Dear Lord Darzi

Dear Lord Darzi,

You are saying that the experiences of patients will affect the funding of NHS Trusts, does this include the experiences of the patient who has to wait four hours in A&E before being told that they don't deal with verrucas there? Will it include the patients who turn waiting rooms into boxing rings, or who call ambulances for a cheap taxi ride home?

If I go to a patient and they want me to carry them downstairs for their cut finger, putting my spine at risk – will I have to do it in order to keep the 'patient satisfaction' high?

And if we don't do this, either due to good sense, or because we have already stretched our current resources to the limit, then you will cut our money.

What about those patients who don't like their GP because their GP isn't 'English'?

Such people exist, and in greater numbers than you might expect. But then the view is a bit limited from that ivory tower of yours.

It is really quite simple – the expectations of the public are rising faster and higher than can be reasonably met. They want everything and they want it now, but are not willing to pay for it. They do not understand that there is rationing in the NHS, but then the government has been unwilling to mention this.

And why stop at 'dashboards' inside hospitals showing their 'quality', why not have a scrolling marquee around the outside of the hospital, it would be just as tacky.

Giving patients choice is a fine idea in principle, but for many of the patients that I deal with they just don't have the knowledge to make an informed choice on their treatment.

-Tom Reynolds

Just another ambulance man.

UPDATE: I'm not the only person to think this way.

16 thoughts on “Dear Lord Darzi”

  1. Just want to say I so agree with everything! More people like you are needed to tell the goverment the HUGE flaws in their “save money, screw the patients and staff” approach. Now all we need is to have the NHS run by people who actually know what it needs! Good on ya tom! xxx

  2. How about a satisfaction system from the ambulance workers? Or from the staff in the A & E?Such-and-such an A & E –

    “Bringing down the number of patients that shouldn't be treated by us, by kicking them out!”

    Number of patients kicked – 5 million in the last two days.

    Number of patients that were treated better as a result – every other patient in the entire hospital.

    Number of lives saved – countless.

    How about that one?

  3. Just had a thought…If a certain hospital/GP was said to be “rubbish” by the information published, would that mean that those people that are really picky and hard to please won't go there? They'll want to go to more “upmarket” hospitals/GP's…

    I reckon if that happens… The satisfaction levels in the “rubbish” hospitals/GPs will sky-rocket…

    It will just be an up and down interval the entire time!

  4. I wish people would stop claiming that the public wants 'choice'. I don't want 'choice'. What would I do with it? 'No, I feel that doctor's characterisation of my primary symptoms reveals an fundamental misunderstanding of the entire endocrine system. Find me another.'As a Joe Public person I just want to know that, if something bad happens, an ambulance staffed by dedicated, sensitive people like you will take me to my local hospital, who will look after me. That's my 'choice'.

    And damn right – if you call an ambulance for a verruca or a cut finger, you should get a whopping great bill for it, and a criminal record if you can't pay.

    Sock it to 'em, Tom.

  5. Except… that I work in a part of the service where 'targets' are generally a bit of a nonsense. Everyone thinks that what we want is a demonstrable good outcome- a live, healthy mum and baby. Unfortunately the 'outcomes' do not measure long term health or mental health. The damage caused by post-traumatic stress, postnatal depression, not breastfeeding, post-caesarean physical trauma and subsequent complications etc… all that costs millions, yet if the mother and baby are both 'well' at discharge that is all that is counted as an 'outcome'.We know that women tell a different story about what they consider to be good outcomes. We know that what improves long term outcomes and saves money is continuity of care, more home birth, more choice and being able to take responsibility for self. Yet because we're not a 'sexy' service, and our outcomes are not easily changeable or measurable (becuase you can't cut waiting lists in maternity), we're a bit bottom of the pile for the number crunchers.

    Claire, Midwife

  6. In the year that the NHS turns 60 it absolutely destroys me inside to watch the Government pick it to bits piece by piece. Yes, hospitals should be accountable to patients. After all the NHS is a Government service run for the patients. However, to suggest a cut in funding to those hospitals/trusts that are not performing well is nothing other than delusional. How will a cut in funding help to rectify the problems that caused these low satisfaction ratings.Why are Gordon Brown and the Labour party so fixated on targets and figures? Surly the only figures that matter in the NHS are how many lives are saved and improved for the better?

    Simple changes in the law to regulate pharmaceutical companies would help free up more money for the NHS. One of the main reasons drugs are so expensive is the long patent periods pharmaceutical companies can have on their new developments. While they have this patent no other drugs company can produce the drug. Thu, a Pharma company has a monopoly over a drug and as such can sell it for as high a price as possible. Yes, Pharma companies have put a lot of investment and time into the development of the drug (it is very costly), but they shouldn't be allowed to make exorbitant profits out of it. Regulating them in a number of ways might help.

    1) Shortening the patent times to something more reasonable (e.g. patent expires once the money spent on development has been matched in income)

    2) Capping what pharmaceutical companies can charge while they have a patent.

    Business might not like this, but a LABOUR government is not supposed to be about doing what business wants….it is supposed to be about SOCIAL JUSTICE. Regulating the pharmaceutical industry more will not be popular, but it certainly will fit in with social justice. The two reforms mentioned above will decrease the cost of drugs which will free up money which can be spent on other areas.

    There are a lot of other things that can be done to reform the NHS, but if I start on them this comment will be far too long!

  7. Succint and so very right!I'd like to know how 'satisfaction' is measured in anyone who has ever been sectioned under the Mental Health Act. The need to section comes from the person's unwillingness to go to hospital voluntarily (assuming there are any beds for voluntary patients). The acute psychotic episode or severe mental illness can mean that the person is unable to make a rational choice at the time of admission, and sometimes for a number of weeks after this….so will all the people who are 'successfully' treated and become more rational later look back and view being sectioned as highly satisfactory? I'd say this would be unlikely.

  8. Hi Tom,Long time reader but first time commenter, and boy, do I agree with you here! I'm with Mike R on this – as a non-medic, I don't particularly want 'choice' (the mantra of the capitalist age!) – I just want a reasonable standard of care in clean, efficient hospitals, treated by staff who are happy and well looked after. I'm not buying shampoo.

    As for targets – jesus. Why, if I go to A&E with a minor sports injury that is unlikely to result in my death or permament disability, should I complain about waiting for a while while staff attend to the three-year-old with suspected meningitis? Unfortunately, as others have said, there will ALWAYS be those for whom nothing is ever right and sadly, I feel Darzi's proposals will have that particular section of society rubbing their hands in glee.

    Cheers for another great blog!

  9. First time commenting, but I couldn't agree more. Who wants choice? What everyone wants is the knowledge that should they need NHS services, they will get a good, timely service from their nearest hospital/GP/whatever. By giving patients choice, you will end up creating 2nd tier hospitals where only the poor/vulnerable will choose to go because it's closest, while those with the means to do so will go further to the “better” hospital.The second thing of getting patients to rate their care is a joke. All of us that work in the NHS can say for sure that in the vast majority of cases you can do whatever you want to a patient as long as you are nice to them. If you smile and keep them happy you can be the most clinically incompetent practitioner in the world and they won't know or complain. On the flipside, clinically excellent people in a bad mood would get poor ratings from patients.

    I know who I'd rather have treating me.

    At the end of the day, the vast majority of the general public do not have enough knowledge to make informed choices about their healthcare or healthcare provider. That's why we're all in work.

  10. So if there is a small surgery where the GP is very popular anyone can register. Small surgery becomes very crowded surgery. Patients register elsewhere another amazingly stupid idea from our inept and floundering government

  11. If hoaxers were removed from the system, and the same with people who want to go to hospital for verrucas etc, do you think that the NHS would need to do ANY of the above?Personally, I don't think they would.

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