Sunday, January 3, 2016

Road to somewhere

If you are an HCP, you already know this.

If you belong to the cynical brigade, a Han Solo-esque smirk escapes your face every single time an episode of poor care or failing of targets are highlighted. The battle weary shrug their shoulders and the expression of "told you so" flits across their countenance.

If you belong to the positivity brigade, then deep down, you know...you know what's happening. In pockets, the sheer passion and zeal of a few try and break the trend- the rest slowly struggle on..slipping just a little bit more.
And its difficult to do that extra bit day in, day out to keep the level of quality where it needs to be. Because beyond all the evangelism, all the NHS workers have their lives, their families, their own selves..burn outs help no one at the end of the day.

If you are a patient, the signs are that people are starting to take notice, starting to worry. There is a growing realisation that the crown jewel, the religion as its called maybe in a spot of bother. There is a worry about the care they will receive, can it be on time;can it be good enough...can things improve from where they are?

As a professional within the NHS, here are a few thoughts for the public and fellow professionals- you may agree or disagree- and indeed its a personal opinion at best

1. Unscheduled care or emergency care:

In my opinion,the 4 hour target is not solvable any more. Without social care, all that is being tried, however well meaning, is now within marginal gain areas at best.

Primary care is flat out, patients arriving are sicker, riskier discharges are happening, an over reliance on senior docs have disempowered junior docs...its now all about the "Now"- without any eye on the future or any lessons from the past. Quicker, harder, faster is the mantra- patients are now commodities to be churned through the system.

I am afraid this one's a busted flush without social care- and dare I say, increased social responsibility of the public towards alcohol etc. Hospital managers are being driven harder- and if I could do anything, then it would probably be an arm around the shoulders to say..."You have tried everything you can- its not your fault". With a mystifying ignorance towards public health issues, this issue is going to get bigger, not smaller.

2. Scheduled care:

This probably has a lot of potential IF we genuinely develop the zeal to work together. I have my doubts- though at a national level, the attitude on this front as regards working together- is there.
Has it cascaded down to local levels? I am yet to be convinced but if, and its a big if, folks can indeed accept that some Trusts will have to take a financial hit etc, then maybe,just maybe, patients may have the chance of a joined up system.
The ingredients are certainly there- both GPs and specialists are more keen to work together...it needs unlocking and strangely, in some cases, permission.

Should you support the Vanguards? Your choice- but if you have a better idea, go for it too. There is a growing appetite amongst specialists and primary care will do well to grab it. Politics as ever will play its part- big questions beyond the doctors is whether we genuinely believe nurses, pharmacists have the potential to input or are held back by vested interests. In short? Good potential with lots of possibilities of fizzling out.

3. Money:

"More in! Robbing Peter to pay Paul! Smokes and Mirrors!" Well, there are different views to it but I will simply say this- read what John Appleby has to say- its pretty straightforward. The finances aren't enough to cope with the demand.

At the risk of sounding like a broken record, it needs an independent review- away from the political football. Either we discuss openly what we stop or we increase funding (by whatever means) to deal with whats needed. I suspect however, with the poll ratings where they are, the Tories will be quite comfortable with the status quo of throwing sticking plasters from time to time.

Stevens got his money- but crucially without the support he needed in public health or social care. And THAT is exactly where this will implode.

4. Type 1 diabetes care:
Finally, to this. I don't know what is likely to happen and I wish all the best to whoever becomes the National clinical Director of diabetes. Personally, I will try and my offer to help anyone- whether it be policymakers, CQC or anyone who is interested.

I am excited to be working on a few projects which I hope will help- whether it be a meeting of specialists around the country to try and draw up a model of care- working with patients; whether it be trying to develop a comic book for type 1 diabetes patients or working with GOSH for a day of TED style talks from patients with type 1 diabetes. They are being done on my own steam- simply because I enjoy using my energy in those type of projects- most importantly? Its fun.

The aim is simply to raise the profile, use Twitter for this, impress to as many as possible that its a serious issue to all and hopefully if that helps even 1 patient have 1 less error or acts as a small impetus to have better care etc...my work in 2016 is complete. To type 1 patients, all I can say? I will keep trying.

So is there any hope in the future? To an extent, yes but this will be a tough year for many doctors whose future is indeed on the line.Whether it be bad advice to a well meaning person or a well designed strategy by ideologues who want less of the public sector, either way, this year will be tough.
I can only assure our local Type 1patients that we,as a department, will continue to try our best while nationally, hopefully bring together some dynamic minds to raise the profile higher

Have a great 2016...hopefully its a road to somewhere.

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