Friday, January 12, 2018

Lost?

You can sense the despair in the air...you can literally reach out and perhaps even touch it. Enough has been documented about the sheer incessant pressure within hospitals, the ramp up of the noise in the media, the chatter on social media...you can't escape it. And with it has come a sense of inevitability about the cycle- yet perhaps a bit more tighter each year. The tough times brings forward a discussion of "how do we solve this problem?" along with the sharp divides of opinions, the same rhetoric of what may or may not work, the health care professionals saying "its the worst ever" and some sticking to smart alec comments about what should be done.

I mean...is it the worst ever? Or do we healthcare professionals harm our own cause by saying so each year- and we get to the "crying wolf" phase- where we get ignored when it actually is the worst ever? I don't know- but facebook posts from former years can be educational...it appears most winters, we struggled. Personally, how bad is it? Let me just say after a long, long time, I was reminded of my days in Kolkata...the sheer volume, the look of desperation in the poor doctors or nurse face...the annoyance that they couldn't do better. Heck, I even discovered places in the hospital I didn't even know existed- or at the very least, never expected to visit as a Consultant Physician. Problem is caught in the sheer white heat of social media, the message does get the counter of "here we go again"- albeit unfairly. Or at least it certainly feels so. It feels different for sure- something has to give soon.

Then there is the inevitability of the debate of "What next?". Take your pick. Hypothecated tax? Immediately appears a raft of idea why its a daft idea/scourge of the world/an evil plan to destroy Bevan's legacy. How about a cross-party commission? Well, that isn't good either- not all parties like it- because lets be honest, why get rid of a political football that has served many so well for so many years? Ok- lets ramp it up- how about a Royal Commission? Pfft, they say- it takes too long- long grass issue. Well, that's really funny and makes me smile. About 2 years and a bit ago, was part of a group which asked for it. Response then? Oh-it would take 2 years- and the NHS "doesn't have 2 years!!" Looking back, it seems we have had a lot of chat, a lot of political commentators have opined, but what has happened as regards funding the NHS question? Fanny Adams. I don't know- maybe, just maybe..if we had done something 2 years ago, we may have had something to discuss, implement, debate etc. But nope, heck, some tin foiled hat people even said we were pushing privatisation. Well, blow me over. 2 years later, welcome to GroundHog Day.

Then we have the debate about structures and funding. The main opposition-for example-to an Accountable Care System seems to vary between- oh its American- that's all evil OR we possibly can't integrate services as it opens the whole service to privatisation. So are we objecting to the structure, the concept or do we want to ban private companies from bidding? Who knows- but integration / working together sounded like a good thing. I have an idea- lets give it a different name...how about National Health Service?

Then we have the "appeal for funding". An ask which each year gets even more....well...peak bonkers. We all know where extra money "should" go- social care, primary care, better prevention health, better community support....where however it does go to? Acute Trusts bottom lines, PFI bills, locum bills, anything to do with improving "flow" with a few hand downs to the other areas which would be more useful longer term....total net effect of using the money? A big zero. A plaster- till next year- when "its the worst ever ever ever...so can we have some money please?" To make it peak W1A season, the ask is led by NHS Providers- the same organisation which was one of the few bodies to support imposing a contract on junior doctors. I may have missed their apology for getting that wrong- but all the money in the world is no good if you don't have the staff. The junior doctors issue was far more about money, it was about morale- it was about the future- it was about a workforce we could ill afford to lose.  It was about standing by your workforce, not disrespecting them...it was much bigger than a pay dispute.Combine that with Brexit, the uncertain economy, an opposition which is level in the opinion polls with the ruling party...and we are a bit...lost,aren't we?

Normally, I always like to say something upbeat, something positive. I am not sure I do about this whole mess. The narrative seems to be lost between - we need more money/ Corbyn will save us/We are the best in the world/Stop Privatisation/ACS is the Devils spawn...all of this means very little when you are standing in the middle of a Medical Assessment Unit and thinking..."This can't be right"- or looking at your duty hospital manager and thinking ..."Dude, you need a hug".

So please- all you clever people- try and come up with a coherent plan- because I am not aware of one- and neither can I see anyway out of this rut- unless we try and get our heads together- and perhaps, just perhaps be open to suggestions beyond our firmly entrenched position.
I don't care what system it is- but I would like to provide a better service than what we are starting to at the moment.

Till the next year.

Wednesday, December 27, 2017

The 2017 Chronicles

2017. Nearly done- and from a professional perspective, its been a year of getting to prefixed targets set- nothing more, nothing less.
No point in beating about the bush- the NHS is in turmoil- with a swirl of politics, elections, more changes beating an incessant drum which has made life suffocating, difficult to concentrate on the job at hand. Yet…albeit from a biased point of view, we in the NHS England diabetes team- can perhaps look back at 2017 with a bit of a smile.

Landing the Transformation funds was a big step forward- with the process of allocation of money-perhaps being…character-building. Either way, at the end of it all, 62 odd million £ were distributed out- with a further roll out of the National Type 2 Diabetes Prevention programme; about 5 million £ specifically to increase specialist nurses in hospitals to tackle hospital safety issues; about 11 million £ to improve uptake of structured education etc. Will money solve it? Nope- but it certainly goes a long way to answering some critics- as well as kickstarting some of the much needed processes that diabetes care needed.

Next step was the landing of the Diabetes NHS RightCare pathway. Blessed by eminent personalities such as Sir Muir Gray, it arrived with 7 key priority areas being focussed on- at a population level. The message coming out has been loud and clear- the days of a "community diabetologist" and a "hospital diabetologist" must be coming to an end. It has been of much personal satisfaction to see this..as I have always believed in…one is a specialist for the system- not of one particular bit of it.
The digital versions of the Type 2 diabetes prevention programme arrived too- a roll of the dice- to gather evidence, to test the theory that digital approaches may work- a preference of a nimble approach towards technology- in an effort to encourage innovation- yet with markers around it. The recently published data also showed the growth in numbers in the face to face T2D Prevention programme

The landing of the FreeStyle Libre was big news- an unconventional approach- yet- in my opinion- a much needed one to share up the status quo- it certainly has caused a stir- and for me, the big thing- apart from the technology- was the whole process of seeing what could be achieved if all forces joined together for the right thing. For me? Getting it to even one person beyond the capability to buy (which is what it was for 2-3 years)- thats a win. As was showing that when we negotiate, we do so for all 4 countries, not for one. We do so for adults and children, not for one segment. Diabetes does not stop at certain ages, nor at boundaries of countries….THAT is created by us as health care professionals- and this year- to me- was about setting the tone for changing that.

The year closed with updates to the DVLA rules for those living with diabetes. Some important first steps- especially removal of the legal barrier to change how glucose levels are to be looked at during driving. Much to be done yet- but this is a big step forward- just as Libre could be potentially opening the door to further technology in type 1 diabetes in the NHS. And finally, the opportunity of brining a Scottish piece of work (My Diabetes My Way) to England- and invest with an aim to develop it further- explore the possibilities of Artificial Intelligence & Diabetes

So whats up in the pipeline? Truckloads…will all of them land? Unlikely- but no harm in seeing where it takes us. I will list them below- to give an idea of what we are up to/ have in pipeline/on drawing board- in no particular order of preference:


  • Type 1 diabetes Digital platform
  • Type 2 Diabetes Digital education offerings
  • Accreditation of Education programmes
  • Discussion around QoF; individualised care- and especially frailty
  • The UK version of "Language Matters"
  • A focus on better technology uptake especially CGM access
  • Possibly Out of Hour support across the country
  • Liaison with pharmacist/ dietician/psychology organisations regards their roles
  • Collaboration with ABPI (umbrella organisation of all diabetes Pharma companies)
  • A possible Dragons Den style Innovation Day
  • Working with ambulance services regards treatments etc
  • Developing something for SE Asian people regards education in T2D management


Enough? I think so- and as mentioned, the NHSE Diabetes team is busy with ideas/thoughts/possibilities- working closely with Diabetes UK , JDRF et al

Personally, apart from all of the above, there's the TAD event, the T1D: Rise of the Machines; Episode 2 of the T1D Comic book….so much on plate- and so much fun to be had. 2017 has been a bit of a blitzkrieg, 2018 could be one step further- who knows. Throw in the GIRFT role to come..touring all hospitals around the country, discussing safety, care, data- and yup, it will be busy, won't it?

Regrets from 2017? Very little. I never came into this role with any expectations- apart from having a bit of fun- and as long as it continues to be- we keep at it. The NHSE Diabetes team are laced with characters who have guided and supported me- yet let me run at my pace- which has been much noted and appreciated.

Resolutions for 2018? Not much to be honest- but maybe smile a bit more, try a bit more charm. I am perhaps a bit more relaxed, a bit more chilled - and the supporters have been far more than the detractors- which is always a good barometer. You can't satisfy all- trying to do so is probably the biggest error anyway. However, more than all? The biggest strength has been the folks who live with diabetes or care for those living with D. Very rarely, if ever, there has been any criticism from them- and I can't thank all of you enough for that. THAT is what has made 2017 so special.

Let's hope 2018 brings us more cheer- as we try different approaches and things- and we are always happy to listen- and hopefully, our work in NHSE shows- we have been trying our best. I wish you all a happy new Year- and look forward-as ever- to your support- as we try to make diabetes care…just that bit better.
Personally I always worry when my interest flags or wavers…or when I feel the challenge isn't there anymore. Not quite done yet to be honest in diabetes…the fire still burns well…lets see if we can make 2017 the warm up act for 2018, shall we?



                    Partha Kar & Jonathan Valabhji….The Maverick & The Statesman 😊


Tuesday, December 19, 2017

New Kid or New Clothes?

How much more change can the NHS take? Or are some changes absolutely necessary? Or are some changes needed to correct the wrongs of the last change? I mean...the only thing constant in life is change, right? These are the questions which -as ever- plagues the NHS- when anything new comes along- and based on our bias, belief, ideology or indeed even cynicism, we tag the latest change with a brush which fits the best description. Talk to senior enough folks- and they will nod sagely - the circles of change have left their mark on them...each cycle bringing something new, rehashing old wounds, bringing some fresh. Factor in that, in essence, we are a bit adverse to change in general, throw in the religion that the NHS is...and what a fascinating cocktail it indeed is.

In the context of all that arrives the latest version...the ACS (Accountable Care Systems). Or ACO. Or depending on your view- the Saviour of the NHS. Or the End of the NHS as we know it. There's been enough commentary on it from well known campaigners, political commentators etc so I won't bore you with that- but will give a personal perspective on it. I couldn't really care less what you call it, you can call it Mickey Mouse for all I care- but if anything purports to get organisations together, beyond their individual Key Performance Indicators- or indeed their bottom lines, then perhaps it can only be a good thing. Now I am not as clever as a lot of folks, perhaps even naïve, can't understand the politics of it all...but a vehicle which says get all your money in one place and work backwards for the benefit of the patients- seems like the ideology to which the NHS should be aspiring to anyway. I mean..I don't care what your Service Line Arrangements are- or how gleeful you feel about doing that extra coding to get more money- at the end of the day, it comes from someone elses bottom-line...Left Pocket, Right pocket, same bloody trousers, isn't it?

For years, I have sat and marvelled at the potential for organisations upping the ante at gaining that extra pound- off each other, off each departments...and after a point? It feels like monopoly money. I could give example after example from my time as Clinical Director of an acute and later community trust- where the arrangements could only be described as...cynical. Efforts to balance your own siloed bottom-line while the whole system tanked.

Anyhow, so what can ACS do? Well, very little to be honest- without the belief of the folks involved in it. Or their ability to convince the majority. Its not about convincing all- heck, we didn't manage that even with slavery or racism- so why try anyway. Its more about inspiring others to believe. A structure is as good as the players involved in it- a bit of a footballing analogy- but it doesn't really matter what sort of Tiki-Taka or False 9 you play with- if you don't have the folks to execute it. Or the belief they can. Or...more importantly- unlearn years of behaviour ingrained in them. As regards the scrutiny of the process, if the Healthcare Select Committee is looking into it,maybe the process will give some assurance- maybe it won't. I don't know- all I do know is this...it really doesn't matter even if all the money in the world appeared- the raw fact is we are still a fair bit away from having the ability to work together-as a system. We are still...primary care, secondary care, community providers....and so it has been for ever. Can we unlearn that? Can the system leaders switch their way of thinking? Or is it time for a fresh generation to try? To me, the structure gives the foundation- whether we can build on it, boils down to our thinking and approach

In short,  as ever- who knows. As Christmas approaches and we enter a period of bonhomie, maybe its time for us to save the NHS - just by gaining the ability to work together- from one pot of money- as well as developing the ability to argue for a bigger contribution to the pot-as a collective. Maybe we could. Maybe Santa may bestow that gift upon us all.

Or at the very least, one could always dream. I wish you all a very Merry Christmas indeed x

Wednesday, December 13, 2017

Diet Wars




It's unquestionably a sign of our times...the lack of mature,sensible and calm debate. The world of health is no different- and noticeably evident in recent debates about the relevance of diet. The views are absolute, there is no budging...and even if that be an admirable trait in some eyes, what hasn't been edifying is seeing the unfettered vitriol which comes with it.
The debate about low carbs and its efficacy in helping with diabetes (yes, all types) has been going on for some time...but recently seems to have slipped into a different gear with the publication of the DIRECT study. That study has been more about low calories followed by primary care based support- rather than low carbs- and the data is there for anyone to interpret. What however has been fascinating to see is believers in the science of low carbs use exactly the same tactics that they have, sometimes rightly, accused others of. The tactic of sneering at research which doesn't fit a view, the view that it needs to be discredited, rather than be seen as yet another option for the average Joe on the street.

Now I will be honest- as many advocates of low carbs will know too,I have no issues engaging with anyone- and I have- whether it be with Aseem Malhotra, David Unwin or indeed the folks at diabetes.co.uk  such as Charlotte & Arjun. I share cordial relations with all- as I see its potential and I also see that it may indeed work for some indeed. By the same token, I also have met Roy Taylor and Mike Lean, the brains behind the DIRECT study in an effort to understand what possible application can be brought to bear in real life- and perhaps seen as yet another option. By the very same token, I also met with the British Dietetic Association too...because give or take? They are all allies to me - giving ideas about what may help the population. As I would with anyone who brought another diet to the table which they believe will improve population health.

There is however a need for a reality check too. Albeit perhaps tongue in cheek, David Oliver makes a very relevant point about the #Carbsnatchers of NHS England. In a policy role, there is a need to strike a balance between what can and should be mandated (smoking in public places is a good example) and what interferes with personal choice. Is it about mandating or is it about giving people the information- and then letting them choose? And where does socioeconomic deprivation fit in with amount of carbohydrates in your food?

Either way, a rational debate is needed...simple mudslinging is likely to achieve little. Comments such as "if you don't eat low carbs, you will have your feet amputated" ...well..I am not sure who that actually helps.I have never been a big fan of shroud waving. There needs to be an acceptance that there maybe folks who consciously choose NOT to adapt a low carb or low calorie diet- that could be an individual call or driven by economy. It's not right to judge others when you don't live their lives.And I have had my share of abuse- as sizzlingly racist as they can get- specifically from the low carb lobby. What has fascinated me is the passion that drives such people to send things like that. I tweeted about it...condemnation from the big guns of low carb lobby? Miniscule - I saw it as tacit encouragement to the hordes...the problem is..if that's how you engage with national policymakers, then the chance of impacting on policy...well...minimal is the word I am looking for. What drives individuals to champion something to such an extent that it crosses all threshold of decency, ignores any science, feeds into the ethos that experts either know nothing or just corrupt? What creates this aura of being self appointed vanguards of public health...I mean , if you want to impact change, why do so from the outside? Why not apply to Public Health and join? Engage in a rational manner and make the case?

A personal viewpoint, if I may? I read regularly and would say am a reasonably informed person. So what diet I undertake to reduce my risk of type 2 diabetes should and is down to me. I have always loved my food and desserts but as time has passed, I am more aware and conscious - but that doesn't mean I have given up on things I have always loved. It's also about what I can afford. It's also about what I can sustain and feel well with. It doesn't matter if YOU feel great being on any new diet, what matters is how I feel on it after trying it. It's about perspective.

At a policy level, we are indeed looking at all the evidence and perhaps a change in guidelines will happen- engage with the process in a sensible adult like fashion and there are enough people willing to listen. And as much as it may be surprising, no, there isn't some Bond-villain style conspiracy going on. You can't impact change by simply being reactive and angry- it's more about winning over people, not continuing in a bubble of folks who believe the same.

And genuinely? If you want to improve diet and create a healthy population, we should perhaps concentrate our efforts on access to the right food- which links with socio economic deprivation. When you are sleeping rough, shivering in the cold, it's not the low carbs or low cals which are at the foremost of your thoughts. A tin of baked beans or a packet of crisp feels like a gift from heaven. 
We would do good to bear that in mind - before tweeting our righteous anger from a smartphone, while comfortably tucked up in a nice warm house- enjoying the blessings life has provided us with.

Sunday, December 3, 2017

Next?

Appraisals are always interesting- but I have mostly actually enjoyed them. Perhaps its been more about who I have done them with. Whatever be the reason, it has always given a reason to reflect, a time to think, a moment to take stock. This year, my appraiser had a fantastic question- at which point - somehow it felt that time stopped momentarily. It was a simple one…"What next?" You would have thought the answer would be simple…surely it was planned? Surely, I had an idea mapped out in my head?

You know the honest answer? I absolutely have no idea. I have rarely had a grand plan- not because I didn't want to but because things have simply happened for me along the way. When my parents sent me to this country, they had one and one ambition for me- something they tried but due to a multitude of reasons didn't quite happen. Times were different, the prism through which folks were judged were different- and I came with a burning ambition to become a Consultant in the NHS. Nothing else mattered- it was a laser like focus. Somehow it was a way of saying thank you to my parents- who sacrificed so much to get me across to a different country. And it happened finally in August 2008. I cant tell you what it meant for my parents- it perhaps chokes me slightly when I think of it- but the pinnacle was achieved.
Post that? Everything has been a bonus. Being Clinical Director of Portsmouth Diabetes team, Super six model, type 1 service…its been fun. And thats what a role tho me is all about- having fun.

Fast forward a few years- and thats been exactly the philosophy - fun. Take it as it goes along, try and focus on a few problems that folks with diabetes go through- and give it a whirl of the dice. Is it a step to something else? Not really. Its been being fortunate enough to be in a position to help others- try a few things, win some battles, concede others- but never failing to have fun. So far, life has been kind to me- met some amazing people along the way, so...whats next? Whatever is around the corner I suppose. I do keep hearing how tough life is as a Consultant- and it can be- no question. I also personally believe it is an opportunity very few people are fortunate enough to have- a spectacular once in a life time opportunity to make a difference to many others. Many dream to get in the position I find myself- and i am certainly going to give it a wholesome try while I am at it. Do I fail? Many many times- made mistakes, made errors of judgement…but thats about being a human being too, I suppose. As fallible as anyone, as prone to errors as anyone else.

Being in the position where I am- just into the 10th year of my Consultant life, its unbelievable where I have got to- mostly by luck, a lot due to being in the right place at right time- and a major part due to colleagues who have always been there…encouraging, supporting, helping. What next? There is no next per se…as ever, the chapter is blank…the book is written as I go along. Its a fascinating journey- they key is to enjoy it as one goes along, learn as best as one can from mistakes- and be humble enough to accept when those who you do this work for, folks living with diabetes, turn around and say "you may have got this wrong". The rest? A smorgasbord of genuine well-wishers, jealousy, politics, personalities….if I am brutally honest.

So I really don't know what's next in my career. Frankly, thats because I never set out to be anything but a Consultant in the NHS. Post that? Its a ride which I am enjoying…some doors will open, some will close…but its pretty much why I try different things like comic books, TED style talks…its just…different..its just…fun. Along the way? If one ends up helping a few folks beyond the day job? Its can't be that bad a thing.

So what's next? I don't know but you are welcome to join me in the ride. I promise you it will always be fun x




Saturday, November 18, 2017

Trial and Error





Do digital interventions in the world of diabetes work? Come to think of it, what defines what digital intervention is? The NHS has a fascinating approach to it all, ultra cautious to technology ( EVIDENCE shouts the detractors in a Len Goodman style) yet utterly oblivious to the clownish approach towards how we deal with governance or indeed evidence issues by sending letters via the Royal Mail. Who knows how much is acted upon, followed up etc.
Our zeal to be evidence focussed comes with a fascinating double edged sword...while entirely appropriate towards new medications..when it comes to technology and digital means, the approach is sloth like, cautious, defensive, suspicious.

Which is why I like the whole idea of disrupting the status quo- and watching the type 2 diabetes prevention digital strategy land has been fascinating to see. A very hard working team has gone through many a rigorous process and finally landed on 5 providers to see what they can achieve. There's a clear commitment to evaluate the results and see what impact it has- not only on usual things like weight, glucose but also, for me, access issues, socioeconomic determinants.
The approach is very simple...in 2017, having a digital platform to complement a face to face programme is about choice, it's about modernising...it's also about saying "I don't know whether it will work- but am happy to road test it and find out". The problem I have with folks who oppose every single thing is that as individuals who pride themselves on their prowess to interpret data, they also quickly succumb to their own confirmation bias. Very few are open enough to say..."do you know what? We are willing to look at this with an open mind". There is indeed the place for assessment of data, independent review before national roll outs...and more importantly business model which makes sense. However tweeting your outrage about something or anything digital from your slick smartphone takes irony to a whole new level, doesn't it?

If you want to know more about the digital type 2 diabetes prevention plan, have a look here. It gives you all the info you need, the process gone through, the areas where this will happen, the follow up plans and what comes next. There is no massive secret plot...just like the allocation of the diabetes transformation funds ( I repeat 42 million £ actually) it's transparent and based on one fundamental principle.."We are trying different things- as the status quo isn't working". As I have said multiple times, the best education programme is the one the patient attends, not the one which feeds on glories of the past. I will be very honest, if I develop any type of diabetes, as things stand with the education courses, I would find it difficult to attend them all. Not because I don't want to, but there is also this thing called life and I would like the system to fit around my busy life, not me fit in with the system. In the modern digital era, if anyone suggests so, it gets the boot and I find another provider who fits my needs. That's the way I do my banking, that's the way I do my shopping or my check in for my flights...why should my health be any different?

So we are here. The Type 2 diabetes prevention digital stream has landed, the Type 2 diabetes one will follow as will the Type 1 diabetes. That is the strategy and we shall find out what it delivers. If the face to face programmes are better, then there's nothing to fear, is there? Time should, in that case, show the digital ones to have failed and we will be the first ones to admit it didn't work. Heck, we should take pride that the NHS is doing something not many are trying- a digital programme nationally with a decent evaluation behind it too. The thing with innovation is exactly that...not everything works...we need to test, adapt, amend and find the one that does work...so we shall try.

The NHS England diabetes team have been clear about its direction:
Strategy and areas of high priority: NHS RightCare Pathway
Money and investment: Nearly 65 million £ into spread of NDPP & improving care
Reducing variation: working with GIRFT team to improve safety etc
Digital strategy: the first one has landed, more to follow
Access to technology: Libre on tariff and national guidance

No doubt we have much more to do - not to mention we have a fair few exciting things in the pipeline- so let's see what the future holds!

The encouraging thing is that we i.e. the NHSE diabetes team spent 2 days at a national conference of diabetes, attended by health care professionals from many quarters- and it was heartening to hear the words of encouragement and overall positivity. Maybe the detractors are just those who love being behind keyboards....to them? My request is bear with us, be patient..I can assure you there's no lack of effort on our part. Feel free to be a constructive critic rather than rage against the machines.

And if you can't, at the very least, don't sit in judgement on those who lives you do not live.You want to have a polite discussion about something you don't agree with? We are very easy to find.



Saturday, November 11, 2017

Keeping Up?

We are certainly in interesting times, aren't we? Technology is coming at us at the rate of knots in the NHS- and the NHS is trying to give it a go of fitting in with it- how successfully -is a debate of a different nature altogether I suppose. The problem is though a traditional "method" has been to block technology based on evidence, governance etc….it appears something has shifted- and thats the attitude of the folks using it- whether it be HCPs or patients.

Take WhatsApp- the puritans will say- don't you dare use it, cos data will be leaked, confidential information will run amok - and Orcs will inherit the earth..or something along those lines. It may be a good line for governance meetings, information commissioners…unfortunately not so for those pesky modern doctors or indeed, patients. In the underground, it rages - rampant. So the suggestion is "But we could create something which will be safe- why not use it?".

Problem? The reaction is.."Naah bruv, am good. I like WhatsApp- thats how we roll- so why don't you see how you can make THAT secure, rather than make me download ANOTHER platform". To most folks outside the NHS bubble of governance, its quite unfathomable that we would want to spend money on more platforms when we have free devices like Skype or WhatsApp. I mean, I can speak to my parents each weekend on Skype- who live in India- for free- but NHS? Shiver me timbers…have you done the Governance Dance yet? And this in spite of the NHS actually using it…oh no Sir, EACH area has to have its OWN governance sign off…cos the N in NHS stands for…well..I don't know…doesn't sound National to me. I paraphrase -but you get my drift.

Lets take now the latest furore of GPatHand…many pros and cons to it- especially valid points made about funding. If you strip away patients, then you need to ensure how you balance the funding…do you increase the "fee" for more complex patients? How does a GP surgery survive etc…and they absolutely must be looked at. But the reaction is -as ever- fascinating. Is it because its done by Babylon- cos all private organisations are the devils spawn? Would we have said hallelujah and about time- if it was done by lets say, the BMA (By the way, why not?)? I don't know the answer to that- but look at twitter- many a folks are saying this works for them too in their busy lives. So what now? This is what is called disruption…or is it modernisation? Do we rail against the concept? Or do we rail against the provider? Or is this the right thing to do because that fits around peoples busy lives in 2017- but without stripping assets?

This is where technology is caught. In the world outside, technology adapts to consumers. In health, we ask consumers to adapt to the system- and we then throw around words like "compliance", "non-attenders" etc. Diabetes is no different- look at education programmes, look at technology- its all about "No- YOU fit in with me"- not.."Ok, lets see what I can do to fit in with the modern world". Education programmes- resistant to change-as thats the way its always been done, thats what got the evidence- so it doesn't matter whether Jo Bloggs can attend or not- its about sticking to what worked in the 80s or 90s. So folks vote with their feet, find their own way- or not- and then we wonder why outcomes are not quite improving. Or indeed the attendance rates.

I have got one super solid tip to many a policy-maker. Try it. Not put it on a powerpoint slide. Not run a hashtag campaign. Its called "Listening to patients". Or as the technology world says "Listening to consumers"- thats how they develop the latest thing we all go "Oh I like THAT" about. Not have a token patient to tick a box on your committee. But actually do it.Technology is no different. If you find time? Look up something in the world of diabetes -something called "We are not waiting". The response from some quarters? Predictably- Governance and evidence. People are not waiting for the future to come to them, they are going and shaping it themselves. The billion dollar qs? Can we keep up? 

Interesting times as I say- but it feels like a moment in time- the NHS -is being prodded into doing things differently. And this one won't come from politicians- but from within the system-as well as the users. Don't block it…much better to enable it. The unfolding of all of this will be fascinating to behold.