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