Wednesday, June 3, 2015

End product

A wry smile. Pushing the chair back in my office, I took a moment to look at the figures- and then look again- with a wry smile. You know those moments in time when you look at something- and you want to ensure it's correct...this was one of those. In fact, I had to go and get my colleagues to sit down and look at it with fresh eyes...just to make sure I hadn't missed anything.

What was it..well this was the 5 year data on our model of care...5 years is a long time but has flashed by..a model which by a distance is the biggest area covered in the UK as regards diabetes models of care go. One pathway- cutting across 83 GP surgeries, 3 Trusts with their own individual politics- and a diabetes population of more than 40000 patients. When you venture on a journey for which you go through a lot of personal pain, you know you stake your reputation on the line- and at the end, the end product boils down to only one thing- outcomes. Yes, patient or user satisfaction is important but in an environment where money is tight, outcomes which benefit a larger populace may sometimes not end up making everyone happy.

The principle was simple- the specialists were coming out to play- be a friend of primary care- pretty old school. No forms, no complicated referral system- you get stuck- you ask- email/phone/face to face- simple and effective. Easier said than done. Vanguards? 5 Year forward view?- we didn't stop locally or wait for the Messiah to show us the way- armed by a fierce determination, an absolutely amazing team - we embarked on a journey. Did we know it was all ok? No but we said we would try- we would try to make a difference.

I won't bore you with details but the vitriol I personally faced, the sneers, the barbed comments..I have never forgotten. Most of them are still around- I haven't forgotten- but I didn't say anything as we staked everything on the end products. This is diabetes- it is and never should be about how good you have been at HbA1c reduction- its about end organ damage prevention, its about admissions, safety. So I waited. Kept an eye on data- and waited. Initial trends were good..though detractors never gave up the chance to pick on data dating back from 2010 or 2012 to say .."doesn't work, won't work". I haven't forgotten, ladies and gentlemen

So today was a special day..all the data from census office, national diabetes audit, public health, local business intelligence, QoF data...were finally in 1 place.

  • Diabetes prevalence has continued to increase at pace- partly due to the public health turmoil we have, partly due to better detection but across 3 CCGs, diabetes prevalence has gone from 5.7% in 2010/2011 to 6.9% in 2015
  • Hospital admissions have surged at a frightening pace- from a total of about 12000 to 17000
  • On the face of that, the outcomes have shown over 5 years:
  • Drop in DKA by 29%; Drop in Hypos by 42%
  • Drop in MI and CVA in patients with diabetes by 22%
  • Drop in diabetes amputations by 39%

Today, we stand vindicated, happy...the detailed article is to follow- but the journey we took those years ago- on a leap of faith has today borne fruit. I will just say one thing- without some amazing local CCG folks and most importantly a super bunch of primary care colleagues, this simply would not have happened- so thank you- muchly.

Much more to come- but those who want to see whether "integration" works - there you go. If you have a better way of doing it, then stop criticising others, make your model and produce outcomes. At the end of the day, its about what end product you show.

I will finish with this. Those who sneered or passed comments, I haven't forgotten. The biggest answer to that is when your own CCG comes and asks us for ideas- because YOU haven't- because you have opted to stay in your palace and benefit a few, not many.
I am no leader- I have never been on any leadership course, never won any leadership award, neither been ever been on any "leadership list". But locally, I have never needed any to those who wonder how to change things...find out willing friends in CCGs or primary care- they are there in abundance..and go do it. 

To the rest of our powerpoint leaders...Partha Kar is not known for false humility- so without any false pretence, go and match what we have done locally with our primary care colleagues. Show some end product- which in the healthcare system, lest you need reminding, are outcomes, not tweets.

And Portsmouth team- across Portsmouth Hospitals NHS Trust, Southern health Foundation Trust and Solent Trust- plus all primary care across 83 surgeries- do take a much deserved bow. You have been simply..awesome x

1 comment:

  1. Congratulations. So refreshing to hear of action instead of talk, system reform instead of patient blaming. Thanks , on behalf of people with diabetes, for being willing to take a risk on doing things differently.