Wednesday, April 9, 2014

A timely hug

The last few days have been profoundly interesting...actually scrap that...it's been a bit of a roller coaster. Some events haven't been too surprising, some have helped me understand myself a little bit better and some have helped me appreciate perhaps why putting your head above the parapet is worthwhile.

But lets start with something which has been so uplifting.Last night, I held a tweet-chat on behalf of Our Diabetes and the basic theme was very simple...lets talk about what works as regards diabetes care, what doesn't work regards diabetes care and finally what in the present structures in the NHS needs explaining or changing. I won't bore you with the details but what was really great was the first bit ...what works, what's good about the NHS. Now let me get this straight...I don't belong to the camp where everything in the NHS is wonderful, everyone works hard, faultlessly simply due to love for patients....and neither am I in the camp that it's an unsafe corrupt,money wasting monolith full of selfish, uncaring  people. in fact, its a mixture with the majority share tilted towards the positive side...and in fact, that's what most people believe and understand. Don't be foxed by twitter...which has its substantial share of evangelism...and thankfully are not representative of the huge majority of people who exist outside the niched world of social media.

What I enjoyed was all the good things I heard...the respect and love for DSNs, the myth busting that GPs weren't good, the myth that all good care is done by specialists...no we had a mixture ..we had a simple realisation...it didn't matter what your job title said, it didn't matter where you worked...what did matter whether you were caring, whether you were there when there was a need, whether you listened and whether you saw the patient beyond just a pathology, beyond just a number.
And for me, it was brilliant..a burst of positivity which I absolutely loved. It dovetailed into what needed to change, improve...but with empathy from patients as to why we are struggling to do so, understanding and even suggestions what to do....and it made me appreciate why it's worth doing what I do.For sure, you will have leaders who will work within the system, talk, try and cajole others to change..and yes, I do that too...but every system also needs their system of disrupters, the rabble rousers...as I say to all our juniors....in a system where listening to patients is still mostly a tokenism...there's only champion to fight their corner..that's you as an HCP..and you have many ways to do it. You can either wait for opportunity to knock on the door..or you can create that opportunity yourself..or you can knock that door down yourself.You need all sorts to make a difference.

Which nicely dovetails into some of the other bits which has helped me realise a bit more about myself. With time, I think I am beginning to understand a few simple things...there are few things which will always annoy me, raise my antibody levels...and the choice over the last few years or even suggestion has been to suppress that..as it may hamper my career. I have however realised 2 things..actually, no it doesn't..all it does is pander to others poor behaviour, encourage the development of leaders who just talk without facing genuine challenge..and in turn the system grinds to a halt as we allow such individuals to hog the leadership positions,spend a lot of time doing gimmicks rather than actually making a difference,

So Partha Kar is unlikely to change...last nights tweet chat showed how much work there is to do..and so far,we are known as a progressive diabetes team because of the team we have, the style I bring..the straightforward talking..which seems to go down well with our primary care colleagues and patients. I don't like hypocrisy..especially those who face to face drip sweet nothings and yearn to work with you but then are different behind your back. the problem with that is yes I do make enemies but I also do make many friends as I go along..and somewhere down the line your hypocrisy will get caught out.The rule then in my book is very simple...I am out. A few years back, I would be a coruscating enemy to make..now..call it age, call it maturity...I ain't that..but you will know whe you stand for the rest of my career. Frankly, I would rather spend my energy to make changes rather than work out how to undermine someone else...but no, I won't forget either.

So there you go...this weeks blog offering. A dollop of positivity with an insight into a perhaps older me. I must end by saying a huge thank you to so many patients or carers involved with diabetes who have helped me refocus, given me a boost of optimism which has been a nice little cross roads to get past. I get paid well, the easier option is for me to do my job plan and go home on time every day, nothing more,nothing less. But you know what..that would be being dishonest to the promise I made to myself so many years back...when I finish my career, I will make a difference to diabetes care. I absolutely promise you that...and thank you to so many for momentarily losing sight of that. Sometimes even Batman needs a hug, doesn't he?

Sunday, March 30, 2014

Awards..why do you bother?

"Awards..why do you bother?" I get asked this question a few times ..or at least I used to but it seems to have ceded a bit nowadays. When we started off on our model of care, plenty of  scepticism, plenty of comments about how this was all about spin, showcasing things a bit better...but I suppose 3 years and a bit later, the support and public backing of our CCGs, colleagues across 80 surgeries along with acknowledgement from NHS England etc...there has been a degree of perhaps grudging admiration from the old guard....when you have continuous and daily requests from CCGs across the country, you know we did something perhaps different, something perhaps a bit bold. We created a name for it "The Super Six model"..while in reality, all it was was changing the definition of a specialist, using their role as an educator, providing support for primary care- as and when they needed it, on their terms, not ours. That was all- and for that, as I have always said, I am eternally grateful for colleagues in the department, in primary care and commissioning roles taking that leap of faith, believing that this cocky, long haired, unconventional fellow wasn't trying to make more silos but was fuelled by a genuine desire to get back to those golden days when a GP was a friend with a different skill set, nothing more and nothing less.

Which brings me to the awards. Over the last few years, we have won,as a department a slew of awards...local, national...you name it, we have been there....HSJ, BMJ, QIC, Guardian Awards...some amazing nights with our team..driving down in a limo with the team and enjoying a fabulous night out. So the question is why? Has it just been about the prestige of winning an award? All about showing off? Well, let me let you in a little secret. One of the main reasons for it can be summed up in 1 word....Morale. The NHS has gone through an absolute battering and some of it has perhaps been justified but a few rotten apples don't make the whole barrel bad. And however much your passion to improve care, your drive to get things better..at some point, at some stage, even the best amongst us will wilt..especially when you are told incessantly that your best isn't good enough. As Consultants, don't get me wrong, but we have plenty to fall back on when the going gets tough..for starters, the salary ain't bad, neither is the pension in the future, neither are the opportunities for CEA awards, private work etc...

However, to a nurse or an HCA or an administration person within your department, it really ain't so. Morale is a key element to make things tick..and what awards do, is help recognise that you do indeed do a good job. What recognition on a national level does is show to themselves that the work you do is comparable to the best in the business. I say so as a lead of the department for over 5 years now..morale shoots up in leaps and bounds...you only need to see the beaming smiles to appreciate what the impact can be. Its uplifting, throws some sunshine on the work you do....and the resultant impact of that..a galvanised workforce striving to take things to the next level. The NHS has always believed that excellence is the norm and thus nothing to shout about...unfortunately the flip of that is that when you have detractors are keen to expose the darkness of failures, you must, absolutely must, have the chutzpah, evidence and strength to counter that with the light of successes.

Other bits? Recognition amongst your peers and even the Trust. You get to be recognised and known, as well as respected as a blue riband service- if you don't think that's important, look at trusts or areas where services have been disbanded because there is no evidence of it being "good enough" or "it's need". It's not the most clinical or politically convenient decision to disband a team which attracts kudos for the trust or is feted in the national arena as a pocket of "excellence". All subtle but important bits to recognise if you are trying to improve patient care. You can shout yourself hoarse about patient care- but you can't provide much without the existence of a well staffed or well motivated team- it's as simple as that. Over the last few years, with the blessing of our local CCGs and our trust,we have blossomed and the fact is that we actually do not have a staffing issue. 

Which brings me to the reason as to why for the nest few years, we,as a team, are likely to stay away from awards. Why? Because the purpose of morale, recognition and building a team has been served. With the cocky confidence that has been my trademark, my calling card and my nemesis, after 5 years as Clinical Director of Diabetes...let me unsheathe that sword from the scabbard one more time to say this....if you haven't heard about the work the diabetes team in Portsmouth are doing, then with the greatest respect, you aren't or shouldn't be involved in diabetes care.
Now its time to consolidate, now its time to get down to the business of making diabetes care for patients the best possible. If in spite of all the resources, we can't deliver, then the fault is mine as the spearhead of the department. If as a leader you are ready to pick up the bouquets, build the case for a well stocked workforce then you must be ready to take the brickbats too if you can't deliver- as simple as that. And I have been incredibly enthused by how the nursing staff and colleagues have responded to that...each area is working on doing things differently...the Hypoglycaemia Hotline has been one, the future developments of the adolescent service an exciting area...the renal service plans etc...I have been amazed by the ideas and drive. 

And THAT'S what awards do. You won't probably see the merry band from Portsmouth much at the ceremonies in the next few years...but when the time is right, we will be back. Till then, we have a job to do for our local diabetes populace.

Sunday, March 23, 2014

Blog 100...#whatyoudone

As I sit down to write blog number 100 over a lovely cup of coffee, you go back to that first blog, done while sitting in a cafe on the Champ Elysée...thinking it would just be my personal reflections, a space to vent...and over the years, it has been just that and perhaps a bit more, perhaps even got one person to think and reflect..who knows..perhaps but it has indeed been cathartic if not anything else.

Anyway, today's blog is more about what I have noticed ever since I have been a Consultant, no- let me take it back..ever since I have been a trainee- and I have smiled wryly at times, sometimes shaken my head and walked away, sometimes even made some sarcastic comments in close quarters..nothing more. But today, let me put this in a blog.

The NHS is full of leaders, full of people who love giving talks, love preaching, love exhorting others to work differently- which is a good thing indeed- what's wrong with that, I hear you say? Well nothing much, except that I have a certain allergy to hearing those speak or preach whose own track records are not much to shout about. I have no problem in listening to the enthusiasm of youth who have started early and are keen to sweep you away, inspire you in their wave of enthusiasm to improve patient care (cue the Natalie Silveys of this world) neither do I have any issue in listening to the experience of age attached to the flag of a shining track record and a slew of patient care focussed achievements behind them (cue Don Berwicks of this world)...the problem is the NHS either spend a lot of time blocking the flush of youth or have few of the seocnd group. 
We have plenty of leaders- the very same folks who get recycled, who have been a part and parcel of the system they keep exhorting the rest to change, keep encouraging others to work differently but when you actually try and look at their achievements or what they have done, then it all looks a bit..how shall I put it...sparse. 

Let's look at an example..Medical Modernising Careers- universally feted as revolutionary idea which would transform medical training, now also accepted as a disaster which destroyed many a career. The pioneers of that radical idea? Still around, perhaps a few CEA points richer...still advising about education..the circle of life goes on undeterred. How about our own speciality? Universally now accepted that diabetes care could be better..if you don't like data or don't believe what the National Diabetes Audit says, go to social media and listen to what patients say. Big "national" voices now exhorting us to "move in the community" when I have sat in meetings in years past and listened to them snigger at the "poor care" primary care provides. I still recall the denigration and snide remarks when we set up our model of care...how it would compromise patients...and today you can wryly smile when their own CCGs ask us for opinions, the same power houses laud us for our innovation. Having respect for primary care isn't innovation, folks, its simple courtesy.

You know why I say this now? Because I am tired of every sphere of healthcare being infested with individuals who specialise in lecturing but have no track record to boost. So I have now decided that in every meeting I go, if the speaker/exhorter/leader isn't someone young who is simply trying to infuse you with enthusiasm (always time for that!) then I will ask "tell me what you have achieved for patients".Tell me one thing that the system or patients thank you for...heck since we now have a hashtag for everything, even start something up like #whatyoudone.

And I exhort each one of you, whether you are a patient, a doctor, nurse, manager- anyone who is passionate to improve patient care- to do the same. 
If the person who is asking you to do things differently has never done so before or even left a trail of past failures, you need to ask whether that's someone to follow, whether your own idea, innovation and enterprise is better served by following your own heart and belief. Ask them #whatyoudone. Something, anything outcome based, anything patients liked, felt it improved their care....

In the words of Peter Drucker.."Effective leadership is not about making speeches or being liked; leadership is defined by results not attributes". The NHS, in these times of uncertainty, needs that sort of leader, not ones who are using the tag as a strap line to justify their existence.


Sunday, March 16, 2014

The Rockstar

"How much flak do you take with this Rockstar approach?" As I slowly sipped on a finely brewed ale, I pondered how to answer that. This wasn't just"someone" asking to whom I could throw a glib answer back along the lines of "price to pay for celebrities" accompanied by a sardonic smile..this was a good friend. A friend with whom I had trained, shared beers with on many an evenings, tales to tell from conferences past, someone who knew me well, someone who I inherently respect,admire and intrinsically trust. So had to ponder a bit before answering that question which I have posed myself on some dark evenings as to whether its worth it. Worth putting your head above the parapet..worth the hassle..worth keeping the reputation of being edgy, controversial, dividing opinions...? and if I am honest? It's tiring..very tiring to continue doing it...but there  has always been a reason, a tangible gain to make and a conscious decision taken 5 years ago.The inherent idea being to change the way a diabetes specialist is looked at, to change the paradigm of thinking, attract controversy, be the lightening rod to anything and everything...and 5 years later, you look back and take stock.

Went to India recently and was having a chat with my dad about a few things and he asked me whether it was time now to simply enjoy my job, not take on the responsibility for everything....and as ever, it gave me a moment to think. We now have a good vibrant, well staffed department, amazing colleagues, a model of care which has sparked new ways of thinking, made people engage more, whether it be Commissioners or providers, a good relationship with our Gp colleagues and local Commissioners....it actually is a happy place to be in. Nurses have taken the onus upon themselves to develop new initiatives, trainees rate us as a high quality training centre...a happy ship indeed.Yes some initiatives still wait..7 day service, hopefully awaiting a final sign off soon and psychology support which should happen, fingers crossed, not too far away...but they all have momentum now. Change takes time unfortunately and in a cash strapped NHS? Treacle it is..laced with cement.

The reason to be "out there" has probably been served...I look around and Southampton under Mayank Patel are making huge strides, the West Hampshire team guided by. Kate Fayers et al are showing what can be done. Further out,  Leicester have taken our model one step further...all good news...it feels much more positive, much more vibrant.
Much more needs to be done but hopefully the MacKinnon lecture inspired a few to do things differently, challenge the status quo.

Perhaps the time is right for me to enjoy my own life and my family a bit more. As. A good friend said, give or take,I probably have another 30-35 years left to go..which is only 1500 more weekends or so. I can only do so much to help the system, take on the system but the trick I suppose has always been not to take failure or slow pace of delivery personally?  It's tricky but as I sit on the beach on a sunny day in Southsea and watch my kids run around with our new puppy, the bigger picture takes a bit more shape.  So no more award ceremonies this year, no more applications...it's time to let the team consolidate and be sure enough of their service to apply for awards themselves.

To my friend, Pete Carey who asked that question...the answer is yes. I do take flak..in fact a heck of it..and as much as the external facade either smiles at it or retorts with a cocksure answer, those close to me will know its not easy. In fact on occasions, the image overshadows the individual and allows mistakes to be made..and mistakes and failures hurt. A lot.
Post Diabetes UK  in Liverpool, the feedback from so many has assured me that now the momentum is there and I feel happy, feel more relaxed about the future of diabetes.

The Rockstar will always be there..it however just maybe time to change the chords.

Friday, March 7, 2014

In memory of Mary


I don't get nervous..actually I don't "do" nervous...but after a long time, as I stepped up to the podium for a public lecture, there was the stirring of butterflies in the stomach.Ken Shaw, that doyen of diabetes, the father figure behind the development of the Portsmouth diabetes centre had just introduced me and invited me to commence the Mary MacKinnon memorial lecture..and I took a deep breath..and a pause.Time seemed to stand still for a moment as I stood up on stage and looked at the audience...a packed hall, a lot of friendly faces, our own team, patients I knew...colleagues across the spectrum of healthcare, industry...they were all there...but most poignantly in the audience sat Mary's husband and brother...this wasn't just a lecture, this was the first lecture after she had passed away. Before the lecture started,Ewen MacKinnon had clasped my hand to say "I know you will be good"...and the enormity had sunk in slowly.

This was always going to be a difficult lecture...standing amongst the midst of fellow professionals...being the youngest recipient always runs the risk of reinforcing the label of an upstart, the rebel...so the balance had to be right...challenge but not spill into cockiness, push but not to the extent of pushing people away....and then there was the added bit of Mary's untimely demise which made it all so poignant.

Truth be told,I had really struggled with getting the slides for this lecture done and Ewen's email 2 weeks previous to the lecture had been a huge help..simply because it said.."Challenge as that's what Mary would have wanted you to do...she never believed in silos, she always believed in the strength of a team...be yourself"

So I decided to do just that...probably after a long time, for just that session, I let "Brand Partha" rest..and I approached it as the boy who went to medical school simply because his dad told him he would never get as much satisfaction from changing someone else's life, as I would get from being a doctor. Yes, the physical flashiness persisted ( I won't bore you with the story of the green jumper)...but on that stage, I was..myself. The rest?  Went a bit like a blur...next thing I remember is an applause, a lot of smiling faces..and as I strode off the stage, some kind words started filtering into my ears..."thank you"; "inspired".. A warm hug from Pratik, a squeeze on the shoulder from Mayank, an appreciative nod from Darryl and Iain...lots of handshakes...and they continued even later during the day...some notable ones being from Pete Carey & Karen Adamson (meant a lot guys!)..good friends who had kind words, trainees saying they would try something different, nurses deciding to think differently, GP colleagues appreciating the focus on mutual respect, lots of tweets in the social media stratosphere...all lovely, warm and fuzzy. This whole exercise was an attempt to try and ask others to see things differently, appreciate the power of working together, think differently and what we could do as a community for diabetes care...past the politics, past the old school siloed working, past the belief of self protectionism, past the corrosive cynicism.

But on this day what mattered was only one thing. I walked up to Mary's family....her brother clasped my hand to say thank you....and then I looked at Ewen. A hand on the shoulder...he leant forward..he sounded emotional...and whispered.."Mary would have been proud of that...thank you so much". A small lump in the throat appeared..a quick clenching of jaw to suppress any emotion...I could only smile back...and I knew my job was done. Yes, this was about inspiring, making people think differently...but above all, this was also a tribute to one of the great figures of diabetes care. Diabetes UK, thank you for asking. Hopefully wherever she is, she would have smiled too.

Rest in peace x

Sunday, February 23, 2014

Say it if you mean it

Last night I tweeted out my bemusement at some of the tweets I was reading with regards to NHS Change Day- and it launched an avalanche of tweets with supporters and sceptics joining in equal measures. It even prompted a blog which I read with interest but at the very outset, if anyone wants to know about my views on the NHS Change Day or other such initiatives, read this or this

I will be honest- the reason I decided to make a pledge was simply because of 2 reasons- Firstly, Pollyanna Jones asked me- I know her from work i had done previously with her- and beyond anything, one thing has always shone through...a genuine fierce desire to improve patient care...and in my book, if someone like that asks, thats good enough for me. Secondly, Roy Lilley's blog..again i know Roy and am aware he polarises opinion but I do know that it takes something extraordinary to break that curmudgeonly cynical heart...a few weeks back, he had thrown his weight behind it and I was in. 
The others involved- such as Natalie Silvey or Damian Roland - i don't know much about. Damian mentions some kind words in his blog about me- but believe you me, I am nowhere near "pretty awesome". My ego is huge, am incredibly cocky, in some eyes, maybe proud...but beyond that do try and improve patient care - or at least as best as I can. Yep, that's pretty much me in a nutshell.

Anyhow, to me, NHS Change Day is something where you pledge to do something that is beyond the norm...but then I saw pledges appear such as "pledge to ensure safe care"; "pledge to ensure equality in workplace"...and something deeper sets itself out. The same principle which has also created cynics about campaigns such as 6C or #hellomynameis. Have we got that isolated or even insulated in work, has it all become so unbearable that we now have to pledge to be compassionate, pledge to say "thank you", pledge to "treat each patient as a member of my family"? If that's where the health system has got to and perhaps Francis does allude to that, then thank god we have even got this event to reiterate to folks what they should be doing...in my opinion..naturally. Saying thank you to staff, not tolerating discrimination, not tolerating bullying should be an ingrained aspect of being a human being, leave alone an NHS employee.

As I said, its my opinion- but I suspect the good thing is that it indeed is driven by the grass-roots (though arguably some cynics oppose even that). In between there are some absolutely brilliant pledges...read the ones about a CEO planning to read bedtime stories to the kids or a CEO pledging to visit patients daily- who have no families. Heart warming...outside what they need to do, outside what they are paid to do...a brilliant gesture for which I have nothing but utmost respect.

To the organisers, a bit of cautious optimism around this...don't let this be hijacked by people jumping on the bandwagon with pledges which raise questions "what  have you been doing so long?" And to counter the cynics? Create some outcomes..some tangible benefits...otherwise its just a social movement which looks amazing to the social media world...but in the vast expanse out there? Another name tag to add to the multiple initiatives...don't allow cynicism to build...allow all to see benefits of such a great cause. Ask people to pledge..say it as if the mean it...not be a part of or jump on to the bandwagon...or have old wine repackaged in new bottles. The NHS needs a boost of optimism...we all know it- and for anyone who works with me, will know thats probably consists of majority of my day job...showcasing hope and optimism.

Pollyanna, Damian, Natalie et al? This is YOUR project..let it be yours and I wish you all the best for it too.However let the euphoria be tempered by its eventual outcomes. However, in the words of Sir William Ostler..."The philosophies of one age become the absurdities of the next..and the foolishness of yesterday has become the wisdom of tomorrow". 

Godspeed ladies and gentlemen.

Friday, February 14, 2014

Prism of our own lives


A flicker of annoyance creased my brows.Yes, there was no denying it..as they say, the mirror never lies....there was a little bit more weight around the midriff than I should carry. Didn't like what I was seeing in the mirror and annoyance certainly was the over riding emotion. 
And believe you me,I try my best to ensure I don't put on weight, with good enough cause too. Just crossed 40, family history of diabetes and hypertension, Asian heritage..would tick the box on all counts as a high risk to having problems. But you know what, it's darned hard to make sure the healthy diet and exercise happens on a regular basis...not because I am lazy but mainly because life, work, kids, travelling takes away time from your hands.The health evangelists would tout that as excuses but when most days you leave the house before 7 am to fit everything in and then come back home sometimes around 9 pm, the desire or even energy to exercise somehow seems to be lower down the priority list..I would rather spend the 20 minutes discussing Spider-Man with my son enthusiastically explaining the importance of webs..or trying to tease my daughter about the increasing "noise" from her room which she claims to be music.

And that's reality. And that's life..and in a nutshell why most people find it so difficult...its not that there isn't necessarily the desire but life has a different perspective on it. When the "present" needs sorting, who has time to protect oneself from the ravages of "future"? I have never ever berated or even criticised anyone coming to my clinic , whether type 1 or type 2 diabetes, for inability to lose or even putting on weight....simply because I struggle to do so myself. Recently due to personal ailments, I couldn't exercise...it was frustrating but at least it was temporary...but it certainly put into perspective what pain can do to you and your daily life. 
We all seem to have an amazing ability to preach, amazing innate sense to lecture..but tell you what, behind that desk,its always easy to give a lecture on the importance of healthy food, the relevance of exercise...but after that,we go back to our own lives... don't live the lives of those who go through their daily travails...so an easy way out is always to lecture and then move on to the next patient. if we all knew so much, how come we don't have lithe, toned athletic looking HCPs all over the NHS? I will tell you why...they all have lives and their daily grind where it isn't that simple.

And that is why when I read articles on "how easy it is"...it makes me annoyed. Yes, indeed diet and exercise is all paramount but lets be a bit more realistic about it, shall we? We have issues with food pricing, issues with accessibility, cultural issues....all of which does not help. There is no denying the importance of what a Mediterranean diet provides but don't  make it all sound so simple and more importantly, don't make others feel guilty or bad for not doing something "so simple". Life isn't the same for everyone so using glib terms such as "you should make time for such important interventions" isn't the way ahead.

You want to tackle this..do so properly. We have a long way to go when the biggest event held in the UK over last 10 years- the Olympics- is sponsored by CocaCola and McDonalds...that plastering of their logos make it more acceptable, not less. Food industry is where the battle is..so lets do so properly..and while that's happening, a bit less of the "Oh, Mrs Bloggs, you have put on some weight" followed by a pause.  We must,as healthcare professionals, have a better approach towards the whole weight loss angle..an overarching policy at a public health level, start at schools,,colleges, explain the importance of knowing how to prepare food yourself and perhaps even consider leading the way as regards being fitter individuals. And more importantly, try and appreciate why diet and exercise may not be so easy to do, rather than be judgemental about it. 

Life has a funny way of stacking your priorities.As a healthcare professional, your focus maybe to make Mrs Bloggs use 20 minutes each day for brisk walking and help her reduce her future risk of heart attacks. Her priority maybe to use the only spare 20 minutes in her day to sit with her grandchildren and read them a storybook. 
Lesson to self? Don't judge others by your own life or barometers..we are all different...so are our priorities. A bit more realism, a bit more understanding will probably take us further more than walking ourselves into a state where we view the world only through the prism of our own lives. One can only hope.