Thursday, September 30, 1999 Published at 16:03 GMT 17:03 UK
The health minister answers your questions
Health Minister Gisela Stuart answers questions from BBC News Online users related to her Accident & Emergency brief.
Q: You proudly claim that the first NHS Direct centres have been "an incredible success". How did you measure this? Simply on consumer reaction or on objective audit? It seems that a recent objective report from Leeds states that only one third of the anticipated calls came through, pushing the predicted cost-per-call up from £1.50 to a staggering £32! Some cost for consumer satisfaction.
The outcome of NHS Direct advice was "Contact your GP immediately!" for 25% of the calls in Northumberland yet only 2.5% of the Lancashire NHS Direct calls - a TENFOLD difference. Yet the two centres are using the same computer advice algorythms. This cannot be explained by differences in the populations.
Is it not time to take stock and analyse what is going on before rolling out the scheme to cover the whole country? If not, it could be an horrendously expensive experiment putting the Viagra debacle in the shade. I personally would like the scheme to succeed, but not at this cost.
You rightly say that we live in an age where there is 24 hour on-line banking, pizza deliveries etc. Should that argument be carried over to non-urgent medical care? There already is 24 hour emergency cover for urgent medical care in place. Can you see your own personal bank manager, solicitor, or even dentist at 3PM on a Sunday afternoon, because it is more convenient to you, as you are so busy during the week!?
Many people have inconvenient medical problems that they feel are not worth the effort of taking an hour off work to see their own GP. How sad. Obviously their health is not that important to them. Yet you expect me, the taxpayer to subsidise their panderings for more convenient health care.
If you want a convenient pizza you damn well pay for it! Those worried well who want convenience should also pay for it! The walk-in centres should be self-financing, not funded by limited NHS cash. Which Peter are you going to rob to pay this particular Paul? Is this simply not going to encourage patient demand and therefore expenditure on an already cash-strapped service?
Where are your strategies for encouraging the public to be confident in their own health and self-management of minor medical problems? Look to the Dutch model.
If you really want political popularity, why not simply abolish prescription charges. Wouldn't you be popular then?
A: NHS Direct at the moment - some 40% of the country are covered by that. By the end of the year it will be 60% and by the end of 2000 the whole country. And what you have to appreciate about the service is that it changes both the way the general public will access the various services of the National Health Service, but also ultimately it will change the way people take responsibility for their own health. The telephone line, 24-hours nurse-led, is not diagnostic, so it simply gives you the next appropriate step to take.
We are undertaking independent assessment by Sheffield University and it tells us that 97% of those who use the service are satisfied. But more importantly and more appropriately some two thirds of the people who ring in do something differently as a result of their conversation with a nurse than what they would have done without the phone call.
A lot of the advertising has been very local and therefore the number of calls is not as high as you would have expected with national campaigns. Once the national campaigns roll out we will get much higher numbers and the evaluation process also tells us quite clearly that it affects admissions to A&E departments. We know some 17,000 people had an ambulance called for for urgent admissions who would not have done so were it not for NHS Direct.
You also raise the issue about saying, wouldn't it be simpler just to abolish the prescription charges? What I'd just like to say to that is the NHS raises some £377m from the prescription charges and what we are committed to is not raising those by more than in line with inflation, but we certainly would not contemplate abolishing them.
Q: I do hope that this email will actually be read by you and not filtered out by your staff. I am taking the gamble that you are totally genuine in your desire to make the NHS a better service for the public and that you do support open debate.
The Staffordshire Ambulance Service NHS Trust has developed an excellent emergency ambulance service model, recognised internationally and singled out for praise by the Audit Commission, your own ministers in Parliament and by the MPs, local councillors and the public in the county.
I briefed Baroness Hayman on the system in December 1998 and although she was most supportive regretted that she was unable to direct that it be reciprocated throughout the NHS.
In short the system provides a much faster response to emergency calls, better clinical care and more involvement with the public than the traditional systems at no extra cost.
The new emergency response performance targets for emergency ambulance services, which come into force next year, will not be achieved by the majority of Services. Staffordshire has exceeded those targets for the last 4 years.
I have, despite much risk to my career and livelihood, tried to persuade others to learn from our example and to highlight our success. Unfortunately my actions have caused more upset than consensus. The greatest problems appears to be that our methods require much more work and risk and there is no incentive for others to follow suit.
My aim in releasing a press release drawing attention to the lack of recognition, during your visit to North Staffordshire on Friday was a rather desperate attempt to draw your attention to our performance.
My great fear is that unless our performance becomes the norm for the NHS the current achievements in Staffordshire will not be sustainable.
In a letter to a Staffordshire MP about our performance last year you stated that one of your senior civil servants would be visiting the Trust in the near future. You will be surprised to know that no one from the Department of Health has subsequently visited or has made any plans to do so. I am also repeatedly told that other Services are implementing some of the Staffordshire systems where appropriate. This actually not true. The system we operate requires a total reengineering and the performance results cannot be achieved by implementing small parts of it.
I am totally committed to following best practice, clinical excellence and openness. I am totally frustrated that I cannot persuade any of your senior civil servants or Ministers to visit the best performing emergency ambulance service in UK and probably Europe. I am convinced that if they did they would very quickly be persuaded that our model should be spread throughout the NHS.
I am disillusioned that as a Chief Executive in the NHS that I cannot get my message through the normal and accepted channels and have to resort to email or press releases.
I do hope that my message final gets through.
A: I am rather surprised by Roger's view. He feels he can't convey the success of the Staffordshire performance through the usual channels. I am a Midlands MP as well as a health minister and I certainly have been aware of the tremendously good work he and his team have been doing in Stafford.
And he's quite right they are outperforming national averages and they are coming up with a very effective radical model, which is clearly right for Stafford.
But I am sure Roger will also accept that before we suggest to other trusts that we adopt that model that we need some independent assessment. What is more significant is that we are committed to delivering local health care from a local level. And each area has to develop a system that is appropriate to their needs and localities and maybe what is right for Stafford may not be right for another areas.
But I'd like to reassure Roger that we do know of the good work that he's done. I also know that the department is regularly sending, as part of its evaluation process, researchers to the area and we will suggest to other areas that they copy his model as and when it is appropriate.
Q: The BBC web-site reports "The RCN recently conducted a telephone poll which showed nurses backed Project 2000."
I am maintaining a small web-site (www.faxfn.org) which has several postings from nurses giving quite a different story. We have much talk of "evidence based medicine". Do we also have the concept of "evidence based education"? Who is doing the research to see if nurse education is working?
A: Geoff raises a significant point about the training programme that we're putting in and we too think evidence-based education is very appropriate. It has strengthened the way we educate our nurses and our mid-wives and that's why we are publishing the challenging agenda for the NHS to make a difference in nursing and mid-wife education.
We've started off by changing the pay and job opportunities and their status. As a result of these changes, we've had quite unprecedented increase in the number of applicants for nurse training and mid-wifery training in last year's figures.
Geoff may be interest to know about the project of 10 educational sites, which we are using as a pilot project to implement our three priorities which we outlined in the consultation document Making a Difference to look at more flexible career pathways, to increase flexible skills and a nurse training system that is more responsive to the NHS.
What's been very important is that the NHS and the education institutions should work together much more closely to come up with a model that is suited to the needs of the NHS and the patients. I know that some of the Project 2000 nurses who've come through that process have very good employment records. And I know that some of the original perceived skills deficiencies were very quickly remedied.
So Geoff raises a good point and the government is responding to that.
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