Tuesday, May 19, 2015


Those who know me can vouch for one thing. I don't do pessimism...very rarely....mischievous? yes..wind up people?...always with a smile...but pessimism? Nope...its all about the art of what can be done. I am not even going to try and do mock modesty but backed by supportive CCGs, primary care colleagues and just a ridiculously good team, we have achieved changes in diabetes care- which others have looked at with admiration or jealousy..depending on the personality. And we have carried on regardless...

But you know what..in spite of the obvious blazing confidence, in the heart of hearts, you know whats coming over the hill is making that all-confident smile get tinged with a bit of wryness, a bit of grimace is probably starting to set in. And it's not the politicians or the media who I am sceptical of..they are doing, what their ideology drives them to...that's life, thats the harshness of what we live with. Have said before, a change in political colour would have made no difference to where we stand  now..so its not about petty politics, its not about ideology- though some may choose to differ..the fact remains that no one and i mean no one had the foggiest idea or bravery to set out a discussion with the public that maybe, just maybe we can't deliver everything anymore. Just start the discussion that the NHS has had a great ride, its been amazing but its now time to be realistic and its no longer everything for everybody. At nearly 67 years, the time to dial things down may indeed be here.

My annoyance and pessimism is centred on those leaders within different quangos who post elections have continued to say it will be fine if we work differently. Don't ..just stop saying that. ..stop using words like "transformational change" without saying we need to change contracts; don't use terms such "boat-rocking" without saying that "we need cheaper alternatives". Be honest...be open...stop using studies to counteract views of each other...of course be positive but with a dose of realism too.

People talk about efficiency drive...what does that mean..would you give up a backroom staff of your organisation? Patient centric...well...have you actually involved the patient? Have you been honest to say that somethings can't be delivered? Come on ladies and gentlemen, good to pick up awards, attend glossy award ceremonies (I have attended a few) but at least come back to your staff and be honest. Don't sit in the echo chamber of Twitter and say "we simply need to work differently".

The dishonesty about it all is now starting to grate a fair bit- especially on twitter. There are few folks in the NHS who genuinely believe this will survive as things are. 7 day GP working is coming- whether with support for Physicians associates or not. 7 day hospital service is coming- rightly too...but let's be honest to say what will now stop. We must otherwise we are colluding and misleading patients who believe we can still provide all.

I wil finish with giving an example of diabetes. Overall, the quality of care in this country is average- due to a combination of factors..can we improve it? Possibly not everything but we may have to prioritise and decide what to aim for. I strongly suggest in your own areas you all start thinking of what needs to stop. There will be some who will want to provide all..as "that's what we do". Just one thing...when you burn out, even the few who would have benefitted from you, don't any more.

Time to think, time to challenge clever word play, time to be honest. Time to think whats high priority and focus resources on that, maybe not everything

Sunday, May 10, 2015

Heal & grace

So it's done. The elections are over- and last week, I had asked for all of our leaders, in the main, the clinical ones to be honest. However what I have seen since the elections results maybe needs one more important bit- the need to heal. For many, at least on social media, the results haven't been as expected- the clashes with those who disagree, or those who have made suggestions for future have been angry, sarcastic, sometimes even vitriolic. The winners have been sometimes a bit gloatful, the losers bruised and unhappy- perhaps some even consigned to the NHS fate.

It needs some space to heal- all professionals need space to heal or a place to be graceful. Over the last 5 years, for reasons which suited many, rightly or wrongly, many have tended to put the reason for the slide of the NHS on the Health care and Social Act. Too many times, it, perhaps has been a convenient and sometimes valid reason to blame for poor patient care. The many neutrals will know the reason are manyfold- issues which we have closed our eyes to, issues we have shied away from, issues which have been in play for years, not just the last few. But now that we know where things stand over next 5 years, its perhaps time to take a step back and see what we can do for patient care. There are many who have succeeded over the last 5 years as well- and there have always been many who have failed even in times of plenty...that goes back to the leadership issues which Umesh Prabhu and Vijayanath refer to- are we honest enough, are we strong enough, can we work and deliver patient care whatever challenges be?

No one is shying away from the money issue and neither was there going to be magic money appearing if your chosen party is not in power. Through my blog, I would like to appeal to many to absolutely keep the faith in the ideology you believe in but please take time to heal, take time to see what needs to change- and above all, go to work in the NHS tomorrow and see what can be done to improve things.

The election results have suited some, it hasn't suited some- thats how democracy has worked forever.  If you believe the NHS is in strife, think why that message never got across to the population. If you believe the NHS is in safe hands, great- then you have what you wanted- now show your patients what great healthcare can be like. For patients, what they need is access and expertise- till that is compromised, it probably is less of an issue- and it is up to oust see whether we can provide this or raise our collective voices to say when it's not.

So- to work tomorrow- us as HCPs either gloating or being angry helps no one- least of all our patients. If your chosen party won, be graceful enough- and work with those who are trying to heal- don't forget their passion to improve care is no less than yours. if you are hurt, then be broad enough to engage with those who may not agree with you but still, would like to improve care. Whatever be the case, don't sit back hoping it all falls down so that you can say "Told you so". That point is where you can't change it anymore either.

My appeal to all those on different sides of the divide (and the country is a divided one)- if you work in the NHS, take your time to heal, enjoy with grace- and once the process is over, join hands to give it your best shot. The numbers are stark- whether it be a 22 billion efficiency savings, 7 day working or increased GP access- remember- pretty much all parties were aligned on it- those challenges would have stayed irrespective of who won.

Give it a try, ladies and gentlemen- otherwise if it doesn't go to plan, do answer to the next generation  whether you tried or just spent time on social media tweeting your joy or angst.

Tuesday, May 5, 2015


So we are nearly there. Perhaps not too far away, the shrillness of the politicking, the electioneering, the preening, posturing will cease- or at the very least not be at the incessant levels it is at the moment. Come next week or thereafter, we will have a government in place- whatever be its colour or hue and the NHS will go back to being the one that needs support from the folks who are in it.

And the NHS, like never before, will need some serious dose of honesty. Not from the politicians- as they do what they always do- promise the moon, play to the audience, shroud wave when possible- NHS is only bt one of the issues in front of them, so no, I don't expect them to suddenly develop a dose of honesty and deliver something immediately. But the NHS needs it, needs a major dose of honesty- from its leaders. Whatever their tag, whatever their title, wherever you are, however many course you have been to...the time to couch bad news in jargon needs to stop.

I hear a lot about leadership, hear about values, the need for patient safety..I hear all of that- but to me, what makes a leader stand out is simple honesty. The ability to deliver the bad news up front- without any flowery tags. We are standing on the edge of a pretty sharp cliff- and any economist or finance director worth his salt will tell you how precarious it is. So why go to meetings and say things like we "need to work differently?' Why couch half baked studies and suggest we have found "other ways" of doing the same job- when the essence is looking for staff to deliver at lower cost? A recent study showed that twice daily ward rounds improved productivity and gave savings....hallelujah said the moneymen....let's do it. Buried in the study is the line that savings were actually based on bed reductions and staff cuts. Who needs honesty when you have a headline?

So on the eve of the elections, please DO go and vote- vote based on your belief, based on who you think would improve the country- but please don't expect whoever wins to "save" the NHS. There is no bigger disappointment than seeing your hero fail. Don't put whichever party on a pedestal and hoping they will "sort" it...nobody will- it's down to you and find something extra to deliver. Whatever cash will arrive, may arrive either too late or be consumed by the parochial age old squabbling as to who deserves it most. GPs? Why not Physician Assistants? Why not pharmacists? Cheaper about? Better quality? The debate will rage...the battles will continue, the posturing will carry on.

So, come next Monday, don't just sit back because your party lost and thus the NHS is domed, don't be happy that your party won and that it will be saved...try and think of something that will help your manager to effect some savings. If you are a leader, be open and honest about the budget cuts needed this year and work with your team. Those who have openly flaunted their political alliances, good on you and much respect too- BUT be a leader enough to go an challenge your own party if in power to deliver even a bit of what they have promised.

Honesty. Use that in your leadership role. People respect that- otherwise behind your back, once they step out of that meeting room? They all know your words about "challenges and working differently" are hollow lies. Give it a try next week. The NHS certainly needs it- past the intense bipartisan views of political affiliations.