Wednesday, September 25, 2013

24/7

Everyday. Everyday the NHS fails us. Everyday it also saves us. It's a daily cocktail and in this age of social media, this age where any international event is dissected and analysed by millions within minutes of its occurrence, the NHS is nowadays fodder.
Its a heady mix..with lots of people with lots of interests. Take your pick..there are the social crusaders who believe nothing in the NHS should be private (have you heard that all recent NHS contracts have gone to private providers? Well...have you actually seen some of the quality of bids from NHS organisations??!); there are the right wingers who believe its a system which bleeds us dry and bar basic healthcare, you get care what you can afford; there are the data demons who dissect numbers and have pitched battles about HSMR (Jarman's crusade) and not to forget the ones who have suffered either due to a loss of close ones (James Titcombe) or the ones who have been shunned by the system and still fight a daily battle against the establishment (David Drew,Kim Holt).

Amongst them all are also scattered the ones who are the daily users, seeing the fractious battles, unable to make their mind up as to whether the NHS is all good, or all evil. Grateful for what the NHS has done for them but at the same time hesitant about raising errors in the fear that it will be used to bring down their beloved NHS a bit further..it's a tricky balance, a Hobson's choice. Damned if you do..damned if you don't.

Let me give you an example. A patient with diabetes gets admitted to the hospital- what kind of care does he or she get? In one word? Variable. It could be fantastic, it could be average or it could be downright poor. Not just me saying it- but if you do want to know, read here,here and here.One of them is in my own hospital- where care, simply put, was substandard. Not an isolated incident..it happens...is it because the people or staff don't care? Is it because they don't know? I don't know the answer to that but to all the educational evangelists out there, there is no lack of protocols, educational events, no lack of effort....what there is a lack of is an access 24/7 to a specialist for advice.

To patients who suffer, I say this, raise it. As a team, I don't see it as a personal criticism but as feedback, nay, even ammo to convince the powers that be for the need of a 7 day service. For me, its an opportunity to learn..how am I supposed to get my service better if I don't get honest feedback? I have noted twitter conversations- the worry about repercussions, the worry that the teams will take it "personally", brush off criticism- and I don't blame them. Forget patients, look at what has happened to doctors within the system who have raised their head above the parapet...pretty much a career destroying move.. hopefully they will find their rightful place in history with time. To patients of mine who read this- I can only say this- raise issues openly. Will you be victimised? I can earnestly promise you..."Not on my watch". I can assure you in the most open way possible that we will try everything within my powers to get things right. Tell me what's not working and as a team, we will do our utmost to make things better.

So we have a challenge to improve things especially out of hours and on weekends.It is fantastic, even humbling to keep on getting on award short-lists but at the same time, that doesn't translate into us putting our hands up where we fall short.We have a fantastic diabetes inpatient team- but alas, they are only as good as within working hours, only as good as the limits of Monday to Friday. The dichotomy for me lies in the belief that general medicine is a core of what I do- and pardon me for heresy, but walking away from the sick 87 year old because she ain't bleeding goes against the ethos of why I went to medical school.
So.we have a plan...we indeed do. It involves the Consultants working on a 1:4 rota; it involves our specialist nurses now moving to weekend working...and we will get there. I have been touched and humbled by the willingness of all to help...there hasn't been strong reservations..there seems to be a huge appreciation that patients with diabetes get a raw deal when we are not around..and we must do something to improve things. For those who believe the NHS staff should just treat this as a vocation and spend all their lives looking after patients, have a heart. The same nurses and doctors have families, children, need weekends to spend quality time..just like anyone else.
Initial conversations have been positive..and it all seems, so far, to have traction within the management hierarchy. The frustration remains that we threw everything we had as regards education..and unfortunately we still haven't been able to take away errors which are simple but so devastating for the individuals concerned. The quick turn over of staff, doctors and nurses alike, hampers any education process and even now, still in the minds of staff, diabetes is never quite as an emergency as a bleeder or a chest pain. Only the person who has a severe hypoglycaemia or an episode of ketoacidosis or the carer will know how untrue that is...so it's up to us to change the face of diabetes care, not anyone else but simply us. Watch this space..it's coming- and yes it will happen while we keep our general medicine commitment going too.

I wouldn't say the work in the community is done..but for sure, progress is being made..the process is in place, the users seem satisfied and outcomes look positive. The next logical conclusion is to see what we can do for 7 day cover of the hospital- and maybe in the near future, even the community..who knows what the future holds?

One of the greatest innovators ever once said.."We don't get a chance to do that many things..and every one of them should be really excellent. Because this is our life. Life is brief..and then you die, you know? And we have all chosen to do this with our lives. So it better be damn good.It better be worth it". In my career, I haven't always got it right, I have on occasions even failed some.. but in a time when one is acutely aware of one's mortality, there is no time to wait for tomorrow. One must try, one needs to come to the finish line and say "I tried with everything I had".

Wish us, the Portsmouth diabetes team... luck. The collective goodwill of so many cannot be in vain. 

1 comment:

  1. Nice thoughts.Good luck with it-sounds like you have support for the process.

    ReplyDelete