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Þ Þ Þ Þ Þ No3 No3 No3 No3 Ü Ü Ü Ü Ü May 2010

A SPECIAL AMIC NEWSLETTER

Info-Flash is reproducing below the full text of an interview made with Lord Ara Darzi. The interview dates from January 2010 and the "reporter" is Dr. Sonia Wartan, member of the "Great Britain Armenian Medical Association." We remind our readers that Lord Darzi was the main speaker during AMIC’s Xth Medical World Congress held in New York in July 2009 (July 1-4, 2009.) Info-Flash in its issue of September 2009, made a short presentation of the communication given then by Lord Darzi on "Robotic Surgery."

We are certain that all our readers will read with great interest the following interview.

Interview with Professor the Lord Ara Darzi

Dr. Sonia Wartan reporting

Professor Lord Darzi was born on 7th May 1960 to Armenian Parents. He was appointed as a consultant Surgeon at the age of 31. Darzi joined Imperial College London in 1994, obtained his Professorship in 1996 and became the Chair of Surgery and Head of Department in 1998. Darzi holds the Paul Hamlyn Chair of Surgery at Imperial College London and the Institute of Cancer Research. He is also an honorary consultant surgeon at St Mary’s Hospital, and the Royal Marsden Hospital. He has held many senior administrative appointments within the Faculty of Medicine at Imperial College, Research Council, Editorial Board of Scientific Journals, and medical royal colleges.

Darzi’s main clinical and academic interest is in minimal invasive surgery and allied technologies in which he and his team are internationally recognized. He leads a team of researchers covering a wide spectrum of engineering and basic sciences research topics including Medical Image Computing, Biomedical Engineering, Clinical Safety, and Robotics. He has published more than 450 peer-reviewed papers and published 7 books.

His work has received international recognition including many awards. He has also delivered many prestigious and named lectures around the globe.

On 29 June 2007, Darzi was appointed Parliamentary Under-Secretary of State (Lords) at the Department of Health by the Prime Minister, Gordon Brown. He was created a life peer on 12 July 2007, as Lord Darzi of Denham. Lord Darzi was asked to carry out a "wide-ranging review of the NHS". His review, High Quality Care for All along with High Quality Workforce were published on 30 June 2008, which sets out how the findings relating to the NHS workforce will be taken forward, and a consultation on a draft NHS constitution.

Center-Right: Lord Ara Darzi, followed clock-wise by Dr. Seda Boghossian-Tighe, Mr. Bedo Yeghiayan and Dr. Sonia Wartan, during the interview.

Sonia Wartan

Thank you for taking the time in your busy schedule to talk to us.

I would like to start with the following:

I believe our readers will be very interested to know any new and exciting surgical technologies in robotics that you are leading at present.

Ara Darzi

There are plenty, some of them were presented in the AMIC’s meeting in New York. Robotics as we know it now is the tip of the iceberg, best described as the first car ever on the road with breakthroughs coming at an ever increasing pace. So its applications at present are very limited, but it has opened a completely new platform of computer assisted surgery, this is primarily because you are bringing the computer chip into the operating theatre. Robots being used not just into the cavities like chest or abdominal cavities but robots used intraluminaly through the mouth, nose, transrectaly and the potential to do much more not just minimally invasive but certainly what we call natural orifice trans-endoscopic surgery. We have been involved in developing ‘snake like’ robots, funded by the Wellcome Trust. There are also a number of other concepts in robotics that we are very excited about and will materialise into the clinical use in the next 2-3 years, they are very much at an experimental stage.

With your experience during your time as health minister, what are your views on the health system that our children (and us during our retirement) will be using? Would it be more or less like the present National Health Service or would it be different? And how?

In the United Kingdom the National Health Service has been with us for the last 61 years. I do not envisage that ever changing and in actual fact I think it is much more relevant post Obama than it has been before. Many people here do not necessarily appreciate what we have in the UK as the NHS has been with them their whole lives. Look at the debates in the United States where 40-50 million people are un-insured with no access to care, I think we have a very sound health system but at the same time we understand that our system itself has challenges in improving the quality of care it provides and we are tackling them. So I still believe that we have the best system right here where we are. However, we need to start working on it because there are still areas where we can significantly improve the quality provided.

As far as society and the problems we all face getting older, I think the challenges are different than the ones that faced the system when I was back in training or in my early years working in the NHS. One interesting statistic shows that most of us are living up to five hours a day extra. Life expectancy when the NHS was created in 1948 has increased by 10 years. That is because we embraced innovation, technology, new devices and new treatments. I think we will see more of that, but there are challenges that arise through the technology and science that has added years to our lives. We have to start thinking whether we are also adding life to the years, because older people might not have the quality of life that they are entitled to and this is a real challenge. That is one example, the other is long-term conditions. I do not think the future is a service entirely focused on hospital provision; the future has to also be in community and primary care, to build that service we need to see more resources and invest this more in primary care and community services.

Polyclinics featured as the way forward for an efficient primary care delivery in your report on the NHS. This will give easy access to the service that is available 8am to 8 pm and during the weekends. How successful the implementations have been so far and are any lessons to be learned from the experience?

In London I have opened seven polyclinics and I am sure more are open now. I think if we look at all the challenges facing us; aging population, long term conditions, well being, prevention, all of those cannot just be delivered in the large hospital setting. This has to also be in the primary and community health care sector. There is plenty of evidence for this argument. Starting with what we have at the moment, we have one of the best primary care systems in the world. This primary care system has two functionalities; firstly a treatment service, which is more or less what 80% of the population needs, and it has a gate-keeping role, which is the referral role. There is a tension between those two because to be a gatekeeper you have to have a small number of general practitioners who know their population well if you want to expand the treatment role. I strongly believe that we should expand the treatment role in primary care because there is no difference between somebody who qualifies from Imperial college medical school London becoming a general practitioner or a surgeon because they are equivalent. I think we need to give more diagnostic capabilities to primary care, to enhance their ability in this area.

Lots of patients come to hospitals to see a specialist unnecessarily, a lot of that could be done in primary care settings, but to do that you need a larger population base because you can’t invest in diagnostics if you are treating a list of 2000-3000 people. You need to come-up with a way, keep the right size of population, small enough to keep the familiarity, but expanded for the diagnostics. That is the concept of polyclinics. Polyclinics are not single buildings, a lot of polyclinics we described are a federated model where 5 practices come together and invest in a core facility in diagnostics. Diagnostics is one arm, well-being, prevention, social services, community services and schooling come under a holistic approach and that is what a good community is all about. If you translate policy into implementation you are always challenged, you will always get different lobbies and people with different agendas. There are fantastic federated models, G.Ps doing surgery and interventions. On the other hand what I will not tolerate are these small single-handed practices in small premises. One has to acknowledge that these people have done a lot of good in their time for patients and for our communities but things have moved on, even in my practice I am one of a team of 4 consultants and 2 nurses specialist and a stoma specialist.

As a professional, academic and international intellectual figure with Armenian parents, I am sure our readers will be interested to hear about any contributions to the Armenian health care system.

I have been there twice and have operated on sick patients and I get a lot of Armenian patients here. We have a PhD student from Armenia with us. That was our idea to build a capacity of academics to go back to Armenia.

We are also contributing to training and we have done some live links with university officers, skills training, sent virtual reality simulators for training purposes, which I understand, is been actively used. I think more could be done there in this respect.

In your reviews "high quality care for all" and "High quality workforce" you emphasis on quality in the NHS. In the present economic environment, how would you envisage the delivery of high quality care with fewer resources?

Well, I think you are right; we have made a fairly bold statement. Quality will be the organising principle of the NHS, but at the same time quality becomes more relevant in economic downturn. It is unlike other sectors; in health quality may be cheaper. If you do something right from the first time, it is much cheaper than treating some of the issues that will arise later. Quality reinforces and also provides a greater momentum in an economic downturn but it can mean different things to different people. Quality is not just the consultation between the patient and me, quality is all about the patient’s journey, and quality is also what the customer thinks not just what the doctor thinks. As doctors we have to think about the patient’s pathway of care as a whole.

I enjoyed listing to your episode of dessert island discs on 22 June 08. I very much enjoyed the very 1st and the last piece of your music choice. They were Yekeghetsin Haikakan, sacred choral music by Vahan Tekeyan and the logical song by "Supertramp."

Would you share with our readers the reason for your choice?

The first choice was because it reminded me of my childhood as a choirboy in the Armenian Church; I had to listen to that every Sunday. The thing about desert island discs is that you don’t just choose your favourite seven songs; you need to pick-up songs which remind you of different decades of your life. To be fair that is one of my favourite songs as well. Not many Non-Armenians know about it and I think that Kirsty Young, the presenter of the programme, was also quite touched by it. The other song was the logical song, I pick it up in the context of what I was doing at the time where a lot of things might not be logical to people at the time but become very logical later. You need to invest in the future.

I note that you are the 1st surgeon ever granted an honorary fellow of the Royal academy of engineering.

How important was this accolade to you?

I am not sure whether many have been appointed since then but yes I was the first one. It was an honour for me; I was always, up to the year before I entered the medical school, very much geared up to becoming an engineer because I came from a family of engineers. Engineering was more relevant to me; I enjoyed visual and tactile tasks rather than being a prescriber. However, I decided to do medicine and most of my research is in engineering, computing and computer science. The honorary fellowship was a great privilege to receive; it had a great value for me as it was from the Academy.

With your duties, do you have any hobbies or spare time?

What hobbies help you relax?

I like boating; I enjoy the water when I can. I still go to Ireland for a bit of boating. I like cooking but I find Armenian cooking much more difficult than others. Cooking is fun and makes you switch off. I enjoy my holidays with my family. I also do some exercise to keep fit.

Do you have any favourite books?

Yes plenty, probably the most relevant is "Yes Minister." This is interesting because it is not just a book. I was given this book at my leaving party for my ministerial position; it was signed by all the civil servants who I had worked with over the years at the Department of Health.

Dr. Sonia Wartan MB ChB, FCARCSI Consultant in Anaesthesia and Pain Medicine Royal Gwent Hospital, Newport, Gwent, UK

Left to Right: Back row, Dr. Lord Ara Darzi and Mr. Bedo Yeghiayan. Front Row, Drs. Sonia Wartan and Seda Boghossian-Tighe