Thursday, July 28, 2016

Greedy ...or Pathetic?

375 thousand. Say it again very slowly. Three hundred and seventy five thousand. Lots of dosh, no? So we had the media with its opinion...usual suspects joined in. It does make one pass a smile. The rules of absolutes broke out in gay abandon as ever on social media- the mix of indignation, the conspiracy angles, the snide remarks about rich Consultants, hacks rolling the dice depending on which way the wind seemed to blow to get some click bait articles out...predictable as ever. A pattern which repeats itself ad nauseum.

So let's look at some things. Let's say for example, this information is perfect, without any nuances of what's been counted. Let's say this man/woman has earned that above their NHS salary. If one assumes that a waiting list initiative pays (let's be generous!!) £1000 for a 4 hour session, this person has worked EVERY SINGLE DAY ( and more) of the year- beyond his 9-5 job. A moment to pause. EVERY SINGLE DAY? Don't like that math..ok...try this, let's say he/she got paid £5000 for every weekend he did extra work. That would mean he worked ALL WEEKENDS of the year and still had to work on weekdays to earn that extra. That's how silly the maths is.
Point being? This person worked to earn it. He/She also paid top rate tax- (no chance of dodging as via NHS, innit?) So grudge him/her all you want for his/her money..spare a thought for the lack of anything else in her/his life.

Let's make this very clear. Earning money is a right. It's not a sin- as long as you do it within the laws of the land. This person has done it rightfully and to do it, has sacrificed a lot of their lives to do so. Good on them-and thank you for helping to see so many and keep waiting times etc down.
That's the system he/she works in. The question should be whether that's been done without compromising their NHS work- rather than gasping at how much they have earned.

Now let's look at "overtime money". Anything above 10 PA isn't overtime, if one gets paid 11 PA, the added PA isn't a separate rate. If you don't even know that about Consultant contracts, then refrain from debate and stop making yourself look like an absolute fool. Overtime money or whatever lazy label you want to put on it, is driven by having to pay folks extra money to do weekends...let's pause a that's not down to the opt out clause. Let me give 2 examples:

Example A: hospitals are busy, medicine patients overflow into surgical beds, operations get cancelled, the waiting times slip. As that is elective work, the hospital- under pressure of targets, are forced to pay more to locums, extra money to existing staff to come and work extra to clear the backlog. The new Consultant contract will focus on that but let's also be a bit honest. For hospitals, it's also tied with payment by results- whose revenue stream far outstrips what managers have to pay for WLI. Let's all not be naive about it. Or you could get rid of targets...I think that's already being whispered a bit more loudly nowadays.

Example B: emergency work- the fast holding belief that more Consultant time would increase flow of patients, the stern belief that paying more would result in getting patients our quicker- why? Because the 4 hour target means everything. Why pay more? Because folks are ALREADY doing weekends as it's not some thing that can be opted out of. Doh.

The point is that all this is circular and as I always say, if managers are not capable or equipped to even implement the present contract, then a change in it will do nothing. Lazy journalism is what it is- that's their job...that's what folks nowadays do- jumping onto bandwagons is part and parcel of the existence of journalists - exemplified none better than comments such as relating that to the linking of cutting of nurse bursary cuts to Consultant pay. I get paid 12 PAs at present ( no, that's not 10 PA plus overtime) and would happily give up 2 PA worth money to fund more nurses or support education. Do please let me know who will do my job though- as again evidently without me casting my messiah like shadow on the wards, no patient can go home. Evidently. 

You create a market, you reap what you sow. In present situations, you want targets and Consultant delivered services, then you have 3 choices:

Pay for existing Consultants to do more - and perhaps have a national tariff on it
Recruit more Consultants
Or accept that Consultants can't deliver everything- ergo be clear to public that others can deliver what Consultants could- albeit without the training or expertise.

 Till that is sorted, most Consultants I know greet such messages with a shrug of the shoulder. Without the Consultants, the system is jammed inside hospitals- THATS the culture we have created. We either scale back from that or live with what we have created. The culture of indignation at others earning done by legal means cannot be scoffed or mocked at based on ideology. Folks earn for their future needs, their family needs and also their own personal choi of lifestyle. Which one takes precedence depends on individuals and circumstances.

These are life choices folks make- whether to spend more time doing work or with their family. 
A 10 PA job with no other work could give you plenty of weekends in a year - if one chooses to do more to have a better quality of life, then we should respect that choice and their right to earn, not bathe ourselves in self righteous and pathetic indignation. 

Friday, July 22, 2016


A regular bubble of simmering anger. The 24/7 world offers enough fodder and the world of Twitter reacts with predictability....the angst, the edge of menace, the self righteous, the genuine frustration...they all simmer together in a toxic cocktail creating an atmosphere which sometimes can become quite suffocating.

Every day there exists some reason for angst and this week has been no different. Forgetting even the ultra bizarre world of politics, the NHS itself has been fizzing with news. A new government, a reinstatement of Mr Hunt, Mr Massey as GMC top boss, scrapping of nursing bursary and of course the NHS "re-set". It's as if there is some design to make some people angry- and Twitter unfurls it with abandon. The tone becomes harsher, insults become sharper, friends turn into enemies and the space for any rational debate shrinks even further. Once upon a time, George Bush was mocked for his "with me, or against me". Social media exists in that sphere nowadays. The world of absolutes. You either work with NHS England or you don't. You either like Corbyn or you don't. You either support the junior doctors or you don't. It's all pretty sharply black and white.

What it has done is simply driving some sensible or perhaps even adult conversation away. What many wouldn't dare to say face to face due to a degree of social etiquette is now passé. Once upon a time, Twitter used to be a milder place, actually a fun place, a place to learn, a place sometimes for support. That world still exists, albeit shrunk. It bristles with indignation, with anger...the lessons of the last General Election , Brexit has taught no one the lesson of the social media bubble. That shouting louder and feeling comforted by like minded people doesn't actually result in achievement of ones goal. We simply shout a bit louder...a bit more unhappy, a bit more angst.

Mute and block have been useful tools but as one can see the abuse thrown at people, you know social media is or has lost its innocence. What does one do... I have no idea..apart from perhaps folks building a thicker skin. It's just an observation...and its a purely personal one that the respectful and polite conversations seem to emanate more from patients within the diabetes community.  There are challenges, but they are more with a willingness to engage in debate, a desire to help improve things. I don't know why but health care professionals, as a proportion, seem more angry, less willing to engage, more dealing in absolutes- including me at various times.

I must live in a different bubble but it's no shame in saying that I have a great job. I do general medicine, I do specialty work, I have great colleagues and for whatever anyone says, a fantastic hospital too. I like to laugh at myself and I enjoy being on Twitter. I know life is tough for many and things need to change, improve etc but the whole argument of more money will solve it is a debate that needs to be had a bit more constructively than..."If you don't agree with it, I hate you".
If that's not possible, then at the very least, maybe make Twitter make a little less toxic - there are many who would like it to be a continued space of education and support.

Let's give that a try, if we can.

Saturday, July 9, 2016


Where do you draw the line? Where is the line which should not be crossed- and what is the level of righteousness that a leader should have? Leadership as ever is a fascinating thing for me- and as much as anyone tries to convince me, I have always believed that leadership isn't for everyone. Yes, you can couch it in different phrases  - the fact of the matter is phrases such as "we are all leaders" perpetuates the belief that following isn't something ok to do. To be honest, following takes a considerable amount of skill and making it out to be something "not quite sexy" is all a bit odd. It maybe good for the coffers of some organisations but beyond that, for the wider population out there, maybe not so. Don't like what I say- have a look around you- every report, every view will opine about the lack of leaders, lack of someone who can inspire.

There is however a flip side to it too. One one side, the cry is for more leaders, the cry is for people to step up- and on the other hand, there is the instant judgements, the morality verdicts and the seemingly desperate urge for our leaders to be…perfect. I suppose one sees public figures as role models- and they need to have a certain standard but when it descends into a mob like vitriol, the question will come for many- why bother? 
Look through history- folks we have looked upon leaders, about whom books, movies have been made, folks who we quote at the drop of a hat- whether it be Gandhi, Churchill, Kennedy, Florence Nightingale…flawed individuals yet wth something special in them to make change, inspire and make following sexy too. Without the microscopic scrutiny of the media, the coruscating focus of social media, the click bait blogs or the instant judgements of twitter…they existed- they led, they changed and they had their flaws- which todays society may have deigned unacceptable, uncouth or even immoral. So how does one square that circle? How does one have a balance when judging our leaders- how does one give them the belief that they can lead, change without their every word, tweet, picture being poured over, interpreted and dissected?

We live in a Big Brother culture- where the sordid, the macabre and the saucy bits attract us. We love the conspiracy theories, we love the conjectures, we love the story of fall from grace…or maybe we just love a story. Full stop. Recently I have seen some posts about folks I have got to know and it has made me wonder why actually bother putting oneself out there. The conspiracy theory angles would make one wonder which supermarket some get their tin foils from- but the tone is accusatory, its pointing, its damaging- and in turn, it sends out a message to those who do it…maybe don't bother.

We ALL live imperfect lives, look deeply, we are all- to a degree, flawed. Maybe we should sometimes remember that when we judge our leaders, perhaps mock them less, perhaps judge them with a degree of care- they too are after all human beings- with the same hurt we would suffer if someone said something derogatory about us. I do have a lot of respect for folks who do stand up to be counted- yes, of course there are some who do it more for power, more for money- but there are also many who do it because they care, because they do believe they can help.

A bit more time for the "leader", a bit less of the self righteousness , a bit less of the moral outrage…and maybe, just maybe, we would give hope to the next generation that leadership isn't just one for the CV but much more…Accountability is important - and leaders need to stand up to be counted on that- but that must not allow for personal slurs.
And if you cant do that, step up to the plate yourself,step under the spotlight and lets see whether the glare is a bit much beyond the comfort of the keyboard.

Do it- and be..perfect.

Friday, July 1, 2016


What is the one thing we could all do with at the moment regards the NHS? Hope would be a good starting point, I suspect.
And it's a difficult one to give, isn't it? Despair has gradually progressed to cynicism, hysterical laughters, wisecracks and blogs as to how it's all going Pete Tong. It's a fine balance too...those who stand up and say "it's all ok, don't worry"….gives you images of that Iraqi general claiming victory while the U.S. tanks rolled in the background...remember that farcical piece of history? 

So what does one do...and more importantly why would one try get involved in anything to do with leadership roles within NHS at the moment? To narrow it down, the number of emails asking me "why bother" from some senior colleagues has been surprising, yet understandable I suppose. Let's take a sense check. Am a Consultant on a very decent salary, actually scrap that, a very good salary in a public sector job, good pensions, the gobby, cheeky-chappy type who would do well in advisory roles...simply on the dint of the fact we live in a world where the show matters, substance comes second, its pretty easy to say “I am ok Jack” why bother indeed?

Many reasons ...if I am very honest, ego is one of them. I have a pretty big ego (there's a newsflash) but I suspect it's also an inherent sense of self belief. I was asked by Bruce Keogh, a man I intrinsically like & trust (whatever your views are on him, I respect - but would appreciate you respect mine too!) and frankly, given all the noises I make about leaders who talk the would be incredibly hollow not to take up the offer of at least trying to change things.

Which brings me to the issue of hope. I travel a lot, I make friends, I make enemies...I can be affable and I can rub people up the wrong way quickly. I have a lack of political correctness about me and have always struggled to suffer fools gladly. It's a character foible but that's who I am and that's what you get with me- and I have absolutely no intention of changing that. I don’t believe in the need for having leaders of a certain mould- variety is the spice of life and all that.
But one thing I have also picked up is the lack of hope. The lack of belief that things can improve. On the flip side, have also met some absolutely amazing people whose dedication to improving diabetes care has simply been astounding.  Problem? We don't hear enough about's easy for me to do so about our work in Portsmouth (it’s that gobby thing again) but in general, people in the NHS are stoic, they are polite, they are humble and they see excellence as part of their job. As a result, we hear little and the masses out there feel the lack of hope.

So I suspect that's what I am trying...trying to join up those people together. Join up patients, joining up professionals...maybe showcase some of the work and see how it goes. I know some of you will go all Tom Cruise on me "Show me the money" (what a film, eh..."you had me at hello"..sorry - do like romcoms a fair bit) and all I can say is watch this space. 

But let me also put back to you that money itself will solve absolutely NOTHING. More GPs won't improve diabetes care unless we as specialists learn to work know, try those things like phones and emails etc to answer and guide a colleague when needed..NOT "do a referral and will see in X weeks"; more practice nurses won't help unless they are given appropriate support/ I have said many a times before, does diabetes care per se need a huge investment to improve things? No, not really. Let me give you one simple example...self-administration of insulin in hospitals- why isn't that a standard national thing? What amount of money will sort that? Or is it the lack of will, the lack of belief that patients can't manage their own stuff and "we know better?" 

It’s been a fascinating few weeks- and If you are someone who has diabetes, lives with someone who has diabetes or indeed works in this arena, I can only offer you hope for now. And there’s plenty of that around- it’s just not visible enough. 

The initial trend seems good-big patient organisations, specialist bodies seem to be getting closer- a distinct palpable urge to work together...and that's a great thing. I can't account for the whole of the NHS but take it from me, these are good times for diabetes care....there's a window we must use if we want to improve care.

I can’t promise that diabetes care will magically improve- but whether it be pathways, markers, long term outcome based work, inpatient diabetes or access to technology- there is a furious amount of work being done by a lot of folks- so keep the faith. There’s much to look forward to but needs a collective belief…hope drives many a things forward- stick with me on this one and we shall see what we can be done.