as a man immersed in evidence based practice must ask where is the evidence that it will work. Those mothers that really need fruit and veg are much more likely to say thank you very much and if they don’t buy some cigarettes are more likely to stock up on fizzy drinks, fast food and crisps. Would these millions of pounds not be better spent on a few more midwives dedicated to maternal education. To paraphrase "Give a woman a fish and she eats for a days, Teach a woman to fish and she eats for life" We as maternity health professionals must stand up and our opinion be counted. Lets not sit back and let another MTAS debacle be introduced nationwide without evidence Yours etc
Competing interests: None declared |
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christina m faull, consultant in palliative medicine university hospitals of leicester le3 9qe
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Given the acknowledged imperative to engage and involve doctors in change and in clinical leadership, why are timescales so misaligned such as the restrictions posed by giving 6 weeks notice to cancel clinics. How can the lack of joined up thinking and misaligned initiatives be overcome? for example restriction of follow-up appointments and admission avoidance. Most doctors can see 100's of ways to improve systems and services but are unable to get changes made for a wealth of different reasons. How can you change this to empower doctors, especially as "power" and "doctor" appear to be concepts that most are trying to drive a wedge between! What will the NHS do about the need for Drs to have career breaks and the consequent need for retainer/retraining schemes. At present it would seem that the NHS is prepared just to loose its doctor employees. I have worked in the NHS for over 20 years. Why do I, like so many others, feel worse about working in the NHS than at any previous time? I can think of many ways of re-energizing me and others but I can not see that this is going to come about. What can you say to reassure me that there is a horizon that is worth sticking around for and one that will not damage my health and my family on the journey there? Competing interests: None declared |
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benjamin dean, sho oxford
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What makes you think that you are suitable equipped to lead this massive NHS review, when you failed so dismally (1) in a much smaller and simpler review of the acute services in just the North Tees area? (1)http://www.nth.nhs.uk/Professor+Sir+Ara+Darzi Competing interests: None declared |
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Brian J Karet, GP Leylands Mediical Cetre BD9 5PZ
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It seems many government initiatives over the years have been tailored to acute medical problems in otherwise fit people and your plans for London, being emulated in other big cities seem similarly focussed. What benefits have these plans for a partially sighted 80 year old with arthritis and diabetes who values continuity of care above everything. Competing interests: None declared |
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jonathan e masters, GP and Hospice Physician IP331LU
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Dear Lord Darzi, Do you think that your Government intended to over reward GPs in order to encourage mistrust from the Public so that patients would have no sympathy for GPs when their surgeries close and Tesco/Virgin/Asda take over the provision of Primary Care? Yours sincerely,
Competing interests: None declared |
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Hans-Joerg Paul, GP Wallingford Medical Practice OX10 9DU
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What is your track record in health economics? Have you worked in primary care? Have you read Barbara Starfield's 'Primary Care'? Competing interests: None declared |
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Amur Amur, Physician Dar-Es-Salaam
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Dear Sir, I have qualified as Facharzt in Internal Medicine in Germany and have completed the European Requirement as Specialist in Internal Medicine.Inspite of fullfilling the requirements due to my nationality I have to undergo another assesment and pay fees to PMETB before being registered by GMC .On the other hand ,German Doctors with Facharzt are registered directly by GMC. I find this policy not appropriate as per equal opportunity POLICY. Competing interests: Registration |
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muhamed albaghdady, locum consultant Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT
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there are many doctors and surgeons in the uk that suffer abuse and lack of oppurtunitis in the nhs,this issue that no one wants/ed to tackle its roots and kept under rap by both members of the nhs, royal colleges councils, and the majority of consultant staff in the uk especialy when it comes to promotion and training oppurtunitis and PMETNB ASSESSMENT, and references this important issue/s need to be tackled soon and very soon as those doctors are frustrated and above all are british citizens that gave their youth to the nhs and are now left on the side. now don't you think this system of employement and short listing on appointment to posts in the nhs especially at consultant level should not be left to few individuals/ cronies at the hospital to deal with? is it not better to set one central committee that deals with shortlisting and interviews and have members from all ethnic groups or the situation is going to continue and frustrate those people and the settlement of their families in the uk resulting in disaffected second generation? this situation cannot be continued in the modern times, the uk must join the civilised world. thank you sincerely
Competing interests: None declared |
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mamta pathak, Specialist Registrar Birmingham B152PQ
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What is the future of the NHS. To me as a trainee who has churned in the system for 10 years, I see no job prospect as a consultant. Lot of us have skills which we cannot practice as there is no funding for the equipment,I see consultants looking worn out and frustrated with the amount of resistance they feel when bringing about a change for patient's welfare. Lot of decisions are left to PCTs to decide who dont always have expertise in the area to make clinical judgements. More and more there is a feeling it is no longer about the better care with patient being the centre of it all but it is focussed around money. Should I just learn to live with this as everyone else has. Do we expect any radical changes in the way the NHS works ? Competing interests: None declared |
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Makhan Thakur, Locum GP Leeds mainly Ls19 7JN
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Professor Darzi seems to be very convinced that Mixed-skill type of General Practitioner Work place will improve our patient care and with this view he is supporting of a pilot scheme in several areas. I am not quite sure how much of experience Prof Darzi might have in his working life performing the duties of General Medical Practitioner ? If he ever had, he would have a very little experience in a variety of subjects of medicine of a common GP. A GP is almost a master of everyday illnesses, he must be able to deal with the person as a whole besides being alert and competent on that subject matter of medicine. Professor Darzi is an excellent surgeon and he just does that. Therefore, I am very doubtful whether his current medico-political interest in sorting out the GPs may not be appropriate? I have been working, at least for 34 years in this branch of medicine including 12 years in establishing out-of-hours ervice in Leeds ( Doctors Deputising Service with founder Dr Mike Ognall). In my experience, I do not believe that Poly Clinic is good for the public nor the doctors who are now young GPs. Where is time and skill going to come from? Any comment! Competing interests: Idea of the Poly-Clinic |
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Francesca Carter, Student ox2 7nn
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What are the main objectives you wish to achieve concerning the NHS? Competing interests: None declared |
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Clive Peedell, Consultant Clinical Oncologist James Cook Univ Hospital, Middlesbrough, TS4 3BW
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I would like to know from Lord Darzi, approximately what percentage of ideas put forward in the two major reports ("Our NHS, Our future", "Healthcare for London") that he is main author, are his own original ideas? More specifically, for example, was Lord Darzi the first person to recommend that Polyclinics are the way forward for London's future healthcare? Is Lord Darzi also aware that many of the current Government reforms are deeply unpopular with both the public and the professions? In addition does he realise the MORI veracity index places politicians at the bottom and Doctors at the top for Public trust? Does he understand that one of the likely reasons for him being selected as Under Secretary of State for Health is to help the government trumpet and sell unpopular reforms to the public with the help of one of "Britain's trusted leading doctors"? Does Lord Darzi understand that this government has a track record of bypassing civil servants, parliament and even the cabinet when policies are being forced through? It's called an "inner circle" and contains far fewer people than the "big tent". Where does Lord Darzi think he fits in to the political landscape and how much influence does he really think he has? Finally, Lord Darzi is quoted as being in favour of MMC. What does he think of the Tooke report? Should the recommendations be adopted in full by the DH? Competing interests: None declared |
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William A H Tenison, GCSE Student Hereford Cathedral School
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As I am studying whether mobile phones contribute to a rise in brain tumours in School at the moment, I would be very interested to hear what your views on this question are. As well as being highly instructive, it would also count as an immenesely useful source in my Physics coursework. Thank you. Competing interests: None declared |
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Rubin Minhas, General Practitioner Sunlight Medical Centre, Richmond Road, Gillingham, Kent. ME7 1LX
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With a recognised gap between the healthcare that is recommended and that which is delivered, Lord Darzi’s interim report1 incorporates a helpful synopsis of the principles of ‘healthcare quality’ outlined by the US Institute of Medicine2. The conclusion of a recent Kings Fund report3 that NHS ‘productivity’ is on a path of slow uptake that could ultimately threaten the viability of the NHS provides a timely impetus to several of his proposals. Lord Darzi’s report is a healthy challenge to professionalism that encourages us to move from what we do, to what we can strive to do better. It should be readily accepted but it has ramifications for policymakers too. Change is not always improvement, but improvement invariably involves change, which incurs opportunity costs as well as benefits and can have unintended consequences. The evidence supporting quality improvement interventions has often been of poor methodological rigour, uncritically evaluated, had small or modest effect size with substantial variation and has been infrequently supported by health economic evaluation4. Wanless et al describe initiatives such as practice based commissioning (i.e. system redesign) as not fully ‘worked out’ and triangulate significant rises in emergency admissions and increases in readmissions within 28 days of discharge, with loss of continuity of care and initiatives to reduce length of stay respectively. They conclude that ‘the failure by government to evaluate policies that absorb billions of pounds contrasts strongly with the efforts made by NICE to evaluate new healthcare technologies’3. Arguments for prioritising urgency over rigour may lack intellectual integrity. For example, medication errors may be the eighth leading cause of death in the US, but if one were to proceed largely on the basis of urgency rather than evidence, the eighth cause would become exempt from the standards applied to the top seven (heart disease, cancer etc) - though greater claims for urgency and expediency can be made for them5. In pursuing a focus on quality for the health service, which incurs opportunity costs in terms of benefits foregone whenever resources are misallocated, what does Lord Darzi believe is the importance of adopting a transparent and evidence based approach to healthcare policy that incorporates rigorous assessments of the clinical and cost-effectiveness of quality improvement interventions? Dr Rubin Minhas
1. Our NHS, Our Future. NHS Next Stage Review. Interim Report. October 2007. Department of Health. 2. Institute of Medicine (IOM). Crossing the quality chasm: A New Healthcare System for the 21st Century. Washington DC. National Academies Press; 2001. 3. Our Future Health Secured? A Review of NHS Funding and Performance. Kings Fund. 2007. www.kingsfund.org.uk/publications 4. Evidence Based Quality Improvement: The State of the Science. Shojana K G, Grimshaw J M. Health Affairs 24, no 1 (2005): 138-150 5. The Tension between Needing to Improve Care and Knowing How to Do It. Auerbach A, Landefeld S, Shojania K. NEJM 357;6:608-613 Competing interests: RM is an NHS General Practitioner. He is a member of an Independent NICE Appraisal Committee and participant within NICE Guideline development. Any views expressed are the personal views of the author. |
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Joe C Murray, Policy Officer National AIDS Trust, 196 Old Street, London, EC1V 9FR
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According to the Health Protection Agency, HIV is a key public health challenge in the UK. Yet there has not been an HIV-specific public service agreement target to encourage focused action on HIV from the NHS. What plans does the Government have to identify such an HIV-specific target, and include it within the NHS Operating Framework, so as to leverage real and effective action for HIV prevention, treatment and care? Competing interests: None declared |
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Swati Patel, General Practitioner Hatch Warren Suregry Basingstoke RG22 4YQ
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I am a GP in Hampshire. I would like Prof Darzi to spend 2 weeks shadowing me, day and night, and then advice me how I can provide extended hours AND continuity of Care for my patients. Competing interests: None declared |
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Josie E Mouko, On maternity leave inbetween FY1 and FY2. Princess Alexandra Hospital, Harlow, Essex, CM20 1QX
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A significant number of hospital beds are occupied by patients who are deemed "Medically Fit For Discharge", sometimes for long periods of time. These patients are generally elderly and awaiting social services/ occupational therapy input/ nursing home placements. This is a hugely cost-ineffecient situation for the government and a poor use of finite NHS resources and personnel, as well as a risk to the patients (such patients are highly susceptible to Hospital Acquired Infections which occasionally result in an avoidable death). How do you propose to address this issue? Competing interests: None declared |
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Felix A Udoh, GP Principal Green Cedars Medical Centre, 93-95 Silver Street, London, N18 1RP
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In a recent letter / article Lord Darzi says he has spoken to a thousand people (he did not specify how this was done but I suspect it was a focus group) and many wished they could see their GP either on a weekday evening on Saturday. Does he think this is an evidence-based approach to reconfinguring primary care services? Has he read the results of the survey commissioned by his own department (see GP Patient Survey at www.doh.gov.uk) at a cost of £11,000,000.00 with responses from 2,295,987 patients 84% of whom stated they were satisfied with the current opening hours? Does he have an explanation for the fact that this survey is not being cited at all in the current plans to reconfigure primary care services and force extension of GP surgery opening times? Does he have an explanation for the fact that this survey has not been cited in public (to my knowledge) by any top government officials since publication? Is the fact that patients are on the whole satisfied with our current opening times inconvenient for his plans? If he is so convinced of his plans, why is he not allowing pilots to be run to test their practical application? Why are GP opening hours being given such a focus despite patient satisfaction when depressed patients do not have access to CBT and have to wait for 6 months to see a counsellor in my locality? Finally, why does Lord Darzi, as a top tertiary care surgeon feel he is qualified to launch a sweeping re-configuration of primary care services? Can he tell us what experience he has of working in primary care that provided him with an insight into the needs of patients in primary care? Competing interests: I am a North London GP |
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Pervaiz A Waraich, hospital consultant manor Hospital Walsall WS29PS
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can I ask the health minister what his plans are to manage GP Surgeries who are increasingly becoming a family business. Most surgeries only take their friends or sons or daughters or relatives as partners who may be less qualified or not as competent. They only give salaried posts to others who may be better than their loved ones.It has become hard for new GPs to take a partnership as the old Gps do not offer partnership unless you are a frind or a family member. Thus patients are missing out in the way of better service.By employing relatives or friends as partners there is lot of risk of cover up of any issues that mat arise. Will the health minister direct all PCTs to appoint GP partners by selecting by a panel of PCT and not by GPs themselves who are extremely biased.This practice is most common in Asian GPs. Competing interests: None declared |
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ASHRAF KHAN, Surgeon Saudi Arabia
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SIR Greetings
Competing interests: None declared |
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Norman P Briffa, Consultant cardiothoracic Surgeon Sheffield teaching hospitals NHS trust, Norhtern general Hospital, sheffield S5 7AU
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i have 2 questions relating to surgery for the Health minister 1. How does one introduce new technology which is known to benefit patients but may incur a cost when PCTs insist they will not pay beyond the tariff? I am referring specifically to endoscopic vein harvesting to harvest conduit for patients undergoing CABG. The evidence is extremely strong (I submitted evidence to NICE who are currently evaluating the technique.)but it is likely that NICE will just say it's OK to perform this technique as long as the usual clinical governance arrangements are in place. 2. If Lord Darzi accepts that outcomes after surgical operations are due to more than just the surgeon (as he pointed out in the Health select committe hearing)but reflect the performance of the whole team, does he agree that the reporting of surgeon specific outcomes is iniquitous and unfair and probably leads to risk averse behaviour. Competing interests: None declared |
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L Tho, Clinical Oncology Research Fellow Beatson Institute G61 1BD
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Radiotherapy services are facing a huge challenge for equal provision and are unfortunately subject to a postcode lottery. For example intensity modulated radiotherapy is superior to conventional radiotherapy in a range of tumours (eg. head and neck cancers) and can spare young patients a lifetime of severe morbidity. Yet this service is only available in a few centres. Much has been made about the equality in providing latest cancer drugs yet radiotherapy, which cures more people than drugs, is afforded very low priority by decision-makers. Why such a glaring disrepancy? Why do hundreds of patients have to suffer for this yearly. Competing interests: None declared |
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Alexander J Hills, final year medical student sw6 4hs, kapil sugand
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Dear Professor the Lord Darzi, You are both actively involved in the cutting edge of surgery and also more recently in politics. My question is would what drives your move into politics? You are both a surgeon and a politician, where do you feel you can a make the greatest impact and why? What is your stance on the loss of free housing for F1 doctors, do you believe it is right to take this away? Competing interests: None declared |
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thomas Hopkins, consultant USA
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For Doctors working abroad at a senior level what opportunities do you see for a return to the NHS as a Consultant? Obviously it is beneficial for the country when people trained at the UK taxpayers expense express a desire to return. Current job opportunities seem meagre. What will you do to change that? Competing interests: None declared |
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Sheo B Tibrewal, Consultant Orthopaedic Surgeon Queen Elizabeth Hspital, Woolwich, London SE10 4QH
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What are your views on the depoliticisation of the National Health Service? Competing interests: None declared |
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Andrew p Thompson, GP Enki Medical Practice B19 1BP
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When I applied for entry to Medical School, great emphasis was placed on the importance attached to ethical values, professionalism etc. This continued throughout my training, and indeed, those who it was felt did not meet the exacting standards necessary of a doctor were quietly taken on one side and asked to leave. Now, having got through a gruelling training and a very overworked apprenticeship, I find that it all counts for nothing and I have a bunch of witless (for the most part) pen-pushers to whom I must answer, and prove my professionalism on an almost weekly basis. I am fully aware that this has happened to a number of other professions, teachers, lawyers ... and that the Shipmans of this world have done us no favours, but the alternative to professional leadership is what you now have, demoralisation, resentment and resignation. I can only watch and bemoan the fact that this phenomenon, described some 25 years ago by Marxist Comentators as the Inevitable Proletarianisation of the Professions, has occurred only after the chance of any organised response by the Proletariat has receded far over the horizon. The question is... why as a colleague are you prepared to connive in this emasculation of independent creative professionalism and preside over a further stage in our descent to grey uniform mediocrity? Competing interests: I am a GP and have serious concerns abou tthe effectof his review for my sanity |
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M Samer Abdalla, Specialist Registrar In Anaesthesia Homerton University Hospital
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How Lord Darzi is going to improve the standards of dental care offered by the NHS? The whole dental care regulations in the NHS need brave solutions. I can not understand why the Dental Care in the NHS is not free, when I and millions of hard working people are paying for the NHS scheme. Too many people with long term gums problems are declined treatment in the NHS. I want REALLY free dental care including dental hygienist. I find it unfair treating patients with complications secondary to chronic alcoholic abuse and smoking while forcing millions of tax payers to pay for their basic dental care. Competing interests: I an NHS Contributor |
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Pip Hayes, GP St.Leonards Medical Practice, Exeter,EX6 7HA
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