Saturday, June 1, 2013

The N word

Boldly emblazoned across all documents we handle within our workplace, flashed across our screens during the Olympics opening ceremony, maybe even one of the top things written in most political parties war rooms. It's the National Health Service...almost a religion for people in the UK, something not to be messed with, something which rouses emotions,fires debates, a symbol of pride for some, a failing beast in desperate need of modernisation ( whisper even the word privatisation softly ) for others..a behemoth where debates about safety becomes polarised into "how dare you touch our NHS" rather than "how can we get it better?"

And yet, the N in that NHS continues to be nothing but a misnomer. Yes, the concept remains the free at the point of delivery...but yet the variations of care simply astounding. And you wonder..if something works well somewhere...what stops it from being adapted somewhere else? For sure, local amendments need to be made...but somehow there seems to be a reluctance to adopt. There seems to be an industry now of folks who specialise in reinventing the wheel...going thro the same pains and tribulations a Trust/ PCT/CCG within even the same county, let alone in another part of the country has gone through. No intention to reach out, learn....get the process moving quicker.

So what is it? Pride? Arrogance? Reluctance to change...or simply if its not come from "my" head, not worth listening to? I attend meetings of peers, not to simply deliver or listen to lectures...but for me, the gold dust moments come in between..talking to them..listening to what they are doing, taking mental notes what I can adapt, what we could do better. I will give you an example..went to a meeting and over lunch started chatting to Dr Chris Walton, a Consultant Diabetologist from Hull. I kid you not when I say he is like Yoda. Calm, measured in his response, always with a smile when I launch yet another "plan"at him. Anyhow, he mentioned that in Hull, they had developed a pathway with their local ambulance trust for patients needing treatment for severe hypoglycaemia. My mind started racing..What a fantastic idea!!! Asked him for his permission to have a look at the pathway, brought it back, sat with our Commissioners, nurse team and ambulance trust, made some local amendments and within 3 months, we were live in action. 5 months in, it has been a fabulous project, ambulance crew happy, patients delighted, front door admissions down...and as a team, we will always be eternally grateful to Dr Walton for sharing his idea. 

 Last year while judging one of the categories in the HSJ Awards, the thought kept on coming in my mind...why on earth do we have such fantastic examples..yet localised in such silos? And it wasn't just diabetes, it was in every single sphere of healthcare, every single specialty within secondary care, innovations within primary care localised, not cascaded.

As ever, I cannot ask the old guard to change..I am too short in the tooth for some. But I can certainly ask my peers and juniors to embrace the idea of an NHS cutting across false boundaries. You want to improve diabetes care...believe it or not, no its not Portsmouth. Its Sheffield for their expertise, Derby for their model of care,St Thomas Hospital, Bournemouth & Poole for their Type 1 service....thats who we aspire to be.Every week, as Clinical Director, I have time set aside to overview all the sub services I run, look at the obvious weak points,try to improve and I can only encourage my peers to do the same. Drill down to the service you run and think what can I do better? Does anyone do it any better? Why can't I email them, phone them, see what they do? Why not visit them? If we all do it, it can only help in cascading good practice, help to lift the overall level of care. 

The N in the NHS will then actually stand for National, rather than, perhaps, notional. Don't be afraid to say the N word...just remember what it stands for.

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