Wednesday, October 31, 2012

Civil Wars

A few years ago,Marvel comics launched a series called Civil Wars...which went on to become a landmark series, a benchmark in story telling not only its depth but in the sheer shocking nature of it. It was,simply put, where all  heroes went up against each other. In short, the system of how superheroes were to be monitored was changing and it ended up creating chasms in the superhero community...making enemies of friends..Spiderman up against Iron Man, Captain America against the Thor. Some stood on the sidelines...deciding not to take sides, but eventually all got way or the other. It was brutal,ugly...but to the readership it was one heck of a read, an amazingly entertaining ditty to sit and be a part of. Sounds familiar at all to anyone? 

2012...the NHS changed, some decided to bravely go where no one had gone before, some vehemently opposed it...but then it all came to pass. The bill got passed and we ended up where we are. Will it revert? Will the NHS be torn apart? Will it be all doom and gloom? who knows..maybe so, maybe not...but somewhere in the middle of all that, well meaning doctors ended up being entrenched against each other. Don't believe me? Read the entries on twitter from well meaning folks. 

GPs sneering against their own colleagues who are trying to make best of the present situation, open apathy, disdain towards folks who have been brave enough to take up the cudgels...all quite disturbing really. I fully respect the views of those who don't like the way the NHS is heading but to suggest all those involved in being CCG leads are politicians in disguise or want more money or simply naive...sorry folks..that's blatantly disrespectful. Don't like what's happening? all means challenge the system or the ones who have made the changes...but why the ones who are trying to make things work under the most uncomfortable financial situation the NHS has ever seen?

Maybe I am just biased, just simply lucky to have folks who are Commissioners who are also doctors and are willing to have an open, adult conversation. For those who feel it was all "OK", here is an example. My first meeting as Clinical Director to discuss diabetes services was with someone, who in those days was a lead in Chronic diseases. No medical qualification to boast it was understandable when the person concerned expressed surprise that there were 2 types of diabetes. The problem was actually then refusing to believe this was the case..and putting it down to me trying to expand the diabetes services. A mention of psychology services was met with the comment.."now you need a shrink too?". To be honest, it was not possible to have a clinical conversation with someone like that...someone who was simply worried about how referrals could be dropped without setting up anything else in the community. "GPs get paid enough...let's make them earn it" was this persons parting excuse me for embracing with glee the opportunity to sit down with a fellow doctor and explain how we could actually make a difference in diabetes care.Dont get me wrong, we need managers and good ones..but their job has to be to manage, not to dictate the health economy..for that you need a clinician. And perhaps the "failing" of the present system is that we have swung from one end to another..rather than trying to find a happy medium.

So we are where we are. Yes, there are parts we don't like, parts we are uncomfortable with, parts with which ideologically lots of us don't agree with...but hang on a second when you say "all was fine". It wasn't..there were some bits which were absolutely crap..for want of a better word. And these guys who have taken up the cudgels...give them a chance to see whether it can be done any better.

This Civil War type of scenario really needs to stop. Specialists are,in a perverse irony, actually enjoying not being a part of it...remember those angry responses from specialist organisation as why they couldn't be part of local CCGs? That clamour seems to have died people have started to realise how difficult it actually is, how difficult it is to plan services in the health economy, balancing the needs of the acute trusts, pressure on primary care, have some sort of accountability over GP practices in their roles as "independent business units", not to mention local politicians and their demands and needs. Want to downgrade a local hospital...try facing the media or politicians...perhaps the same ones who have sanctioned the change in the NHS Bill and have suggested that "more resources need to move to community". So guys and gals...relax and instead of starting to appear like a baying bunch of wolves waiting for it all to fail...maybe step forward and give these folks a helping hand. Rather than saying inane things like "there is no need for a community nurse".. do actually see how that nurse can actually help your practice nurses deliver better care.

I am getting slightly tired and fed up of the negativity that surrounds it simply a British thing or is it an urge not to see anything succeed? The Olympics however have given me hope...this was an event which was shrouded in negativity...but then the sheer levels of success and determination of those athletes made us all believe. maybe, just maybe a similar thing will happen in the NHS..maybe those doom mongers will actually fade into the background...maybe the positive stories will shine through..maybe folks will stop tying to find the negatives in every success story....maybe...just maybe...we will get to a happy medium between managers and clinicians. And don't give me that tosh that these guys aren't committed. For starters they are more committed than a GP who refuses to open his books even when data suggests that poor patient care is being provided or the specialist who believes that the patient should dance to his or her tune..and its all ok to create a wall of inaccessibility around themselves.

I won't tell you how the comic book series "Civil Wars" ended. All  I can that I live in hope.In the words of Martin Luther King Jr.."We must accept finite disappointment, but never lose infinite hope". I do indeed live in hope.

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