Sunday, December 27, 2015

An interesting year

Another year. Gone. Just like that. Whoosh. Whistled past while we all wrestled with life. And it's pretty obligatory to have a look back. Look back as time fizzed by and hair greyed just a tad.

And I will be honest...personally, it's actually been a satisfying big things per se but the aim was to keep 2015 as one of the job one is supposed to do and try to do it as best as possible. NHS work was good - job satisfaction was high and as ever it boiled down to the colleagues or should I say, friends I work with. I work about 8 weekends a year, I work with an amazing team, have good relations with local primary care and Commissioners...sometimes it's not a bad idea to stand back and take stock. Sometimes its easy to forget the bigger picture.
Taking stock suggests it's not a bad place to be in- about 7.5 years after being a Consultant. Tips for anyone interested as regards a good working condition? Find a good team to work in...and invest a heck of a lot of time in building relations. Keep it casual, keep it simple, don't forget your sense of humour...and cardinally? Learn to laugh at yourself..believing your own hype is always a slippery road.

Nationally or in general the NHS got itself in the throes of an odd mix.
On one hand, if you looked hard enough, there were some good ideas out there. I am a believer in the principle of Vanguards - I like the concept, I like the direction as regards system leadership, need to measure outcomes of systems...and that is exactly how healthcare should be delivered and measured.
It's a sad indictment of the times that all of this is somehow hamstrung by the tentacles of politics. Money talks as ever..and whichever way you turn, the sums don't add up. We talk about a transformation fund, we talk about innovation...whilst also talking about financial balance. John Appleby is not someone to turn your nose up at....if he says we are in trouble, we actually are.
Money did come as per the ask of Simon Stevens but without public health and social care support, all it has the potential to be is an expensive sticking plaster at best. Politics doesn't allow thoughts for the future, it only lives in the present, learning nothing from the past.

Patient safety continued to be a focus..and one of the highlights of the year was meeting James Titcombe. You can disagree with his views but you certainly can't fault him for his drive to ensure no one else goes through what he has. Jeremy Hunt tried positioning himself as someone devoted to patient safety- and then proceeded to hand the initiative to his detractors by withholding safe staffing guidelines for nurses. If that was a faux pax, he then managed to embroil himself in a quagmire by not only embarking on an ill advised battle with junior doctors but also converting them into a lightening rod for all factions within the NHS to unite. One of the smoothest operators in politics somehow, against all odds, walked himself into a cul de sac.

Finally, there was something different in 2015..and if there was an award for the showstoppers of 2015, it had to go to the junior doctors. Whether it be their sterling work forcing a government to back track or the Christmas number 1, the rebel alliance have found their Luke Skywalker to rally behind. The NHS - a factional beast on so many levels..GPs, specialists, Nurses, pharmacists...finally..managed to look a bit more than the usual rag-tag bunch. Managed to learn the importance of unity. That should act as a message for ALL political parties...a united staff is a powerful beast..and the public is now pretty aware the NHS is in a spot of bother. Closest thing to a religion as someone said...the Tories would do well to keep an eye on this ticking time bomb on their hands. So..much kudos to the junior doctors for teaching many an old dog some new tricks.

2016 is nearly here...and I will finish with something which has been a personal belief. I rarely join "campaigns" but this year I did join NHS Survival. Why? Because, beyond the political slants, beliefs or whatever, the NHS does need a review of its funding...the sticking plasters applied depending on what political pressure the ruling party is under, doesn't serve anyone. Some have said other such reviews such as Wanless haven't worked, so why another commission? One fundamental difference..a pre agreed cross party agreement to abide by the findings. 

A commission comprising of patients, safety advocates, the main political parties, think tanks....wishful thinking? We shall thing is for one else have much of a solution. The mood- bar a few quarters of shiny chirpiness on social media- is actually hostile...and we run the risk of actually not letting Vanguards place to breathe and flourish. The key for that does indeed lie with the government...whether to spend 2016 (and post that even closer to the next election cycle) in fractious battles with the staff...or take the gauntlet properly.

Here's hoping. Wish you all a fabulous 2016.

Wednesday, December 9, 2015


You have to be careful nowadays- the main 2 corners of NHS emotions either centres around doom and gloom  deep from the bowels of Mordor...or happy, shiny positive change things- where unicorns gently glide over sparkly rainbows- and you have to be careful not to be sucked into either of those- as the reality of the NHS continues to be somewhere in between. Mostly average to good care- spattered with examples of excellence and blighted by occasions of poor care- what we learn from either of those-again-is variable at best- but that pretty much in a nutshell is where we are.

 However, all said and done, what I am seeing now is a situation I at least have not witnessed. There are many merits to the discussion about family structures and what support children offer (or don't) to their parents- and perhaps much of that has been masked by the social support provided by the State..but we are now in different times. Hospitals are now having greater number of patients inside hospitals waiting for "something". Bed blockers is a reprehensible term- one to be condemned to the history books- and the dissolution of social care is now having a domino effect on many a services. 

Think of this beds are choked...greater number of patients are stuck due to no fault of theirs- the 4 hour target creaks and understandably hospital managers are under the kosh to try and resolve this. The irony? No amount of doctor time would help in helping these people go home- all it does is either make the doctor a bit richer or cancel elective work- causing further knock on effects- whether it be simply put financial revenue for the Trust or simply poor care to those for whom THAT elective clinic has been one they have waited for- or is of utmost importance.

Social care is now in crisis- and there needs to be a realization that the NHS needs to focus its attention to have a concentrated effort in raising a collective voice asking "what next"? I do ward rounds on weekends- and bed after bed I walk past- with frustration- unable to contribute much as a clinician...and that number is increasing every single time I go back on the wards. To the powers that be, please do raise the query- either that or we challenge the structure of a society which has devolved the responsibility of their parents to the State. 
I have sympathy for hospitals who are beaten up over a 4 hour target when a significant reason for that isn't due to lack of medical/nursing engagement or simply "process". What does happen as a consequence is those who are in hospitals due to genuine medical reasons are then discharged quicker, a bit more risk taken, a bit more closer to the edge...opening up further gateways to error- ask any GP and they will tell you about the patients being sent home- the risks being taken nowadays

The system is choked- and now the knock on effect is falling on edification  elective work, challenging safety and going to the basic core of keeping patients safe. More doctors and nurses isn't the answer- use that money (if you have it) to buy social care- THAT will keep patients safe- that will help patients- and that,just, may help the 4 hour targets.

Wednesday, December 2, 2015

Joshua's story...

Have you ever seen The Verdict? A most excellent movie fronted by the iconic Paul Newman..if you haven't, I suggest you do. It's about a lawyers battle to bring justice to a patient left paralysed by errors, how a man out for money changes along the course of the movie to be the one to bring justice..a most riveting movie indeed. I have always thought how awful it would be if someone actually had to be in the shoes of the parents...but thankfully it was only a movie, right?

Errors or for that matter any data showing perhaps suboptimal care is always a tricky subject. Due to a multitude of errors, some due to data collection, some due to petty politics, medical professionals by nature, at least in this country, regard any such mention with healthy doses of cynicism. For sure, it must be a cock up on part of the data collectors or perhaps a conspiracy on behalf of someone who wants to bring the service down. The NHS is emotive, the NHS breathes fire into folks, the defenders of it are stout and quite rightly too...but do we sometimes stop to think of the ones who fall within the cracks? Politicians don't help either..either using data to berate professionals or indeed make ill judged pot shots at their result it becomes a football. A culture of hammering the professional builds up walls and any attempt to raise any errors are seen as berating the whole profession...the whole NHS..the lines are so sharp that even those who perhaps try to play a fine balance are seen as those who haven't chosen a side...both parties part of the ultimate Bushism...either with us or against us. 

This blog is about James Titcombe..a man who has been through the gamuts of all of the above. Passion on both sides have boiled..whether it be a dad, whose loss is incomparable against some who have taken his challenges as an affront to the whole midwifery profession. What struck a chord with me about James was when I got to know him more..was some of the similarities I had gone through many years back. And I have seen all sides of midwifery on a personal amazing caring, gentle side, soothing balms during times of pain...and an experience with my second born which I would never forget. I like to keep my personal life just that...but lots rang a bell...and this man is trying to correct something, trying to use the grief he has been through to make sure no one else goes through what he has gone through...and for that, we must laud him. Some of you may not agree with him but that must not translate into abuse..that must not translate into slurs...if there is even a little bit to learn from his book..please do.

To all colleagues  and juniors, I urge you to read his book "Joshua's Story". I am not an emotional man but as a dad, it felt hard to read..really really hard. Many a moment I had to take a break...but I read through it all to try and make sense..try and understand...and hopefully keep true to the ethos of putting the patient first. It indeed is a poignant and perhaps quite sad read..but there is much to learn if you believe in patient safety and I would urge you to go through it. I will certainly recommend it to my juniors every time I talk about patient safety.

Finally, a big thank you to James for inviting me tonight...felt quite ordinary in a room full of big names- but I do appreciate the gesture..and I wholeheartedly acknowledge what it must have been to go through what you have. Tonight I go home and hug the kids a bit tighter..thank you as a doctor..and more a parent. Joshua would have been a wonderful child...wherever he is, may he always rest in peace.