Friday, July 18, 2014

The Servant God

How many times have you heard that one? The old stereotype built in by years of media, bluster and self-aggrandisation...the all-powerful doctor who knew it all, blew everyone away with their knowledge, their skills, their arrogance...whisper it softly perhaps even God like in their ability and demeanour...healers weren't they? They told the patients what to do...and they did. They told the nurses what to do...and it happened. A paternalistic model doesn't develop overnight, does it?

But then times changed...the world changed...patients, quite rightly, found their voice, became more inquisitive about their care, tried to know more about why their care may have faltered.and then found their Gods, self-styled or otherwise, wanting. And as sure as what happens when you see your hero or deity slip, obeisance changed to disappointment, disappointment then moved to anger. How dare they? How dare they fail their duties? The disappointment in seeing these God like creatures be fallible, be prone to the same errors as others, with the same foibles hurt...the angst was palpable. But slowly but surely the tide has started to change...even the media has started to move on. Yes, most of the Consultants are still ridiculously charming, handsome, sweeping folks off their feet, but the George Clooneys and Patrick Dempseys were also fallible, with emotions, making mistakes.perception is key, isn't it? How big a role the media plays in the depiction of anything...all you need to look is at the public perception of success of CPRs and the disproportionate attachment to reality.

The bigger question is who wanted the God like status...perhaps it was society in those ages, perhaps it was the desire of some, perhaps it was the wish of many..who knows. What I do know is that in  a modern era, that's not a title most young guns who have become Consultants want...(though recently a vascular trainee did do his best to change my romantic view on that) and to be honest, unless we shed such ridiculous artificial notions, you can forget about any level of patient or staff engagement.

Lets make it crystal clear what doctors areHuman beings, trained to do a specific job, at the cost of the taxpayer. Human beings with exactly the same amount of foibles as anyone elsePossessing the same level of angst, empathy, indifference, passion, tiredness as anyone else. Lets not elevate them to the level of Gods as I can guarantee you it will, as it already has, end in disappointment.  

By the same token, don't say they are servants either. That implies lesser rights than others, a person at the whim of others, a person who must serve their masters, come day, night or otherwise. Let me repeat again...they are human beings with same needs, same desire to sit down with their families at end of day, same need to enjoy the latest Marvel movie and talk silly with their kids, same interest to go out with their friends and enjoy a drink or two.  I know there are many who like to label themselves as servants, public servants, servant leaderswrong terminology, wrong perception- and by your evangelism, you tar the majority who are struggling to battle the everyday pressures while balancing their own lives. Use that tag...you can kiss engagement goodbye too. They/We are paid by the tax payers...do please hold us to account but don't give us tags that create an illusion.   

The system, as I say, with any topic of discussion, is always like a pendulum.swinging from one extreme to another. Yesterdays God needs to be todays servant is the chant- the reality is that patient engagement or staff engagement, as always, is a 2 way street. Treat patients with respect, they engage.doctors are no different either. I am pretty sure I echo many when I say I am no God, neither am I anyones servant. Just a professional trying to do his job, with passion and desire to improve patient care. On the way, mistakes will be made and all one can promise is to learn from that and make things better.

Treat me as a God.absolute power in the end corrupts absolutelytreat me as a servantin the words of Charles De Gaulle..In order to be come the master, the politician poses as the servant.

I have no desire for that either. Have a great weekend x

Friday, July 11, 2014

Era of the nurses

All good things must come to an end,as the saying goes. And after 5 years, it's certainly time. 2010 July I was asked to become the Clinical director of the Diabetes department in Portsmouth Hospitals NHS Trust and no, it actually doesn't feel like "just yesterday". Time has moved at its own pace and 5 years later,you just feel its time for someone new..one thing I picked up in a leadership event was the ability to know when to move on..and the time is now.It just feels right.

For many years, the job has indeed come first,be at work by 630/7 am, working on the emails, spending evenings away negotiating with GPs, Commissioners, stakeholders, travelling, learning from others...it's been a long road. A long road but worthwhile every single bit of it and as I look back, it is with a great sense of pride at the legacy being left behind. A model of care which is viewed by many as a pioneer, many accolades, improving outcome measures, raising the profile of diabetes within and outside the Trust,..I have enjoyed every single bit of it. Of particular pride has been the fact that in spite of all the focus on clinical delivery, research and innovation has blossomed and feedback from trainees have suggested the department to be one where they feel they are looked after with ample educational opportunities.A department where morale appears good, low sickness and staff turnover rates suggests a happy work force while patient feedback has improved consistently as testified by low complaint rates..while hopefully we have paid more than just lip service to patient engagement via our Sweet Meet, our launching of a 7 day diabetes service, etc

People always ask me the catalyst behind our success...there are 2 strokes of luck which I don't know how to ask anyone else to replicate. Firstly, the ability to work with a dream team, with not colleagues, but friends, friends who are passionate and have delivered care with a smile..making work..fun! Secondly, an incredible alignment of the stars where we had a fortuitous combination of clinicians, Commissioners, Managers...all ready to make the changes needed, changes which attempts to redefine how diabetes is delivered within acute Trusts. There have been many to whom the success can be attributed to but Portsmouth hospitals CEO, local CCG commissioners, managers such as Sarah  Malcolm, Melissa Way, Lesley Munroe,Clinical managers such as Richard Jones, Simon Holmes ...I can only thank you for the support shown over the years.There has been treacle which people above have helped cut past...all of which have improved care enormously..so thank you.

So to the inevitable question...who next? For years, I have heard debates and discussions as to how nurses are the lynchpin of diabetes care...but always been a bit bemused by the lack of them or paucity of them shaping diabetes care. So, in a last bold "outside-the-box" move, as a department, we have suggested that Lisa Skinner, our existing nurse lead take over the role of the departmental lead. Hand in hand,I am also stepping down from diabetes lead roles in the community and asking Jane Egerton to take over lead role in Hampshire with Alison Tier in Portsmouth. Thus, a creation of a fantastic nurse triumvirate who can shape and run diabetes services across the community and acute services.We talk about nurse leaders...my suggestion is lets stop talking and do some walking in diabetes care.I firmly believe that these are exciting times for local patient care and with Lisa, Jane and Ali in charge, the local community care will be served amazingly.

In 5 years,I have tried, tried as much as possible and also fully appreciate the "Marmite" factor I bring to the table. The NHS is caught in a Hobson's choice...on one hand, changes need to happen quickly while the present structure of the NHS, management chains are not set up for innovation, quick,fast movements. To put grease on those wheels, relations have been bruised..but in my book, rightly or wrongly, relations can heal..what doesn't heal is the poor care we provide while we sit and mull and spend hours thinking how to ensure we don't hurt each other's feelings. In 5 years, our strength has been pace, the ability to make changes quickly, adapt to the times, be flexible and sadly, on occasions, it has needed more fire than charm. To all the NHS leaders who talk about change, medical engagement...look at the system where treacle frustrates and you will learn why engagement is so low down the scale..at a time when you need it more than ever before.

 Finally, as a clinician I continue to do my work and revert to my original passion...type 1 diabetes care..all across from adolescence to adult life. Lots of things to do locally and nationally..lots of ideas in my head...the world does look exciting with the potential! There are bits which I would have loved to resolve such as psychology support but discussions are at a good stage so I am hopeful we should be able to close that Achilles heel soon.
To Lisa, I wish you all the best and as with my colleagues, unflinching support to you as we all know how patient focussed you are and what you will bring to the table. Advice? The role of a clinical director in my book, is two..One, ambassador for the department and Two, the patient advocate in a management circles. Never back down from what you believe patients would benefit from, never accept a compromise which you know will compromise care of patients with diabetes. Stick to that..the rest?Falls in place.

An exciting future awaits us.The era of the nurses beckon..Lisa, Jane, Ali....May the Force be with you. Amen.

Wednesday, July 2, 2014

Simply the best?

Its bloody confusing. If aliens descended and started reviewing twitter, newspapers, blogs, media reports...they probably would just shake their heads and leave- simply confused by the lack of consistency in any news story about the NHS. A recent example of that was the recent Commonwealth Fund report which compared different countries and came up with the analysis that the NHS was the best in the world, maybe even the universe. Cue folks going absolutely bananas...twitter was agog with adulation, back slapping, joyous outpouring...none of which is surprising given the absolute shellacking its been taking recently.

As ever with the NHS, any sensible debate around the findings or even using it to plan for the future has been pretty impossible. We again break into silos...in general three..."Team Happy".. proclaiming that its all fine and its the fault of the government that a perfect system is being broken apart- and it absolutely was the land of milk and honey 5 years ago; "Team Angry".. who vociferously proclaim that there are evil healthcare professionals out there, uncaring, money driven, dark,dastardly souls , killing folks and must be stopped ...and finally "Team Sensible" the more rational or sane ones whose voices tend to get drowned a bit while idealogical battlegrounds are marked out, posturing is done, credit is claimed for the NHS being amazing..while a rational debate to actually debate where we go from here in a few years time...no sir..that's a tricky option, isn't it? 

The Tories say we must name and shame GPs in an environment where we can't recruit them for love or money, present GPs are fed up with everything thrown at them...then countered by Labour saying they will organise for patients to be seen within 48 hours.Even the RCGP joins in saying more money to primary care will solve the puzzle...while any sensible person will tell you its not just about the money, its about the morale. Why would you pick a job, whatever be the money, if you face such incessant pressure and public flagellation- especially when some specialities offer a better work life balance, less abuse? Stuff their faces with gold...give over..those days are long gone.

So let's look at the Commonwealth Fund report...those who want to improve don't rest on their laurels..they don't just say - ah well, we are the best, so why bother improve any more ..they look at areas where they can improve. So where is the UK NOT good...look down the table..its in one category..we come 10th out of 11 countries...the section? "Keeping people healthy"...and in a nutshell thereby encapsulates the impending crisis of the NHS. We are amazing, fabulous, awesome etc etc in looking after people who are sick - and lets make no bones about it- but we are rubbish at stopping people GETTING sick. Cue increased pressure, cue need for more resources...and when that doesn't happen? The bubble..for want of a better expression...bursts. So if you are genuinely trying to learn from the report, where exactly are the initiatives to keep people healthy...do remind me who are the sponsors for the World Cup or even the Olympics again? The penny drops.

So to Team Happy, I say, rejoice but also be humble enough to see that there's only way from number 1..that's down. Rather than blame it on specific governments, maybe we need to address the issues which will make us slip from that enviable pedestal- as a profession we need to challenge ALL politicians. To Team Angry, yes mistakes do happen but by god, we are trying our best every day with cramped resources to learn and move forward. Don't denigrate this amazing institution- work with Team Happy or even better let the folks from Team Sensible have a say.

The NHS..Simply the Best? Possibly yes..will it stay there? Not if we as a profession fight siloed corners and idealogical battles...the capacity or its strength to cope will wholly depend on the agenda of prevention. If we can't tackle that..then we are dead in the water...whether that health system is a private sector led one or a public sector one. And THAT is the bottom line..cos the Common wealth Fund report said so.

Sunday, June 22, 2014

Scot-free?

It's a thought which came into my mind while having a discussion with some trainees. Going through the e-portfolio, you have to admit it's a chore and there are numerous seniors out there secretly grateful they didn't have to do anything as onerous as this..however beyond that, whatever be the motivation of educationalists (and there are some debates about that) there's no denying the numerous and rigorous testing of ones competence junior docs have gone through. "Have you done enough procedures?" / "Have you got proof of that?" / "What do YOU self assess yourself as regards competence in that procedure?" / What does your supervisor think about your competence in that supervisor?"...endless..all in an effort to root out the Shipmans of this world. 
A person who was a psychopath first, a doctor second- but came to be the harbinger of all that's evil about doctors..those uncaring fiends which had to be rooted out. ..the irony probably being that Shipman would possibly fly though an e-portfolio- eyes closed, undetected. Anyhow, I digress.

If you look at Consultants, yes, it maybe flawed, yes, it could be used better..but performance management is a buzzword which has stuck in the NHS and raises different levels of hackles. "Have you started your clinics on time? / Have you finished your theatre list too early? / What's your LOS?"..I won't discuss how blunt those tools are in this blog sometimes...here's an example..recently a manager asked me what time I started and finished clinic..he opined it was less than the 4 hours of a PA. I pointed out that I also had 20 adhoc slots through the week- which equated to not just an hour but more than that..put in place to help adolescent patients who couldn't attend at times of my choosing but would rather at their choosing. Patient choice anyone? He understood but felt it would be easier for him to collect his data if I didn't do these adhocs...I am older now..so a polite smile and a firm no is what he got. 
Did try to point out that whether I am good or bad as a doctor also had to be measured by what patients thought about me (both paper and on-line link available to view); what my colleagues thought about me (360 appraisal available), what outcome measures such as admission to hospital for the adolescent patients were (again, publicly available)..Ah but I digress again.

So to the basic initial question...how do you measure the competence or lack of a non clinical manager? I tried on twitter, lots of ethereal answers, lots of intuitive thoughts, lots of well respected and leaders with their thoughts..the end product? Actually very little.The question has to be however why that is the case. Does this continue to engender the feeling of "them" and "us"? Is it blasphemy to suggest that the managers, who perhaps rightly or wrongly see themselves as the guardians of public tax money which the nefarious, wine swilling, lazy Consultants are frittering away are scot free of any scrutiny themselves? Or is that there is something robust out there which I am not aware in which case I profoundly apologise publicly to all managers for the frivolous nature of the comment above?

I have seen plenty of managers in my time as a clinical manager- some "good", some "ordinary", some "awful"..aha...I hear you ask...how did you know what they were? One characteristic stood out...listening. Listening with one thing in mind..improving patient care..and I am afraid not all do. For some its about meeting a target, a number...and if that's what they are judged on, then I understand the reasons why. When your job is on the line- whatever your profession, patient care related evangelism seems to drop down the agenda- nothing wrong with that- as its easy to criticise from the outside when YOU are not in the same position...but it again suggests that the markers to judge the manager, if indeed they do exist, is wrong.

So, as I laze on a Sunday afternoon, I ask all the leaders, all the bodies, NHS Confederation, NHS Graduate Management scheme..to come up with something which could be useful. Something which ties in with what the clinicians are trying to do- and makes all sing from same hymn sheet. Something radical like perhaps measuring the TEAM- consisting of the clinician and manager- on patient outcomes, feedback etc...you win accolades and awards together, you also take the criticism and fallout together.

Till that day, till you have something unified, till the day we have clinicians being measured on targets they haven't helped design- and the right or wrong impression that managers are running scot-free..it doesn't matter how many courses you run on teamwork or group hugging, the NHS will always be divided into "them" and "us". If the driver for different members of the teams are different, then there is no chance of those teams pulling in the same direction. 

So..who wants to work on that with some clinicians? I am game...anyone interested or rather just be scot-free?

Monday, June 16, 2014

Hotel California

It's an ever shifting conundrum..what exactly does one attend international conferences for? I suspect it changes as your career and focus changes but in the main, at least for me, it has been about trying to learn something new, perhaps be excited by some innovation that can be brought back to where I work..and then again, there is the networking. Always an intangible concept it's something which is unparalleled in its richness..talking to peers, colleagues, absorbing ideas from each other..bouncing ideas off each other...and as my annual sojourn to the American Diabetes Association comes to an end, it's ticked pretty much every box. In short, it's been absorbing, fascinating,rejuvenating and dare one say, sometimes even eye opening.

Lets face it...a few days in San Francisco is no punishment and as the plane touched down on the sun-kissed tarmac, away from the incessant lurching from one crisis to another in our beloved NHS, a smile crossed my lips. Sure the killer jet lag reminded me acutely of those days left behind when jet lag was beatable with one more glass of whiskey...now the bed seemed more appealing a surrounding rather than yet another round at the bar....but I was ready to do some learning.

And boy, there was some..and then some more. Learning about engagement with adolescents, listening about self management tools, shared decision making...so much the NHS could adapt..actually let me correct that..so much we in Portsmouth could adapt. I have never belonged to the camp that we have nothing to learn from the Yanks...the healthcare system maybe different, may not be to ones socialist liking...but the passion and desire of the healthcare professionals, the innovation desire are the same...and if we can take something back which may help our local patients, why the heck not try that?

A fascinating session on hypoglycaemia provided riveting insight into complicated studies..in fact left me confused a bit..but as ever, Dr Pratik Chaudhury with his Braniac level knowledge enlightened me while chomping on some bacon.Ah the beauty of networking! Social media came to the fore, was discussed though one got the feeling the UK may indeed be miles ahead of the game...only 1 poster illustrating its benefit in diabetes care was perhaps disappointing but at least it was being discussed, it was put there.

Sessions on retinopathy showed how amazing the NHS retinal screening service has been and much much kudos to those who had set it up..something that had helped tender diabetes as a cause for blindness down the charts...reinforcement that what you are doing is good is always an essential part of learning, isn't it?
A fascinating session discussing roles of a specialist ( Endocrinologist), primary care physician and a nurse practitioner was practically déjà vu.Here were some of the main challenges the PCP were facing in the NHS....overload of work, too much being thrown back from hospitals, multitude and explosion of drug classes,retirements and inability to fill posts....how does that sound, UK GPs? Models of care were rising up the agenda...but one major theme came out of the meeting...togetherness, talking to each other, relations, understanding the needs of the patients, a shrinking financial pot....no different challenges then.Fascinatingly eye opening

And then there was the meeting with so many...not just the people I knew ( bumping into David Kerr as ever a pleasure with his explosion of ideas and suggestions)..but folks from the Mayo clinic, Kaiser Permanente, folks from India, Chile, Holland, France ..not trying to ape their model of work but looking at clinical work, things that can be brought back...in meetings with these guys, felt like a sponge...projects building in my head..watch this space..I have some ideas which I want to bring to where I work...shared decision making tools, clamp studies, glucose monitoring...felt just like a kid in no candy shop. Some evangelists continue to believe that there is no better HCP than on the UK...I can assure you the passion and verve shown by so many from other countries were no less...we must be open minded enough to learn not be suckered into a jingoistic belief of British is best. The healthcare system maybe the best arguably but the professionals desire?Same everywhere.

So it's home time tomorrow..and simply put, I have loved it.Made some new delightful friends, sharing a drink or two with them in the evenings, joking about life and the rest..and all of it has been helped by the superb organisation shown by the ADA.Hats off to all involved for pulling off such a huge meeting with aplomb in such an amazing city....it has been much appreciated. Lisa and Gary...you know who you are...a sincere thank you

America...will be back next year in Boston..thank you for the hospitality. And as you like to say..Good night. and God Bless. X

Saturday, June 7, 2014

Scylla and Charibdes

Homer had described it perfectly...no, not the yellow loveable being from the Simpsons but the original Homer, the Ancient Greek who penned the Iliad and the Odyssey. In the Odyssey, he describes two irresistible and dangerous monsters called Scylla and Charibdes who sat in the Strait of Messina, a narrow stretch of water the hero,Odysseus had to cross..and thereby was born the oft used idiom "between Scylla and Charibdes". English literature was one of my favourite classes to attend in school, perhaps made even more appealing by an amazing teacher...and I still recall Mr. Peters closing the book with aplomb while explaining that idiom and with his deep baritone explaining how in life we would always be faced with these two monsters. Today we have it in the NHS.

The NHS is not perfect. In fact, let me be perfectly honest, it never will be. Even if the whole country's GDP was diverted to the NHS, it still won't be. Why? Because we are in the business of looking after humans, their illnesses, their sufferings...by humans with their fallibility and foibles. Anyone who promises you an error free health system is either naive, ignorant or lying. So not surprisingly the NHS has them..in fact quite a bit of it. In between the amazing wonders done each day, errors occur and there is a drive to get it better..and there always has been..will errors still happen inspite of all the guidelines, the check lists, the hashtags? Yes, it will.

The problem begins when people hide them, deny them, cover them up...step forward Bristol, step forward James Titcombe, step forward Francis...and the perception is built that the staff just want to hide errors, be content with mistakes..an imperfect system stands exposed,warts and all. The public looks on in horror as the prom queen is shown to be someone who also takes cocaine as a pastime. The religion that is the NHS takes a beating and the perception of  a secretive culture is built.....and there you have Scylla.
For anyone who may even have an iota of tainting the sacred cow of the NHS, it's like Christmas. Every single campaign raised, every single whistleblower who are absolutely and absolutely doing the right thing by highlighting mistakes that the NHS should learn from becomes a lightning beacon for those who want to show the warts of the prom queen. How did that Abba song go again..."The King has lost his crown"...

And then we have the national campaigns such as "Hellomynameis", "6Cs", "NHSchangeday"... Each and every single one of them admirable concepts but my unease towards them has always been known..not because of the ethos of them but because how it can be misrepresented.When I first heard about the campaign which Kate Granger has championed so well, I must admit to being a bit surprised. Why? Because when I gave my medical final exams, or my PLAB or my MRCP, introducing yourself to a patient was a non-negotiable, mandatory thing to do. In fact, I was told clearly that if I didn't introduce myself to a patient, I would fail. I then was a house officer, then a senior house officer and at every step saw my Consultant introduce himself or herself by name...surely it was normal standard practice? But then,as I grew up, it dawned it actually wasn't...so more strength to the campaign...but the unease persisted as again anyone with an iota of an agenda could potentially use it. 
And lo and behold, we now have the Daily mail and the Telegraph showcasing "how awful the healthcare professionals are..they don't even introduce ourselves...thus thank heavens we now have a campaign"..or words to those effect. Criticise  those papers as much as you want but they do have a readership..and whatever retractions you get, however many re-tweets you get on twitter, sadly, reputations are easy to tarnish, much difficult to regain . Think of this one for a headline.."Nurses need courses on compassion as  it has been felt they haven't any". I refer to the 6C campaign...a great initiative aimed at changing the culture but one headline with potential to destroy a lot of faith..anyone working as an HCP will know that headline is sensational..what about the populace at large? And there you have your Charibdes...any openness or desire to change  seized upon with ruthless efficiency by those who have papers to sell or an agenda to push.

So the NHS is caught, isn't it? All the whistle-blowing etc has exposed foibles which have been needed to learn from...but seized upon as failings. And any attempt to correct them are seen as more examples of..yes..you got it..failings.The PR battle is being lost every day...each days end brings a sign that the battle maybe slipping away ever so slightly. Finances are tight, patient expectations are through the roof, evidence based medicine lies in tatters...There are plenty of folks with the desire but each day the ones who are more keen to get their head down, finish the job and just go home to their family rises. 

I will finish with one little story..in that school classroom as Mr Peters explained the ferocity of Scylla and Charibdes..their monstrosity and desire for destruction, I recall someone saying that it was impossible to survive them...to which Mr Peters with his baritone boomed.."Never forget Odysseus survived them both".How will the NHS fare? Time will tell..it's ticking to some form of conclusion...someday the history books will look at these times and marvel at this fascinating passage of time. 

Saturday, May 31, 2014

Pioneer

It depends on how you want to use the word I suppose. If as a noun, it means "a person who is among the first to explore or settle in a new country or area". If as a verb, it means "develop or be the first to use or apply (a new method, area of knowledge, or activity)". 

I was sitting in the hotel lobby when the news came up on my twitter feed...the news that HSJ and Nursing Times had published their first list of social media pioneers. Clicked on the link and let me not pretend to have false modesty- and say it frankly- was very pleasantly surprised to see my name here. When you look at the other names in the 12 named, there's Kate Granger,Teresa Chinn, Sepsis UK, Anne Cooper, James Titcombe, Julie Bailey to mention a few- and the first reaction I had was "Wow". Exalted company indeed given the work the individuals have done- and compared to their efforts, pretty much a fledgling effort- but then again, after the initial euphoria, maybe the word pioneer has been relevant as a verb in this context- and indeed,as a Consultant in diabetes, my "mission"- so to speak- has been to showcase and highlight the good and not so good bits about diabetes care in the UK.

As I always say, we need to step away from the polarised debate that either its all amazing within the NHS or its all bad...as ever and as with most things in life, the reality sits somewhere in the middle. To those who say its all good, just come into hospitals where inpatient diabetes teams don't exist or out of hours/ weekends- appalling is a kind word to describe the care that goes on. I referred to Gillian Astbury and what precipated her death...we talk a lot, we got Don Berwick coming along, we had Francis, we have had reams of campaigns, courses, twitter debates- but I can absolutely guarantee you that such cases still happen- every day within the NHS- some due to a lack of engagement from management, some due to lackadaisical leadership from specialists, some due to most systems paying lip service (yes, still) to what patients want. 

To those who say it's all bad, look at the data as regards death rates from diabetes and see what the NHS has achieved- some amazing work. If you don't believe in statistics, have a chat with my dad- was a Consultant here in the 70s and he will tell you how far care has come. See what primary care has achieved, laud them for what they have taken on inspite of no further resources thrown their way. I referenced it in my Mary Mackinnon lecture and I will say it again- primary care is where its at- and we need to stop the finger pointing and support them, not keep lobbing poison laced grenades with impunity.

It's thus been fantastic to be nominated and for that I thank the people involved- Dean Royles, Jennie Middleton, Shaun Lintern among others- for recognising the worth of diabetes and the importance this particular disease process has in the well being of the NHS. I look forward to continuing to use social media to help put the agenda of diabetes up for constant discussion...look at the power this holds. Diabetes UK recently decided to debate on twitter the use of the campain called ChoccyBarred to raise funds. The whiplash ike response was noticeable- and call it a hasty retreat or a listening to the masses, credit to Diabetes UK for backing down from a campaign which could have been potentially so damaging to so many.

Finally, my firm belief that it is us,as specialists, who have a huge role to play in improving diabetes care, the onus lies with us to change the status quo- as mentioned before, listening to patients, are still, in the main, confined to powerpoints- the frustrations are palpable. At the table, thus, till things genuinely change, there is only one person who can then fight the battle on behalf of the patient with diabetes- and that is us, as the specialists- whether that be with any middle manager who wants to see whats financially viable rather than focus on patient care, whether thats engaging with CCGs, whether thats at risk of swallowing an insult or two...the role of specialists are paramount. It is, simply put, not acceptable for a specialist to say that we cant provide 7 day service as management is blocking it...you must find a way- and as has been shown by a few, there are many a way- you just need to know which weapon in your armoury can breach the fort.

So thank you to HSJ and Nursing Times for the nomination- I can promise to continue to do what I do best, raise the bar, create a discussion- the NHS needs disruptive leadership- I have never had or will have any issues providing that. 
When I set out as a Consultant, I made a promise to make a difference to diabetes care by the time I finish...and that's a promise I intend to keep.