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.