When I got the call from the Prime Minister to join the government it was
truly a bolt from the blue. Like most people I was interested in the change
from Blair to Brown but I’d been in an operating theatre most of the day and
the idea hadn’t crossed my mind for a minute. When it came it was as
daunting a prospect as it was an unexpected offer.
My first instinct was to decline.
I’m a doctor not a politician. My priority is people as patients not as
voters.
But as I listened to the Prime Minister explain his agenda – how he is driven
by a desire to take the NHS reforms of the last decade to an even higher
level, with quality of patient care at the core and the health care
professionals trusted to lead the necessary improvements – I began to come
round to the idea of stepping up to the challenge.
I was interested. I wanted to help. Perhaps, I offered, as an expert adviser
or something behind the scenes?
Then it was Prime Minister’s turn to decline.
Typically, he was absolutely straight with me. He insisted he wanted a
clinician as a Health Minister: to lead change in ways which the NHS staff
could have confidence and embrace for ourselves; to bring change at the
frontline, led from the frontline – with all the added value, skills,
knowledge and experience this would bring to NHS reform. Incidentally,
that’s why he agreed I should continue my clinical practice in the NHS.
So, I thought about it for a while, discussed it with my family and agreed.
One of the biggest decisions of my life. Certainly, the greatest of my
professional career.
I still don’t have a Ministerial red box (I carry my papers around in my old
black medical bag) but I do have a clinical practice. I do a list on Friday
mornings, hold an out-patient clinic at lunchtime, see my research students
in the afternoon, then do another list on Saturday morning and a clinic in
the afternoon.
The first big test for me was the announcement of the “Next Stage Review” –
the task which Gordon had asked me to perform as a Minister. The Review,
which we are calling Our NHS, Our future will bring together patients, NHS
staff and the public to develop a new vision for a 21st Century national
health service ahead of the 60th anniversary celebrations in 2008.
To be honest, straight away I encountered some cynicism among clinical
colleagues. I was expecting it. I told them I would not have agreed to get
involved if this was a means of avoiding awkward decisions. As I said to
them, I believe this is a genuine attempt to shape the future of the NHS in
a unique way based on the medical evidence and led by the clinical
community. If I am wrong about that, judge me on the outcome but don’t jump
to a diagnosis before making the examination. Some people have suggested
that the review is about me producing a national blueprint for the NHS. It
isn’t. That’s not what patients or clinicians want. It is about finding
ways to empower them, as the users and producers of healthcare, to find the
right local solutions for improving the NHS and making it genuinely world
leading. It's this emphasis on local control and patient empowerment that I
hope will be my lasting legacy to one of the great institutions of the
modern world - the NHS.
And judge us on the way we do things too. My boss, Alan Johnston, Ministerial
colleagues and I, supported by the Chief Medical Officer, Chief Nursing
Officer and the NHS Medical Director, are all determined to engage the
professions and the public in this review. So far I have met around one
thousand front-line staff from right the way across the NHS. I have tried to
engage them as a medic not a minister. Focusing on the quality of patient
care, not just the quantity of patients seen. Listening, not lecturing,
trying to build a shared understanding of what needs to change, why and how.
My honest assessment is that clinicians – doctors, nurses, midwives and other
health professionals - are ready to get engaged. They want to help make
things better. After all, that’s what we do in health clinics, hospitals and
people’s homes every day of the week. We know what the problems are and we
want to be part of finding the solution.
The government was right to make the big investment the NHS needed back in
2000. We did need to drive waiting times down, doctor and nurse numbers up.
We were right to bring in extra capacity – including from independent
providers – and to think about new roles for nurses and pharmacists.
There has been controversy around many of the reforms. Payment by results has
challenged some hospitals. Patient choice still sits uncomfortably for some.
I know that for many clinicians even engaging in the debate around these
issues has been hard.
But times have changed. For ten years the debate has been about increasing the
quantity of care. As a clinician I believe the debate about health reform in
this country has now shifted onto our territory: raising the quality of
patient care.
This is a debate I hope doctors and the rest of the NHS team will feel more
comfortable in joining. I believe they will because I have never met a
health professional who didn’t have the quality of care uppermost in their
minds. We might have different ideas about how best to achieve it but we
share a fascination about improving quality outcomes from the treatment and
care we give.
I want all those with that fascination to focus it on helping to make our
review really something special: the product of the shared professional
commitment to quality I know exists across the NHS.
Never again do I want to hear that there is a polarisation between the views
of ministers and those of health professionals. In the past, the medical
profession may have been accused of standing in the way of change because it
was wary of system reform. In my experience, clinicians do have the appetite
for change, as long as there is a clinical argument for change. This is our
opportunity to scope the improvement in patient care we want to see.
On Tuesday, I have to make my first ever presentation to the Cabinet about
progress on the review. Frankly, it’s a little bit scary; like performing
for the first time in front of the consultant surgeon when you’re a medical
student.
But it’s not the most important meeting taking place that day. Across the
country there will be a series of engagement events bringing professionals
and patients together with members of the public. More than 1,000 people
will be involved in what is effectively the biggest of the Government’s
citizens’ juries so far. We will be discussing questions around health and
well-being, quality and access.
It is important though, that no-one starts to believe that this review or the
challenge of improving quality of care is somehow about avoiding fundamental
reform. It is a way of better shaping the reforms not halting them.
There is no getting away from the fact that people do expect easier access to
primary care, particularly GP services out-of-hours. This is what I have
heard consistently from participants in the Review so far, and I believe
they are right.
We cannot avoid the challenge of better cleanliness and infection control in
hospitals. I know, as a surgeon, that cleanliness and infection control is
crucial to quality of care, and it is already clear from what I have found
in the last eight weeks that this is a major issue of public concern too.
We are getting there, but we have got to do better, and tackling this must be
one of our top priorities.
We have to get better at managing long-term conditions, like diabetes and
dementia and at dealing with stroke and heart attack. These are all quality
issues too.
Neither is this review is about kicking reform into the long grass. We are
already taking action on those areas the public have told us are priorities.
For example, in his speech last week Alan Johnson acknowledged the growing
demand for greater access to primary care services and asked me to use the
Review to find practical ways of taking this forward. Next week, he will be
unveiling a package of measures to further raise standards of infection
prevention and control. We want to send a clear signal to patients that
doctors, nurses and other clinical staff take their safety seriously. So we
want to give more responsibility to matrons and nurses in tackling this, by
reporting problems direct to hospital boards, for example.
I don’t mind admitting that I’ve lost some sleep both before and since
accepting Prime Minister’s offer to join the government as a Peer of the
Realm.
I took the job because I believe that NHS staff – dedicated people who help
save lives and change life chances every single day – are not instinctively
opposed to change in the health service but dedicated to it. It is precisely
because we want the best for our patients that we want to see improvement in
the quality of the care they receive. It is that change and improvement
doesn’t happen or doesn’t happen quickly enough for the benefit of our own
patients that causes much of the frustration.
Our NHS next stage review is the chance for clinical staff – and the whole NHS
team – to demonstrate that we can be the change-makers in health care.
In the end, when Gordon Brown asked me to get on board the reason I eventually
said yes is that as a clinician I believe passionately that NHS reform no
longer needs to be done to us but can be done by us. The opportunity is
there for us now. It is time for all of my colleagues to really get on board.
Professor Lord Darzi is parliamentary under-secretary of state at the
Department of Health
