Public 'juries' in 10 cities linked up live last week to kick off a huge consultation to help decide nothing less than the NHS's future. And the prime minister put in a suprise appearance. Helen Mooney reports
'This is Birmingham calling,' the host declared as she kicked off what the Department of Health claimed was its 'biggest ever consultation' on the future of the NHS last week. In true Eurovision style, the Birmingham audience was linked up live to nine other cities around the country. The miracle of modern technology meant that a cheer went up from York.
'Hello from happy, sunny York,' the regional host proudly proclaimed, leading to a national competition between the 10 strategic health authorities to outdo one another on how nice their weather was. All that was needed now was Abba or Katrina and the Waves to emerge from the wings and the party would have really got going.
The government, however, was hoping that the consultations, attended by a thousand people across the country, would stimulate debate on the future of the NHS.
Designed to canvass opinion about reform, the consultation was spearheaded by junior health minister and surgeon Lord Darzi to start the 'listening phase' of an exercise that will culminate in his report to the government in June. This will set out what needs to happen to ensure the future of the NHS for the 21st century.
He will also publish an initial assessment in October to inform the comprehensive spending review.
According to Lord Darzi, the NHS and government need to 'take stock, take a breath, plan for the future'.
Lord Darzi's challenge
Ministers say his report will set priorities for the next 60 years. Its major themes will be access, quality and safety. Or as health secretary Alan Johnson sees it, 'a vision for the next decade of the health service'.
Lord Darzi in particular is thought to favour giving patients more choice of primary care services.
In October, he will hold a conference of NHS trusts, charities and private companies to work out how patients could access GP services near their place of work or gym during the day, and near their home during evenings and weekends. The DoH has agreed to let Virgin describe its proposed new outlets as 'health centres', offering GP consultations from high street premises. Boots and Lloydspharmacy have also said they are interested in providing GP-style services. This also forms part of prime minister Gordon Brown's plans to stamp his mark on the NHS and steal a march on the Conservatives ahead of the next general election.
Anyway, back in Birmingham the Eurovision-style day had all started rather jovially with a meet and greet over coffee. The participants, or as the government wants us to refer to them, 'citizens' juries', were a mixed bunch of 80 patients and the public and 40 NHS staff.
One of the organisers confessed that the group was not necessarily a 'true representation' of the West Midlands population: the event wasn't geared up for people with disabilities, and it was said that no mental health service users had been invited - but nobody seemed to mind.
Paid for their time, and with the guarantee of a free lunch, the public invited to sit on the juries were pretty happy. Organisers Opinion Leader Research ran the event for DoH with military precision. Mind you, they have had practice, as less than two years ago the same firm sorted out then health secretary Patricia Hewitt's consultations ahead of the Our Health, Our Care, Our Say white paper. Oh, and last time they were paid over£1m for their work, thank you very much.
Fingers on buzzers
First off everyone in Birmingham was assigned to one of 12 tables and, until lunch, everyone stayed in the same places. Mixing with the public and staff were table facilitators, with laptops for noting down answers, and fingers-on-buzzers style devices. The juries around the country were asked questions themed throughout the day. These included:
What are your main concerns for healthcare in the future?
What are the most important factors in delivering a high-quality service?
What would help demonstrate that the service is safe, effective and high-quality?
What actions would you like to see to tackle the spread of infections in hospitals?
What are the current barriers to accessing health services?
One of the participants said that a high-quality service meant 'good treatment, respect and communication'. And she challenged the NHS to 'think outside the box' to ensure better access. 'Do you have to have GPs as gatekeepers to all NHS services?' she asked. Another said there should be the option to bypass GPs and go directly to a specialist if the patient wanted to.
Access also came up as a big issue for the participants. As one put it: 'We're not ill on a 9-to-5 basis. I need to see my GP when it is most convenient for me. I often can't take time off work to see them, and when I actually can, I can't get an appointment for that time.'
All participants at one of the tables were unanimous that NHS staff needed to refocus on taking pride in their work.
Perhaps not surprisingly, cleanliness was raised by jurors throughout the consultation. One member of the public, James Leach, said he was impressed that the government had issued new guidelines instructing medical staff to wear short sleeves and get rid of ties. 'Cleanliness is important, especially with the MRSA issue, but whatever happened about bringing back the matrons?' he asked. Another participant said that staff should not be allowed to wear their uniforms once they had left work.
Before you knew it the morning session had whizzed by and it was time for a quiz on the audience's general perceptions of health and healthcare. 'Fingers on buzzers everyone,' boomed Vicki Cook, the Birmingham chair.
'How many people in the UK are unaware that they have chronic heart disease?' asked Ms Cook; Table G's answer of 5.7 million was the closest - and they were rather ironically given a box of chocolates, although Ms Cook did remind them to enjoy 'everything in moderation'.
The next 10 years
Then on to some polling of the audience: 93 per cent strongly supported the NHS as a tax-funded system free at the point of need, and in Birmingham 69 per cent of participants said they were satisfied with the NHS.
However 44 per cent wanted to see improvements in waiting times; 40 per cent said getting an appointment to see their GP needed 'a lot of improvement'; and 66 per cent said reducing MRSA rates needed 'a lot of improvement'.
After the free lunch, the jurors were reseated at different tables. But before more debate it was time to hear what Mr Johnson and Lord Darzi, who had turned up for the afternoon, had to say.
The health secretary said he wanted the NHS to respond to changes in society. That included 'doing far more to ensure people have a choice in primary care as well as in acute hospital services'.
He added that the focus was on identifying priorities for each region. 'We want to empower people and give them a say on their NHS. This is a look towards the next 10 years and actually delivering a healthcare system that is focused completely on patient care, that moves away from the structural reorganisations that we have had in the past'.
Lord Darzi added that hospital A&E departments were coming under huge pressure from patients needing services that could have been provided by a GP.
'The system will not be sustainable in the next decade if we don't have alternative models of out-of-hours,' he said.
The afternoon's debate centred around health and well-being. 'Prevention is better than cure, and presumably it's cheaper for the NHS,' said Michaela Cavill, a mum from Warwickshire who said she was worried about childhood obesity. Jane Clavey, head of legal services at Worcestershire Acute Hospitals trust, agreed. 'We are very good in the NHS at looking after people once they get ill. We need to refocus that to put the emphasis on prevention now,' she said.
No sooner had the afternoon debate got going, then Ms Cook was back - to announce the arrival of the prime minister Gordon Brown.
The jurors were surprised. Nobody had told them he was coming. 'That would explain the sniffer dogs this morning,' whispered one. After listening to what participants on some of the tables had to say, and making table 12 laugh, it was naturally Mr Brown's turn to speak. His central message was about access and about how the government, once again, wants to listen to what staff and the public have to say.
'Many, many people do get proper access but many more people feel there should be better access, on weekends and evenings in particular,' he told the audience. 'At one table someone made the point that we're not ill on a 9-to-5 basis. We need a whole range of services for people who work late.'
He added that improving access to health services would be the government's 'top priority' over the coming months. He promised to 'listen and learn'. 'You say what needs to be done and we will feed back to you and you will be able to judge whether we have listened and learnt and acted upon what you have said.'
The Birmingham participants seemed impressed. Only time will now tell if he can deliver.
The Darzi report: a man with a very grand plan
In July, newly appointed junior health minister Lord Darzi, a surgeon by profession, was tasked with carrying out a national consultation on the future and, perhaps more importantly, future quality of the NHS.
He will publish an interim report in October to inform the government's next comprehensive spending review. In this he will set out what he has learned so far from the consultations he has had with NHS staff, patients, and the public. His final report will be published next June.
Following last week's consultation, eight clinical leads from each strategic health authority will be consulting locally and feeding back to Lord Darzi what clinicians are saying about how the NHS should look in the 21st century.
Lord Darzi has been asked by the government to review the following challenges:
Working with NHS staff to ensure that clinical decision-making is at the heart of the future of the NHS and the pattern of service delivery.
Improving patient care, including high-quality, joined-up services for those suffering long-term or life-threatening conditions, and ensuring patients are treated with dignity in safe, clean environments.
Delivering more accessible, convenient care integrated across primary and secondary providers, reflecting best value for money and offering services in the most appropriate settings for patients.
Establishing a vision for the next decade of the health service that is based less on central direction and more on patient control, choice and local accountability and that ensures services are responsive to patients and local communities.