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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We know that the population of Britain relies on the food and resources of land equivalent to the area of 4 Britains. In a world where food and other resources are running out ,and where every human being is a climate changer, wouldn't a policy on sustainable populations be the most influential on the health of all human beings? Why doesn't the Department of Health address population? (Why has the BMJ not had an issue devoted to human (over)population since 1997?) Competing interests: Trustee of The Optimum Population Trust |
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Michael Jameson, St Albans, Herts AL1 3TX
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Q: In the context of Big Tent politics, is the age-old concept of a self-registering and self-regulating profession out of date? Competing interests: None declared |
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Mary CM Macintosh, Director of National Chlamydia Screening Programme Centre for Infections, 61 Colindale Ave, London NW9 5EQ
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Shifting the Balance of Power devolved finances to local level and is in danger of failing to deliver public health initiatives. If the government believes that ring fencing finances is no longer appropriate, what other mechanisms or strategy does Lord Darzi recommend to implement important public health initiatives such as the sexual health strategy? Sexual health of people in the UK compares very poorly to that of their European counterparts, an observation made for over thirty years. Sexually transmitted infections continue to rise. The government introduced a sexual health strategy in 2001. However the fact that ring fencing is no longer used resulted in difficulties in implementing the strategy and in particular the setting up of a National Chlamydia Screening Programme, a key component in addressing the commonest sexually transmitted infection leading to subsequent infertility. The screening programme has already had over 80 million pounds allocated to it at local level and although roll out in England is now well underway the longer term goal of controlling chlamydia is dependent on 152 individual local programmes all signing up and delivering, a challenging task by any stretch of the imagination. Variation in performance is causing real challenges in ensuring an equitable service. Fair and personalized services have been stressed by Lord Darzi as key objectives for the future NHS. Yet sexual health, is not a topic that lends itself readily to public advocacy. Therefore how will Lord Darzi address such issues which must be similar for other public health initiatives Competing interests: None declared |
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Regis HANKARD, Professor in Pediatrics CHU Poitiers, 86000, France, Marie Alphonse, Médéric Roncheau, Elise Mok
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We do believe that this later study by Cole et al. will have a great impact in better detecting children’s malnutrition. In France like in many industrialized country, malnutrition affects especially the hospitalized children suffering from chronic diseases. We previously estimated between ten to fifteen percents the frequency of hospitalized children malnutrition depending on primary to tertiary care status of the unit (1). Unfortunately no nutritional index is systematically reported on medical files and most of the time height is not measured compromising any nutritional index calculation. Moreover many junior physicians do not have a firm knowledge on weight for height calculation and interpretation so we developped recently a tool allowing easy calculation of weight for height ratio (2). As a consequence hospital malnutrition remains mainly unnoticed. Obesity epidemics greatly improved nutritional assessment through sex and age BMI reference charts and IOTF cut-off lines. We conducted a study to evaluate the relevance of the third centile of the BMI French references (3) as a threshold of malnutrition compared to a weight for height (W/H) lower than 80%. We also compared them to new Cole’s et al. cut-off values for grade 2 malnutrition using the Excel macros referenced in the article. The studied population was composed of fourth form pupils from 28 voluntary colleges in Vienne, France. 1296 of 2407 pupils aged of 13,6 ± 1,1 were included in the analysis (1111 presented incomplete data). 1,9% presented malnutrition according to the BMI, 2,2% according to the W/H and the new Cole’s cut-off. 15% had a BMI > 97th centile according to (3) and 2,5% were undersized (lower than 2 standard deviations for height). 54% of children with a BMI < 3rd centile had a W/H< 80%, mainly because W/H failed to detect malnourished chidren who were small i.e. stunted children. More interestingly, 83% of children with grade 2 malnutrition as defined in the present Cole’s article had a BMI < 3rd centile for age and sex according to French references and 58% a W/H < 80%. These data suggest that the 3rd centile for BMI may be a relevant index in the screening of children’s malnutrition. It allows the screening of children who are both underweight and undersized. The present results need to be confirmed by a survey of other age groups to widen the field of application of BMI. 1) Hankard R, Bloch J, Martin P, Randriansolo H, Bannier F, Machinot S et al. Etat et risque nutritionnel de l’enfant hospitalisé. Arch Pediatr 2001 ; 8 :1203-8. 2) French speaking society for clinical nutrition and metabolism (SFNEP) website : www.sfnep.org/images/PDF/dp-dede.pdf 3) Rolland-Cachera MF, Cole TJ, Sempé M, Tichet J, Rossignol C,Charraud A. Body mass index variations: centiles from birth to 87 years. Eur J Clin Nutr 1991; 45 : 13-21 Competing interests: None declared |
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charles Wynn Jones, consultant orthopaedic surgeon Univ Hosp North Staffs
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Dear Fiona, Could you ask Lord Darzi what is being done to respond to the advice give by me to the casemix sarvice on HRG compilation especially for complex hip surgery that reflects complexity comorbidity and actual hospital costs. Currently much revisional hip surgery and pelvic reconstruction surgery is done at a loss by specialist orthopaedic hospitals. There is the most bizarre situation currently in that it is almost impossible to find out what the hospital reimbursements are for some of these conditions and operations unless one looks back on what was paid to the hospital and then cross check the codes submitted ..Its like breaking the enigma Code and a waste of time .Why is there no transparency?? . I gave detailed information to the casemix service on a costly type of patient that is not uncommon now ...that is with a periprosthetic fracture around a THR . Such patients are complex to treat and slow to respond ie very costly and yet no new OPCS code has been agreed and to treat such patients make a loss for the treating hospital . The very existence of some of our famous specialist orthopaedic hospitals is being threatened and the much beloved ( by this government)Treatment centres of course never see such patients as they cherry pick the better earning conditions. Can Lord Darzi assure me that advice given by experts in this field will be listened to and acted upon. I am sure this complaint is mirrored by other specialities. Competing interests: I am an orthopaedic surgeon in the NHS and someone who has submitted evidence to the casemix service on the topic of costing hip replacements etc |
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MOHAMED AMIN, Paediatric registrar Queens Hospital, Romford, RM7 0AG
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Dear Prof. Darzi, Its very interesting to know about the concept of polyclinics to provide health care to people near their own homes. My suggestions are as below:( My dreams) 1) Polyclinics manned by GP'S and most problems could be sorted out by GP's with special interest.(GPWSI- Depending on how much the DOH will encourage this) 2) Secondary care consultant from each speciality to visit the polyclinic depending upon workload in each area. 3)Consideration for provision of DAY CARE UNITS at the polyclinics to be run by GP's with special interest who in turn can liase difficult cases with secondary care hospitals. 4) Provision of Radiology and Lab services , may be additional physiotherapy etc depending upon the work load. thats my dream of an ideal polyclinic. regards, Dr.M.Amin Competing interests: I am starting my GPVTS Training from April 2008,and I am highly interested in Provision of Quality Paediatric Primary care. |
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Betsy Aidinyantz, Student BA Health and Social Care Practice University of Kent/Medway
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First of all, as an Armenian, I would like to say how proud I am that Dr Darzi has received such a high post within the government. My question, along with many of my fellow students, is whether Dr Darzi will be looking at reshaping the care services to ensure that good standard of care is given to all individuals, regardless of colour, race, ethnicity, gender and sexual orientation as a moral minimum? Whether funding will allow individuals freedom of choice of carer and that a sense of dignity will be restored to the nation, especially to the elderly? Yours sincerely, Betsy Aidinyantz Competing interests: None declared |
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Stephane G Watteeux, GP principal HP7 0HG
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Lord Darzi feel he will be able to keep GP's engaged with his changes as he has not got any Primary care experience? Competing interests: A young GP worried about his future! |
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Angus Macdonald, General Practioner Cornwall EX23 9BP
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As per BMJ instructions: - Lord Darzi As a patient, do you have an NHS GP? When was the last time you visited him or her? How was your experience? As a professional, you are a tertiary care specialist. By definition this subtantially limits your contact with General Practice. When was the last time you had any significant face to face professional contact with General Practice. How do you feel qualified to contribute to the future of primary care provision in the rural isolated part of Cornwall where I work? AM Competing interests: None declared |
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Diana E Menzies, Consultant Psychiatrist in Psychotherapy Henderson Hospital Services, 2 Homeland Drive, Sutton, Surrey SM2 5LT
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Specialist residential therapeutic community treatment for people with personality disorders is being decimated by changes in the commissioning of specialist services, despite being part of the guidance for service delivery in the NIMHE document Personality Disorder: no longer a diagnosis of exclusion (National Institute for Mental Health in England, NIMHE, 2003), and despite evidence of clinically significant improvement and a cost-offset to the nation of about 90% following treatment (1-5). This funding crisis is essentially a consequence of devolvement of commissioning from National Specialist Commissioning Advisory Group (NSCAG) to Primary Care Trusts (PCTs). Some PCTs have decided to divert the money to develop local services for personality disorder, understandable when government guidelines recommend this development. However, those personality disordered clients who attend for residential treatment have a greater degree of personality pathology than those who attend day services (6), and referrals for residential treatment are still received from those areas that have local outpatient and day services. This demonstrates what has also been recognised, namely that a range of services and treatment approaches are needed to respond to the spectrum of complex needs of this client group. Furthermore, these are clients for whom intensive, residential treatment is suitable and beneficial (7) and who would be excluded from outpatient therapy due to the clinical risk of deterioration. Cost-per-case funding was demonstrated in the early 1990s to contribute to deterioration in the service offered to personality disordered clients (8-11). Importantly, cost-per-case does not provide the host Trusts with the financial security that it needs to run the service. Closure is being discussed for the 3 remaining NHS residential services in England. Discussions with private and independent sector providers have not led to anything that would ensure the survival of treatment for the current client group. When questioned, Ministers for Health say that decisions have to be made locally. Yet the independent Review of Commissioning Arrangements of Specialised Services (12) recognises that those services which are used only sparingly by PCTs need to be funded by collaborative commissioning arrangements, as indeed was suggested by NSCAG in its Final Report (13, 14). Otherwise the skills and experience gained over decades (two of the services predate the NHS) of treating people with personality disorders will be lost. This will add to the impoverishment of psychological treatments available to psychiatric patients (15). Not only will gaps emerge in developing a “seamless” service for people with personality disorders, but closure of these services will also be to the detriment of many who benefit indirectly through the training and consultation provided by the service (16). While transitions in funding may destabilise many services, there is a strong argument to ensure that public monies invested to date in developing and providing specialist services are used properly, and that the effectiveness of policy and commissioning arrangements, alongside clinical service provision, are subject to rigorous and transparent, evidence-based evaluation. Diana Menzies, Consultant Psychiatrist in Psychotherapy, Henderson Hospital Services. References 1. Menzies D, Dolan B, Norton K (1993) Are short term savings worth long term costs? Funding treatment for personality disorders. Psychiatric Bulletin, 17, 517-519. 2. Dolan B, Warren F, Menzies D, Norton K. (1996) Cost-offset following specialist treatment of severe personality disorders. Psychiatric Bulletin, 20, 413-417. 3. Chiesa M, Fonagy P, Holmes J, Drahorad C, Harrison-Hall A, (2002) Health service use costs by personality disorder following specialist and nonspecialist treatment: a comparative study. Jounal of Personality Disorders, 16, 160-173. 4. Chiesa, M., Iacopani, E., & Morris, M. (1996) Changes in Health Service Utilization by Patients with Severe Personality Disorders before and after Inpatient Psychosocial Treatment. British Journal of Psychotherapy, 12, 501-512. 5. Davies S, Campling P (2003) Therapeutic Community Treatment of Personality Disorder: service use and mortality over 3 years follow-up. British Journal of Psychiatry 182 (suppl. 44), 24-27. 6. Lees, J. Evans, C., Manning, N. (2005) A cross-sectional snapshot of therapeutic community client members. Therapeutic Communities. 26, 3, 295-314 7. National Institute for Mental Health in England NIMHE. (2003). Personality Disorder: No longer a diagnosis of exclusion. London: Department of Health 8. Dolan, B. M., & Norton, K. (1990). Is there a need to safeguard specialist psychiatric units in the NHS? Henderson Hospital: A case in point. Psychiatric Bulletin, 14, 72-76. 9. Dolan, B. M., & Norton, K. (1991). The predicted impact of the NHS white paper on the use and funding of a specialist service for personality dis- ordered patients: A survey of clinicians' views. Psychiatric Bulletin, 15, 402-404. 10. Dolan, B. M., & Norton, K. (1992). One year after the NHS Bill: The extra-contractual referral system at Henderson Hospital. Psychiatric Bulletin, 16, 745-747. 11. Dolan, B., Evans, C., & Norton, K. (1994). Funding treatment of offender patients with severe personality disorder. Do financial considerations trump clinical need? Journal of Forensic Psychiatry, 5, 263 -274. 12. www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/Commissioning/CommissioningSpecialisedSevices/fs/en 13. www.advisorybodies.doh.gov.uk/NSCAG 14. Pidd, F., & Benefield, N., National Severe Personality Disorder Service Report, NSCAG, August 2006 15. Frauenfelder, C. UK mental health charities call for more psychological treatments. BMJ, 2006;333:936 (4 November), 16. Drescher, U. Evaluation of the Henderson Outreach Service Team Module on working with people with enduring, complex and severe emotional and behavioural problems (Personality Disorder). May 2003. Internal Report. Competing interests: None declared |
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William R Smith, Retired SG17 5JH
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From my six years involvement with PPI Forums I am now convinced that the only way we will be able to deliver a free at point of delivery healthcare in the future will be to charge for elective procedures (based on income of the recipient). Acute care should continue to be free but those who can pay should contribute to elective surgery and medicine. This would enable us to fund the continuing healthcare 'needs' of the population and shift the emphasis to preventative care. Competing interests: None declared |
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Steven Ford, GP Haydon & Allen Valleys Medical Practice
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Supplemental to my earlier questions and with specific reference to rural medical services: Our CT has been discovered to have developed plans for providing services without GPs from April 08. This is in anticipation of local practices being unable or unwilling to accept budget 'offers' or simply closing as they become non-viable. When the practices close the pharmacies will follow shortly after - two more services that rural communities everywhere will lose. This sort of development is not a misunderstanding or unforeseen. It is the deliberate destruction of services that private providers are most unlikely to be able to replicate, even in part, in this environment. This may be tangential to your current efforts but, nonetheless, integral with this area of government policy. Are you wholly without reservation or shame concerning those whose political bed you have chosen to share? Steven Ford Competing interests: I am a GP |
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mark palmer, GP Emscote Rd Surgery CV34 5QJ
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What is his experience in General Practice that gives him an ability to do this project?
How would he respond if I or other GP colleagues were to be appointed to develop his surgical practice?
Kind regards
Dr Mark R Palmer
MRCGP FRCS
Competing interests: None declared |
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Christopher. L. Manning, CEO Primhe Twickenham TW11 9HG
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Dear Lord Darzi, People with Medically Unexplained Symptoms account for a very high percentage of NHS work. Such people (at least 50% currently of both out- patients and in-patients) will be told by conventionally trained doctors that they "have nothing physically wrong with them". Yet, the training of doctors and other health and social care professionals still relies heavily on fascinomas and rarities and is not even up-to-date, being based on antiquated and non evidence-based Descartian mind-body and physical- mental paradigms. We should be disinvesting in often extremely expensive and redundant interventions and investing in effective psychological approaches and interventions that address distress, somatisation and mental illness 'caseness' across all areas of clinical practice (and not just the traditionally perceived 'mental' ones). So...my question is: "When is the NHS going to start training doctors in evidence-based neurobiology/neuropsychiatry/neuroimmunology and its application to the physical experiences of many patients, in terms of dealing with the above?" Yours Sincerely Dr Chris Manning Competing interests: As a taxpayer, I fund a system that spends at least 50% of it's time telling patients that they have "nothing physically wrong with them" |
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David R Warriner, F2 Paediatrics Scarborough Hospital, YO12 6QL
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Dear Sir. In October you stated your vision for the NHS of the future as one which is "developed and owned by patients, staff and public together" with no mention of the goverments role. As a reknowned expert in minimal access surgery, do you feel that parliaments access to the NHS should also be minimal; rather than being at the whim of successive prime ministers, governments and policy changes. Yours, David Warriner Competing interests: None declared |
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L Sam Lewis, rural GP Surgery, Newport, Pembrokeshire, SA42 0TJ
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1. Just what does HE mean by this polyclinic concept ? 2. Why and how does he think it solves which of London's problems ( with examples and evidence ) ? 3. Where and when does it become inappropriate (examples and evidence ) ? ( rural needs vs. population density , Primary and social care vs. secondary care issues ) Competing interests: I am rural GP, thankfully in Wales |
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john sharvill, GP Deal Kent CT 14 7AU
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My I ask what experience of primary care do you have, whether as a student, in your training, or more recently? If not much please could you find the time to talk to those working enthusiastically as GP's (not the pct 'representatives')and their patients. There have been some very good articles in the BMJ re your percieved proposals from such people and that seems to be agood place to start. As you will know the vast majority of consultations in primary care do not fit into a single biologiacl system failure and that is perhaps the core difference between primary and secondary care. Applying secondary care solutions to the general population is rather irrational. Competing interests: Keen for the prinary care to exist in the nhs in the future |
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Jasmine E Salih, GP Leeds
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I would like to ask Lord Darzi why it is no longer compulsary for Primary Care Trusts (PCTs) to reimburse practices for maternity locum costs. If we want women to be doctors, then we have to accept that at some point in their career they may become pregnant and require maternity leave. Now that it is no longer compulsary for PCTs to reimburse practices, they may decide not to reimburse or, as in the case of Leeds PCT, to reimburse at a much reduced rate. In my opinion, the failure to support practices in covering maternity leave locum costs can only lead to discrimination against women of child-bearing age when applying for jobs. Lord Darzi says he stands for fairness. I would like him to explain how this can be fair. Competing interests: As a female GP of child-bearing age I am concerned that I will face discrimination when applying for jobs. As a locum GP my job market may be affected. |
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Amir Nisar, Consultant Surgeon Maidstone Hospital, Kent
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Dear Lord Darzi, We have seen may changes in NHS in recent years. The worse affected are the Junior doctors as their training period is reduced. Have you got some new model to improve their training and what will be the role of the simulators to bridge this area of weakness in our system? Competing interests: None declared |
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Pushpa Wijetilleka, Staff Grade Psychiatrist Derwent Unit, John Conolly Wing, West London Mental Health Trust, UB1 3EU
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As a psychiatrist who has been working for the Older People's service over the last seven years, I have come across the following scenario, which demands closer consideration. Elderly immigrant British citizens who have worked and brought up families in the UK often express wishes to spend their retirement in their country of origin. This desire is prevented by the NHS policy of not allowing NHS treatment for people who have lived outside the UK for more than three months. Patients who have paid national insurance through their working life in the UK are deprived of the right to NHS care if they prefer to be looked after in their own country. I think there should be a scheme to look after this group of people when they return to this country to visit their children. I would be thankful to you if you could give kind consideration to the above issue and make arrangements to acknowledge the contributions these citizens have made by implementing policies to support their cause. Wishing you the best of luck and success in your new post. Dr Pushpa Wijetilleka Competing interests: None declared |
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Pushpa Wijetilleka, Staff Grade Psychiatrist Derwent Unit, John Conolly Wing, West London Mental Health Trust, UB1 3EU
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I would be thankful to you if you could consider better career progression prospects for Staff Grade and Associate Specialist doctors. Currently, there is a lack of structure/guidance with respect to career progression - I would be thankful if you could make arrangments to appoint a Consultant/clinical tutor in each hospital department to guide this group regarding their career progression. I would also be thankful if you could look into the prospective pay rise for SAS doctors, agreed in April 2005. These proposals are currently in the hands of NHS employers; delays in implementation have lead to the demoralisation of this industrious group. The above group of doctors are a very hardworking group; their contribution to the NHS should be recognised and rewarded, in a similar manner to that of their Consultant and GP counterparts (who were given new contracts with better renumeration). Competing interests: I am a staff grade doctor. |
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Sati Ariyanayagam, Consultant Physician Peterborough Hosp Foundation Trust
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A You are a London Based Employee of the Department of Health. In the circumstances it is likely that you will be seen as some one with a conflict of interest given your connection with the establishment. How will you convince the London residents that your recommendations are not prejudiced with a degree of protectionism within tertiary care? B The plan for London has not been accompanied by costing. Given the difficulties and the pressures NHS is under how will you convince the Londoners of the feasibility of the plan in terms of financial viability? Competing interests: ? Member of Council BMA ? Member Medical Ethics Committee BMA |
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Paul E Watkins, Veterinary Surgeon BS25
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I am led to believe that as part of NHS management, staff are required to provide their managers with 6 weeks notice of absence, for example for attending a funeral. Can the Lord Darzi answer: 1 How are staff to attend such events, which often occur at less than 6 week's notice. Are the government going to introduce a system where everyone has to give 6 weeks notice of their impending death? 2 Does he provide a minimum of 6 weeks notice when he has to be away from either his NHS or goverment posts? Competing interests: None declared |
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David Mitchell, Microbiologist Trinitty College, Dublin
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C difficle is a problem in the UK and elsewhere. It is carried by ~10% of the population. It is a spore forming organism. Currently laundry in the UK is cleaned at a temperature of 71 degrees centigrade for 3 minutes. This is inadequate to kill any C difficle spores that have contaminated the bed linen. C difficle spores are also resistant to most detergents. Since laundry is washed in large containers it is virtually certain that all all sheets and similar articles will become contaminated. This method of cleaning was approved before C difficle became a recognized problem. It is sufficient to kill enterococci. The test used to check the adequacy of washing includes culturing for enterococci but not C difficle. Sheets will survive higher washing temperatures but this does shorten their useful life span. The question I would ask is: why does the UK continue with a laundry system that is virtually certain to enhance the spread of C difficle when relatively simple measures such as raising the water temperature might reduce this problem significantly? Competing interests: None declared |
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Wendy-Jane Walton, GP Marden Medical Practice, Shrewsbury SY2 6DL
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The changes proposed in the interim report will have profound and far reaching effects on General Practice. General Practice is a highly specialised service which does not always conform to conventional 'biomedical' models of care, but which through in depth knowledge of our patients in their social setting, brings a great deal of wisdom to the consultation, often minimising the need to refer into secondary care. In the clinical pathways model GPs are not represented as a body and therefore do not have a collective voice. Why have GPs been excluded from the consultation process, having only minimal representation on the clinical pathway groups, without any direct consultation with Primary Care as a body? Competing interests: None declared |
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john L OGLE, GP Principal Cannington, Somerset, TA5 2HB
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Has anyone at HQ considered doing a cost-benefit analysis on Managers in the NHS ? How much more money would be available for patient care if they were no longer part of the wage bill ? Competing interests: None declared |
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Mohammad Farhad Peerally, Medical Student University of Sheffield Medical School, S10 2RX
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Do you think students from non-eu countries who have completed their undergraduate medicine from a British medical school should be allowed equal right to compete for foundation and specialty posts as UK/EU-born students? (Note 1) these students came here in good faith before the law was changed and inspite of paying about £100,000 to their University for medical school training, the tax payers are investing £250,000 for every single one of them. 2) Foundation training is essential towards recognition by the GMC and recognition anywhere else in the world 3) Many of those students come from countries who don't have the facilities for specialty training) Competing interests: International Undergraduate Medical Student in UK |
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David P Kernick, GP Exeter EX41HJ
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To what extent do you think someone can stand outside a complex system (both complex in space and changing with time) such as the NHS and engineer it towards defined objectives? Would not a better approach be to encourage the conditions to allow the system to emerge in such a way that reflects the context in which it operates? The facilitation of trust, reciprocity and co-operation would be useful first steps - suspiciously sounding like the fundamental values of the NHS! Competing interests: None declared |
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peter s barling, full time GP oswestry sy10 7hr
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In what way has the reduction in total hours of graduate specialist training from 30,000 to 8ooo hours been of benefit. Competing interests: None declared |
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Philip Seager, Public Governor Sheffield Teaching HospitalFoundation Trust, Foundation Trust S10 2JF
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I wrote a comment to Professor Darzi with a similar title, and a similar theme. For some reason it was not included. More importantly, this topic was not dealt with in spite of the fact, as Dr Manning pointed out, that the enormous waste of resources and of patients' best interests is wasted pursuing a range of symptoms rather than addressing the underlying problem of teaching an understanding of bio -psycho-psychological interactions underlying most conditions that we have to care for. I also noted elsewhere, that Sir John Tooke's recommendations for medical training included 6 months each of medicine and surgery. In Sheffield, since 1982 we were able to offer 4 months each of medicine, surgery and psychiatry to two rotations of pre-registration house officers, greatly to their benefit and that of their current and future patients. It is important that this process should be enhanced in the future training of junior doctors, so that all doctors may receive this type of experience. Competing interests: Retired psychiatrist, Sheffield |
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