Saturday, December 28, 2013

2014 beckons...To change or not to?



You pause at landmark birthdays, don't you? Or that's what the world would have you believe. Time for a different Partha, a different focus? Maybe mellowness with age? At 40, stepping into middle age, is it time for shifting gears? As I sit here and reflect over the last few years, the answer to that does become obvious.

So what has time taught me? A Consultant post in 2008 followed by widespread joy and adulation...5 years later, even in my wildest dreams I couldn't have imagined the distance that has been travelled and the experiences gained, the lessons learnt whether it be via social media or in real life...and my personal learning points? As below....

Empathy and evangelism: The NHS has had a major cathartic moment via Mid staffs, Francis report etc and has brought forward a degree of empathy on social media rarely seen before. Evangelism towards this particular trait has been breathtaking...as if the NHS never did empathy before..lots of Consultants, nurses from the past have only held a wry smile. Empathy is something we learn gradually about but you know what..it is damn tiring to do so 24/7. Somewhere in the middle, lots have forgotten that HCPs, as anyone else, are human beings..same foibles, same passion, same problems and for many, families getting sacrificed at the altar is not an option. Does that make them a less empathetic person? No, it  doesn't.

Power and Influence: As one of my good friends recently said, the present currency is not power, but influence. And my observation? Official high ranking posts are now subject to so many rules, regulations and targets that good people end up doing things, getting involved with issues they would never do otherwise. I know so because they are different individuals when they are free from the trappings of such roles.And that's not for me...change can be brought by influence and that is where its at. Some existing targets are simply meaningless but we persist due to political expediency and beyond our control to influence.

Money and practicality: There is a surfeit of folks willing to work differently. At the end, sorry folks, but the money has run out. Yes I know the Clive Peedels and Jackie Davis will tell you how not having transactional costs would save money, how not having the Trident would help the NHS...the reality? Thats beyond the realm of control of folks like us. They are political issues which at the moment don't look like getting resolved. So let me put this bluntly, the system has, as things stand, run out of capacity. So an honest dialogue with patients is where its at..when there isn't a service available, It isn't because the doctors/nurses don't care or the CCGs are evil people just saving money...they simply don't have enough money. Everyone knows it..we just don't know what to do about it any more. Roy Lilley has been talking about it since I first met him..in 2009.

Leaders and credentials: An explosion of leaders seems to have happened..unfortunately not without much credentials. Lots of talk, lots of meetings, lots of lectures, opinions...but dig deep, these leaders have just moved around from one failing project to another. A good speaker and some funky PowerPoint slides does not make a good leader I am afraid...I recall going to a meeting a few years back on 7 day working when a Consultant stood up as a lecturer and passionately said how important it was to provide 7 day senior cover. Problem? I was his house officer once upon a time and his contribution to the wards in those days? At best once a week. 

So you know what? Here's what I will do in 2014....give 110, maybe even 120% at work..but outside that, even if I have 1 extra hour, its for my family..As a friend said...."Because in the end no one ever says they wished they had 1 hour more for work but many wish for hours with those that matter most"

I am very fortunate to be in a position where I am....a Consultant working across an acute trust and 2 community providers, across 80 GP surgeries and its been an education, building bridges, appreciate all the pressures and you know what? There's no course that will teach you that level of mutual respect between primary and specialist care. It gives the chance to build influence and I have some big ideas, presence of some like minded individuals..it could be quite exciting, Who needs national documents when you can forge your own way? 
And finally? Have honest conversations with patients about where things are as regards money but try and work within the system to see what can be done. Example? Patients complained about lack of diabetes input ver weekends, we worked with Commissioners, used existing Best practice tariffs..3 months later..we are there..thanks to all concerned working together. 
I have spent a significant time listening to leaders talking, debating and then as a unit, we went ahead and created a new model of diabetes care. After being involved in 130 odd CCGs so far all looking at fundamentals of our model, we know what we did was the right thing..to take that jump, stop waiting for a national document...sometimes you believe in your team, believe in your vision and take that step.  

So...why change something thats worked? Fight passionately for patients, look after your family and work with like minded colleagues to effect big systematic changes but within the present financial margins. Exciting times ahead locally....and I am positive we can make some fundamental changes...though appreciate at some point, the systems capacity problem will bite. 

So 2014....Partha Kar has no intention of changing at all...mellow down? Pfft..it's time to shift up a gear. Ready or not...this could be interesting. Lets get down to business, shall we? 

Tuesday, December 17, 2013

Game-changer VI: Make it happen

"Do you think you are ready to go home?"....a cursory question on the wards whilst on the quest for early discharges was met with a mumbled "Yes, sure". Something wasn't quite right...a few more questions dug up the once proud police officer now living in a bungalow looking after his bed bound wife, riddled by stroke. This was his fourth admission over the last few months.."just a fall" murmured the elderly gentleman....adding "I am really trying, honest"...as his eyes moistened, at the sharp end of the NHS, all those powerpoint presentations seemed a million miles away..all those evangelical, buzzing leaders who told us that things were getting better seemed all a bit..false.

There had been no lack in this gentleman's care...multiple involvement from multiple professionals of multiple qualifications...just nothing joined up, all working in their silos, trying to meet their organisations targets and satisfaction surveys. Was he happy with their services? Of course he was..but no one had asked him whether society had repaid him, no satisfaction survey with the system.
It hurts me, especially as I am one of those who tries to live in optimism, tries to create a bubble where at least for a bit it seems ok..and then you walk into the daily grind and the bubble evaporates just like one of those recurring dreams of El Dorado.

The system needs boldness, the system needs big decisions..we all know it,we all talk about it..and then we walk away from it. The debate about the NHS always seems to degenerate into an idealogical sparring while honest conversations rest in the background.

So you know what...it's time for the CCGs to step up to the plate..I have met enough to know that these bodies are filled with honest, caring people who want better care..so I suggest go for it, be bold. Commission services which patients need, make providers work together..you have had your time to bed in, be the nice guy..and by now the basics of what healthcare needs should be apparent.If not, go and find out what works where and stop reinventing the wheel. Beg, borrow or steal a pathway, a specification which has or is working, make local tweaks if needed, genuinely involve patients in it and then ask the local,providers to deliver. If they don't want to, ask them to explain to patients why they can't or won't.


Be bold, take the step forward, make all the organisations work together to  what YOU want. An analogy?When you want to build a kitchen, you don't sit and negotiate with a builder why a toilet would be better. If you need a kitchen, then that's exactly what you need....to GP leads..you wanted power? Go on, show us what you are made of. I am sure plenty will wish you Godspeed. At least then that retired policeman, to whom society owe a debt, will go home, safely