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