Saturday, August 27, 2016

Respect...

It rarely fails to fascinate me. And in my opinion- is a key issue to a whole lot of disputes which ranges within the NHS. Its probably applicable to life too- but lets keep this to within the NHS.
Do you know what I am talking about? Ok- its the sheer inability to treat adults as…well..adults. Have a look at the junior doctor issue- my views is well known- it hardly matters whether I work for NHS England or the Ming Dynasty (No- there is NO parallel there- don't be naughty)- my view is what it is- its been handled appallingly. And it stems from the inability to treat a group of qualified professionals as..adults.

Lets check this theory out. Lets take the example of a junior doctor I supervise- she is 32 year old, she has a mortgage, she is married- along with the fact that she is a fantastic professional. Society has trusted her enough to have a mortgage, have a family, treat her as an adult when she goes on holidays, watches a movie- yet we, somehow, have been incapable of doing that. When this group of folks started off by trying to say in a decent manner- guys, this won't work, its tough as it is, we have gaps, we are struggling, we have training issues…the response from a significant part was what? Well- it was a bit of 'There, There"..a bit of "Well in my days"…a bit of " its a holistic profession"..and a whole lot of "well you are all kids so what do you know"…let me tell you what happens when you treat adults like that…its annoying, its disrespectful, its patronising and it creates friction. Funny that we have such an angry bunch of people around, isn't it?

Let me give you another recent example- a trainee comes to see me- has had an incident flagged about her- there has been a meeting where some folks around a table have decided what rating the fault was. She, has had no opportunity to answer the question raised, she has had no right of reply but hey, there's report to her educational supervisor. On which godforsaken planet is that even remotely right? Its awful, a lack of respect but stems from treating, once again, groups of adults as…well..not quite adults. Times are different, ladies and gentlemen, the take it and lump it era is quite rightly over.

Then came the issue of 7 day services and the risks being evident from leaked reports- and the response was simply astonishing fro many quarters. A lot of tut-tutting, a bit of "Meh, its just a risk register"…folks -UNDERSTAND the angst here..its being proven right after being fobbed off..respect that- again, adults talking to adults. Maybe the misnomer,as pointed out by many, sits in the term, "junior" doctor. A risk register existing is no good for patients unless there are mitigating processes put in place to put a red into green over course of time. If thats our attitude to any patient safety issues (hey, we have it n the risk register) then lets not bother with this lark of improving patient care. Its not the register that matters- its the effort to make sure the register has no cause to exist that matters.

So it continues- the NHS and its inherent way of being paternalistic- for ages, it has done so with patients- the "its ok, I know more than you", the "There, There"- and that has now seeped into bringing that attitude to our own generation next. What chances do patients have of moving past lip service to "patient engagement", "patient centred care" or whatever the latest buzzword bingo is -if we cant even treat our own colleagues with a degree of respect adults deserve. Its not all about politics- when such a group of hard working folks, raise an issue- listening to their concerns isn't that tough.

So I don't know how we move on- but I would like to appeal to many within the NHS- whatever be your position or grade- to respect adults for what they are. You don't need to be fit a certain "prototype" to be seen to be experienced and knowledgable. Experience is of course important- but lets not ignore the youth either. Treat them as adults- they could turn out to be amazing allies to ensure risk registers don't have a reason to exist.

As the saying goes…"Give Respect…then you will get some back"


Sunday, August 21, 2016

Where We At

So I have started my new role. At least I think I have. I mean, I have a badge which gives me access to Skipton House, so I must have. Either way, its been about 3 months or so in this new role as Associate National Clinical Director in Diabetes with NHS England. Did I hear a boo and a hiss? Ah well, anyway, it's a role and as promised to many of those who live with diabetes, here goes as regards an update as to where we are! After all, its all about transparency,isn't it?

So lets start! Recall me making the three priorities? So where we at? 
As a follow on from some of the work started on a Type 1 diabetes pathway, paths merged with some fabulous work being done by the London network- and to cut a long story short, we are very close to having a national Type 1 diabetes pathway- which hopefully will guide CCGs and STPs to develop these accordingly. Before my primary care colleagues jump up, no, this does NOT involve you doing more work- so rest assured- and hold fire till you see it. It hopefully will have the blessings of all relevant diabetes organisations soon- specialist/patients etc- and we should be able to progress things soon!

Next up in the pipeline are plans to develop online educational modules for diabetes patients (Bournemouth are already doing a fabulous job at one for Type 1 diabetes - and I don't like reinventing the wheel- may as well back something of excellence!) To emphasise, these will be in conjunction with existing structured education platforms so hopefully will help to support education. Other exciting developments are possible online platforms for blood sugar downloads etc- and yes, as part of all this, am meeting all and sundry to see whats out there- and try to narrow it down to the best available.Other exciting areas are a national Type 1 diabetes platform- that anyone can be referred to- patient or carer- a sort of one stop shop of all curated information available.

As regards technology, a lot of discussions with Abbott and debates regards Libre availability. We- after plenty of coffee and discussions- hopefully do have a plan and I can only assure all that we are working very closely with the company. I must stress that there is a process involved and if we are to invest public money into it, evidence is key - which takes time to gather and accumulate. We shouldn't be too far off it (the recent data published at the American Diabetes Association meeting and the work done by the Scottish group are certainly helpful)- but again, do bear with us on this one- its not something that has been rejected or put on the back burner! I personally would like this to happen- as I do see its benefit- but patience and time please.

As regards inpatient diabetes, again, plans are afoot- which involves role of CQC, a possible adaptation of self administration of insulin becoming a necessity, definition of inpatient diabetes teams or indeed its presence in the diabetes aide-de-memoire for STPs to follow. The aim is not to have inpatient diabetes teams as an "option" but as a fundamental part of acute Trusts- given that 15-20% patients admitted at one point have diabetes and the errors are far too many!

What else? Much actually…the "impossible tour"? Oh yes, letter being drafted to go to all teams- and if they want, will be visiting for sure! There's a meeting with the Night Scout team coming up, there's keeping an eye on data from Cheshire, there's discussion on information for pregnant mothers, education run by patients for professionals ("Flipped Education"!) and of course, the issue of extending the Best Practice Tariff…did I ever say its actually been quite good fun?

Finally, a mention to the team with whom I work- the background work being done by many is simply amazing-and especially Jonathan Valabhji who as NCD has been a fantastic guide- and believe it or not, in diabetes care, changes should be coming. There are many more ideas but for now, even landing those above will be a step forward.And of course there's TAD 2 (wasn't the 1st one fun?) and the Type 1 diabetes comic book.

3 months or so in- about 9 to go- No, its not a time limited job for 12 months but its a point where I assess my own role. If in 12 months, nothing much has changed, it maybe time for someone else to try. Till then, its actually not all doom and gloom…a tweet recently said "If you are not in revolt, you are in cahoots". Well, I respectfully disagree. I have a limited time doing the job I do- and I will work with anyone to try and improve diabetes care- whatever be the structure or political colour.There are many ways to help patients- I respect your fight- in return I ask that you respect mine too.

Over the course of time, as projects are launched, I will take time to pay tribute to some amazing professionals and patients who have been helping along the way. For now, you know who you are- and a genuine thank you. 
Much more to be done- but the support received so far? Simply magic- and thank you for that. To everyone else. I reiterate it again…if you have a good idea or a constructive suggestion, come and talk to me. I will always find time- promise!

Will update again in 3 months- but till then? Keep asking, keep suggesting and keep prodding…just do it with awareness for some one who also has a life, a family and a full time day job too! :-)

Sunday, August 14, 2016

Look up...

A fair bit of palpable angst dripped out of the voice. A young gentleman- early in his career- yet a bit unsure of where things were heading. As I sipped on a delectable cup of hospital coffee, you had to wonder what sort of role we as seniors continue to play in this whole saga of the NHS, the crunching environment of finances - and the responsibility towards patients we hold.

Politics always has fascinated me- and there is no denying Britain has offered a lesson in politics- which no one has been able to predict- the twists and turns being of a monumental proportion- and in the middle of it all, the healthcare system has gone through the squeeze. Junior doctors turned out to be a lightening rod for many, perhaps serving a bigger agenda for some- while most of the young doctors just want a good secure future, the ability to see patients and the support to do their job well. What DOES one say to these people? That the system is all shot- and we shouldn't bother? That we are willing to sacrifice them while we think of how changes can be made in a political landscape which has baffled many?

Whatever be ones belief or political leaning, a democracy without a healthy opposition is always a bad thing- whosoever is in power- and the billion dollar question sits with that young individual…what about me? And we must find some time to answer that somehow. I don't have all the answers but if one looks at Facebook forums, the answer doesn't sit there. Its angry, its burning, its driven with angst, its for a call to arms, its for the "greater good", its "actually all for the patients"…..what about the ones who struggle NOW? What about the ones who have uncertainty over their careers NOW?

I wish I had the answers- and I do not judge those who fight the way they choose- but we must also have some time who want to have some answers now…and thats what this blog is about. I wish all of those who have taken the cudgels up to save the NHS or raise issues but for the many others, a plea to also find time for all those juniors caught in the middle…juniors who want to know they have done the right thing by choosing this amazing profession, juniors who want to know that seniors are there for them- not just walking away with a shrug of the shoulders.

As a collective, we can and we should try- at least in my opinion. It costs little to buy a weekend team a round of coffee, find time to smile, say hello, talk about how #medicineisbrilliant and how, all said and done, its still such an amazing profession to be a part of. Not many get a chance to help others- and we should have our roles in there- making our generation next feel wanted- feel they are part of this entire family.

There are many ways to save the NHS- if thats what you want- whether that be by being part of a political alternative, or raising voices on the streets- or indeed working within the system to help others. Or just do the simple things every day- and make sure we have a bunch of good, motivated doctors to look after us when we need them. Many ways to help the NHS- and we would do well not to lose sight of them.

So, in the month of the Olympics, where inspirational story appears daily, as a senior, to all the junior doctors out there…take some time to look up too. I certainly will try to extend a helping hand when I can. Failing all..theres always time for a coffee and an arm around the shoulder.

Wednesday, August 3, 2016

Hey You!

You there. Yup..you. First day as a doctor? Just sat through inductions of hand washing, fire safety etc? A slight feeling of the butterflies? Tell you what, have a quick read below...and see whether it helps!

So I am Partha, been a Consultant for about 8 years now. Work in a big DGH, got some management experience, love my clinical work, also educational supervisor to a fair few, College tutor etc...so a bit of experience under the belt. And you know what? First things first...WELCOME!!!

You will know about the uncertain times, the contract saga, the bitterness, the angst, the White rage....and yes, lots of it is true, lots of the angst is warranted. But beyond that, there's also the profession you chose. Ah I forgot to say I also teach medical students and I have yet to meet anyone who has chosen this because it "pays well". Let's be very honest...with the grades you folks got, you could have picked another profession which pays better..but you didn't. You came into this knowing the hard hours, the tough shifts...and today you are here.

So a few simple tips from someone who really enjoyed his days as a "junior" doctor ( not my favourite term to describe a qualified professional in my book!) ...
Relax and try to enjoy the job. There will be good days, there will be bad days....but overall it will be a time rich with experience and learning. Make friends, and yes, that absolutely involves everyone else...some of my best friendships have been with nurses, physios, pharmacists, OTs....apart from the fun, the team spirit helps to cut past many a tough day. Try it...you won't regret it.
Then there are the patients...be nice, be kind, and always try to keep a smile going. Doesn't take much but in a scary hospital surrounding, it means a lot. I know it as have been on the other side of the fence. Especially at night- an extra hello makes a lot of difference.

Finally? It's not a Disney cartoon out there where everything ends well. Neither is it Mordor where Orcs rove the wards to make life hell. Everyone in their own way is trying..and yes, even those managers who are easy targets? Believe you me, they try and they work their socks off- driven by the same passion as you to improve a patients life. Just in a slightly different way. You will hear others say "In my days". My tip regards that? Meh. We had many perks you folks won't ever have.

So enjoy yourself, watch, learn, observe and welcome to the mystical world of medicine. Much is wrong with it in the NHS but much much is also right with it- above all, the people in it. Bursting with ideas, passion, energy..it is a wonderful experience which you will carry for the rest of your life.

Enjoy your time and however hard it is...keep that smile going. There is nothing better to confuse an approaching frown than an infectious smile.

Ladies and gentlemen? Best of luck x #medicineisbrilliant

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 bit...as 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

Broken?

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

Perfect?

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.