Friday, January 18, 2013

The pace of change...

7th March 2012...still remember that day pretty well. The evening before had had a relatively busy night, meeting up with friends and colleagues in Glasgow at the Annual conference of Diabetes a late start was warranted..till I got rudely interrupted by my phone. It was someone important from our local health economy and the "hello" sounded tense, a bit gruff. Cagily I asked the reason- and it seemed a story had broken in the press about amputation rates and Portsmouth had taken a beating. We were the second worst or thereabouts....this was bad, this didn't make the local health economy look good...and then the bombshell, I had to go on TV to do a press briefing. Tried all sorts of excuses to wriggle out of that one, but nope, it had to be me. And so it was done- hastily borrowing a shirt from a colleague, asking the cameraman not to include the jeans in the frame, it was done...Admittedly a bit wrong footed as the year before had been spent on trying to solve the diabetes conundrum...where doe it sit..primary care or secondary care? Contracts had been signed..the Super Six model was just off the ground...and then this hit. Since then, much water has flowed under the bridge...public meetings to raise profile, to discuss issues at hand, the usual cynicism, the usual culture of shifting never was anyone's fault....and finally it triangulated to 2 key areas. The lack of enough multidisciplinary clinics to look after patients with ulcers and the timely referral of foot problems to podiatrists. 

And for me the whole journey till this point has been an educational trip. Diabetes UK were a big ally- doing road shows  chasing Commissioners, chasing the Trust, highlighting the poor care..NHS Diabetes helped...everybody pitched in. Locally the Commissioners engaged in negotiations, different Trusts housing different professions ergo podiatrists under one Trust and Consultants under another managed to come up with a in with the newly founded Community provider..all of this happened. Vascular and Orthopaedics pitched in. Easy, wasn't it? Who said fragmented systems couldn't come together, data sets "meant nothing" was all so simple, wasn't it?

The problem is all of the above on paper sounds very simple. Attend any course, any event organised by lets say the Kings Fund or NHS Institute..and they make it sound quite easy to achieve. The other day I watched an episode of "The Thick of It" and by god, it reminded me of an event I had attended in the not too distant past. That was an attempt to get 3 Trusts to get together and "think differently"...facilitated by folks who didn't have the foggiest idea as to what diabetes care meant, the challenges it threw up for a primary care physician, the frustrations of a specialist or the befuddlement of the patient with the multiple providers. 3 events later, none the wiser, I asked the other attendees what they thought they had learnt. The consensus? Diddly squat.

Sorry I digress...but for us as a locality, we have finally managed to get the multidisciplinary clinics going, as of last week and agreement to roll out an educational portfolio for practice nurses et al led by podiatrists, hopefully within a very short time. The question I have is that why does it take 9 months to do that? A senior colleague with whom I shared my frustration suggested that in NHS timelines, this was like moving in supersonic pace...but thats not good enough for me. Just because things are not right, we accept that? I would like to challenge that notion to the hilt...and my observations of this whole process has been twofold. Firstly, there is no shortage of people who want to do the right name it, managers, podiatrists, commissioners, contracts team, doctors,,everyone wanted to help. Secondly, there are just too many cooks in the whole process.  We are very quick to criticise and go into ultra panic mode when the dreaded word "privatisation" is mentioned but how much time do we spend on streamlining  the system we have at present? Too many chiefs, too few Indians does come to mind..but the last time I used that adage, people looked at me strangely...before the penny dropped. They thought I was genuinely touting for more "folks like me" (Indians, geddit?) to be involved. Duh.

Anyhow, but each bit has its silver linings and some folks irrespective of their employing organisation have simply been amazing,,so a big thank you to Melissa Way, Jim Hogan, Daryl Meeking, Sharon Tuck, Mike Quinn, among a few to make it happen...the irony is that one of them said,"just doing my job". And thereby lies the catch. Today, in the NHS when someone just "does their job", it is seen as being "dedicated", "outside the box"...while it should be the norm. Every little bit adds up...for every such thing whether it be something as "simple" as taking 9 months to get extra clinics going to the catastrophe of "Mid Staffs", we just provide fodder to those who would like to change the NHS one more time. When we as staff within the NHS do this, knowingly or unknowingly, it makes us look, simply put, foolish to say "Why mend something which isn't broken?" I would like to challenge all the powers that be to effect changes needed for patient care swiftly once recommendations are made, not sit and mull it, discuss it in multiple committees or worry about all the possible pitfalls.As Lincoln said.."Things may come to those who wait, but only the things left by those  who hustle".

So we begin a journey to try and amend the poor amputation dataset. This is going to take time, energy and patience..but I have full faith in the individuals around that they will do it. We now have to wait and see. Fingers crossed, we can.

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