No GP surgeries will close

New Health Centres won't replace existing practices, insists Lord Darzi.

ANDREW MARR: Another review, just another review?

LORD DARZI: No this is not a new departure.

This is the next stage review.

It's part of the process of reform that we've seen over the last eight years.

What's different about this as you correctly pointed out, it's high quality care for all. Also the process is very unique.

It really involved near enough two thousand clinicians, doctors and nurses, colleagues across the country in ten different regions. So there's been ten different local reports led by clinicians in partnership with patients and the public.

It's evidence based. And what I published on Monday is what I call the Enabling Report. What tools could we give them out there to make change happen locally?

ANDREW MARR: Let me come onto the tools in a minute. I mean I've read my way through it. And quality appears again and again and again, on almost every page.

Does that mean that over the last few years there's been too much box ticking and not enough, not enough focus on quality of care?

LORD DARZI: Not at all. I mean Andrew, it's quality that matters to patients. When you're sick in the most vulnerable part of your life you want quality of care.

ANDREW MARR: Absolutely. I'm just wondering why you highlighted it so much.

LORD DARZI: What I'm highlighting it. You know it's taken us eight years to build the foundations of the NHS. You know NHS was falling apart back in the fiftieth anniversary.

We're even debating whether it actually, it should survive or would it survive. You know back in '94 I was appointed in St Mary's. You know in those days we had patients on my waiting list waiting for eighteen months, you know.

And when I came to A and E, talk about stroke care, when I came to A and E you know patients were lying on trolleys overnight. You know we had to build the money. We had to get the doctors. We had to get the nurses. You know training a doctor takes seven years. We've seen tremendous improvements in outcome, don't get that wrong. We've seen that.

ANDREW MARR: Well a huge amount of money has gone into the Health Service.

LORD DARZI: Absolutely.

ANDREW MARR: A lot of it has gone in pay rises for Health Service staff. Do you feel any sense of irritation or grievance that you're still, as a government, struggling with the professionals for the next stage reform given how well they've done, comparatively speaking, over the last few years?

LORD DARZI: I don't feel that. I think we've made the investment. We've seen the fruits of the investment. There's no question about that. I mean the waiting list, the, the numbers, quantity which were talked about before.

That's the past now. We have no waiting list. We have no patients waiting in A and E. What, what energises people like me, doctors and nurses out there, is really to focus on what matters most. What brings us to work is to provide a better quality care.

ANDREW MARR: Now turning directly to the Report, one of the things, a key recommendation, is that hospitals and doctors who are thought to be doing well on quality should get extra money. Where is that money going to come from? Because there are no proposals here for new money.

LORD DARZI: Well Andrew we're spending a hundred and ten billon pounds. Never in the history of the NHS we've spent so much money. We've doubled the budget over the last eight years. What we're talking about next year, there will be an uplift of about two point seven, three percent.

In actual fact in the Comprehensive Spending Review the growth that we've seen is about six point eight percent in cash terms. From next year onwards what we're saying we want to give more say to patients, more clout to patients. And talking about quality, it's not just about outcomes, it's about patient experience. How could we...

ANDREW MARR: So, sorry, can I just...

LORD DARZI: .. give patients more clout in the system. And you're right, from next year onwards...

ANDREW MARR: They'll get - I don't understand. It's going to have to come from somewhere else inside the budgets though.

LORD DARZI: It's part of our budget which was announced last October in the Comprehensive Spending Review.

ANDREW MARR: And if I'm a hospital and...

LORD DARZI: Yes.

ANDREW MARR: .. and I want to do well on quality...

LORD DARZI: Yes.

ANDREW MARR: .. how is this going to be measured? There's going to be questionnaires to, to patients or...?

LORD DARZI: There are three aspects of quality. Firstly safety which is paramount to patients and we know...

ANDREW MARR: Right okay.

LORD DARZI: .. that are the concerns. Then there is outcomes and the effectiveness of treatment. And also patient experience. The next decade is going to be having a higher regard to patient experience where there...

ANDREW MARR: So nurses will be coming around to me saying "How was it for you?" as it were? "Were you treated properly?" "Were you given dignity?" and so on?

LORD DARZI: Absolutely. We're asking...

ANDREW MARR: And okay...

LORD DARZI: .. the profession at a local level to measure what they do. Andrew you know this and I know as a clinician, you can only improve things if you can measure them.

ANDREW MARR: Okay. Well let me turn to another funding issue...

LORD DARZI: Yeah.

ANDREW MARR: .. very relevant at the moment which is so called co-payment. If I've got cancer and I have heard of a drug that I think will help me...

LORD DARZI: Sure.

ANDREW MARR: .. and I pay for that drug with my own money at the moment the NHS in effect washes its hands of me. That is unfair and ideological.

LORD DARZI: Well Andrew you're right in raising this. Could I just make, put it in context? These are very small number of patients in whom looking at drugs who have not yet received NICE approval. And in those cases, as you know, Secretary of State Alan Johnson made an announcement. One of my colleagues, Professor...

ANDREW MARR: But an injustice, an injustice to a small number of people is still an injustice.

LORD DARZI: We will be looking at that. We will have something to say about that in September, October. But again it's very important, whatever we come up we don't in any way erode one of the most important principles of the NHS which is care, free at the point of need, without, irrespective of your ability to pay. But at the same time, as you correctly point out, we have to have a high regard to the public, the changes of expectations and what they're telling us when it comes to...

ANDREW MARR: So this is something that could be looked at again you think?

LORD DARZI: We will be looking and we'll be reporting back to parliament in September or October of this year.

ANDREW MARR: Can I ask you about another area of where you're, been much associated with, which is so called polyclinics where you get lots of GPs together and they can all work together and you'd have wider range of options.

Now people understand I think that this could offer a better service for you know healthy, busy professionals rushing in and out of work.

LORD DARZI: Yeah.

ANDREW MARR: But for older people...

LORD DARZI: Sure.

ANDREW MARR: For people with children...

LORD DARZI: Sure.

ANDREW MARR: .. there are going to be, by definition, fewer nearby local GPs. They're going to have to travel further and that's going to be hard on them. All around the country Conservative Party and other people are saying this is...

LORD DARZI: Sure.

ANDREW MARR: .. simply wrong.

LORD DARZI: Sure. Well Andrew firstly the polyclinic was a London initiative. I led that piece of work when I was a clinician working in London.

ANDREW MARR: But it's being talked about...

LORD DARZI: No...

ANDREW MARR: .. for the rest of the country.

LORD DARZI: There's been a lot of confusion about this. We're talking about hundred and fifty new health centres across the country. This is additional money. This is not replacing current practices.

ANDREW MARR: So you don't think GPs will close...

LORD DARZI: Ab...

ANDREW MARR: .. surgeries will close?

LORD DARZI: Absolutely not. This is additionality. We want patients to have the choice. Patients are telling us they want better access. These health centres will open eight to eight seven days a week.

Is there anything wrong with that, being able to access your GP on a Saturday or a Sunday? And there's two other things I want to add to that. You don't have to change your registration. You could still stay with your...

ANDREW MARR: Right.

LORD DARZI: .. GP and access these, essentially just going in as a health centre, providing you a walk in service.

ANDREW MARR: Sure. Could I ask you about one other aspect of the Report which is it does ask for quite a lot more bureaucracy of one kind or another. National Quality Board. Quality Accounts. And on it goes. And again there's no more money. A lot of people think there's too much bureaucracy by far in the Health...

LORD DARZI: It's not...

ANDREW MARR: .. Service already.

LORD DARZI: It's not bureaucracy Andrew. It is transparency. Every organisation...

ANDREW MARR: There's lots of people...

LORD DARZI: ...

ANDREW MARR: .. who are going to have to be paid to you know...

LORD DARZI: Every or...

ANDREW MARR: ... do your transparency.

LORD DARZI: Every organisation that provides health care, I believe, has to also provide the users of the service, the type of information that the patient needs to use to exercise their choice.

I strongly believe in choice. And choice isn't about doctors and journalists choosing. It's about the patient out there being informed, empowered with the knowledge to make that choice happen.

ANDREW MARR: But, but for instance every NHS organisation's going to be required by law to publish quality accounts...

LORD DARZI: Absolutely.

ANDREW MARR: .. which is going to require more people to sit there and draw up these quality accounts and more frankly paper pushers.

LORD DARZI: Andrew, Andrew, you know if I am in my work on a Friday and Sat, Saturday, if I don't measure what I do and show that to those who use my service you know what am I doing?

ANDREW MARR: All right.

LORD DARZI: It's very important that not only I empower the patient and give them the clout but also for me. The only way I could improve my service is to know what the customer thinks of my service.

ANDREW MARR: All right. Lord Darzi thank you very much indeed for coming in.

LORD DARZI: Thank you Andrew.

INTERVIEW ENDS

Please note "The Andrew Marr Show" must be credited if any part of this transcript is used.

NB: This transcript was typed from a recording and not copied from an original script.

Because of the possibility of mis-hearing and the difficulty, in some cases, of identifying individual speakers, the BBC cannot vouch for its accuracy

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