Friday, July 11, 2014

Era of the nurses

All good things must come to an end,as the saying goes. And after 5 years, it's certainly time. 2010 July I was asked to become the Clinical director of the Diabetes department in Portsmouth Hospitals NHS Trust and no, it actually doesn't feel like "just yesterday". Time has moved at its own pace and 5 years later,you just feel its time for someone thing I picked up in a leadership event was the ability to know when to move on..and the time is now.It just feels right.

For many years, the job has indeed come first,be at work by 630/7 am, working on the emails, spending evenings away negotiating with GPs, Commissioners, stakeholders, travelling, learning from's been a long road. A long road but worthwhile every single bit of it and as I look back, it is with a great sense of pride at the legacy being left behind. A model of care which is viewed by many as a pioneer, many accolades, improving outcome measures, raising the profile of diabetes within and outside the Trust,..I have enjoyed every single bit of it. Of particular pride has been the fact that in spite of all the focus on clinical delivery, research and innovation has blossomed and feedback from trainees have suggested the department to be one where they feel they are looked after with ample educational opportunities.A department where morale appears good, low sickness and staff turnover rates suggests a happy work force while patient feedback has improved consistently as testified by low complaint rates..while hopefully we have paid more than just lip service to patient engagement via our Sweet Meet, our launching of a 7 day diabetes service, etc

People always ask me the catalyst behind our success...there are 2 strokes of luck which I don't know how to ask anyone else to replicate. Firstly, the ability to work with a dream team, with not colleagues, but friends, friends who are passionate and have delivered care with a smile..making! Secondly, an incredible alignment of the stars where we had a fortuitous combination of clinicians, Commissioners, Managers...all ready to make the changes needed, changes which attempts to redefine how diabetes is delivered within acute Trusts. There have been many to whom the success can be attributed to but Portsmouth hospitals CEO, local CCG commissioners, managers such as Sarah  Malcolm, Melissa Way, Lesley Munroe,Clinical managers such as Richard Jones, Simon Holmes ...I can only thank you for the support shown over the years.There has been treacle which people above have helped cut past...all of which have improved care thank you.

So to the inevitable question...who next? For years, I have heard debates and discussions as to how nurses are the lynchpin of diabetes care...but always been a bit bemused by the lack of them or paucity of them shaping diabetes care. So, in a last bold "outside-the-box" move, as a department, we have suggested that Lisa Skinner, our existing nurse lead take over the role of the departmental lead. Hand in hand,I am also stepping down from diabetes lead roles in the community and asking Jane Egerton to take over lead role in Hampshire with Alison Tier in Portsmouth. Thus, a creation of a fantastic nurse triumvirate who can shape and run diabetes services across the community and acute services.We talk about nurse suggestion is lets stop talking and do some walking in diabetes care.I firmly believe that these are exciting times for local patient care and with Lisa, Jane and Ali in charge, the local community care will be served amazingly.

In 5 years,I have tried, tried as much as possible and also fully appreciate the "Marmite" factor I bring to the table. The NHS is caught in a Hobson's choice...on one hand, changes need to happen quickly while the present structure of the NHS, management chains are not set up for innovation, quick,fast movements. To put grease on those wheels, relations have been bruised..but in my book, rightly or wrongly, relations can heal..what doesn't heal is the poor care we provide while we sit and mull and spend hours thinking how to ensure we don't hurt each other's feelings. In 5 years, our strength has been pace, the ability to make changes quickly, adapt to the times, be flexible and sadly, on occasions, it has needed more fire than charm. To all the NHS leaders who talk about change, medical engagement...look at the system where treacle frustrates and you will learn why engagement is so low down the a time when you need it more than ever before.

 Finally, as a clinician I continue to do my work and revert to my original passion...type 1 diabetes care..all across from adolescence to adult life. Lots of things to do locally and nationally..lots of ideas in my head...the world does look exciting with the potential! There are bits which I would have loved to resolve such as psychology support but discussions are at a good stage so I am hopeful we should be able to close that Achilles heel soon.
To Lisa, I wish you all the best and as with my colleagues, unflinching support to you as we all know how patient focussed you are and what you will bring to the table. Advice? The role of a clinical director in my book, is two..One, ambassador for the department and Two, the patient advocate in a management circles. Never back down from what you believe patients would benefit from, never accept a compromise which you know will compromise care of patients with diabetes. Stick to that..the rest?Falls in place.

An exciting future awaits us.The era of the nurses beckon..Lisa, Jane, Ali....May the Force be with you. Amen.

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