Wednesday, December 28, 2016

A Year to remember

2016. 

Year of the Apocalypse if you followed the media. Its difficult to shake that notion admittedly- even past the usual clickbait hyperbole of social media- what with so many stunning events- or perhaps some just didn't fit the narrative of our own. Brexit or the Trump victory- lest we forget made 2016 the high point of some folks lives- whether we individually agreed or not…but it was perhaps undeniable how the world just became a little less tolerant of anything that devoted from our individual perspectives. There were no more good guys or bad guys…this was like an old school western where everyone bore their cross, everyone had their shades of grey.

Personally, the lowest point seemed to be Allepo where driven by politics and a general impotence, the world saw lives shattered and shared their indignation in 140 characters- yet seemed powerless to do anything. We all got numbed by the latest child bleeding- and somehow it all became just another headline…that was perhaps a nadir of 2016..again, perhaps put more into focus than past events such as Darfur due to the white hot gaze of social media and 24 hour news cycles.

But you know what? professionally…its been actually a pretty good year. The NHS continued to  struggle inevitably- but more of that later. To look at the positives, the beginning of the new year brough many together to create a Type 1 care pathway- we are now a whisker away from publishing it- and the seeds were indeed sown that day. Further on, we had the TAD event, we had a comic book published, locally, the 5 year data came out as regards the Super 6 model of care- and of course, the new role of joining the Diabetes team at NHS England. The crowning bit was finally getting the transformation funds to be released- throw in the advanced discussions regards digital initiatives around education, plans in place regards access to technology for Type 1 diabetes, opening up communications regards dietary interventions for Type 2 diabetes….its not been that bad a year. In between the absolute mayhem going on, diabetes- has actually had a good year- and believe me, theres a few more up our sleeve. Keep an eye out for 2017.

But what about the wider NHS? Well- about 18 months ago, I joined an eclectic bunch of folks to develop NHS Survival- its call? A cross party commission to look at NHS funding. Life is all about timing- now we see that idea gather some steam- the billion dollar question has to be- is it a bit late now? Or not? I don't know the answer to that- but I d know this…without social care funding, the system is broke. I love all the energy and drive about process but when nearly all of the country is now failing the 4 hour target, its no longer the process. Its simply the system. In 2017, I see it worsening- and when the system starts judging your effectiveness on how many discharges you can get -rather than quality…we all know, deep in our hearts, its not the process anymore.

What hurt me most? The whole junior doctor saga. What should have been an honest debate about 7 day provision, descended into utter farce as the system locked horns with one of the most dedicated bunch of people working in healthcare. Many health journalists or indeed those with chips on their shoulders regards doctors enjoyed the skirmish- at the end of it all, no one won. We stayed where we were with 7 day services- we just lost a lot of good will in the process. Who repairs that is something we all debate…my view is simple- it has to be those who will continue to be part of the system- they are the senior clinicians. Many move on- we are here to stay- we must nurture our own generation next.

So- to 2017. To those living with diabetes, I promise to keep trying. I will make mistakes, I won't get everything right- but I will try-whether I stay on in this NHSE role- or not. Wider, we are into tough times, big decisions will be forced and life will feel tough, angry, bitter from time to time. Everyone will fight it in their own way- but as a clinician, sometimes its just about doing the best for the person in front of you. Try to keep your wits about you- and maybe, just maybe, realise that there are no black and white characters in this storyboard. We all bear our own crosses.

And thats all we can try to do. I wish you all a beautiful 2017 x

Thursday, December 15, 2016

Gauntlet

We are here…ladies & gentlemen. The diabetes transformation funds- to the tune of £ 40 million. And in the main, its generated good feedback, energy and enthusiasm amongst many- though appreciably its been laced with a dash of misinformation, a slice of cynicism and a generous portion of cautiousness. To be honest, I don't mind any of that- and frankly, would be odd if there wasn't. We live in austere times- times when -depending on where you work- coming to work is a struggle. Constructive criticism of plans is always welcome and indeed should be. To beat the era of post-truth, we need healthy debate- and whatever strategy the diabetes team in NHS England has come up with- we are open to listening-as long as it doesn't descend into a swirl of simple negativity or even abuse.

So to where we are- 4 strands for money- each with a very singular focus:

Strand 1- about improving safety within hospitals- enough evidence to suggest too many errors - causing harm- we must try to change that. Enough talking, enough data collection, its now about the intervention. If YOU as a CCG feel you need to improve this, here's your chance
Strand 2 - about improving amputation rates.
Strand 3 - about improving structured education- Type 1 and Type 2
Strand 4- improving variation- this, to me, is a key area. What ideas do YOU have to improve this? is it about better access to specialists? Is it about different model of care? Is it about the right medications? Is it about the IT system or is it about the education? If you think the X needs investment, here is your opportunity!
Many talk about "evidence-base"- well, look at the National Diabetes Audit- and then let me know if investment in these areas lack the evidence, or not.

Now to the flip side- lets be honest- will this solve the problems? Not by a million miles- but can it help kickstart some stagnant processes? Absolutely. However, this should not mean such initiatives need to be greeted with negativity- as said before, constructive criticism is fundamentally different from the all corrosive negativity.

Here are some quick answers to the naysayers:

"Only 40 million?" - Well, I agree- it would be fab to have more- but in an environment when many, many other areas could do with even a fraction of that? Its a definite positive. We dance around junior doctors & "timely discharge summaries" when in our heart of hearts, we know, without social funding, its tinkering at its finest.

"Not enough time to fill out form" - Yes, its a tight timeline but at the same time, they also do focus the mine perhaps. If your CCG is swamped, then as a specialists or a GP lead, help them out. Also, you would have thought some plans would already be there- surely, if diabetes care is not good where you are, there are some plans which were simply waiting for an "investment"?

"Will we get the money?" - a critical question- and we would like to keep a close eye on this too. This money is NOT to fill out a CCG bottomline- categorically-its to improve diabetes care. More to come on that one!

"Its over 2 years, right?" - No-its 40 million- each year- check the Operating Framework Guidance. If  CCG say otherwise, we are happy to clarify

"What's the point?" - What shall I say? If you are someone who believes in improving diabetes care, then that question should not emerge. If you are someone in a position to improve it- and have that question, perhaps step down and ask someone who has the belief…there's always the point- its always worth the try.

Finally, to all- its a bidding process- so not everyone will get the money- and yes, there is the risk, some areas will be better than others.

To all commissioners, if not sure, ask your local teams, ask patients, come with plans to stand the best chance. To 1 care, it may not be anything to you in the bigger scale, but it could be too- without you involved, no model of care works- help your CCGs out if you can.

And specialists- this is where you have to pick up the gauntlet. THIS is why we do what we do- we are supposed to be the folks speaking for the patients we look after…step up to the plate, ladies & gentlemen- for this particular crossroad, forget the differences with your CCGs, the battles- and go try to see if you can help. Standing back helps no one, If we want to use this money well, we must- and I insist, we must, lead on this one.

Any questions, ask. But tips n the meanwhile? Be innovative, think broad, think across "Trusts", find allies- and I wish you all the best for the process. The bids will have to come via the STPs- but the CCGs will be the ones to help form them. Think broad, could it be the Trusts? Could it be the "Alliances"? Could they- hold on to my horses- work together to bid?

There are a few other things we have hopefully coming across in 2017 from the digital side of things…in the interim?  Will everything work? No. Nothing does. But is there enough to change where things stand at the moment regards diabetes care? Yes-absolutely

I have heard one thing continuously…"if only diabetes care had some money"….? I will give you my hypothesis...money alone will solve nothing. It will be the will to work together...and the money undoubtedly helps to kickstart the process. Diabetes- for ever- have asked for some transformation funds. We have now got the opportunity...go on...pick up that gauntlet.

Lets give this a go.




Sunday, December 11, 2016

Failure


"Love the comic book for Type 1 diabetes…very inspiring. Plus the Super six model…great news on that too"- she said.
The ego felt a tad more inflated. "Thank you-nothing special- anyone can do that"- I said with a grin and a tinge of early morning self-grandiose false modesty. "But…" her voice trailed off…"but its pretty impossible for anyone, isn't it? Look at what you have done..you never fail..pretty special- but don't think that's for anyone"

A bit more small talk- and she walked away from the corridor conversation. A junior doctor on the wards- full of beans, full of ideology….but those words made me think.
"You never fail"
Really? Me? Never fail? As I look back, the career has been laced with failures- perhaps we as leaders never talk about them. Perhaps we just are to afraid to fail, too shy to admit defeat. It certainly made me think…is that a self created perception? The "hero" who never fails? The one with the Midas touch?

So todays blog is about failures- or at least a few of them- and I will try to be as honest as possible…why? Because each one of them hurt, And it hurt a lot.

Lets rewind back to 2002. Had finished a Locum post in Bournemouth, and reasonably confident in getting a training number in the Wessex region. Along with me were 2 other locums that day. I interviewed well- or so I thought. No dice. Everyone got a post- except me. Effectively I was the worst. 2 posts- 3 candidates. Didn't get it. And boy.. it hurt. That was a proper crossroad of my career…a whisker away from giving up diabetes as a career- even filled in a radiology application. Haunted by comments about "perhaps you should go back to the Midlands"- I was close to even considering packing my bags and going back to India. But then I met Iain Cranston- my first foray into Portsmouth..the rest? History.

A quick jump forward to 2005. A research post in a prestigious institution. Knew the ones who interviewed me, had worked there. 2 applicants-1 post. No dice again. That stung too- feedback suggested I didn't have enough leadership skills. Again, Portsmouth came to the rescue…a research post, 3 years later, an MD….failure had just simply opened up another door.

A few years later…riding high on a crest. Youngest CD in hospital. New model of care in place. Surely a shoo-in for the Chief of Medicine job? Blogs were written in hope- and then about the subsequent drop from the dizzy heights of success. Look it up- you will see the hope- and then the crash.
That taught me a lot of things- the power of politics, who your friends were, how dynamics worked…it also taught me that you never take anything for granted. That also opened up the subsequent chances of working with a CCG, working as a clinical manager with a community provider- and of course, now the national role. Unlikely I would have been able to do any of those. One failure? Doors to other arenas

I could go on and on. The grant application rejections, the rejection by Diabetes UK as regards their Professional Council, failing in a Discharge Co-ordinator role -getting sucked into a mesh of politics….career is littered with them. To those who read my blogs, I absolutely will not ask you to take away that my career has been laced only with success- on the contrary- the lows have been more than the highs.

So there you go. People remember your success. they remember the good times, the awards, the accolades…people see the Super Six model of care success, they did not see the sense of insult, rage, burning of soul when in public a manager asks you to leave a room as you tried to force the issue of patient safety & 7 day services in diabetes care.  Its the totality which makes you who you are.

So to anyone who reads this?

My name is Partha Kar. I am one of the pioneers of the Super six Model, I am an innovator who is part of many successful initiatives. I also have failed many many times. I am also never ashamed of them. The key lies in learning from them- and trying again. See what other opportunities open. Don't be afraid to fail- its only part of a fantastic journey.

Thats what makes it all worthwhile. And anytime you feel down about failing? Come and have a chat- I have been an old hand at failing.


Tuesday, December 6, 2016

Thank you Bracknell

I must say I have really enjoyed the varied directions my career has taken over the years. Tried my hand at a fair few things- some have worked, some haven't- but all, bar none, have been an amazing learning curve..learning about politics, the different rules/regulations, the twists & turns- as well as understanding the issues from different perspectives.

None of them have been fryitless- whether engaging with the CQC, being on the General Advisory Council of the Kings Fund...but it was with a particular interest, about 18 months ago, I had taken up the offer of becming the secondary care advisor to Bracknell & AAscott CCG. One primary reason was to understand why CCGs couldn't or wouldn't do X, Y or Z. Was it just filled with nefarious folks who wanted people to suffer, didnt understand what pressures the system was going through- or just folks doing a tough job with multiple constraints of finance & politics hampering them?

And you know what? Its been an absolute blast- perhaps I haven't been able to contribute as much as I would have liked- but its been such a rich, fantastic learning experience. A particualr thank you to Karen Maskell for asking me to join- and I must say its been worth it- the richness of experience gained completed the whole set of working for an acute provider, community provider as well as a CCG. I met some amazing people on the board- folks who were passionate, committed and tried darned hard to make a difference to the local people. I sat and observed the passion, the drive as well as the calming influence of few- all driven by a measure to improve things.
Whether it be Jackie, Sarah, Martin, Sally, Lynn,Nigel or indeed the amazingly baritoned William Tong...it has been nothing short of a learning experience and a privilege to know you all.

So- a thank you to all on the board- and finally its time for me to move on. Present commitments dont allow me to carry on- and its right someone else gets the opporuntiy to help the CCG - someone with more time than me. Its been a joy and I wish you all the best for the future- with no doubt that in you all, the local populace have good people at the helm. To the many who havent had the benefit of working in or with a CCG, try it- or at the least, try to get to know the folks doing the job. Views such as GPs on the board don't care or finance guys are all about the money...those myths will clear very sharpish. On the contrary, I suspect we must thank them for having the gumption to step up to the plate and try in very challenging times.

Thank you folks- its been a blast x

Sunday, November 27, 2016

Heart of hearts

I don't know how many of you do ward rounds but I swear you should. Just for the heck of it. Just to experience what Bill Murray went through in Ground Hog Day. Beyond my niched world of diabetes, I do what is colloquially called "Unselected work". In simple definition, its known as seeing anyone who comes to the ward- none of the "No Sir, its not quite the level of heart failure needing Cardiology opinion"..nor the "Ooh, old but not quite old-as it doesn't fit the latest criteria". Nope- anyone- heck, even the fractures. I jest of course but you get the drift..its all a world of specialism while we dance around on egg shells trying to fit round pegs into square holes.

Then there is the fascination of this ethereal thing called 4 hour target. How in the blinking blue hell is a target for which the acute Trust only is liable when the problem is with the system of ANY use…beats me- but hey, what would I know? Evidently its a marker of system pressure- well if thats the case, then open the newspapers- plenty of indicators there- don't need a target to drive everyone up the wall when no one in their right mind actually believes this is achievable without adequate social care.

When discharge targets and achievements take precedence over all else, the world of healthcare has taken a turn into another arena where teaching, healing, pastoral roles- are all footnotes of history. An assumption that professionals keep patients back on hospital beds, or refer them just for the lark drives us into unknown realms of mutual mistrust and finger pointing. The facts never bear out- its all about anecdotes, its all about that stray incident. Sensible plans would be to focus on the biggest area which could unblock the log jam (yet to understand why everything in hospital is so focussed on toilet analogies!) but nope, its about the small things. Someone obviously took the tagline of ASDA a bit too seriously (Every little bit helps)..the amount of time we theorise what quicker discharge summaries would do…and we wonder why our junior doctor colleagues wonder what exactly their role is on ward rounds anymore.

I said this about 3 years ago- and I will say this again. The 4 hour target is irreparable- its no longer about the process-its now about capacity. We can spend as much time as we wish blaming each other (ah if only we all did GIM / ah if only we had more radiology scans / ah if only patients didn't turn up) they are all- bar none- tinkering with the small margins. Every little bit helps- but when you are rejoicing at scoring one, but already eight down, even the most optimistic Liverpool supporters from Istanbul will tell you- there is a limit to ones dreams. At some point, they roll into fantasy.

In the middle of all this, I admire the dedication of all those who do this day in, day out- whether they be nurses, physios or there "flow"-managers…I have no idea how you do it- and keep sanity. What I would ask however is perhaps all to realise that there really isn't anyone who's working less than you. When a radiologist says 'don't send unnecessary requests"- I can promise you- I don't. I do so when its needed. I don't get paid more for an extra scan, neither do I like to irradiate people just because I like the Incredible Hulk storyline.

The system needs to understand mutual shots do so little- and if you haven't done someone else's job, you really have absolutely no right to criticise another, Junior doctors do jobs nowadays I would simply hate to do- ticking boxes has never been my thing, you see. 

By all means, rail against the system, rail against the lack of social care which is buckling hospitals, the lack of community beds, the lack of adequate primary care provision….but go easy on each other. The 4 hour target is a relic from an age- which doesn't exist anymore. Maybe its time for one across the system- I don't know what it is- but this much I do know, without social care funding, the emergency stream is all about how pretty you can make your powerpoint slides. 

In your heart of hearts, you know that too. Don't you? 



Sunday, November 20, 2016

Post-Truth

Post truth. That's the word nowadays. The Oxford dictionary has said so- and we are where we are. 

Defined by the dictionary as an adjective “relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief”- in other words, simply put "all bets are off". The days of evidence, the days of rational debate lies in tatters- its now about emotions, its about beliefs, its about "taking sides", its about "with us or against us"….the divides are sharp, the discussions are bruising and nothing, simply nothing is any more "unacceptable". In a notable diversion from usual business, both sides of the Atlantic chose the same word this time- the world of "post-truth"

In a world fed up by establishment let-downs, the sheer impact of political correctness, we have the rise of the personalities, the world of the outrageous…the signs were there- when Z-grade "celebrities" were feted by the media compared to genuine artistes…who needs a Dylan when you have a Kardashian…we now have moved to the full blown culture of outrageousness- where its politically correct or a liberal to say "sexism or racism is not acceptable"…the cult of publicity hungry figures- the utterances of Katie Hopkins & Piers Morgan occupies more time than Aleppo. We are numbed to brutalities, numbed to yet another dead child…we are more fascinated by what Trump will tweet next. The US elections played out like Brexit 2.0 - a fixed social media bubble that the "righteous" would win, while millions just got tired and fed up of the rhetoric and just wanted "change"- however outrageous it may be. 

Where in this world does the ethos of an NHS exactly sit anymore? The belief of everyone having care based on need, little else- the fantasy of liberal elements or the sign of a "modern" society? Or it is the definition of "modern" that has now changed forever? The NHS or its future seems to be playing out in a similar manner- a camp who predicts doom at all turns, pictures of people dying in the streets, professionals scrapping for day to day living, the only thing that would impact change being money, NHS England are the dark side..…countered by a world where its simply about working together, working differently, irked by the folks who scream blue murder at the mention of any changes, exhorting the erst to do more when theres little left in the tank. The divisions are sharp, the politics is dark- and many many folks watch this unfold with a depending sense of macabre predictability 

Having said that, there are always rays of hope…hope that out of all of this, something, maybe something will come out. As part of this blog, I wanted to mention 2 recent meetings I have had with my NHSE hat on- which gives me hope…hope that perhaps -somewhere along the sharp lines of divide, exists some hope. 
The first one has been the BMA and GP colleagues- a refreshing view to whats possible on many issues and the second one the junior doctors organisation in diabetes, the YDEF. I won't go into details but I have been touched, humbled and delighted to see the approach- built on one fundamental bit- to improve care for folks with diabetes. And to me, thats good enough.

We live in odd times but I have been, am and always will be an eternal optimist- and I believe in the basic essence of humanity to do good. So far, in my role, I have come across so many willing to try- that just maybe, in the post truth era, we may have a chance. 

Who knows- but when you ask a group of junior doctors to design a pathway for Type 1 diabetes- and they start with making the patient needs the primary aim…there's hope. 

Theres always hope. And till that is there, its always worth a try.Don't try and convince me otherwise- and please, don't dissuade anyone else from trying either.


Saturday, November 12, 2016

"Super 6 Diabetes": 5 years on



Outcomes…at the end of the day, thats what it must be all about. Has to be. Everything else in a healthcare setting is worth little, little more than waffle, colourful powerpoint slides, clever words, analogies- but sadly little else. Even the words of empowerment & empathy- words derided by some - is driven towards outcomes- whether they be happier patients or staff- they all lead to one thing- better outcomes. What exactly are we doing this job for?

I am yet to meet a single diabetes specialist who went to medical school to improve an HbA1c- and in a way, quite rightly, that same question is being raised, louder by the day- as to the medications and the outcomes. its never been about surrogate markers- but always about outcomes.
So to the Super Six diabetes model- and it is with significant pride we looked at and finally have published the 5 year data. Is it the ultimate model of care- not by a far stretch of imagination- and to be fair, we are in discussions about adapting to changing times, adapting to new structures…but the principle? Sound as much today as it was all those years.

The model was always very simple. Specialists use the hospitals for high end stuff- and the rest to be managed in primary care- but with one little tweak- be there in primary care too- visiting surgeries, physically seeing patients with GPs/Practice Nurses- as well us being accessible via phone/email etc
It cut across 80 odd GP surgeries; 3 provider Trusts, 1 ambulance service - and it held its own- bound by a very core strategy- the SAME group of specialists working in BOTH community & acute settings. It is my steadfast belief that the term "Community Diabetologist" is nothing but a tautology. The community has a hospital as PART of it- the hospital is not a separate entity and back in 2009/2010 when the word Vanguards and STPs did not exist- we ventured forward and tried to fuse all of primary and secondary care together.

Problems? Of course many- a lack of a unified IT, variation in degree of enthusiasm amongst primary care, community & acute providers with different financial drivers and targets to attain ("How many phone calls did you receive" - rather than "How many hypo admissions have we prevented") but then again, no one said it wouldn't be a challenge- and I love a challenge- so here we are.

I won't say more about the details of the results (have left relevant  links at the end of the blog) but this is more about being very grateful to so many who have taken this so far. I have never trained to be a leader, never declared myself as one either- and a leader is only as good as those standing next to him or her. Without my colleagues -whether they be in the department- or in GP surgeries- nothing would have happened. Why is integrated care so difficult- because its tough to get a collective view together cutting across so many providers- by effort, default, and a significant help of luck- we got there- and 5 years later, its been worth it

Whatever be the next versions- the model of care will change now- but 5 years of working differently has been really helpful-both for education as well as building relations with primary care. How DO you improve diabetes care- if you don't stand by; help; support and build relations with colleagues who look after 90-95% of those you purport to look after?

Today, it is with a lot of pride we see similar models coming up, being discussed and indeed versions being created. We,as a team, never had any monopoly on this- so if you want to know mores ever, just ask. 
And to so many across the South East Hampshire & Portsmouth area- Consultants; GPs, Nurses, Managers, Commissioners- thank you- its been worth every single moment.

To others reading it, my tip? Keep trying. Failure is normal- try again. And then try some more. Persist and keep focus. Build a team around you. And keep trying. Keep focus- keep at it and judge your efforts on outcomes. 
As the saying goes…"If Plan A doesn't work, there are 25 other alphabets. Stay cool"

Special thank you to:
  • Sarah Malcolm, Melissa Way, Lyn Darby(Commissioners/Managers)
  • Gwen Hall, Jane Egerton, Debbie Fishwick, Sarah Moutter, Ali Tier (Nurse specialists)
  • Jim Hogan, Paul Howden, Andy Douglas, Barbara Rushton (GPs)
  • Sue Harriman, Katriona Percy,Ursula Ward (CEOs)
  • Simon Holmes (Medical Director,Portsmouth Hospitals)
  • Bruce Keogh
  • And of course- the super-duper awesome legends /colleagues I work with everyday in Pompey
x


To read about the 5 year data:


To read more about Super Six Model of Diabetes Care: 

Sunday, November 6, 2016

Standards

It's a very weird world we live in... I suppose the whole Brexit thing and the bit about "not caring for expert opinions" perhaps should come as no surprise. I have always been fascinated by the NHS culture of how it looks at healthcare and who would be the most appropriate person to care for someone. It's a mind boggling cocktail…...fuelled by the issues of affordability, the system has always turned to someone else to provide that care. The views become starkly divided into "cheaper labour- how dare they" and "disrespect towards others profession...the sheer arrogance of elitists"...and all sensible debate stops.

Let's take the example of where we are at. A big issue is one of variation of care...how do you propose to improve that if everyone and anyone can have a go at it? I will stick to diabetes- if only to stop the barbs of "what do YOU know"...but it's simply amazing- at all levels. Consultants delivering pump services without formalised training; 1 care delivering high level diabetes care without a standard to aim against, nurses delivering care without any standard way of measuring quality...where does one stop? Is it all about money and do we deliver good care or service to the patient when we ourselves have no national set standards as to what "training" or "good" is?  I recently went to a meeting where a nurse specialist was clear that the care of the pump patients could be handled by a GP. How? Why? Is it because it's seen as simple? Or is it because we have no standards to say "No, X or Y shouldn't do this because they haven't trained?"

Or is it because we take a cavalier attitude to long-term conditions? Maybe the impact of that is not immediate, too long term for any of us to worry about it- compared to say the ability to put a cardiac catheter in? I don't know...this is me mulling loudly...but the more I do my national role, the more I am amazed at what is seen as acceptable. Why would you see something as acceptable, which you wouldn’t find the same if it, was your own family…or even yourself?

Empathy/Caring is a fundamental part of healthcare..but so is knowledge. There cannot be a system where any attempt to suggest the most appropriate person to deliver healthcare is seen as arrogance or protection of a profession. There cannot be any shame in saying "I can deliver X or Y better than anyone else- as I trained to a nationally set standard - on the taxpayers money". The world of health loses relevance when knowledge isn't a fundamental part of clinical care. In the midst of that, we somehow lose sight of that group of people who maybe, just maybe, may know more about the subject than us, if you haven't trained and feel like having a go, then at the minimal, listen to those who live with it.

Something needs to give. I can only speak for diabetes..and in the world of diabetes, the way to tackle variation does hinge on some basic facts and tenets of knowledge too, some standards of deliver, some standards of knowledge. If diabetes care was so easy, then we would have cracked the conundrum by now...getting everyone to have a crack at it doesn't work. Look at the results, look at the outcomes...we have much to do. Does training involve issues such as carbohydrates etc a any level regards Type 2 diabetes? Does it involve interpretation of blood glucose profiling for Type 1 diabetes? I am sorry to say..it doesn’t. Not as a standard that all must have.

So maybe the conversation needs to happen as to what a trained professional is, what the levels of knowledge should be, what a nurse should be doing or undergoing training to deliver care, what a Consultant or team delivering Type 1care should have in their repertoire...Tough? Maybe. But if you want to tackle variation, then it has to be linked with education, clear standards and maybe even part of that education delivered by those who live with it.

It's the 21st century. The plane analogy bores me nowadays when we can't even get basic standards in place. Let me make this clear….in that industry, a baggage handler is a critical part of the whole operation, a fundamental part of the whole travel experience. But whatever be the crisis or situation, under no circumstances would they be asked to fly a plane.


We have much to travel in diabetes care…technology is fantastic and we live in amazing times but so is the need for basic standards- at all levels. If we accept any else, then we compromise for the sake of money, ego, worry about hurting others feelings- but the only folks who suffer are the ones who we are supposed to be looking after. Take a moment….and think about that.

Sunday, October 23, 2016

Not for all

Leadership. Ethereal. Magical. Inspiring. Sexy. Disdain. Mockery. So many terms can be used to it- and I have always watched all the debate with a relative amount of mirth. I am pretty clear on this one- I have not done any leadership courses, got any badges, certificates..am instinctive by nature- and the best teacher has perhaps been time. And studying careers of sportsmen, their leadership styles- but most importantly having decided early on to surround myself with folks whose judgement you trust- without batting an eyelid.

So what is it that ails the ethos of leadership? Leadership quangos abound, courses drip feed into your email boxes, conferences spring out of nowhere-and yet..every analysis of the NHS tells you one story- "lack of leadership"…why is that? Is it because we don't have the right type, is it because we don't have enough do-ers or is it because its nowa term which is abused as a career opportunity? Or is it simply a mixture of all three? Throw in the climate of fear we live in…the urge for our leaders to be perfect, the public flailing from an army of arm chair critics- and is it is also a factor pushing the best talent away?

My personal observation has been all of those have contributed to it- and I have always held the belief that leadership isn't for everyone. It isn't. You can couch it in any way you want, drape it in sophisticated language- but it simply isn't for everyone. The need to do so is also driven by the fact that the system in its drive to get more leaders went to the other end f the pendulum and made being a follower…unsexy and unattractive. Let me make it very clear- it isn't. Any leader worth their salt is only as good as those who follow him/her- following isn't unsexy, following is an integral part of the trust you have in your leader, an integral part of making the whole thing work…an integral part of delivering care, an integral part of delivering outcomes.

Throw in then the leadership buzz of "Moving on" or indeed " bringing everyone together". Look at history- and look again- who do you want to pick? Gandhi? Kennedy? Alex Ferguson? Obama?  Lincoln? And then think whether their success was in spending years and years in trying to get everyone together- or was it after a point where they had a critical mass of believers and enacted their vision? Leadership isn't easy- its not for everyone.

The belief that leadership involves compromise is true indeed- but to an extent. In many cases, in a healthcare environment, in many cases, compromise means compromising the position of only one group of people…patients. When you build a risk register for example and compromise on your time line to make a "Red" to a "Green"- you only compromise the patient- no one else. YOU-as a leader- still take your salary home. The patient whose care has been graded as a "Red" is still suffering- think of that.

So we need to have a think about this- who or what is a leader? And debate it properly? In all spheres of life, a leader is determined by your outcome and accountability. A fact which somehow doesn't work in the NHS- or rarely does. Why is that? Is it to encourage anyone to have a go because of the title or is it because we aren't brave enough and lost our focus in the world of leadership quango?

So- leadership…No- its not for all- and lets stop insisting it is- we do disservice to the individuals we are going false belief to-and most importantly to patients- who suffer from leaders who don't have the requisite skills. Leadership is tough- leadership is about having a tough skin- sometimes its a very lonely place, a tough place- a place beyond the glitzy award ceremonies- and thats where  you earn your corn. So if you want to be one- stand up to be counted, judge yourself on outcomes and be ready to put your hand up when you get it wrong.

Leadership isn't for all. Sorry to disappoint- but then again…following is pretty cool too.


Monday, October 17, 2016

Start somewhere



Everything begins somewhere. Somewhere with an idea. So it was..me and Mayank Patel- trainees together, friends for long, comic book affectionados...the conversation one day turned towards fusing that idea with the work we both do. Now for those of you don't know Mayank, picture an anti-Partha and you have it. Think of the brashness, the arrogance that drips from me...reverse that, mix it with an endearing smile, a zen like sense of calmness and you have Dr Mayank Patel.

So it was an idea...and the game was afoot. Thanks to the connections of life and mostly due to Neil Black in far away Londonderry, the chance arose to meet yet another young chap called Danny McLoughlin..a bundle of infectious energy with a scorching talent for drawing (if you haven't read his comic book on cancer...you have missed out )....the game was now definitely afoot. Then came the quick fire round of use of Twitter to find a few folks with Type 1 diabetes who shared the passion for comics...and up stepped Jen, Laura, Joe and Andy.

The rest? Time flew by..and the awesome foursome worked with Danny...we kept our involvement to a minimum ...I don't have type 1 diabetes, how indeed does one form a story about that? But when the final product did come along, the sense has been one of joy, happiness and sheer sense of achievement. I love what the comic book has come to be and thank you to so many on behalf of Mayank and I for all the kind words and suggestions...indeed we have been most touched. Most importantly has been the priceless feedback from patients and their carers...if even one person benefits from it, the job is indeed done.

Where next? Well, there indeed is no limit if we want to take it further. A song based on the comic? Virtual reality use to use the comic as an educational tool? (Would YOU as a HCP want to know how it feels to be in hospital and miss your insulin? Would a patient want to understand the impact of alcohol on blood sugars?) , translate the comic into other languages? Perhaps even take the comic in a different direction...use another character in the comic to show another aspect....who knows...maybe.

All said and done, it's been an enthral ling experience. To many who feel innovation doesn't move fast enough, all I can say? Stick to it..it does..we did a TED style event, we have done a comic book..all based on ideas and the sheer belief that we will indeed finish it. Keep at it- and don't keep waiting for permission. If you believe it will help patients, the only permission you need is that of the patients. The system will bend to your will- it always has in my experience. Whether it be our Super Six Diabetes model or any initiative that we have believed will help, the system will bend to passion, drive and a united team effort. Go do it.

Finally,a footnote. Along with the appreciations, there have also been a few barbs about whether the comic book is a profit making exercise. If you must know, none of the patients charged a dime...they did so voluntarily. We did pay Danny and his company for the work- and that money came partly from the charitable funds of Portsmouth Hospitals NHS Trust & University Hospitals Southampton NHS Foundation Trust. The rest, Mayank and I paid from our own pockets. Normally I wouldn't have mentioned it, but the pettiness, albeit not surprising in today's world, makes me do so- and hopefully sets the record straight. I have moved to a zero tolerance of twattery but it's important patients & carers knows the facts too. It is a free resource for anyone to use- as simple as that.

So, thank you to all- and thank you to many others for helping to spread the word. Read it, pass it on and keep suggestions coming as to what you may want for the sequel! Till then, beyond the comic book, have faith, fix your aim, check with the patients who you want to help...and go forth and have fun. For those with Type 1 diabetes? Rest assured, there's more fun stuff to come.

Wednesday, October 5, 2016

Say something

It burns. It absolutely sears a mark in you- and if you haven't experienced it, you will never ever understand it. Doesn't matter how many equality and diversity courses you do, you just won't get it. Many emotions boil within and how one reacts to it does perhaps depend on your personality- whether you deal with it by leaving, or by sarcasm, simply shutting up or even lashing out. But it burns nonetheless. Comments about being a foreigner, someone who doesn't belong, someone who is prejudiced based on your skin colour, your accent….it burns.

This country has been good to me- many a times I have been asked this question- if there was racism, would you have got to where you are? Perhaps wrapped in overtly simplistic way of looking at life, the answer is perhaps not. The fact however is that racism has always been there..comments from a Consultant whilst looking for a training job (We don't have jobs for folks like you in the South)- they have rankled- but it perhaps just made one more determined to get a job down south- and make your mark. And Britain by and large has always been a tolerant country- nothing warms your heart than going to London- yes, there is that degree of "isn't London so much better?" but the simple ways of life where your colour, where you came from doesn't matter..is indeed  reflection of what a mature society is all about.

But things have changed…subtly at first and then with the impact of a sledgehammer- fuelled by Brexit, fuelled by the Katie Hopkins culture- today we are in a world of dogwhistle fun and games. It erupted all around us- those who voted to "Leave"- were either blissfully unaware of the permission they gave others- or were just aware and didn't care- either way, the genie is out of the box. Today, we have headlines asking for listing of foreign workers…you read headlines like that- and you worry, not about yourself but about your kids. You worry about their future, you worry about the world you live in, you worry what we are leaving them behind.

Which brings one to the NHS. This xenophobia has now managed to filter its way to the NHS-  beyond all the disputes, today, the NHS is looking at "foreign doctors"-  giving them labels…the same doctors this country desperately begged, borrowed, lured to help them in their times of need. Yes, many came for a "better" life- and yes it was a 2 way street- but do not make them feel unwanted. This country owes- over the years a huge amount of debt to foreigners in every sector of the NHS- and shame on any leader who wishes them away- or even if unknowingly makes them feel so. More medical places are indeed welcome- but there is no need-none-to pander to the xenophobic right by lacing that with "lets get rid of the foreigners".

I always take aim at leaders in the NHS- and today is no exception. Stop the nonsense talk about harmony, stop talking about Change Day, stop talking about imposing junior contract,stop talking about all drivel- and as one, say this is not acceptable. The NHS will always need doctors, nurses and allied professionals from other places…by driving them away, you harm your own population. To the Keoghs, Stevens, Mackeys et al- THIS is your time to say this is not acceptable. Beyond the politics- if you care for the NHS, be clear to the powers that be- leave the xenophobia out.

To those reading it, it hurts- it hurts a lot. When I do what I do- whether it be my clinical work or national plans, I don't do it as an "overseas doctor" or "foreigner"- I do it because its the right thing to do for folks in this country- a country which i have seen as my own- a country whose pedigree you admired due to the wars they fought against fascism and the rest. If tomorrow the thousands like me decide not to be dog whistled at and leave, the loss is unlikely going to be ours. 

Claimed your own country back- I am not sure what from to be honest. And once again, our fabulous NHS leaders? Take a stand, make some noise…make folks like us feel a little more valued and less worried about our families than we are at the moment. It would be much much appreciated 

Wednesday, September 28, 2016

Daz, Shaz & Kate

2010 I think it was. Or maybe 2011…either way, the memory has always lurked deep. Waking up to headlines of Portsmouth amputation rates. And it hurt. We had embarked on the Super Six diabetes model- trying something different…things like 3 different Trusts working together, specialists working inside GP surgeries. Its all the rage now, you know- but hey those days? Ah blasphemy…I still have saved some of the scorchingly negative emails from leaders of the diabetes world- how this model would spell the end of specialists- surprisingly little about patient benefit and all that.

Anyway, I digress- but hey- you know what- it hurt. A lot. The pointed remarks from other specialty colleagues as to why we should be the ones to do general medicine, no one else…the barbed comments about legless Pompey lads..ah the black humour of medicine, eh?

So we tried - and I am not going to bore you with all the details, the journey- but its the point where we are at which matters. Same newspaper- same people- but this time, with a far more positive headline- and today morning, I smiled. No, didn't smirk but smiled. It didn't hurt all those years ago regards who said what- I brush off non-constructive criticism pretty quickly (its a character flaw/trait which has served me well so far…) but what hurt was the fact that genuinely, we weren't doing local people much favour with what we were providing.



Enough will be written by someone and somewhere about what we achieved, what was set up but this blog isn't about that- but is more of a thank you to many of the unsung heroes who should take the kudos but never will-simply due to their quiet and polite nature. And there are many…whether it be local GP leads such as Paul Howden, Jim Hogan, Barbara Ruston, David Chilvers et al or commissioning managers such as Sarah Malcolm- there are indeed many who have helped along the way. No system, and I repeat, no system can improve without a cohort of folks working together -whatever be their title or grade. Have there been obstacles? Many- and I could spend much time on false promises, threats or even attempts at bargaining to get foot clinics in place- but tonight- I won't. Tonight is about the ones who did the good stuff- the folks who cut across divides and helped.

Folks -who have moved on- Mike Townsend, Graham Bowen - folks who have been part of the change, Diabetes UK in the form of Jill Steaton, local patient advocate (now theres a man with passion!) Raymond Hale…so many to name, so few words for a blog..but thank you to you all.Orthopaedic surgeons such as Billy Jowett, Irwin Lasrado-folks who have been fabulous- or vascular chaps such as Mark Pemberton, Simon Payne or Perbinder Grewal…who said surgeons and medics cant work together?

But a major kudos perhaps sits with the amazing twosome of Darryl Meeking, Consultant colleague & Sharon Steele., lead podiatrist. We like to call them "Daz & Shaz" but their grit and determination to see things to this point? Simply remarkable- turning the tide in such present environment is no mean task- and they indeed are individuals who will shy away from taking the credit…but on behalf of many many patients and staff- a big thank you to both.
Much more to do- and results need to get even better- but this is a journey which takes time, determination and a lot of patience. To anyone looking at foot data- have trust in your local team, back them, support them…and yes- give them time.

A final word to someone who left our department for greener pastures..Kate Marsden…one of our specialist nurse colleagues- who was instrumental in many changes to local foot care. Thank you for what you started, your energy, drive- we haven't forgotten what you did- and we all are grateful…and miss you too. Data is what it is- numbers are what they are…but to change something positively needs something and someone special

So…Daz, Shaz, Kate and many others- thank you. You all have been very special indeed x

Thursday, September 22, 2016

The beginning?




I did an "update" style blog about 1 month ago regards my national role…"Where We At"- and promised an update in about 3 months- but I might have underestimated a bit the pace at which some things have been moving! I know, I know…I am acutely aware of whats happening in the NHS…junior doctors, STP plans, disputes, 4 hour targets, Vanguards, anger…all of it- I work, you know? Haven't given up anything in mu day job- so acutely aware of all the issues- but its just been a delightful month as regards diabetes.
Yes, I know its a narrow view- but hey-its my passion to improve that sector of care- so bear with me, ok?

So what have we had? Well, lets start with the website, shall we? A curated information portal for anyone with Type 1 diabetes- a wonderful, amazing piece of work driven by some super folks- the brainchild of Sophie and Mike- helped by Pratik & Laura- along with support from so many- what a spectacular piece of work it has been. Much to be admired, much to learn from- folks- I am so happy that we kickstarted this. As part of this, meeting the folks who have helped with Digibete..wow, what amazing stuff indeed.

And the comic book- dear Lordy- cant wait for its launch- it is SPECTACULAR- if I may say so. The 4 folks who have helped create it- more to be revealed later- but I genuinely hope it does become a source of funned inspiration for many- just so glad its complete.
Then we are on the verge of declaring the date for the next edition of TAD - remember the last one? Oh the Type 1 diabetes pathway is also ready- just a final tweaks- and many many thanks to all those who have helped so far (you super folks of the London network, Diabetes UK, ABCD and all those who came to #talkT1)…I hope you can see why I am just so delighted? And I know some think these are gimmicky and don't contribute much- well, I disagree- ladies and gentlemen, every little bit of support we can create? All of it helps.
Nestled in there has been the launch of an online education programme for Type 1 diabetes (BERTIE)- led by the Bournemouth team. Evidence based? Not yet. But hey, when folks are not going to any of the evidence backed programmes, then maybe its time to upgrade ourselves to the 21st century- and try something different- yup? Time and evidence will tell where it sits- but I like it- I like the effort- and would encourage all to back it with optimism- albeit with a cautious one.

And finally to the big one. And it does come down to it- yes, money. NHS England have just declared their plans and funding etc for next few years- and there are 5 areas which have additional funding- and its such a delight to see diabetes amongst them.
Kudos to Jonathan Valabhji- the quiet man always speaks the loudest- and for me, working with him has been nothing but an absolute pleasure- we are chalk and cheese as someone said- I would rather go for Butch Cassidy and the Sundance Kid…far more catchy-I reckon!

Beyond the National Diabetes Prevention programme- 4 key areas will be ones to tackle and prioritise- improved uptake of structured education; improving inpatient diabetes (that pesky insulin errors!); improving foot care and finally, tackling variation. 40 million pounds to do it. Enough? We shall see. More than what has been norm or most other areas? Yes. And frankly- now its up to diabetes leaders to earn their corn. You wanted ammo- here you are. Go engage with your CCG, Vanguard, STP and come up with plans to improve those areas of priority . We would want insulin errors to be a relic of the past, we want amputation rates to be the lowest- go and do it.



In the midst of all the cacophony, diabetes has a chance. And its now. Don't lose the chance. If you are someone who lives with it, are a carer, works with folks who have it, passionate about it..come together and lets get this done. There are many more strands of good news potentially in the pipeline  ( a possible e-diabetes passport; CGM; expansion of NightScout as a few teasers!) but for now, its time to get up and get things better.

Let this be the beginning of something special.The chance is there- lets not let it slip.

Sunday, September 11, 2016

Honest debate

Its nigh impossible to have an honest debate about the NHS, isn't it? Forget the politics, the funding for a moment- its rarely possible to do so within NHS circles. Now lets lay some cards on the table before anyone unfurls their indignant banners and views. I have been asking for an honest debate about NHS over many many moons- go check my blogs over last few years. Heck I have even been involved in asking for an honest cross-party commission to look at NHS funding when many leaders were singing Hakuna Matata or running around a fire chanting Kumbaya whilst waiting for the holy grail of leadership to land. For information, I also stood outside Richmond house supporting our generation Next while many ducked, weaved, touted out sanctimonious lines about "patient care". Just in case you missed any of my views- these folks called junior doctors- they care- and they care a heck of a lot- so lets stop knocking them.

Beyond that, just so we are clear- as I have said before, lets get some credentials laid down. Not to clarify how "awesome" I am but it appears I need to do this time and again- as "what do you know? /You look young/Wheres your experience" is such a prejudiced and regular opinion that it genuinely is starting to get on my wick now.
So- here we go- worked in acute Trust as clinician & manager; worked in community Trust as clinician & manager, part of a Think Tank; involved with CQC; work as a secondary care advisor on  a CCG; spend truckloads of time with GPs- in their surgeries and oh yes, also work with NHS England. So don't give me that nonsense that I don't know enough- am sure theres much to learn but enough knowledge about internal politics, tariff and silos too

So let me make it crystal clear- I want to improve diabetes care & outcomes- and yes, some of it will need funding- no question about that. I have publicly said this before- we fought tooth and nail locally to get 7 day acute diabetes service, it needed staff & finances (a quick thank you to Julie Dawes on that!)- no magical "working together" did it- nor was my leadership skills so awesome that I made it happen with some cool alien powers. However, beyond that, lets be a bit more honest and ask some questions in that case.

Lets start with acute Trusts. PbR does NOT work for long term conditions- everyone knows that and accepts it- the journey of someone with an LTC cant be reduced to widgets- plus it is now a perverse source of stopping integration/working together -or whatever the term is this week. So how many exactly are up for working to a Year of Care Tariff on diabetes? Care to give up any extra money (which PbR brings re diabetes) to primary care? To invest in technology?Or is it only about how to keep acutes going as they are?
Its a tough question- but if you want to have an honest debate, lets start it. What about Best Practice Tariffs- lets say for diabetes? Does every single penny go to the Paediatric teams? No-it doesnt- so where is it? Does it go to the adult teams to help them? Why not- aren't you part of one acute Trust? Why is an adult team scrambling for a psychologist, patients getting admitted due to lack of metal health support when the tariff can justify all of that- why the locked in silo to a paeds team? Want honest debates? Lets start it now.

How about primary care? Theres X million in QoF solely for diabetes. Ok- tell me what you could do differently with that money.(No- I am NOT planning on "taking it away"- don't be silly- I am not the Lord) QoF in diabetes is now more about process than quality- most GPs know that and find it frustrating- so if we wanted to use that money differently, what would you ditch from present QoF, what would you keep to improve care? An honest debate? Lets start it now. You want more investment- well- tell me what that translates to- whats the plan? Which primary care group has a plan for diabetes care?Bring it along- lest chat. I don't have all the answers but am sure as heck ready to listen

So you know what? I am with you about "saving the NHS". But lets do it as a system- shall we? From a diabetes perspective, I will try my darned hardest to improve care (whether I stay in this job or not)- but give me a system plan- not what just 1 care need or just acutes need.
As one of my patients always likes saying…"I don;t really care who works where- as long as I am seen by someone who knows what they are doing- and on time". 

An honest debate? Lets start it now.Email me, talk to me, phone me..heck even use Twitter if you want- but lets  have that debate,shall we?

Tuesday, September 6, 2016

Enough

Enough. Just enough. This has now gone far too long- yup- its the whole junior doctopr fracas- and we are now at yet another crossroad - of perhaps an opportunity...so I am going to use this blog to implore- NOT my junior doctor colleagues but to many others within the NHS to get a bit more involved to help resolve this.

Lets get something pretty straight. A 5 day strike with less than 2 weeks notice wasnt the brightest idea- and forget about the points to be made to the government- this was more about testing the seniors as regards what they can do to keep patients safe. Those 5 days would have been tough- would it have been unsafe- well, its all areas of conjecture- there is no precedence for it- and in Star trek speak- its indeed a bit like "Going where no doctor has gone before". Anyway, we can criticise the BMA for all we want but lets also laud them for making the right decision on this instance. It's a moment in time, an opportunity- or one more opportunity to resolve this ugly acrimonious fracas.

So this blog is to all NHS leaders or even media with influence in "higher circles" ( yes thats you HSJ)- yes- those ones who make their way on to lists, attend the glitzy award ceremonies, tweet, write blogs, run organisations...drop the cuddly chat, drop the theorising about compassion, empathy- and get a bit more involved. You are important enough, know enough people- well, go and say to NHS Employers and DH- please, do go back to the table with the BMA. Did you say "why? Well- at the very least, to give peace a chance, ask the BMA what they want, have an adult conversation behind closed doors, try again- do whatevers needed to stop a 5 day strike in October.

Be a bit less biased- drop that chip on your shoulder about doctors or your hate towards a union- and be a leader. Powerpoints, degrees do not make a leader- if you GENUINELY believe in patient safety, forget the circular debates about who has the better argument- just try to help resolve this- altogether ask both parties to get to a table- yes- again- yes, one more time- for sake of patients.
The GMC, rightly were worried about patient safety- well I do ask them too- they were accused of bias by many juniors- well, show to them that your worry extends to asking NHS Employers to resolve this. Health Education England were rightly worried about training being compromised- well, extend that to DH and ask them to ensure our generation nexts future is not compromised

Am I a  leader? Don't know- haven't made any lists - but I work in circles where I can ask the powers that be to engage with the juniors. So I will try. I will ask.
If YOU  are someone who can influence that- then do it too. Please. An FMLM fellow? A Keogh fellow? A Chief Executive? A Medical director? You know enough people- do the necessary. Stop being political and trying to protect your job- a 5 day strike is a month away- do what you need to do for patient safety.

I will be honest- I have never done a leadership course - so I don't know what they teach on those courses...but let me finish with a quote regards leadership..


Remember that. And go do the needful.

Saturday, August 27, 2016

Respect...

It rarely fails to fascinate me. And in my opinion- is a key issue to a whole lot of disputes which ranges within the NHS. Its probably applicable to life too- but lets keep this to within the NHS.
Do you know what I am talking about? Ok- its the sheer inability to treat adults as…well..adults. Have a look at the junior doctor issue- my views is well known- it hardly matters whether I work for NHS England or the Ming Dynasty (No- there is NO parallel there- don't be naughty)- my view is what it is- its been handled appallingly. And it stems from the inability to treat a group of qualified professionals as..adults.

Lets check this theory out. Lets take the example of a junior doctor I supervise- she is 32 year old, she has a mortgage, she is married- along with the fact that she is a fantastic professional. Society has trusted her enough to have a mortgage, have a family, treat her as an adult when she goes on holidays, watches a movie- yet we, somehow, have been incapable of doing that. When this group of folks started off by trying to say in a decent manner- guys, this won't work, its tough as it is, we have gaps, we are struggling, we have training issues…the response from a significant part was what? Well- it was a bit of 'There, There"..a bit of "Well in my days"…a bit of " its a holistic profession"..and a whole lot of "well you are all kids so what do you know"…let me tell you what happens when you treat adults like that…its annoying, its disrespectful, its patronising and it creates friction. Funny that we have such an angry bunch of people around, isn't it?

Let me give you another recent example- a trainee comes to see me- has had an incident flagged about her- there has been a meeting where some folks around a table have decided what rating the fault was. She, has had no opportunity to answer the question raised, she has had no right of reply but hey, there's report to her educational supervisor. On which godforsaken planet is that even remotely right? Its awful, a lack of respect but stems from treating, once again, groups of adults as…well..not quite adults. Times are different, ladies and gentlemen, the take it and lump it era is quite rightly over.

Then came the issue of 7 day services and the risks being evident from leaked reports- and the response was simply astonishing fro many quarters. A lot of tut-tutting, a bit of "Meh, its just a risk register"…folks -UNDERSTAND the angst here..its being proven right after being fobbed off..respect that- again, adults talking to adults. Maybe the misnomer,as pointed out by many, sits in the term, "junior" doctor. A risk register existing is no good for patients unless there are mitigating processes put in place to put a red into green over course of time. If thats our attitude to any patient safety issues (hey, we have it n the risk register) then lets not bother with this lark of improving patient care. Its not the register that matters- its the effort to make sure the register has no cause to exist that matters.

So it continues- the NHS and its inherent way of being paternalistic- for ages, it has done so with patients- the "its ok, I know more than you", the "There, There"- and that has now seeped into bringing that attitude to our own generation next. What chances do patients have of moving past lip service to "patient engagement", "patient centred care" or whatever the latest buzzword bingo is -if we cant even treat our own colleagues with a degree of respect adults deserve. Its not all about politics- when such a group of hard working folks, raise an issue- listening to their concerns isn't that tough.

So I don't know how we move on- but I would like to appeal to many within the NHS- whatever be your position or grade- to respect adults for what they are. You don't need to be fit a certain "prototype" to be seen to be experienced and knowledgable. Experience is of course important- but lets not ignore the youth either. Treat them as adults- they could turn out to be amazing allies to ensure risk registers don't have a reason to exist.

As the saying goes…"Give Respect…then you will get some back"


Sunday, August 21, 2016

Where We At

So I have started my new role. At least I think I have. I mean, I have a badge which gives me access to Skipton House, so I must have. Either way, its been about 3 months or so in this new role as Associate National Clinical Director in Diabetes with NHS England. Did I hear a boo and a hiss? Ah well, anyway, it's a role and as promised to many of those who live with diabetes, here goes as regards an update as to where we are! After all, its all about transparency,isn't it?

So lets start! Recall me making the three priorities? So where we at? 
As a follow on from some of the work started on a Type 1 diabetes pathway, paths merged with some fabulous work being done by the London network- and to cut a long story short, we are very close to having a national Type 1 diabetes pathway- which hopefully will guide CCGs and STPs to develop these accordingly. Before my primary care colleagues jump up, no, this does NOT involve you doing more work- so rest assured- and hold fire till you see it. It hopefully will have the blessings of all relevant diabetes organisations soon- specialist/patients etc- and we should be able to progress things soon!

Next up in the pipeline are plans to develop online educational modules for diabetes patients (Bournemouth are already doing a fabulous job at one for Type 1 diabetes - and I don't like reinventing the wheel- may as well back something of excellence!) To emphasise, these will be in conjunction with existing structured education platforms so hopefully will help to support education. Other exciting developments are possible online platforms for blood sugar downloads etc- and yes, as part of all this, am meeting all and sundry to see whats out there- and try to narrow it down to the best available.Other exciting areas are a national Type 1 diabetes platform- that anyone can be referred to- patient or carer- a sort of one stop shop of all curated information available.

As regards technology, a lot of discussions with Abbott and debates regards Libre availability. We- after plenty of coffee and discussions- hopefully do have a plan and I can only assure all that we are working very closely with the company. I must stress that there is a process involved and if we are to invest public money into it, evidence is key - which takes time to gather and accumulate. We shouldn't be too far off it (the recent data published at the American Diabetes Association meeting and the work done by the Scottish group are certainly helpful)- but again, do bear with us on this one- its not something that has been rejected or put on the back burner! I personally would like this to happen- as I do see its benefit- but patience and time please.

As regards inpatient diabetes, again, plans are afoot- which involves role of CQC, a possible adaptation of self administration of insulin becoming a necessity, definition of inpatient diabetes teams or indeed its presence in the diabetes aide-de-memoire for STPs to follow. The aim is not to have inpatient diabetes teams as an "option" but as a fundamental part of acute Trusts- given that 15-20% patients admitted at one point have diabetes and the errors are far too many!

What else? Much actually…the "impossible tour"? Oh yes, letter being drafted to go to all teams- and if they want, will be visiting for sure! There's a meeting with the Night Scout team coming up, there's keeping an eye on data from Cheshire, there's discussion on information for pregnant mothers, education run by patients for professionals ("Flipped Education"!) and of course, the issue of extending the Best Practice Tariff…did I ever say its actually been quite good fun?

Finally, a mention to the team with whom I work- the background work being done by many is simply amazing-and especially Jonathan Valabhji who as NCD has been a fantastic guide- and believe it or not, in diabetes care, changes should be coming. There are many more ideas but for now, even landing those above will be a step forward.And of course there's TAD 2 (wasn't the 1st one fun?) and the Type 1 diabetes comic book.

3 months or so in- about 9 to go- No, its not a time limited job for 12 months but its a point where I assess my own role. If in 12 months, nothing much has changed, it maybe time for someone else to try. Till then, its actually not all doom and gloom…a tweet recently said "If you are not in revolt, you are in cahoots". Well, I respectfully disagree. I have a limited time doing the job I do- and I will work with anyone to try and improve diabetes care- whatever be the structure or political colour.There are many ways to help patients- I respect your fight- in return I ask that you respect mine too.

Over the course of time, as projects are launched, I will take time to pay tribute to some amazing professionals and patients who have been helping along the way. For now, you know who you are- and a genuine thank you. 
Much more to be done- but the support received so far? Simply magic- and thank you for that. To everyone else. I reiterate it again…if you have a good idea or a constructive suggestion, come and talk to me. I will always find time- promise!

Will update again in 3 months- but till then? Keep asking, keep suggesting and keep prodding…just do it with awareness for some one who also has a life, a family and a full time day job too! :-)