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