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.

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