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, 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 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 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 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 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, 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. 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 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.