Wednesday, April 30, 2014

Sorry Gillian



“It was a wholly avoidable and tragic death of a vulnerable patient admitted to hospital for care but who died because of a lack of it”.. so said Mr Justice Haddon-Cave while pronouncing the verdict on the case of Gillian Astbury. If you don’t know that name by now, then throw away all the leaflets you have collected about “safe patient care”, the courses you have attended learning about the 6 Cs or even joyfully pledging to be part of NHS Change Day. Because if you don’t know that name then all of what you have done are gimmicks and you have learnt nothing.

Gillian Astbury, was a 66 year old lady who dies in 2007 in Mid Staffordshire hospital because of not being given her insulin. She was the lady whose case Francis reviewed and criticised the Health and Safety Executive, whose case finally provoked the HSE to bring criminal prosecution against the Trust- which concluded with the judgement as above associated with a fine of £200,000. I won’t go through the details of what the Francis report said but it cannot get any more damning. To all those who say Mid Staffs was over-reported, I say read this case and then suggest have a humble moment- and then reflect how different it is to Mel Gibson’s drunken rants about the Holocaust.

But you know what’s astonishing? Even today 7 years later, even after the Francis report, these occurrences are regular. Ask any diabetes team inside a hospital; ask patients who are afraid to go to the hospital…reason? Diabetes still continues to be an ignored pathology within hospital trusts. Look at the National Inpatient audit results..and the results are stark. Evidently education will solve all- I can absolutely assure you it doesn’t-sadly.

Most hospitals still run a 5 day service- with patients openly saying their worry about going to hospitals on weekends, we still dither, we still stall. As a specialist, it has made me angry in the past- but reading that news made me pledge never to brook any resistance to what must be done. Is it my role to appease others or to pledge to Gillian’s family that we have learnt and we now will treat patients with diabetes with the respect they deserve? Today, publicly, I choose the latter and lucky to have local Commissioners and Trust senior executives who support this- so no more obstacles, no more meetings, this now must happen. Patients with diabetes don’t choose a 5 day service and neither should we deliver one

Finally a word to all the so called diabetes professional organisations. Sometimes it’s a good thing to simply say sorry, take responsibility for our lack of passion as specialists that we haven’t been able to show the leadership needed to fight the battle for patients with diabetes. I have yet to see a single statement from the specialist diabetes body ABCD, Diabetes UK..in fact anyone acknowledging this horrible error which we must not let happen again, saying something on the day when the judgment was pronounced, something which shows a williingness to learn and make amends.

So you know what? I don’t stand for any organisation but to Gillian’s family- I say sorry. I swear I will do anything within my powers to make sure this doesn’t happen where I work. And if you want to stand in the way of that, stand in the way of what patients need to avoid another Gillian Astbury, then I am afraid your role in whatever capacity in a healthcare setting is defunct.

Lets do what needs to be done, shall we?

Saturday, April 26, 2014

The 3 letters

I travel a lot nowadays...spend a lot of time talking to different healthcare professionals, meeting either face to face or virtually with Commissioners, patients, use social media..or whatever means there is to try and either spread some examples of innovation or sometimes even just to listen...and time and time one thing has always stood out...the still-burning desire or belief that we are different organisations, we all have interests to protect...while for patients that has traditionally mattered little..who cares what badge you hold if you can provide kind, compassionate,timely and appropriate care? When I have been a patient, it hasn't mattered...nor do i think it does for most users of the system.

And that's what is the biggest bug bear of the NHS...multiple organisations, the essence of competition which has pit colleagues against each other, making enemies out of old friends, raising ambitions amongst clinical professionals to "expand their territories".. 


There needs to develop realisation of that amongst all of us, managers take a lot of hammering within the NHS...is it because they are married to the ethos of the employing Trust and their goals- thus creating perceived obstacles in front of the clinician who would like to think of the pathology as a system wide one? A moment to ponder whether those obstacles will melt if we feel our employer body is one- the NHS. 

All managers, clinical or otherwise, who I work with are very well aware of my simple motto...in any Trust organisation you work in...if you are not a clinician- you have one and one role only t- help the clinician deliver the appropriate evidence based clinical pathway as smoothly as possible- not thrown spanners, create curve balls ...if the clinician gets frustrated and walks away- the only one who suffers is the patient..not to forget the creation of a cynical clinician. A clinician has a much longer life span within an organisation, comes with lots of past experience...listen, learn and help...whether you are running Human resources, Information Governance or Operations. This is healthcare which has a paucity of a supply stream...run the clinician ragged...the system fails- and the only job on the line? Not the clinician. Only person to suffer? Not the clinician either. Its that individual for which this "industry" has been built...the patient. 


Personally I have a near legendary reputation/notoriety of being persistent, never backing down- and so far have yet to fail on any business case, any negotiations with management- Trust or Commissioners..some take more time than others but eventually they happen- they always do. If my team who has clinical care at their core believe X needs to happen- and sense checking that with patients confirm this...then X does and will happen. Partha Kar has yet to back down from anything or anyone.
The problem? I am starting to see young exuberant leaders starting to lose their zeal, build the cynicism...leaders who are on the ground- not doing gimmicks on social media- the leaders if we lose then patient care on the ground is certain to suffer. To all non clinicians within the NHS, bear that in mind. Today s hard nosed drive to get to a target is damaging patient care for the future.

Your name tag which proudly demonstrates your organisations name means little...what matters..is the name of the kind soul who is trying their best to be there when needed. There's one sign there that matters- 3 letters- N.H.S. Ever heard the Minnesota branch of Microsoft declaring that they are "Minnesota Microsoft"? No- they are proud to be Microsoft- part of a gig prestigious company...question is why that same pride, ethos doesn't exist within the NHS yet.

That's what the person opposite you will take away along with the thought of being cared for when the need was there. Passionate about the NHS? Want to "save" it? 

Think of the 3 letters on the badge- the rest should fall in place. And if it doesn't, think whether you genuinely believe in patient care.

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?