Lord Darzi: You Ask The Questions

The minister with responsibility for improving patient care answers your questions, such as 'Are doctors paid too much?' and 'Will we ever find a cure for cancer?'

How many hospitals do you think should be closed? Dan Inson, by email

My review of the NHS is not about closures – it's about delivering high-quality patient care. Any changes to services should be about what is best for patients and based on the best clinical evidence. These decisions need to be determined by people locally – clinicians, the NHS staff, patients and public. Medicine is constantly changing – more and more is being done to detect people's health problems earlier. These advances mean patients who previously required hospital treatment can more frequently be cared for in their homes. As part of my review of the NHS, I'm focusing on ways to improve the care patients get as they move through the NHS. It's not going to be about buildings or closures.

Should we bring back matrons? Patricia Niblock, by email

We already have. After an absence of 30 years, the Government brought back matrons in 2002. There are about 2,000 matrons already in post and we aim to recruit an additional 3,000 next year. Leadership and accountability is very important in the health service – whether a matron or anyone else on the clinical team.

Have you always been a Labour Party supporter? John Swaine, Oxford

I'm a clinician not a politician but I was honoured to be asked to take on this role. I am proud of the unprecedented investment into the health service we have witnessed over the past 10 years of this government. It has helped transform the NHS for both patients and staff. I am now pleased to be part of the team delivering further improvements and hope my work will ensure clinicians have a clear voice within the Government.

You want to shift work out of hospitals and into GP surgeries – but GPs complain of being overworked. How will you square that circle? Simon Mills, Windsor

GP practices are the front door to the NHS and where most care already takes place. Increasingly, work that used to take place in hospitals can now be done nearer to where people live – in their communities or even their home. That's good for patients and helps hospitals focus on the specialist care they need to deliver. As we transform how care is delivered, we will need to be more creative about deploying our clinical specialists better. This isn't just about GPs. I would like to see more of a role for nurses in helping to support people with long-term conditions such as diabetes. And I'd also like to see consultants going out into the community and holding local clinics..

Do you want to see more private companies providing GP and hospital services Fiona Hamilton, Acton

I'm keen to see services improved for patients. Who provides the service doesn't matter – as long they deliver services to NHS standards and provide good value to the taxpayer. Competition in the health service can be a good thing – I've seen it help drive up standards and offer patients increased choice.

Had you been in charge five years ago, with the benefit of hindsight, what single change would you have made that could have created a stronger NHS? Kate Pearse, Ashford

While a lot has been done to improve the NHS over the past decade, it is clear more could have been done to engage staff. Some of the changes have not been fully supported by medical professionals, because government has focused on the means, and not the end – the quality of patient care. We know that for change to be truly effective requires clinical engagement and leadership. Part of my role is to ensure we place clinicians at the heart of the decision-making process.

More conditions are treated with drugs or minor interventions instead of surgery. Will there ever be a time when surgeons become redundant, Andy Mason, Hampstead

As a practising surgeon, I certainly hope not. Even with innovative developments in drug treatments and care moving closer to people's homes, there are certain conditions that will always require surgery.

My team and I have developed techniques for less invasive procedures – such as keyhole surgery – which is better for patients but actually requires greater surgical expertise. While the role will continue to change, there will always be an integral role for surgeons in our system.

Why are medical jobs being given to those from overseas when there are qualified British doctors who are unable to gain employment? Ashwin Ramamurthy, by email

Overseas doctors have made and continue to make a huge contribution to the NHS over the years. Indeed, for most of its history the NHS has relied upon the contribution of doctors who trained outside Europe. However, we have a responsibility to ensure qualified British doctors are able to gain employment and this is something the Government are looking at carefully.

You work at a university. Do you think the new electronic system for assessing new doctors is flawed? John Brewin, Cambridge

While the principles that led us to modernise medical careers were absolutely right, there were some veryserious issues with how the scheme was implemented. I know it's been very difficult for junior doctors – I saw some of my brightest students struggle to get the jobs they deserve. The Government was right to apologise for the distress caused.

Do you think everyone should automatically be an organ donor, unless they opt out? Francis Walker, London

We know there is a shortage of organ donors and the Government is trying to improve the situation. We have the organ donation task force to look at the issue of presumed consent. They will be taking into account as many different views as possible.

With the news that cancer can be avoided by a good lifestyle, should the Government do more to make people lead healthier lives Henry Anderson, Hounslow

While a lot is down to the individual, the Government has a role in supporting people to make healthy choices. That is why we introduced a smoking ban and are working on an obesity strategy. I've also asked the clinicians working with me to look at how we can help people stay healthy.

In the battle against MRSA, isn't deep cleaning hospitals missing the point? Neil Moreton, by email

For the fight against MRSA to be effective requires a multi-faceted strategy. The deep-clean programme is part of a wider range of measures, such as screening patients before they come into hospital, that we are asking all hospitals to take to ensure we reduce healthcare-acquired infections and improve the safety of our patients. The NHS is taking this issue very seriously and we will work with all our hospitals to ensure we reduce infection and increase patient confidence.

What is the main complaint you hear from patients about the NHS? Richard Baker, Farringdon

Patients have told me that they sometimes feel like a number in the system rather than a person. We need to make the patient experience as personal as possible and I have made this a priority.

At £110,000 a year, are GPs being paid too much? Jeff Porrit, by email

I think GPs do a vitally important job and deserve to be well rewarded for their efforts. A significant proportion of their income is now related to the quality of care they provide and that can only be a good thing. We will continue to tie GP income to patient experience, and we are working with GPs to ensure that at least 50 per cent of practices extend opening hours.

You were born in Iraq. What do you make of the current state of the country? Maajid K, London

Although I was born in Iraq, my family are Armenian and I was raised in Ireland. Progress has been made in bringing security and stability to the country – but clearly there is more to be done.

For someone with connections to Iraq, did you support the invasion? Chris Bute, by email

I was not privy to the information that led the Government to support the invasion. Clearly this was a complex situation where decisions had to be made. I think the key now is to support the Iraqi people and help them to develop their country into an economic and viable state.

As medicines become more expensive and varied, isn't the NHS doomed? Shaun Barlow, SE14

It's an interesting point. I'm a passionate believer in a universal tax-funded healthcare system, free at the point of need. Clearly, the NHS needs to consider how it keeps pace with the ever increasing number of technologies and medicines. Innovations can sometimes offer significant savings. Statins, medicines which reduce the risk of heart attacks and strokes, are a good example.

In 1997, Tony Blair said he'd get rid of the internal market in the NHS. He didn't. Should it be removed now? P Foucault, by email

The internal market was a top-down system driven by price competition, where patients followed the contracts negotiated by strategic health authorities or GP fundholders. I would argue it has been replaced with a fairer system in which there is no negotiation over price, care is provided according to national standards and funding increasingly follows the choices made by patients, who tell us they want better quality and faster access to services.

Most people have a bad impression of the NHS, but good personal experiences of it. How on earth can that be changed? Dr G Waters, by email

It's really good that nine out of 10 patients who use the NHS rate their care as excellent, very good or good. Unfortunately, that doesn't always translate into a wider sense of enthusiasm about the service and there is a greater appetite for bad news about the NHS than good. We all need to challenge that – patients, public, staff and the Government. Through my work, I encourage staff working in the service to be proud of its successes and be ambassadors for the good work being done.I also want to get more patients talking about their good experiences.

Are there too manymanagers and not enough nurses in our hospitals? Frank Jenkins, Cardiff

There has been a significant increase in the numbers of staff across the NHS, which has helped transform the service. I used to be the only colorectal surgeon in my hospital. Now I am one of a team of four surgeons working with colleagues including two full-time stoma nurses, two specialist nurses and a nurse consultant. Many people don't realise how essential managers are in ensuring that patients receive the care they need. There are far fewer managers than people think; they make up less than 3 per cent of the total workforce.

New Labour has spentbillions on the NHS and nothing seems to have improved. Where's it gone? Sophie Williams, by email

There have been many improvements. Back in 1997, the NHS was in relatively poor health. Investment levels had varied considerably over previous decades, hampering proper planning. I only have to look in my own experience to see the progress that has been made – there are more staff in my team, our patients do not wait as long for operations and their care is of a higher quality and much more personal.

Is it right an unelected person has so much power over the future of such a huge public institution? Philip Barry, London E3

I'm part of an elected government and it was a great honour to be asked by the to join the team. I am a practising clinician, seeing patients two days a week, and thus much of my working life is, and will continue to be, centred on patient care. I intend to draw onmy experience in clinical practice, research and teaching to ensure I add value.

If you could make everyone do one thing to improve their health, what would it be? Val King, Richmond

Take regular exercise.

Do you listen to music during operations? Linda Edwards, Brighton

Yes, sometimes. My preference is Led Zeppelin and Pink Floyd and occasionally Capital Radio.

Will we ever have a cure for cancer? Dave R, by email

We are making great strides in treatments, some of which we could not have imagined. We may eradicate some specific cancers but it is unlikely we will eradicate cancer altogether.