Thursday, July 28, 2016

Greedy ...or Pathetic?

375 thousand. Say it again very slowly. Three hundred and seventy five thousand. Lots of dosh, no? So we had the media with its opinion...usual suspects joined in. It does make one pass a smile. The rules of absolutes broke out in gay abandon as ever on social media- the mix of indignation, the conspiracy angles, the snide remarks about rich Consultants, hacks rolling the dice depending on which way the wind seemed to blow to get some click bait articles out...predictable as ever. A pattern which repeats itself ad nauseum.

So let's look at some things. Let's say for example, this information is perfect, without any nuances of what's been counted. Let's say this man/woman has earned that above their NHS salary. If one assumes that a waiting list initiative pays (let's be generous!!) £1000 for a 4 hour session, this person has worked EVERY SINGLE DAY ( and more) of the year- beyond his 9-5 job. A moment to pause. EVERY SINGLE DAY? Don't like that math..ok...try this, let's say he/she got paid £5000 for every weekend he did extra work. That would mean he worked ALL WEEKENDS of the year and still had to work on weekdays to earn that extra. That's how silly the maths is.
Point being? This person worked to earn it. He/She also paid top rate tax- (no chance of dodging as via NHS, innit?) So grudge him/her all you want for his/her money..spare a thought for the lack of anything else in her/his life.

Let's make this very clear. Earning money is a right. It's not a sin- as long as you do it within the laws of the land. This person has done it rightfully and to do it, has sacrificed a lot of their lives to do so. Good on them-and thank you for helping to see so many and keep waiting times etc down.
That's the system he/she works in. The question should be whether that's been done without compromising their NHS work- rather than gasping at how much they have earned.

Now let's look at "overtime money". Anything above 10 PA isn't overtime, if one gets paid 11 PA, the added PA isn't a separate rate. If you don't even know that about Consultant contracts, then refrain from debate and stop making yourself look like an absolute fool. Overtime money or whatever lazy label you want to put on it, is driven by having to pay folks extra money to do weekends...let's pause a that's not down to the opt out clause. Let me give 2 examples:

Example A: hospitals are busy, medicine patients overflow into surgical beds, operations get cancelled, the waiting times slip. As that is elective work, the hospital- under pressure of targets, are forced to pay more to locums, extra money to existing staff to come and work extra to clear the backlog. The new Consultant contract will focus on that but let's also be a bit honest. For hospitals, it's also tied with payment by results- whose revenue stream far outstrips what managers have to pay for WLI. Let's all not be naive about it. Or you could get rid of targets...I think that's already being whispered a bit more loudly nowadays.

Example B: emergency work- the fast holding belief that more Consultant time would increase flow of patients, the stern belief that paying more would result in getting patients our quicker- why? Because the 4 hour target means everything. Why pay more? Because folks are ALREADY doing weekends as it's not some thing that can be opted out of. Doh.

The point is that all this is circular and as I always say, if managers are not capable or equipped to even implement the present contract, then a change in it will do nothing. Lazy journalism is what it is- that's their job...that's what folks nowadays do- jumping onto bandwagons is part and parcel of the existence of journalists - exemplified none better than comments such as relating that to the linking of cutting of nurse bursary cuts to Consultant pay. I get paid 12 PAs at present ( no, that's not 10 PA plus overtime) and would happily give up 2 PA worth money to fund more nurses or support education. Do please let me know who will do my job though- as again evidently without me casting my messiah like shadow on the wards, no patient can go home. Evidently. 

You create a market, you reap what you sow. In present situations, you want targets and Consultant delivered services, then you have 3 choices:

Pay for existing Consultants to do more - and perhaps have a national tariff on it
Recruit more Consultants
Or accept that Consultants can't deliver everything- ergo be clear to public that others can deliver what Consultants could- albeit without the training or expertise.

 Till that is sorted, most Consultants I know greet such messages with a shrug of the shoulder. Without the Consultants, the system is jammed inside hospitals- THATS the culture we have created. We either scale back from that or live with what we have created. The culture of indignation at others earning done by legal means cannot be scoffed or mocked at based on ideology. Folks earn for their future needs, their family needs and also their own personal choi of lifestyle. Which one takes precedence depends on individuals and circumstances.

These are life choices folks make- whether to spend more time doing work or with their family. 
A 10 PA job with no other work could give you plenty of weekends in a year - if one chooses to do more to have a better quality of life, then we should respect that choice and their right to earn, not bathe ourselves in self righteous and pathetic indignation. 

Friday, July 22, 2016


A regular bubble of simmering anger. The 24/7 world offers enough fodder and the world of Twitter reacts with predictability....the angst, the edge of menace, the self righteous, the genuine frustration...they all simmer together in a toxic cocktail creating an atmosphere which sometimes can become quite suffocating.

Every day there exists some reason for angst and this week has been no different. Forgetting even the ultra bizarre world of politics, the NHS itself has been fizzing with news. A new government, a reinstatement of Mr Hunt, Mr Massey as GMC top boss, scrapping of nursing bursary and of course the NHS "re-set". It's as if there is some design to make some people angry- and Twitter unfurls it with abandon. The tone becomes harsher, insults become sharper, friends turn into enemies and the space for any rational debate shrinks even further. Once upon a time, George Bush was mocked for his "with me, or against me". Social media exists in that sphere nowadays. The world of absolutes. You either work with NHS England or you don't. You either like Corbyn or you don't. You either support the junior doctors or you don't. It's all pretty sharply black and white.

What it has done is simply driving some sensible or perhaps even adult conversation away. What many wouldn't dare to say face to face due to a degree of social etiquette is now passé. Once upon a time, Twitter used to be a milder place, actually a fun place, a place to learn, a place sometimes for support. That world still exists, albeit shrunk. It bristles with indignation, with anger...the lessons of the last General Election , Brexit has taught no one the lesson of the social media bubble. That shouting louder and feeling comforted by like minded people doesn't actually result in achievement of ones goal. We simply shout a bit louder...a bit more unhappy, a bit more angst.

Mute and block have been useful tools but as one can see the abuse thrown at people, you know social media is or has lost its innocence. What does one do... I have no idea..apart from perhaps folks building a thicker skin. It's just an observation...and its a purely personal one that the respectful and polite conversations seem to emanate more from patients within the diabetes community.  There are challenges, but they are more with a willingness to engage in debate, a desire to help improve things. I don't know why but health care professionals, as a proportion, seem more angry, less willing to engage, more dealing in absolutes- including me at various times.

I must live in a different bubble but it's no shame in saying that I have a great job. I do general medicine, I do specialty work, I have great colleagues and for whatever anyone says, a fantastic hospital too. I like to laugh at myself and I enjoy being on Twitter. I know life is tough for many and things need to change, improve etc but the whole argument of more money will solve it is a debate that needs to be had a bit more constructively than..."If you don't agree with it, I hate you".
If that's not possible, then at the very least, maybe make Twitter make a little less toxic - there are many who would like it to be a continued space of education and support.

Let's give that a try, if we can.

Saturday, July 9, 2016


Where do you draw the line? Where is the line which should not be crossed- and what is the level of righteousness that a leader should have? Leadership as ever is a fascinating thing for me- and as much as anyone tries to convince me, I have always believed that leadership isn't for everyone. Yes, you can couch it in different phrases  - the fact of the matter is phrases such as "we are all leaders" perpetuates the belief that following isn't something ok to do. To be honest, following takes a considerable amount of skill and making it out to be something "not quite sexy" is all a bit odd. It maybe good for the coffers of some organisations but beyond that, for the wider population out there, maybe not so. Don't like what I say- have a look around you- every report, every view will opine about the lack of leaders, lack of someone who can inspire.

There is however a flip side to it too. One one side, the cry is for more leaders, the cry is for people to step up- and on the other hand, there is the instant judgements, the morality verdicts and the seemingly desperate urge for our leaders to be…perfect. I suppose one sees public figures as role models- and they need to have a certain standard but when it descends into a mob like vitriol, the question will come for many- why bother? 
Look through history- folks we have looked upon leaders, about whom books, movies have been made, folks who we quote at the drop of a hat- whether it be Gandhi, Churchill, Kennedy, Florence Nightingale…flawed individuals yet wth something special in them to make change, inspire and make following sexy too. Without the microscopic scrutiny of the media, the coruscating focus of social media, the click bait blogs or the instant judgements of twitter…they existed- they led, they changed and they had their flaws- which todays society may have deigned unacceptable, uncouth or even immoral. So how does one square that circle? How does one have a balance when judging our leaders- how does one give them the belief that they can lead, change without their every word, tweet, picture being poured over, interpreted and dissected?

We live in a Big Brother culture- where the sordid, the macabre and the saucy bits attract us. We love the conspiracy theories, we love the conjectures, we love the story of fall from grace…or maybe we just love a story. Full stop. Recently I have seen some posts about folks I have got to know and it has made me wonder why actually bother putting oneself out there. The conspiracy theory angles would make one wonder which supermarket some get their tin foils from- but the tone is accusatory, its pointing, its damaging- and in turn, it sends out a message to those who do it…maybe don't bother.

We ALL live imperfect lives, look deeply, we are all- to a degree, flawed. Maybe we should sometimes remember that when we judge our leaders, perhaps mock them less, perhaps judge them with a degree of care- they too are after all human beings- with the same hurt we would suffer if someone said something derogatory about us. I do have a lot of respect for folks who do stand up to be counted- yes, of course there are some who do it more for power, more for money- but there are also many who do it because they care, because they do believe they can help.

A bit more time for the "leader", a bit less of the self righteousness , a bit less of the moral outrage…and maybe, just maybe, we would give hope to the next generation that leadership isn't just one for the CV but much more…Accountability is important - and leaders need to stand up to be counted on that- but that must not allow for personal slurs.
And if you cant do that, step up to the plate yourself,step under the spotlight and lets see whether the glare is a bit much beyond the comfort of the keyboard.

Do it- and be..perfect.

Friday, July 1, 2016


What is the one thing we could all do with at the moment regards the NHS? Hope would be a good starting point, I suspect.
And it's a difficult one to give, isn't it? Despair has gradually progressed to cynicism, hysterical laughters, wisecracks and blogs as to how it's all going Pete Tong. It's a fine balance too...those who stand up and say "it's all ok, don't worry"….gives you images of that Iraqi general claiming victory while the U.S. tanks rolled in the background...remember that farcical piece of history? 

So what does one do...and more importantly why would one try get involved in anything to do with leadership roles within NHS at the moment? To narrow it down, the number of emails asking me "why bother" from some senior colleagues has been surprising, yet understandable I suppose. Let's take a sense check. Am a Consultant on a very decent salary, actually scrap that, a very good salary in a public sector job, good pensions, the gobby, cheeky-chappy type who would do well in advisory roles...simply on the dint of the fact we live in a world where the show matters, substance comes second, its pretty easy to say “I am ok Jack” why bother indeed?

Many reasons ...if I am very honest, ego is one of them. I have a pretty big ego (there's a newsflash) but I suspect it's also an inherent sense of self belief. I was asked by Bruce Keogh, a man I intrinsically like & trust (whatever your views are on him, I respect - but would appreciate you respect mine too!) and frankly, given all the noises I make about leaders who talk the would be incredibly hollow not to take up the offer of at least trying to change things.

Which brings me to the issue of hope. I travel a lot, I make friends, I make enemies...I can be affable and I can rub people up the wrong way quickly. I have a lack of political correctness about me and have always struggled to suffer fools gladly. It's a character foible but that's who I am and that's what you get with me- and I have absolutely no intention of changing that. I don’t believe in the need for having leaders of a certain mould- variety is the spice of life and all that.
But one thing I have also picked up is the lack of hope. The lack of belief that things can improve. On the flip side, have also met some absolutely amazing people whose dedication to improving diabetes care has simply been astounding.  Problem? We don't hear enough about's easy for me to do so about our work in Portsmouth (it’s that gobby thing again) but in general, people in the NHS are stoic, they are polite, they are humble and they see excellence as part of their job. As a result, we hear little and the masses out there feel the lack of hope.

So I suspect that's what I am trying...trying to join up those people together. Join up patients, joining up professionals...maybe showcase some of the work and see how it goes. I know some of you will go all Tom Cruise on me "Show me the money" (what a film, eh..."you had me at hello"..sorry - do like romcoms a fair bit) and all I can say is watch this space. 

But let me also put back to you that money itself will solve absolutely NOTHING. More GPs won't improve diabetes care unless we as specialists learn to work know, try those things like phones and emails etc to answer and guide a colleague when needed..NOT "do a referral and will see in X weeks"; more practice nurses won't help unless they are given appropriate support/ I have said many a times before, does diabetes care per se need a huge investment to improve things? No, not really. Let me give you one simple example...self-administration of insulin in hospitals- why isn't that a standard national thing? What amount of money will sort that? Or is it the lack of will, the lack of belief that patients can't manage their own stuff and "we know better?" 

It’s been a fascinating few weeks- and If you are someone who has diabetes, lives with someone who has diabetes or indeed works in this arena, I can only offer you hope for now. And there’s plenty of that around- it’s just not visible enough. 

The initial trend seems good-big patient organisations, specialist bodies seem to be getting closer- a distinct palpable urge to work together...and that's a great thing. I can't account for the whole of the NHS but take it from me, these are good times for diabetes care....there's a window we must use if we want to improve care.

I can’t promise that diabetes care will magically improve- but whether it be pathways, markers, long term outcome based work, inpatient diabetes or access to technology- there is a furious amount of work being done by a lot of folks- so keep the faith. There’s much to look forward to but needs a collective belief…hope drives many a things forward- stick with me on this one and we shall see what we can be done.

Saturday, June 25, 2016

2 words...

So we are here. One referendum done, another crucial vote around the corner. I will be clear about it- I voted "Remain" not based on any economic issues but one and one thing only- the importance of a multicultural, all togetherness that the present world needed. To assume all those who voted Leave are bigots is silly and crass but for sure, it gives the minority the belief that their view is supported now by more than half of the country. Racism has always been a part of Britain- its got a bit more polished as time has progressed. As uncomfortable as it sounds- let me be blunt about it- when you are still doing Equality workshops in 2016, when you look at all the NHS arms length bodies and who leads them,..well…bias comes in different shapes. What you certainly didn't want is all of it to come creeping back into the open..back to the days when no one would sit next to my mum in Dudley on a bus in the 1970s.
Looking at whats happening today all over social media, welcome to a new world where the Trumps, Hopkins, Farage et al of the world are seen as voices of the "suppressed". No, they aren't- they are just an eloquent face of the ugliness which has always brimmed under the surface.

Lots in the Leave side voted for that due to the need for individual identity- not be part of a bigger mass- controlled by "others". I get that. We see that in the NHS don't we? A fierce passion in individual identity- whether it be their own GP surgery, their department, specialty, hospital- but a lesser drive when asked to sacrifice their individuality for the need of the NHS. So why surprised to see that in the wider world- we all love our own islands, don't we?

Which brings me to the next upcoming vote- one on the junior contract. We live in a strange climate- where the ferocity of negativity prevents many from giving a contrary view. I also appreciate that what I say next will bring forth some anger, some sniping about my background- perhaps even how because I work for NHS England I am some sort of government stooge. It will be forgotten very quickly how vocal I have been in support, written blogs, argued on their behalf on social media,railed against HSJ about their "leaks", how I went and stood with them front of Richmond house inspire of my national role….I have seen what reaction Jane Dacre has got from some- the same Dacre who has been simply outstanding in her support. But frankly, I couldn't care less. If you want to say something to me, grow a pair, come out from behind the keyboards and debate it with me- face to face. If you can't, thats your problem, not mine.

So I will come straight to the point- Vote Yes. Is it perfect? No. Is it better? Yes, I think it is- and I have read through it- just like I have read the previous ones. The imperfections need to be ironed out behind the scenes- working within the process. The ground gained compared to the first offered version is vast- and there is much to be proud off what has been achieved- as a collective. Does it tackle the issues of equality and patient safety better than the previous versions? Yes in my opinion. Again, its my opinion- none of which is binding or worth listening to if you don't want to, but that indeed is my view. I have also seen the heat Johann has taken on social media- here's my tip- if you fancy doing his role, go do it- but don't slight him-it takes a brave man to stand up and take all the heat he has to negotiate what he has.Arm chair leadership is only that, nothing more.

So is it a safer contract? Yes- key does sit with the Guardians- and it is up to as seniors to play our part. Is it a contract which is more fair? Yes - definitely in my view compared to previous. As the saying goes, you don't get what you always want, you get what you negotiate.
A"No" vote opens up further uncertainty and I can't quite see what exactly the play is after that. Will the EWTD go- perhaps so- would that make future contracts any more palatable? Rebellion is great-as long as its to an end- and I am not sure what that is. The system needs to heal, it needs to move on- careful that by creating or encouraging more anarchy, you don't hasten the demise of what has been the main issue, at least from my perspective- ensuring patient safety.

If it indeed is a No vote, I hope there is a plan…because if,as champions of the No vote. by whipping up frenzy, you end up compromising the careers of many bright young folks as well as patients….look no further about the situation the Leave campaign leaders find themselves in today. History will be the judge…and happy to be proven wrong. 

So if you are a junior doctor- and read this blog- take your time, think for yourself…and then I have 2 words for you- simply as a suggestion.

Vote Yes.

Saturday, June 11, 2016


Inadequate. Depends on how you look at it, isn't it? Depends on how you react to it. The Care Quality Commission came to our Trust and rated the Urgent & Emergency services as inadequate. Cue the predictable response. Listening to the media is a waste of time- as gone are the days of Walter Cronkite, Edward Murrow et al- we now live in the era of click-bait. Upstarts chasing bad stories, leaking salacious details is all what its about. Change the system? Don't be silly- its about the personality- damn the consequence of the shattered lives one feeds on or even leaves behind. So lets forget about them- it matters how one looks at it.

Funnily enough, as with most things, diabetes care has "led" the way- and on a personal level, had faced the sharp end of it back in 2010. We were one of the, (or was it "the"?) worst as regards amputation rates.  I learnt quickly- whatever you said would be seen as being defensive- I still recall the sarcasm laced comments from those in better positions than us- but you learn to accept it for what it is- and you work at it, with your team to make it better. 6 years later, much to do? yes- but have we moved on? I think we have. So back to the CQC…rile at them, be angry at them- and indeed there are many views as regards their use, motives or indeed existence- the reality is that till things change, they are here and they have published a report which rates part of where I work as inadequate.

I won't spend much time on reasons but whatever way you cut it, the past is what it is. It perhaps is up to the present to try and rectify it for the future. For reasons outside their immediate control, today, staff working in the Urgent pathway are the focus of attention, the source of click-bait- but would I take my loved one to be seen by the Portsmouth ED or MAU department? Yes, in the blink of an eye-because I know what the staff stand for. Don't believe me? Look at the CQC report- the "Caring" section- rated as Outstanding. Buried under the bad news, sits the Outstanding tag as regards the level of Caring.

I suppose it matters how you look at the ratings. One cynical view would be to ignore it completely- and walk away from it- not sure who wins or loses with that. Its easy for me to stay out- hey- our department is involved in young people and children and outpatients- CQC says its "Good"- so why bother? I bother because its my Trust, I bother because I owe a lot to this Trust over my years as a junior doctor or helping me to develop me as a Consultant. I can spend time berating the CQC or we could do our bit to help improve whats needed. Its a question of equity, its a question of everyone pulling together and this will bring into focus the need for all to do whats needed- so lets do it. The past is what it is- we could analyse it, dissect it, point fingers at others- or we could make sure we get that bit sorted.

Is Portsmouth Hospital a bad trust? No- have a look at the CQC report- if this was a report card, a fair smattering of blue and green and some amber with one red. Its nearly easy to in fact forget the red. But we must not. Our critical care is outstanding- lets rejoice at that, lets learn from that. And then lets go try and turn that one Red into something different. This is my Trust, a Trust of which I am unashamedly proud- and I don't give a monkeys about click bait stories. I however do care about patients and their needs, I do care about reputation and I also do know what amazing staff the hospital holds.

In the words of Abe Lincoln… "Let no feeling of discouragement prey upon you- and you are sure to succeed". To all the staff of Portsmouth Hospital who read this, you do an amazing job- day in, day out- and for that…thank you. Now lets get that little red bit in that report sorted, shall we? 

Saturday, June 4, 2016

Impossible is..nothing

Inspiring. Funny. Charismatic. Cocky. Winner. That's everything Ali was. And amongst his many legendary quotes- the one above has always stuck with me. Has always been a burning drive for me- the word impossible has always seen as a challenge- and thereby the approach to all things with confidence. Has always helped to have an amazing team around who have been supportive all along the way but I have a burning desire to improve Type 1 diabetes care- and the quote from Ali has been nothing but a source of inspiration.

I have ideas- many of them to improve Type 1 care. Some of them pretty random, some of them perhaps ambitious, some of them maybe even basics- but I do want to try doing them. A few months back, the idea of having TED style talks by folks with Type 1 diabetes seemed like a crazy idea- but here we are- a website (  up and running with all the talks available- and hopefully more to follow. One of the most inspirational events I have attended- I want to hear more from such folks, help spread the message to HCPs what life is about living with Type 1 diabetes.

So here are the extent of my ideas- I want a type 1 diabetes pathway template for the whole of England- a pathway that takes into account patient needs, trained people delivering it as well as being cognisant of the fact that this is the 21st century where email is NOT an innovation.
I want a digital platform for folks with Type 1 diabetes- a one stop place where anyone diagnosed with Type 1 diabetes can go and find all information they need- not have to sit and search on the internet for support. I want to have a comic book showing life with Type 1 diabetes ; I want to explore areas that are providing good care- interrogate success as the saying goes….many other ideas I have in my mind…so much to do.

I want to visit each diabetes team, talk to them, find out the challenges, talk to their MD and CEO as to what support they are giving their teams to improve care for folks with diabetes- I want to see what can be done to help diabetes teams all across the country- are their executive teams aware- do they value diabetes care? Do they value safety? I want inpatient diabetes care to be a fundamental part of hospital inspections, are there self administration insulin protocols- if not, why not…so much to do. I want to have peer reviews- not scary CQC visits but peers reviewing each other- diabetes team from Sheffield paying a visit to Portsmouth- why not? If I can't take criticism from a friend, who can I take it from…so much to do.

To everyone out there- if you genuinely want to help improve Type 1 diabetes care- please- do come and help. All offers gratefully received- and to those who are already helping, you help keep my burning desire going- so thank you. I don't know how long I will do this role for- but as long as I am doing it, I will certainly give the dice a good whirl.

Ambitious? Yes. Impossible? No. The NHS has been much kind to me- and I will certainly try my best to see what i can give back in return. 
Impossible is not a fact…it is an opinion.
Impossible is potential. 
Impossible is temporary. 
As the great man said….

Impossible is…Nothing.