Saturday, June 25, 2016

2 words...

So we are here. One referendum done, another crucial vote around the corner. I will be clear about it- I voted "Remain" not based on any economic issues but one and one thing only- the importance of a multicultural, all togetherness that the present world needed. To assume all those who voted Leave are bigots is silly and crass but for sure, it gives the minority the belief that their view is supported now by more than half of the country. Racism has always been a part of Britain- its got a bit more polished as time has progressed. As uncomfortable as it sounds- let me be blunt about it- when you are still doing Equality workshops in 2016, when you look at all the NHS arms length bodies and who leads them,..well…bias comes in different shapes. What you certainly didn't want is all of it to come creeping back into the open..back to the days when no one would sit next to my mum in Dudley on a bus in the 1970s.
Looking at whats happening today all over social media, welcome to a new world where the Trumps, Hopkins, Farage et al of the world are seen as voices of the "suppressed". No, they aren't- they are just an eloquent face of the ugliness which has always brimmed under the surface.

Lots in the Leave side voted for that due to the need for individual identity- not be part of a bigger mass- controlled by "others". I get that. We see that in the NHS don't we? A fierce passion in individual identity- whether it be their own GP surgery, their department, specialty, hospital- but a lesser drive when asked to sacrifice their individuality for the need of the NHS. So why surprised to see that in the wider world- we all love our own islands, don't we?

Which brings me to the next upcoming vote- one on the junior contract. We live in a strange climate- where the ferocity of negativity prevents many from giving a contrary view. I also appreciate that what I say next will bring forth some anger, some sniping about my background- perhaps even how because I work for NHS England I am some sort of government stooge. It will be forgotten very quickly how vocal I have been in support, written blogs, argued on their behalf on social media,railed against HSJ about their "leaks", how I went and stood with them front of Richmond house inspire of my national role….I have seen what reaction Jane Dacre has got from some- the same Dacre who has been simply outstanding in her support. But frankly, I couldn't care less. If you want to say something to me, grow a pair, come out from behind the keyboards and debate it with me- face to face. If you can't, thats your problem, not mine.

So I will come straight to the point- Vote Yes. Is it perfect? No. Is it better? Yes, I think it is- and I have read through it- just like I have read the previous ones. The imperfections need to be ironed out behind the scenes- working within the process. The ground gained compared to the first offered version is vast- and there is much to be proud off what has been achieved- as a collective. Does it tackle the issues of equality and patient safety better than the previous versions? Yes in my opinion. Again, its my opinion- none of which is binding or worth listening to if you don't want to, but that indeed is my view. I have also seen the heat Johann has taken on social media- here's my tip- if you fancy doing his role, go do it- but don't slight him-it takes a brave man to stand up and take all the heat he has to negotiate what he has.Arm chair leadership is only that, nothing more.

So is it a safer contract? Yes- key does sit with the Guardians- and it is up to as seniors to play our part. Is it a contract which is more fair? Yes - definitely in my view compared to previous. As the saying goes, you don't get what you always want, you get what you negotiate.
A"No" vote opens up further uncertainty and I can't quite see what exactly the play is after that. Will the EWTD go- perhaps so- would that make future contracts any more palatable? Rebellion is great-as long as its to an end- and I am not sure what that is. The system needs to heal, it needs to move on- careful that by creating or encouraging more anarchy, you don't hasten the demise of what has been the main issue, at least from my perspective- ensuring patient safety.

If it indeed is a No vote, I hope there is a plan…because if,as champions of the No vote. by whipping up frenzy, you end up compromising the careers of many bright young folks as well as patients….look no further about the situation the Leave campaign leaders find themselves in today. History will be the judge…and happy to be proven wrong. 

So if you are a junior doctor- and read this blog- take your time, think for yourself…and then I have 2 words for you- simply as a suggestion.

Vote Yes.

Saturday, June 11, 2016


Inadequate. Depends on how you look at it, isn't it? Depends on how you react to it. The Care Quality Commission came to our Trust and rated the Urgent & Emergency services as inadequate. Cue the predictable response. Listening to the media is a waste of time- as gone are the days of Walter Cronkite, Edward Murrow et al- we now live in the era of click-bait. Upstarts chasing bad stories, leaking salacious details is all what its about. Change the system? Don't be silly- its about the personality- damn the consequence of the shattered lives one feeds on or even leaves behind. So lets forget about them- it matters how one looks at it.

Funnily enough, as with most things, diabetes care has "led" the way- and on a personal level, had faced the sharp end of it back in 2010. We were one of the, (or was it "the"?) worst as regards amputation rates.  I learnt quickly- whatever you said would be seen as being defensive- I still recall the sarcasm laced comments from those in better positions than us- but you learn to accept it for what it is- and you work at it, with your team to make it better. 6 years later, much to do? yes- but have we moved on? I think we have. So back to the CQC…rile at them, be angry at them- and indeed there are many views as regards their use, motives or indeed existence- the reality is that till things change, they are here and they have published a report which rates part of where I work as inadequate.

I won't spend much time on reasons but whatever way you cut it, the past is what it is. It perhaps is up to the present to try and rectify it for the future. For reasons outside their immediate control, today, staff working in the Urgent pathway are the focus of attention, the source of click-bait- but would I take my loved one to be seen by the Portsmouth ED or MAU department? Yes, in the blink of an eye-because I know what the staff stand for. Don't believe me? Look at the CQC report- the "Caring" section- rated as Outstanding. Buried under the bad news, sits the Outstanding tag as regards the level of Caring.

I suppose it matters how you look at the ratings. One cynical view would be to ignore it completely- and walk away from it- not sure who wins or loses with that. Its easy for me to stay out- hey- our department is involved in young people and children and outpatients- CQC says its "Good"- so why bother? I bother because its my Trust, I bother because I owe a lot to this Trust over my years as a junior doctor or helping me to develop me as a Consultant. I can spend time berating the CQC or we could do our bit to help improve whats needed. Its a question of equity, its a question of everyone pulling together and this will bring into focus the need for all to do whats needed- so lets do it. The past is what it is- we could analyse it, dissect it, point fingers at others- or we could make sure we get that bit sorted.

Is Portsmouth Hospital a bad trust? No- have a look at the CQC report- if this was a report card, a fair smattering of blue and green and some amber with one red. Its nearly easy to in fact forget the red. But we must not. Our critical care is outstanding- lets rejoice at that, lets learn from that. And then lets go try and turn that one Red into something different. This is my Trust, a Trust of which I am unashamedly proud- and I don't give a monkeys about click bait stories. I however do care about patients and their needs, I do care about reputation and I also do know what amazing staff the hospital holds.

In the words of Abe Lincoln… "Let no feeling of discouragement prey upon you- and you are sure to succeed". To all the staff of Portsmouth Hospital who read this, you do an amazing job- day in, day out- and for that…thank you. Now lets get that little red bit in that report sorted, shall we? 

Saturday, June 4, 2016

Impossible is..nothing

Inspiring. Funny. Charismatic. Cocky. Winner. That's everything Ali was. And amongst his many legendary quotes- the one above has always stuck with me. Has always been a burning drive for me- the word impossible has always seen as a challenge- and thereby the approach to all things with confidence. Has always helped to have an amazing team around who have been supportive all along the way but I have a burning desire to improve Type 1 diabetes care- and the quote from Ali has been nothing but a source of inspiration.

I have ideas- many of them to improve Type 1 care. Some of them pretty random, some of them perhaps ambitious, some of them maybe even basics- but I do want to try doing them. A few months back, the idea of having TED style talks by folks with Type 1 diabetes seemed like a crazy idea- but here we are- a website (  up and running with all the talks available- and hopefully more to follow. One of the most inspirational events I have attended- I want to hear more from such folks, help spread the message to HCPs what life is about living with Type 1 diabetes.

So here are the extent of my ideas- I want a type 1 diabetes pathway template for the whole of England- a pathway that takes into account patient needs, trained people delivering it as well as being cognisant of the fact that this is the 21st century where email is NOT an innovation.
I want a digital platform for folks with Type 1 diabetes- a one stop place where anyone diagnosed with Type 1 diabetes can go and find all information they need- not have to sit and search on the internet for support. I want to have a comic book showing life with Type 1 diabetes ; I want to explore areas that are providing good care- interrogate success as the saying goes….many other ideas I have in my mind…so much to do.

I want to visit each diabetes team, talk to them, find out the challenges, talk to their MD and CEO as to what support they are giving their teams to improve care for folks with diabetes- I want to see what can be done to help diabetes teams all across the country- are their executive teams aware- do they value diabetes care? Do they value safety? I want inpatient diabetes care to be a fundamental part of hospital inspections, are there self administration insulin protocols- if not, why not…so much to do. I want to have peer reviews- not scary CQC visits but peers reviewing each other- diabetes team from Sheffield paying a visit to Portsmouth- why not? If I can't take criticism from a friend, who can I take it from…so much to do.

To everyone out there- if you genuinely want to help improve Type 1 diabetes care- please- do come and help. All offers gratefully received- and to those who are already helping, you help keep my burning desire going- so thank you. I don't know how long I will do this role for- but as long as I am doing it, I will certainly give the dice a good whirl.

Ambitious? Yes. Impossible? No. The NHS has been much kind to me- and I will certainly try my best to see what i can give back in return. 
Impossible is not a fact…it is an opinion.
Impossible is potential. 
Impossible is temporary. 
As the great man said….

Impossible is…Nothing.