Saturday, May 31, 2014


It depends on how you want to use the word I suppose. If as a noun, it means "a person who is among the first to explore or settle in a new country or area". If as a verb, it means "develop or be the first to use or apply (a new method, area of knowledge, or activity)". 

I was sitting in the hotel lobby when the news came up on my twitter feed...the news that HSJ and Nursing Times had published their first list of social media pioneers. Clicked on the link and let me not pretend to have false modesty- and say it frankly- was very pleasantly surprised to see my name here. When you look at the other names in the 12 named, there's Kate Granger,Teresa Chinn, Sepsis UK, Anne Cooper, James Titcombe, Julie Bailey to mention a few- and the first reaction I had was "Wow". Exalted company indeed given the work the individuals have done- and compared to their efforts, pretty much a fledgling effort- but then again, after the initial euphoria, maybe the word pioneer has been relevant as a verb in this context- and indeed,as a Consultant in diabetes, my "mission"- so to speak- has been to showcase and highlight the good and not so good bits about diabetes care in the UK.

As I always say, we need to step away from the polarised debate that either its all amazing within the NHS or its all ever and as with most things in life, the reality sits somewhere in the middle. To those who say its all good, just come into hospitals where inpatient diabetes teams don't exist or out of hours/ weekends- appalling is a kind word to describe the care that goes on. I referred to Gillian Astbury and what precipated her death...we talk a lot, we got Don Berwick coming along, we had Francis, we have had reams of campaigns, courses, twitter debates- but I can absolutely guarantee you that such cases still happen- every day within the NHS- some due to a lack of engagement from management, some due to lackadaisical leadership from specialists, some due to most systems paying lip service (yes, still) to what patients want. 

To those who say it's all bad, look at the data as regards death rates from diabetes and see what the NHS has achieved- some amazing work. If you don't believe in statistics, have a chat with my dad- was a Consultant here in the 70s and he will tell you how far care has come. See what primary care has achieved, laud them for what they have taken on inspite of no further resources thrown their way. I referenced it in my Mary Mackinnon lecture and I will say it again- primary care is where its at- and we need to stop the finger pointing and support them, not keep lobbing poison laced grenades with impunity.

It's thus been fantastic to be nominated and for that I thank the people involved- Dean Royles, Jennie Middleton, Shaun Lintern among others- for recognising the worth of diabetes and the importance this particular disease process has in the well being of the NHS. I look forward to continuing to use social media to help put the agenda of diabetes up for constant discussion...look at the power this holds. Diabetes UK recently decided to debate on twitter the use of the campain called ChoccyBarred to raise funds. The whiplash ike response was noticeable- and call it a hasty retreat or a listening to the masses, credit to Diabetes UK for backing down from a campaign which could have been potentially so damaging to so many.

Finally, my firm belief that it is us,as specialists, who have a huge role to play in improving diabetes care, the onus lies with us to change the status quo- as mentioned before, listening to patients, are still, in the main, confined to powerpoints- the frustrations are palpable. At the table, thus, till things genuinely change, there is only one person who can then fight the battle on behalf of the patient with diabetes- and that is us, as the specialists- whether that be with any middle manager who wants to see whats financially viable rather than focus on patient care, whether thats engaging with CCGs, whether thats at risk of swallowing an insult or two...the role of specialists are paramount. It is, simply put, not acceptable for a specialist to say that we cant provide 7 day service as management is blocking must find a way- and as has been shown by a few, there are many a way- you just need to know which weapon in your armoury can breach the fort.

So thank you to HSJ and Nursing Times for the nomination- I can promise to continue to do what I do best, raise the bar, create a discussion- the NHS needs disruptive leadership- I have never had or will have any issues providing that. 
When I set out as a Consultant, I made a promise to make a difference to diabetes care by the time I finish...and that's a promise I intend to keep.

Thursday, May 15, 2014

Maria Purse

I have known her for a few years now and she rarely ceases to amaze me. Practically indefatigable, always with a smile, always optimistic...even in the most dark days when someone has lost their cool, she has been pretty rock solid. Works far harder than what she is paid for, balances her personal life, little baby at home...pretty close to Wonder Woman in my book. The world wouldn't know her- as she isn't on twitter, isn't on Facebook, rarely spends time preaching about what "needs to be done" or winning awards...just gets on with the job. What do you reckon- describing a Consultant? A super Nurse? Nope, she's a manager- and a bloody super one at that. I have sat down over a coffee many a time and always, without fail, what has come out has been the deep seated desire to improve patient care. Her name? Maria Purse. She works in Queen Alexandra Hospital- and in my 5 years as a clinical manager, have always had time for her- based on one thing- the ingrained desire which shines through of keeping patients at the centre of any plan.

Do you know why I mention her? Because I have stumbled upon so many examples in my travels where clinicians are getting jammed or tired of plans getting put on the back burner to improve patient care. Somehow for some, management is about keeping the numbers right, its the fear of being "performance managed" on targets which admittedly clinicians are not subject to. Let's be honest- if a 4 hour target fails, the Consultants still get their salary- yes, reputation wise it may hurt but its not linked to salary (just to clarify- neither should it be) but for the poor manager caught in between, their job rides on it. 

When you have one party desperate to get to a target or improve one, come hell or high water- on which ones job depends and then that conflicts with someone for whom patient care is paramount- two things happen. In the main, the clinician gets tired after some point, shrugs his shoulder and walks away...clinical engagement becomes a sound byte. The NHS is jammed to the edges, to squeeze anything extra, you have only one currency left..goodwill. Lose that and those targets sink further. Result? The truculent manager loses his/her job, moves on..the clinician stays..after all...this is healthcare..patients come to see clinicians- the manager is the character actor in the show. Don't forget that for a clinician, it makes for an easier and simpler life if you put your head down, do your job..and pick up your payslip at the end of the month. And to be honest, the payslip ain't too why bother? Sometimes, flashpoints erupt...and it boils down to what extreme you are willing to go to improve care...go the whole hog and be called a whistle-blower as in the case of Raj Mattu et al..or play a singular tightrope with the system. 

And to be honest? It's disappointing especially after I meet Liz Saunders, Pollyana Jones, Fiona Rodden and others who talk a different language, meet folks from NHS graduate scheme who burst with enthusiasm to stand next to a clinician and help. Hopefully with time the mentality will either change or the old dinosaurs who stand in the way of clinical care will make way for the new generation. 

To anyone involved in management, here's my gauntlet put a Maria Purse, see how targets can be achieved by keeping patients at the centre- learn and sense how it can be done. Otherwise, although harsh, the reality is that in all likelihood, the clinician will still be there long after you have gone- picking up the pieces of a system wrecked by the obstinancy of chasing targets to protect one's own job. The dust hasn't yet setlled on the Francis report; a report which caused angst to so many hard working souls...lets not aim to create another such one.Remember the name- Maria Purse. She is trying darned hard to ensure we don't have another one. 

As a clinician, I promise you I am. Are you?