Saturday, April 6, 2019

3 months- and a bit

April is here- and its been one busy year so far for diabetes care in the NHS. Things seem to be constantly moving- and perhaps a reflection of the amount of challenges in front of all us within the NHS England Diabetes team.

January brought the much awaited NHS Long Term plan- much debate and discussion around content in the wider NHS- but within the diabetes community, it generally landed well. Continuance of the Transformation funds- albeit at reduced levels were welcome- and helped ease pressure on CCGs who have been wondering how to continue funding projects which have been built on the back of central funds. It also brought news of CGM funding for all Type 1 diabetes pregnancy from 2020- making us one of the 1st countries to bring research of the CONCEPTT trial into reality.

February saw the DVLA finally approve CGM and Flash monitoring being accepted as means to check glucose levels-and was a welcome step to modernisation. Diabulimia pilots were also announced -based in London and Wessex- which will hopefully give us ideas about further roll outs; funding needs etc in this huge area of importance and concern. This month also saw the arrival of the revised GP contract- and it was of particular importance to see the shift from simple target based care to recognising frailty as an important part of individualising care. We believe this will help hugely- if not anything else- stopping unnecessary admissions and/or causing harm by unnecessary, non evidence based chase of targets.

March brought us the annual conference of Diabetes UK- and further announcements about results from the DIRECT study- the intervention with low calories in an effort to put Type 2 diabetes into remission- another research which is being looked into being trialled by the NHSE Diabetes team in real world setting. This conference also highlighted further data coming from the National (Type 2) Diabetes Prevention programme- with encouraging results - and most importantly showing the interest from primary care to refer people to this ambitious project- one of the first of its kind across the world. In between, a long awaited and hotly debated fresh update of the Libre/Flash Glucose monitoring came out too- along with a different way of directing funding to ensure the post code lottery ended.

April brought the start of the roll out of the Flash Glucose take across the NHS- and personally, its been very pleasing to see a full uptake across the board. Some areas are working out the process- so actual delivery to patients will perhaps start in May- but its good to see there is no refusal anymore. One NHS- one rule- and its also about showing that uniform access can be done. Every single tweet, message, email highlighting somebody somewhere getting this? Makes me happy- very happy indeed.
On a personal level, in between all of the above- February brought "Type 1 diabetes: Rise of the Machines 2"- which was all about looking at OpenAPS, patient choices and how we work with all concerned to make this mainstream. Events such as these are popping up everywhere- and a pleasure to be part of the Scottish version of this in May. And of course, there was "TAD"- want to know about it? Read here.

So whats next? The GIRFT work is moving on- and we have started on our national report which will make some relevant recommendations. I am interested to see what the Low Carb App/ programme can bring to the NHS- so will be working with them to find out more...and am keen to look at better Out of Hour support using existing technology- in the absence of enough staff to do so 24/7.

In the field of technology?Next up is ensuring Insulin Pump access is provided irrespective of where you live- and identifying whether the block to this -which is actually legally mandated- is a CCG- or a specialist centre. Then could come CGM access- getting this uniformly across the country- to start with for pregnancy- will give us plenty of pointers...and what would you say if I said we can get to the same point as Flash with Libre....uniform access across the country? Its definitely do-able and in my mind? The road map is there. Can it be done? I think it can- but will ruffle a fair few feathers on the way.

So there we are. 3 months and a bit in. Uniform way of doing things- that's the overall aim. We have done so for Flash glucose. Can we do it for safety? CGM? Type 1 diabetes care overall?
Below is what is feasible in 18 months for one singular technology (Orange: CCG with NO access; Green: CCG with agreed access) - and I would ask every single professional in diabetes dedicated to improving diabetes care to think of this...."If we all joined up together, what could we possibly achieve?"

The answer is....A heck of a lot. These are strong positive times for diabetes care- and the responsibility for taking that opportunity? Sits with us all- irrespective of what title we hold.

Sunday, March 31, 2019


Another year passes us- as the concept of TAD or Talking About Diabetes gains strength. Never been too complicated to be honest- and pretty much a meeting of minds of 3 individuals who believe in 1 thing: Type 1 diabetes care will improve by the collective power of the willing; the joining of the collaborative- and a unified patient voice. Throw in the ability to inspire, the ability to give hope in a long term condition which has plenty of upas and downs; making people believe you are not the only one....and progress is made. Healthcare professionals role in this arena? Not too tricky to be honest- facilitate; support; get folks together.
Crack self management beyond the power points and the glossy words; encourage more peer support...the rest will follow.

19th March 2015- on a trip to Pitlochry, Scotland- I met with Peter Hindmarsh and Catherine Peters. We chatted, we thought it would be fun...and 4 years later? Look where we are. 
I am not going through the events of the day- as am sure if you follow the hashtag #TADtalk2019 you will find plenty of stories and excerpts as to how the day went. To me? The ethos was of getting people together- you do that- the rest of the magic just happens- and so it did.

Whether it was Amy, Mohammad, Lauren, Sam or indeed James- they all told their story- and left a story behind- some part to inspire, some part to make you believe- and I suspect beyond those living with Type 1 diabetes, the lessons for the HCPs in the audience were probably better than any book will teach us. Respect the community, the community will respect you back- its as simple as that. I know Amy well enough- and was sure her story would be amazing and inspiring- but I listened closely to all the others too- and as with everyone else, it was new to me too. This wasn't scripted, rehearsed- simply from the heart. The determination of Mohammad shone through; Laurens story about the Queen giving her "the look"; Sam talking about some absolutely ridiculous feats as if it was a stroll to pick up milk- they all made me shake my head in awe. Simple lessons really to all of us who spend time looking after Type 1 don't lead their lives, don't prejudge; don't dictate; don't assume. 
James was a delight- giving up time to actually stand forth as a role model for those with Type 1 diabetes. Effortless charm, square jaws and a not too shabby smile to boot- he had the attendees eating out of the palm of his hands. What stood out was the patience and time he took to chat- and an everlasting moment for me- was his words for Oliver. I won't share them here- but it will mean a lot to a 10 year old struggling to deal with Type 1 diabetes- and that is what this event is for. Who knows- could even be a turning point for the little man.

Jade- well, I won't eulogise much- as social media has rightly showered her with love- and to actually come and do the play- a day before Mothers day....a few days after her mother had passed away- showed the strength this woman holds. I was over the moon when she agreed to do this for the day- and all I can say? Her mum will be looking down at her daughter with a lot of pride. 
The little ones who had gone to be part of the TADPoles event came up with a fabulous constructed rap- and beneath the fun, sat the message about what words mean- whatever the age of the person. Poignant yet delivered with panache.

A few words for the boy who actually held the day together- Joe Meade. 12 years old (or maybe ?!3)- as someone said? Many adult hosts need to perhaps learn from him as to how to host an event. Bundles of confidence, a cheeky smile....Joe won many hearts over. Role models come in many shapes and sizes- and he is certainly one.

A big thank you to all who came- took time out on a weekend to be part of this event. The event is as good as you make it, continue supporting, help it to grow- its for the gbdoc community...a day to celebrate, a day to mingle, a day to smile, perhaps even to cry- but amongst friends.

A final word to a lady called Samantha Rowlands- without whom  a lot wouldn't have happened- and an absolute driving force as regards the organisational side of things- and as ever, it's the behind- the-scenes folks who make the event what it's worth.

Where to next? Let's see- as a team, we will sit down shortly- and see what we can do.  TAD 5 is definitely on the cards- do we go for a ballot option next year? Do we take TAD on tour? Do we take it outside the country? What about speakers? Should there be any limit to who we dream about for future events? Time will tell- and in due course, revealed too. 
For now? Its time to enjoy what has been- and take a simple message away. You don't need to be some sort of superstar to be a role model. You can simply and that could be enough for another person. Believe in yourself- help another person struggling with their Type 1 diabetes- and the community thrives even more.

"We all know the truth: more connects us than divides us. But in times of crisis, the wise build bridges, while the foolish build barriers. We must find a way to look after one another as if we were one single tribe"

T'Challa - Black Panther 2018

Saturday, March 16, 2019

Flash FAQ

So its been about a week or more since the national criteria for Flash Glucose Monitoring has landed- and as ever, there have been conjectures, theories, queries- and here are a few pf them- with some clarifications:

1. Can this criteria be changed or tightened? 
This question comes from the last iteration done by RMOC. Areas such as East of England, London etc added their own criteria-some banal ("Your cholesterol must be good to get a glucose monitoring device"...go figure) to self defeating ("Must attend DAFNE"- except that local centre cant provide that for 7 months). Or a regional criteria was roundly ignored by local CCGs.
So let's make this clear. NO- this is the criteria or to be accurate? The MINIMAL criteria. CCGs are at discretion to add and expand if they wish- but not tighten it.
One NHS, one criteria- let's stop playing snakes and ladders about this or spending time in fancy conferences talking about it. I am bored of faux-love for patient care.

2. But..the CCGs have "no money"
Well, till November 2018, about 70% did have the money- the rest decided not to invest in it. So this time? We have top sliced each area to a certain amount. Its very simple- and specifically targeted at areas such as West Kent who "didn't want to have a conversation". The remit this time is clear. We have hived off money- if you don't use it for this specific tech? You lose it. It's the minimal expected spend per area. If more forward thinking areas feel this would benefit wider spend, then they are free to do so. As mentioned, it's the minimal spend. If you don't even want to spend that, then you better have a good excuse as to why- as the issue isn't the money. You want to know how much money has been hived off for your CCG? Well- we have made it open and transparent. Go and have a look- here. I will even save you scrolling through- it starts from page 5. It's the MINIMAL spend expected.
Is this new money? No- because that would be grossly unfair on the majority of CCGs who did fund it the first time around. This is to ensure the remaining would come on board- or lose the money

3. What about "me"? 
It's quite simple. At a population level. look at the criteria- and speak to whoever looks after you diabetes - that could be the local specialist or your GP. If you fit the criteria, the non prescribing isn't down to money- see above. We will put some information shortly on NHS.UK for the public to see what this means for them. If you don't fit the criteria, then please have patience. Giving this device to everyone on insulin would have meant a spend of about 700 million£. If we did have that sort of money to invest upfront, it's likely it wouldn't be just for one specific tech. Having said that? The overall plan was for A) Getting this on the NHS B) Getting to a uniform criteria and C) Expanding as the market shifts, prices change, further data emerges. We are at Stage B

4. But what about the "data"?
Honestly- stop boring me with this. Look at the world wide data available, look at the 1 year data emerging from national audits. Yes, its for a self selected group- which is EXACTLY why this isn't for everyone- yet. If that still doesn't float your boat, go and talk to those using it. Listen- learn- and if you haven't - stop wasting everyones time by lecturing about how focussed your area is on self management- and "keen to listen to users"- or whatever nonsense that powerpoint states. Match your talk with your walk- or get someone else to do the job. Visualising your data more regularly and more often improves your self management and control. So either you as a "chief of decision making" try pricking you finger 8 times / day every day for even 1 month- or think whether a device which could give you 20 readings / day would be more useful.

5. My doctor isnt trained/ I have no training
Thanks to work from the Diabetes Technology Network, this should not be an issue/excuse. Online webinars, modules- free- are being set up. If you are a specialist and don't know about glucose monitoring- go and learn it- and have a chat with your appraiser too about the CPD you should be doing if looking after people with Type 1 diabetes. If you are a patient? Use them too- or in your case? Peer support is where a lot of the answers sit. Look also at the requirements for starting this device.

6. What about the "more important technology"? 
Insulin Pumps are mandated by NICE. If you are not getting as per NICE criteria, then raise it with us. CGM- is not mandated. Uptake has been rising steadily- and its progress will also come with time. The Type 1 technology pathway is about outlining the next steps. Cost IS a prohibitory factor. I see a lot of - quite rightly- issues against Pharma companies about variable insulin costs- I am yet to see much push from patient groups/influential bloggers asking tech companies to lower their prices. Flash is the disruption- as is OpenAPS. And let's be crystal clear- as documented previously- we did have a road map till Roche objected to the way we were handling Flash glucose monitoring- which took us two steps back after three steps forward.
Nonetheless? Use of RMOC, different way of allocating funding etc for Libre? A step forward- and could be the template for much more. The green lighting of CGM for all who are pregnant and have Type 1 diabetes hopefully shows the willingness to take this issue forward.

7. But I cant drive with this- and still have to use traditional means?
Suggest check the updated DVLA guidelines

8. But we need to set up "local processes and pathways"
Well, this has been around since November 2017. Thats about 17 months ago. If you as a system still haven't set up one, maybe being an ostrich and ignoring what others were doing wasn't a very clever idea in the first place. Tip? Ask other CCGs who have slick pathways -and adapt them asap- its not rocket science.

9. Hospital team needs more clinics and "capacity"
Find out how others are doing it without asking for the above. This is part of a diabetes service. If you haven't asked for more clinics when a new insulin or drug came along -why would you do it for a new way of checking your glucose levels? use online resources, peer support, group education....theres many examples across the NHS of exactly that.

What happens next? Well- it should be pretty simple for CCGs. You have a criteria; you have money allocated- now get going- and for starters ensure you spend the money allocated.
What will the team be doing? Tracking data, issuing clarifications, ensuring patients get what has been set out in the NHS Long term plan. It will be interesting to see what happens when a CCG decides to work against the NHS Long Term Plan - as backed by the Department of Health- especially in an era where self management, use of technology seem to be the buzzwords.

Personally? I have been asked whether its time to "move on; time to let the system "do its thing"

Wrong. I want YOU as a patient to let me know if you fit the criteria and your specialist team or GP or CCG refuses. I will be bringing complete transparency on this- and that includes CCG and individuals who are blocking for no financial or clinical reason- bar their ego or whatever it is. But I want to know. There is absolutely no one or any name big enough for me not to challenge. I have zero ambitions after this role within the NHS- so absolutely nothing to lose. I "move on" when the job is complete.

A bit tetchy? Perhaps- and lest we forget the long list of those objecting to a technology which- to me- is a fundamental shift of diabetes care? Has included fellow HCPs; patients who want X but not Y for others; CCGs; folks within NHS England; rival tech companies. Being told by fellow professionals or self appointed patient leaders "not to raise expectations of patients"; being told to be corporate as that is supposed to matter more than the need to get a 6 year old child a device that would save them from pricking their fingers 8 times a day. Being lectured at for tweeting and showing data that there is a post code lottery. Having complaints being put in by NHS leaders for making their reluctance transparent...for trying to get a device to the population which will improve care. And someday? It gets to you.

BUT? We are still here- at the start point of hopefully something bigger. Whatever be the way anyone looks at this long road taken? The bottom line has always been about bringing this tech to the NHS and to people- irrespective of where they live- and irrespective of whether they can afford. And THAT is what the NHS should be all about.I wish it could be for more- and time will allow that too.

A few words of thanks to folks like Emma and Pratik- who have stood by me through thick and thin and of course to one person who has actually stood in firm support during all the tough times- Simon Stevens-and who has been instrumental in helping through this process- and helped me ignore all the barbs (plus I think his team got fed up of my pestering I think). That is wholly appreciated- and given all the backing needed to make this happen.

For now? Let's take a moment to reflect, learn- and hopefully have a more smoother way to be able to get innovation into the NHS- and not be subject to pilots, pockets of good care or indeed the whims of individuals in positions of power. And if not anything? Hopefully this journey would leave enough tips and learning points to benefit the wider NHS too.
It's always desirable to collaborate to improve patient care- and will continue to be the main mantra. Lest we forget? the MAJORITY of the NHS did exactly that. But our desire to collaborate should not become a rate limiting step or a convenient shield to hide behind at the expense of patient care.

To finally sign off? We are about 2 weeks from kick off- and I will be watching this very closely. The message to all parts of the NHS in England is clear.
Get. It. Done. Or make your excuses in public to those living with diabetes.

I promise I will be in attendance too.

Sunday, March 10, 2019

Conference Cogitations

A few days in Liverpool- attending the annual event of Diabetes UYK- attracting health are professionals from all parts- and a few of those living with diabetes. Add in the added day where folks with diabetes could attend and discuss all the key bits from the conference- and it was set to be a busy week indeed

And it didn't disappoint from that aspect...lots of discussions, talks- and will summarise- what to me- were the key highlights- and could have big impact on diabetes care going ahead.

1. Type 2 diabetes is no longer a progressive disease: A fundamental paradigm shift in Type 2 diabetes care- changing the way we look at this type of diabetes. Whatever your criticism of the DIRECT study, one cannot ignore the long lasting impact it will leave. The debate will continue as to the "best" way to obtain this; the "best diet"- but for what it's worth? It offers hope to many; gives options to many- and whatever option they choose? They at least have an option. The scientific community stood, listened and reflected on that salient fact.

2. Mental Health issues can't be ignored much longer: Loud and clear this message came through- this was now something of paramount importance- and multiple sessions confirmed its place and importance for diabetes care. The noise on this arena will continue to grow louder- and quite rightly too

3. OpenAPS is here:  Patient power coming to the fore- you can hide from it- but its upon us, A packed session showed its relevance -and pleasantly surprising to see the growing consensus amongst HCPs to look into this and offer support. Early days- but we have traction on this.

Other usual suspects with continued promise such as immunotherapy in Type 1 diabetes by the amazing Colin Dayan continued to be debated- and appear tantalisingly close- with a cautious optimism- understandably so due to the numerous false dawns in this arena. Inpatient safety continued to feature as did issues around language...all in all, a good comprehensive programme- and a conference ably led by Nicola Milne.

Personal favourites were watching what the Liverpool Diabetes Partnership have been up to- no question about the quality of work emanating from that part of the country- and listening to the work led by Reza Zaidi and Fulya Mehta in transition care. Something to emulate for sure in many places- if not anything - the obvious camaraderie the team share with a desire to improve diabetes care in a vulnerable population.
I really liked the work from the Carbs and Cals group- as the focus (or lack of it) on ethnic populations is an Achilles heel for healthcare. Certainly something to look at and push forward. Same for the work being done by Arjun & Charlotte regards the Low Carb App- and what we can do to take it forwards, collect data, offer as options etc.
An opportunity to discuss further work in the Type 1 diabetes arena in India was interesting- and who knows what shape that takes in the future. Its always been a burins desire of mine to do something for let's see!

Some areas where possibly more focus is also needed- and I would perhaps pick out two. One was bariatric surgery- I think we should look at that option more- and secondly a greater focus on the lynchpin of diabetes care in the NHS- Practice Nurses. A good chat with Nicola Milne about this- and I think something for NHSE to pick up too.- let's see.

In the middle of all of that, landed the updated Libre criteria- detailing the who, how and why. As mentioned previously? This wasn't to satisfy everyone but to take the next step forward- and the reactions- in the main- show appreciation for that- which is good. Beyond the keyboard culture of social media, it was good to see that on the Insider Day- where many of those living with diabetes came and interacted with constructive suggestions.

A word of thanks to Chris Askew for his leadership in this whole process- and working in a fabulous collaborative way- which helped create the buzz around the area. It was also nice to see certain individuals stepping up to the broader challenges - the world of diabetes care is indeed safe in the hands of Emma Wilmot; May Ng; Reza Zaidi; Pratik Choudhury et al.

Finally? The best times I had was with the family where I am most comfortable- the evenings spent with the Portsmouth Diabetes team- an absolute blast- and confirmation of one thing as ever for me. When you need to forget everything for a bit- and want to sit with folks who see you just as Partha- and not sell you their work or product?

The Portsmouth team always helps to do just that.

Friday, February 22, 2019

On the cusp

Finally...its done. Submitted for final approval to the NHS England top tier. Yes- am talking about the updated national guideline for a uniform minimal criteria to offer Freestyle Libre to the NHS. November 14th 2018- World Diabetes Day was when NHS England stepped in to end the nonsense going around in the name of localised commissioning. A system where you could get the device in Derby, but not in Leicester; where you could get it in East Kent, but not West Kent; Bath but not Gloucester.
So we ended it- with a commitment to fund to a minimal criteria across the board.

4 months down the line- we are at the cusp- of getting this published. As its submitted for the final ok, its now out of our hands- and days spent tinkering words here and there, changing and rechanging even punctuations....just to ensure no one could or would misinterpret it- has finally ended. To some, its taken too much time- but the team have been keen to get this right-as much as possible. We have asked specialists across the board, have had contributions from those living with diabetes, charities, CCGs themselves, folks of medicine optimisations....we have made this as broad as possible- which of course brought with it myriads of views, opinions, thoughts- ranging from the sharp and intuitive to the downright banal.
Throw in views from those of specific groups such as Cystic Fibrosis, Dialysis patients, those who self funded but can't anymore- and its been something soul sapping while we sit and realise we can't please everyone- someone somewhere will be disappointed and angry- maybe even hurt. Yet, this is probably the best we can do.

On a population basis, we are hoping from a position of 5% of Type 1 diabetes patients in England (as things stand) getting this to hopefully 20%. The basic position? Try and ensure someone in Kent gets as much access as someone in Hampshire. That we don't have a situation where local whims or even socio economic situations causes disparity in uptake. I keep hearing from experts in technology as to how we should provide technology more, increase uptake....all data suggests a sharp rise in technology has achieved one thing- a widening divide based on socioeconomic disparity- and we have to be clear we don't do this again. Beyond the bubble of social media, specialist centres or indeed forums, there are thousands who haven't heard of Libre- who may benefit from this and other technology- yet....

So? We are here. Possibly a big moment for technology access in diabetes- possibly something new. And with it comes nervousness too. Nervousness whether specialists can handle this; nervousness about whether patients will still have blocks in front of them; whether there will be yet more fights ahead of us....and then there is the bigger one- rival companies and their challenge.

I have made no bones about the fact that companies have been a big barrier- whether that be objecting to the DVLA (hey wasn't that fab news!) or dropping letters of threats to us or the NHSE CEO. Will they object again? I don't know- I hope they don't- but one thing I have realised is pretty simple. At the end? It's all about business- whether you host patient bloggers; patient events or have tag lines- when it's your bottom lines getting hurt or shareholders squirming? The users don't matter- its their money that matters- not them.

We are also expecting snipes from some quarters- and lest we forget, it wasn't just companies who have tried to block/throw aspersions- its also involved specialists with-funnily enough-research work funded by rival companies- being indignant about the science yet strangely coy about their conflict of interests. Its also involved patient leaders/bloggers- strangely enough- again- those who have been backed by...yup- you guessed it...rival companies.
It's one heck of a murky world- but? Thats life- and we are here. Personally? Once this role is over- I would share a drink with any of the above. But for now? We sit on different sides- and its not personal- but business.

What happens next? I don't know. All I can say? We have given this our best shot- with the envelope of money we have had. Don't forget- the guideline is the MINIMAL expected- progressive CCGs will have freedom to expand further if they so choose.

We now rest...maybe even brace for the reactions- but all I can honestly tell you? We couldn't have done any more. Wish us luck

Sunday, February 17, 2019


It’s like an annual trip on a carousel. And as inevitable as the sun rising in the morning….a winter and descriptions of A&E department overcrowding; 4 hour targets melting; hospitals in strife, annual discussions of the worst winter ever…till the next trip on that merry go round
Now you may be thinking -what does a chronic disease specialist even understand about the front door and 4 hour targets? Shouldn’t he just stick to…type 1 diabetes or whatever he babbles on about on twitter? Niche topics- why doesn’t he stick to that!

As it happens, perhaps a little bit. In our Trust, happened to be the lead for the Emergency pathway back in 2010...when I started our acute medicine colleagues used to work till 5 pm; when I finished, they worked till 10 pm- in shifts. Made a lot of friends in that department that Christmas! I have worked with Turnaround teams, have worked with ECIST (Emergency Care Intensive Support Team)- not once, but twice…..factor in that as a team, we visit 80 GP surgeries nowadays through the year and have first-hand experience of pressures GPs are under….and yep, have some knowledge. But over the course of time, you realise the futility of it…national roles do give you a broader view of life…you actually understand this is nigh impossible to crack. Not because of "lazy colleagues", "process issues"...but simply because it feels like Ground hog day.
And before you say anything anymore? Finished my tenure with a 4 hour target result after 12 months of work- at 97.4% - the heady days of 98% targets

A few reflections from my experiences for what it’s worth?

1. 4-hour target: Making this the bastion or beating stick for the local acute Trust doesn't work. A patients’ journey is intrinsically connected to community trusts, social care, primary care set up. If none of the others are subject to the same targets, why on earth would they have any initiative to crank up the pressure or deliver to the same level acute Trusts do? As a result of this "isolated" target, acute trusts try and put pressures on areas only they have influence over- cue poor flow managers running around, cue inappropriate discharges, cue elective work being dropped...all of which only causes bad blood, fractured relationships...and the merry go round goes on. I have worked in community trusts- and the view there? The 4-hour target is intrinsically the hospitals problem. An isolated target? You can’t shift it- without pulling all into that target pressure.

2.Multiple avenues: Stop creating more and more avenues for patients to access. Either they are poorly thought out or implemented. Cue people still attending A&E in spite of money spent on these other venues. Stop blaming patients for attending A&E...if that’s what they are choosing, stop the multiple channels, bolster A&E, put the resources there rather than spreading existing resources thinly, depriving the local A&E and causing more of a backlog. If the NHS is about patient choice, then maybe listen to the patients? Yes, it would be fantastic to have all GP surgeries working 24/7, but a) lets be practical about it. They are doctors and human beings plus not twiddling their thumbs and b) its going to take some serious time and negotiations to achieve that….so till that El Dorado is achieved, some support for the local A&E would be nice.

3. Publicity: If you are going to tout A&E as a place where >90% will be seen within 4 hours- and mostly by seniors, then don't be surprised when patients prefer to go there. It's natural. So either decide to make A&E the only hub or go easy on the publicity blitzkrieg. Evidently, we want the NHS to believe in the principle of "markets". Well, in a "market" system, you don't build a swanky shop and then spend time educating "customers" not to go there.

5. 24/7 Consultant cover: If you genuinely want that, stop playing silly politics and either invest OR decide which work needs to stop. I am happy to do all sorts of cover and don't need an extra penny- but do please let me know which pituitary clinic or adolescent type 1 diabetes clinic you want me to shut down. I work on average 60 hours a week- and frankly, don't want to do more, even for more money. If you want me to be there at 2 am in the morning, then I need some sleep next day morning. I can't do a clinic-its dangerous- and as amazing as I am, I need sleep- like any ordinary human being. So let me know which clinic to cancel or provide me with resources to get another colleague. For the patient who needs help with their pituitary tumour, that clinic cancellation is as important as the person admitted at 2 am.

6. History:We forget all too quickly what we as a profession have done to ourselves. First, we created a specialty called acute medicine- and left the rest of general medicine to rest of the medical teams. Then one by one, we made every specialty special- they left general medicine- and then we were nearly left with only geriatricians and acute medics doing most general medicine work- the rest were a combination of a few genuinely interested- and the rest seeing it as a chore…then we discover we have a workforce issue willing to go General medicine- and try to go back to what we broke in the first place. Well, duh.

7, Social care: Decimate this, you decimate ability to flow. In an ageing population with multiple morbidities, you don’t need to be Einstein to figure that one out. The simplicity of that is ..well..simple…yet? We are where we are

6. Finally, STOP reinventing the wheel. Stop bringing continuous flow of new people- well-meaning no question- who think they have a brilliant new idea. They don't- it’s an idea other people have had, tried….and failed. Find out what plans were there, what worked, what didn't work. I see plans nowadays being advocated on twitter etc gleefully as the "new thing". I hold my head in despair when I check my emails from 2009-2010..same plans..same glee,,followed by "let’s find another idea". And please stop doing hashtag gimmicks – it doesn’t help any flow- bar achieve a few more followers and some talks around the country. 

Am sure there's plenty more..but unless something big and radical happens, I can tell you for a fact that NEXT winter will be back to the wall stuff. Till then, all power point talks, all plans are nothing but hot air and playing politics with the NHS.
Ah well, I will go back to Type 1 diabetes and the rest. To be honest? What do I know about unscheduled care? Somebody give me a call when this problem is solved. I promise I wont be waiting up for that one.

Saturday, February 9, 2019

Life For A Child

No rants, no show boating, no pontificating for this weeks blog- but a straight forward request to all those who find time to read this.

In our own lives and bubble, life is never easy- so many things which always make us think- "This can be better; my life can be better"...I suspect in the hum drum of life- as well as that oft used term called "privilege"- we sometimes forget about perspective too.
Insulin is one such thing. In Type 1 diabetes, there's no way around it- simple as that. You don't have it, you die. Thats as basic as it gets. No hyperbole, no political correctness- that's just physiology. And anyone who suggests things like cinnamon or low carbs or other such nonsense as a replacement is at par with the anti-vaxxers squarely responsible for the return of Measles to the modern world. Dangerous charlatans who d actually deserve a special place in hell.

In this context, we, in the UK, live- in comparison- a life of privilege. We debate about Freestyle Libre, we have angst about access to pumps- but never do we pause to even consider the lack of insulin. It's a given fact. If you have Type 1 diabetes? The NHS will provide. Free to the person concerned, funded by the tax payer- you will get the insulin needed to survive.

There are however parts of the world where this is not the case. If you find a moment, have a read of this- and perhaps a moment to reflect as to what we can all do.

I rarely ask for anything- I do live a life of privilege- and yes, my pay could be better, yes, my pension rules suck at the moment- but I would never be denied of insulin if me or one of my family had Type 1 diabetes. Even if the system couldn't provide it? I would go and buy it.
4£ would help provide insulin to a child for a month; 10£ would do that for 3 months. At the moment, this charity (Life for a child)- whose solo motto is "No child should die of diabetes"- (which in 2019 is something that should not be needed, but is happening)- is running a campaign called "Spare A Rose" to try and hook on to Valentines Day to draw more support. Give one rose less to your loved one- and instead give that money to help save a life.

I would be immensely grateful if YOU could find a moment to donate something, anything you can to this charity. For reference- here is the link:

If you admire me for the work I do and appreciate my passion to improve Type 1 diabetes care- and would like to say some sort of thank you? Please contribute.
If you dislike me for the marmite factor I bring to the table, find me unbearably cocky and self-aggrandising? Still do- as your dislike for me should not translate to not donating to a cause which we all should feel is a good one.

Finally, a huge appreciative hug to the British Medical Journal who have agreed to donate my fee for writing a monthly blog to this amazing charity.

In anticipation of your kind generosity, thank you all x