Friday, June 15, 2012

Notes from Philly...

Jet-lag is an absolute pain in the backside...economy class privileges don't quite give you the benefits of ignoring all that, nope, no silk pyjamas or bed, heck, we don't even get silver cutlery! Outrageous I say and down with the capitalists..off with their heads..( of course none of that is true if I am upgraded...British Airways, I love you..don't you forget that...) Add in the fact that my hero, Barack decided to take a visit to Philly which temporarily shut down the airport, causing a near tail ending of aircrafts and the mood wasn't exactly sparkly to say the least.
However, behind all that, lay a fabulous few days.Philadelphia was a fantastic experience on a personal level. It was the American Diabetes Associations annual conference and it's always fascinating to see whether the Yanks way of looking after diabetes is different or not. For once, I had decided to become a student again! Managed to download the app on my IPad, did my own itinerary and I was ready...everyday morning, diligently, I was the at the Pennsylvania Conference centre, attending lectures, going around posters and there was so much to learn! No big nights this time around, people even asked whether I was "ok"! Thought it best to concentrate on type 1 diabetes and adolescents and learnt plenty about exercise and effect on glucose levels, when to advise patients to do aerobic exercise, when to undertake resistance exercise, all dependant on their blood glucose, the concept of fast bursts of exercise to prevent blood sugars dropping low...all very very fascinating indeed.
I sat fascinated furiously typing into my IPad listening to the advances made in type 1 diabetes, listening to some of the great researchers quietly confident that they will have something to reverse or prevent Type 1 diabetes, the science behind it, the hours spent by the researchers.

Beyond the world of Type 1 diabetes, I heard about the surveys done in residential homes, nursing homes around the US and the startling facts and figures. Made me wonder why we hadn't got such financial figures in the UK and promptly sent off an email to Alan SInclair...ahh the joys of technology!!
A walk around the posters revealed some intriguing studies in progress, new drugs in trial, Glimins, new GLP-1 analogies, new basal analoque insulins...no shortage of research all over the world in an effort to make diabetes care just that bit better.Stood by and then tweeted about Roselle Herrings poster at ADA, an example of innovation at Guildford looking into preventing admissions for folks with diabetes.. who says we in the UK don't do good work? Further also made a mental note to set up a session for the team in the department updating them about the "new" things I had learnt in Philadelphia...even managed to surprise myself with the level of diligence...or maybe I was just getting older.

And then there was the company. Apart from folks who I see regularly...it was particularly fun to catch up with the Scottish contingent. I don't know what it is about them...but somehow they don't take themselves too seriously. Gerry, David, Chris, Russell...fabulous company to have around, especially when an England football game was on. In our table at the sports bar, I was perhaps the only guy rooting for England, surrounded by a Welshman, multiple Scots and a Canadian!
Evenings were spent amongst experts debating studies, debating the relevance of tight control of diabetes,and it was a delight to talk to national leading lights such as Simon Heller, Gerry Rayman et al hearing their views on studies. Frankly a better educational event I have rarely been to....but...there was a but lingering in the background.
Time after time, it came back to one thing.... whenever healthcare professionals working in England got together. It was the variability of diabetes care around the country.An underlying zeal burnt amongst all to "make it better" but somehow the answer wasn't there, somehow the frustration bubbled under the surface. Before setting foot on the plane, I had promised myself not to indulge in politics, not to "sort out the world"...this was a trip for my own learning, wasn't it? But as they say, who ventures wins...so it was certainly time the last few evenings to revert to type.
I sat down with Gary Tan, a scarily intelligent man and a better visionary I have yet to meet, sat down with Stephen Lawrence, a mild mannered man with passion, zeal and charm....and it was fascinating to exchange ideas.One theme stood out...if one thinks of it, Diabetes in England are blighted by the multiple organisations they have...Diabetes UK, ABCD,PCDS, CDC,NHS Diabetes...it's like going through an alphabet...the point being that for the general mass out there, a lack of cohesive vision has not, does not help.
Thus were borne the idea of a think tank...why not form a think tank of 8-10 folks taken from all organisations who could come up with a plan or a model which would deliver integrated diabetes care in the country? Throw in people like Gary, Niru Goenka, Jonathan Valabhji ergo people who have actually done this in their locality and you could, potentially, come up with a model whereby patients get optimum diabetes care irrespective of where they live. The recent NHS Atlas of variation of diabetes care makes scary reading and it's time to accept that we ALL have failed our patients, not because we are not committed, but because we haven't been able to rise above the politics to work together.

A document outlining how to deliver an integrated or coordinated diabetes care with all diabetes organisations ( primary, specialist and patient groups) behind it should be accepted by all doubters and in this present climate where the avalanche of data shows suboptimal diabetes care...surely the NHS Commissioning Board and Department of Health would ignore at their own peril? Use the media, show what we are doing as a united force...and trust me, it will work. As I have said previously, the Type 1 young patient struggling with their hypos or the Type 2 patient needing their foot care done, does not care who we work for..they just want to be seen by qualified professionals who know what they are doing and are adult enough about working together, not isolated in silos strong in their belief that "no one else can do it" or "we don't need anyone else".

So for a day, in comic book parlance, I wasn't Tony Stark, the maverick who doesn't work well within teams, I wasn't Bruce Wayne walking the thin line between light and darkness...for a day, I was someone who just wanted to get everyone to the table. It stayed with me even through that jet lag and was the first thing I did when I opened my computer...an email to all the organisations suggesting the think tank, suggesting the possibility of working together with the caveat that we have little time to lose. April 2013 is when all Clinical Commissioning groups go live..and we must have something ready for all CCG to use for diabetes commissioning before this opportunity passes us by. Initial responses have been positive...so I wait...with cautious optimism.
If that comes to pass, then the trip to Philadelphia would have been an immensely successful one..not only would I have learnt something educationally but maybe, just maybe I may have some sort of teeny weeny contribution to improving diabetes care in this country.

And oh yes, sorry about giving up the uber cool role of Tony Stark/Iron Man? Not in the slightest...remember the man who got all the Avengers to the table...? He was Nick Fury aka Sam Jackson...the coolest badass in the planet. Now where did I place that eyepatch....

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