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?

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