Sunday, September 21, 2014

Lest we forget

I am all for innovation and working differently. In fact, the diabetes team where I work is well known for being at the cutting edge of working differently...check the articles, the awards, the feedback from local patients,primary care, CCGs...it is a fact that the diabetes team from Portsmouth are always up for trying new things, new ways of working within the existing financial constraints and envelopes....so the last thing you can accuse  me of being a cynic towards innovation.

But some things are now starting to grate...there's now been a few meetings I have attended, seeing a few twitter chats, a few workshops I have been to...where I think people are now being misled, deliberately or otherwise. How many times have you heard this..."working together is the way ahead"; "collaboration", "value based leadership"...aware of all of them, understand them all...but to indicate that will solve the problems of the NHS is simply put..misleading at best, irresponsible at worst. You create the impression that it's the intransigence of some which is preventing progression of healthcare and money isn't the key factor..when it is THE factor.

As part of my travels, I see projects all around the country, some fantastic ones, which all agree with, including CCGs..but can't move due to lack of start up funds. The are some fabulous 7 day working plans..again..jammed due to lack of start-up funds. For sure, there are inefficiencies in the system..use of technology could be better, interaction could be better...but to say money isn't an issue is blatantly false, It is THE issue...the question is whether any money invested is tied in specifically to transformational work or not. Last time, the cash injection came, it got squandered. The most recent one has been about meeting targets...where's the one needed to transform services?

For all those who speak about working together, if you are in a system when one provider has a profit, do you hand it over to primary care ( where it is needed) or put it into social care budgets or do you make sure your own bottom lines are flush to make yourself look good? If this is one system, surely the budget is also one...one that should be accessible to ALL parts of the system? But it isn't...and that's what grates when I hear folks talk about working together. Working together is not about having group hugs but actually helping each other with finances...got the chutzpah to do that or are we still stuck on eloquent words?  To say 7 day services can be achieved without investment or compromising on elective care is unrealistic and let me repeat myself, promoting to many the view that's it's down to a few HCPs unwilling to work on weekends. I work in Portsmouth Hospitals and on a weekend, at any given point of time, there are, just within Medicine, 8 Consultants on the floor. You want more, you either have to get more or make sure they have time off during the weekday, which compromises the clinic, lists they would otherwise do. Why?Because that person does actually have a life outside his work and may actually like some time off. Do I hear someone say "but weekdays are so much better to have time off"? That's also the time when the kids are at school and the Consultant may actually enjoy seeing his kids...to paraphrase someone...people get ill all the time, you are a father only once for your kids.

So, I ask all such vocal evangelists to maintain some perspective and responsibility.Hinting that if you don't do weekends, you are less patient centred is a desperate attempt to send many on a guilt trip, which is fundamentally wrong.

Let me end giving you 2 perspectives. As a clinical director, we have put in place fundamentally different ways of working in diabetes within acute and community trusts...with my natural sashay of arrogance, let me add that if you haven't heard about that,then suggest you do. We also have 7 day diabetes service in place..something most trusts don't have ( yes, including some of our leaders who talk about patient care being at forefront of everything)... And let me be categorical about this...this has been done by a combination of changing culture, working differently AND INVESTMENT. In case you missed it...the word is INVESTMENT.

As a person and a doctor, let me put this perspective. I love my job, love working in my department,have always done weekends, have a supportive Executive team who "get" diabetes...bar some usual work related politics, I am passionate about improving diabetes care and am most happy seeing patients. I also believe that my patients would hopefully testify to that too.But if I am asked to choose, my family will always, and always come first. If you think that makes me a less caring doctor, then shame on you for making many dedicated doctors and nurses feel that way.
We all have responsibilities as leaders...but however well intentioned, our own evangelistic passion and vision should not consume others in that flame. That would be something we should all bear in mind.

Next week:  Life without the NHS...beyond the scaremongering...

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