Wednesday, September 28, 2016

Daz, Shaz & Kate

2010 I think it was. Or maybe 2011…either way, the memory has always lurked deep. Waking up to headlines of Portsmouth amputation rates. And it hurt. We had embarked on the Super Six diabetes model- trying something different…things like 3 different Trusts working together, specialists working inside GP surgeries. Its all the rage now, you know- but hey those days? Ah blasphemy…I still have saved some of the scorchingly negative emails from leaders of the diabetes world- how this model would spell the end of specialists- surprisingly little about patient benefit and all that.

Anyway, I digress- but hey- you know what- it hurt. A lot. The pointed remarks from other specialty colleagues as to why we should be the ones to do general medicine, no one else…the barbed comments about legless Pompey lads..ah the black humour of medicine, eh?

So we tried - and I am not going to bore you with all the details, the journey- but its the point where we are at which matters. Same newspaper- same people- but this time, with a far more positive headline- and today morning, I smiled. No, didn't smirk but smiled. It didn't hurt all those years ago regards who said what- I brush off non-constructive criticism pretty quickly (its a character flaw/trait which has served me well so far…) but what hurt was the fact that genuinely, we weren't doing local people much favour with what we were providing.

Enough will be written by someone and somewhere about what we achieved, what was set up but this blog isn't about that- but is more of a thank you to many of the unsung heroes who should take the kudos but never will-simply due to their quiet and polite nature. And there are many…whether it be local GP leads such as Paul Howden, Jim Hogan, Barbara Ruston, David Chilvers et al or commissioning managers such as Sarah Malcolm- there are indeed many who have helped along the way. No system, and I repeat, no system can improve without a cohort of folks working together -whatever be their title or grade. Have there been obstacles? Many- and I could spend much time on false promises, threats or even attempts at bargaining to get foot clinics in place- but tonight- I won't. Tonight is about the ones who did the good stuff- the folks who cut across divides and helped.

Folks -who have moved on- Mike Townsend, Graham Bowen - folks who have been part of the change, Diabetes UK in the form of Jill Steaton, local patient advocate (now theres a man with passion!) Raymond Hale…so many to name, so few words for a blog..but thank you to you all.Orthopaedic surgeons such as Billy Jowett, Irwin Lasrado-folks who have been fabulous- or vascular chaps such as Mark Pemberton, Simon Payne or Perbinder Grewal…who said surgeons and medics cant work together?

But a major kudos perhaps sits with the amazing twosome of Darryl Meeking, Consultant colleague & Sharon Steele., lead podiatrist. We like to call them "Daz & Shaz" but their grit and determination to see things to this point? Simply remarkable- turning the tide in such present environment is no mean task- and they indeed are individuals who will shy away from taking the credit…but on behalf of many many patients and staff- a big thank you to both.
Much more to do- and results need to get even better- but this is a journey which takes time, determination and a lot of patience. To anyone looking at foot data- have trust in your local team, back them, support them…and yes- give them time.

A final word to someone who left our department for greener pastures..Kate Marsden…one of our specialist nurse colleagues- who was instrumental in many changes to local foot care. Thank you for what you started, your energy, drive- we haven't forgotten what you did- and we all are grateful…and miss you too. Data is what it is- numbers are what they are…but to change something positively needs something and someone special

So…Daz, Shaz, Kate and many others- thank you. You all have been very special indeed x

Thursday, September 22, 2016

The beginning?

I did an "update" style blog about 1 month ago regards my national role…"Where We At"- and promised an update in about 3 months- but I might have underestimated a bit the pace at which some things have been moving! I know, I know…I am acutely aware of whats happening in the NHS…junior doctors, STP plans, disputes, 4 hour targets, Vanguards, anger…all of it- I work, you know? Haven't given up anything in mu day job- so acutely aware of all the issues- but its just been a delightful month as regards diabetes.
Yes, I know its a narrow view- but hey-its my passion to improve that sector of care- so bear with me, ok?

So what have we had? Well, lets start with the website, shall we? A curated information portal for anyone with Type 1 diabetes- a wonderful, amazing piece of work driven by some super folks- the brainchild of Sophie and Mike- helped by Pratik & Laura- along with support from so many- what a spectacular piece of work it has been. Much to be admired, much to learn from- folks- I am so happy that we kickstarted this. As part of this, meeting the folks who have helped with, what amazing stuff indeed.

And the comic book- dear Lordy- cant wait for its launch- it is SPECTACULAR- if I may say so. The 4 folks who have helped create it- more to be revealed later- but I genuinely hope it does become a source of funned inspiration for many- just so glad its complete.
Then we are on the verge of declaring the date for the next edition of TAD - remember the last one? Oh the Type 1 diabetes pathway is also ready- just a final tweaks- and many many thanks to all those who have helped so far (you super folks of the London network, Diabetes UK, ABCD and all those who came to #talkT1)…I hope you can see why I am just so delighted? And I know some think these are gimmicky and don't contribute much- well, I disagree- ladies and gentlemen, every little bit of support we can create? All of it helps.
Nestled in there has been the launch of an online education programme for Type 1 diabetes (BERTIE)- led by the Bournemouth team. Evidence based? Not yet. But hey, when folks are not going to any of the evidence backed programmes, then maybe its time to upgrade ourselves to the 21st century- and try something different- yup? Time and evidence will tell where it sits- but I like it- I like the effort- and would encourage all to back it with optimism- albeit with a cautious one.

And finally to the big one. And it does come down to it- yes, money. NHS England have just declared their plans and funding etc for next few years- and there are 5 areas which have additional funding- and its such a delight to see diabetes amongst them.
Kudos to Jonathan Valabhji- the quiet man always speaks the loudest- and for me, working with him has been nothing but an absolute pleasure- we are chalk and cheese as someone said- I would rather go for Butch Cassidy and the Sundance Kid…far more catchy-I reckon!

Beyond the National Diabetes Prevention programme- 4 key areas will be ones to tackle and prioritise- improved uptake of structured education; improving inpatient diabetes (that pesky insulin errors!); improving foot care and finally, tackling variation. 40 million pounds to do it. Enough? We shall see. More than what has been norm or most other areas? Yes. And frankly- now its up to diabetes leaders to earn their corn. You wanted ammo- here you are. Go engage with your CCG, Vanguard, STP and come up with plans to improve those areas of priority . We would want insulin errors to be a relic of the past, we want amputation rates to be the lowest- go and do it.

In the midst of all the cacophony, diabetes has a chance. And its now. Don't lose the chance. If you are someone who lives with it, are a carer, works with folks who have it, passionate about it..come together and lets get this done. There are many more strands of good news potentially in the pipeline  ( a possible e-diabetes passport; CGM; expansion of NightScout as a few teasers!) but for now, its time to get up and get things better.

Let this be the beginning of something special.The chance is there- lets not let it slip.

Sunday, September 11, 2016

Honest debate

Its nigh impossible to have an honest debate about the NHS, isn't it? Forget the politics, the funding for a moment- its rarely possible to do so within NHS circles. Now lets lay some cards on the table before anyone unfurls their indignant banners and views. I have been asking for an honest debate about NHS over many many moons- go check my blogs over last few years. Heck I have even been involved in asking for an honest cross-party commission to look at NHS funding when many leaders were singing Hakuna Matata or running around a fire chanting Kumbaya whilst waiting for the holy grail of leadership to land. For information, I also stood outside Richmond house supporting our generation Next while many ducked, weaved, touted out sanctimonious lines about "patient care". Just in case you missed any of my views- these folks called junior doctors- they care- and they care a heck of a lot- so lets stop knocking them.

Beyond that, just so we are clear- as I have said before, lets get some credentials laid down. Not to clarify how "awesome" I am but it appears I need to do this time and again- as "what do you know? /You look young/Wheres your experience" is such a prejudiced and regular opinion that it genuinely is starting to get on my wick now.
So- here we go- worked in acute Trust as clinician & manager; worked in community Trust as clinician & manager, part of a Think Tank; involved with CQC; work as a secondary care advisor on  a CCG; spend truckloads of time with GPs- in their surgeries and oh yes, also work with NHS England. So don't give me that nonsense that I don't know enough- am sure theres much to learn but enough knowledge about internal politics, tariff and silos too

So let me make it crystal clear- I want to improve diabetes care & outcomes- and yes, some of it will need funding- no question about that. I have publicly said this before- we fought tooth and nail locally to get 7 day acute diabetes service, it needed staff & finances (a quick thank you to Julie Dawes on that!)- no magical "working together" did it- nor was my leadership skills so awesome that I made it happen with some cool alien powers. However, beyond that, lets be a bit more honest and ask some questions in that case.

Lets start with acute Trusts. PbR does NOT work for long term conditions- everyone knows that and accepts it- the journey of someone with an LTC cant be reduced to widgets- plus it is now a perverse source of stopping integration/working together -or whatever the term is this week. So how many exactly are up for working to a Year of Care Tariff on diabetes? Care to give up any extra money (which PbR brings re diabetes) to primary care? To invest in technology?Or is it only about how to keep acutes going as they are?
Its a tough question- but if you want to have an honest debate, lets start it. What about Best Practice Tariffs- lets say for diabetes? Does every single penny go to the Paediatric teams? No-it doesnt- so where is it? Does it go to the adult teams to help them? Why not- aren't you part of one acute Trust? Why is an adult team scrambling for a psychologist, patients getting admitted due to lack of metal health support when the tariff can justify all of that- why the locked in silo to a paeds team? Want honest debates? Lets start it now.

How about primary care? Theres X million in QoF solely for diabetes. Ok- tell me what you could do differently with that money.(No- I am NOT planning on "taking it away"- don't be silly- I am not the Lord) QoF in diabetes is now more about process than quality- most GPs know that and find it frustrating- so if we wanted to use that money differently, what would you ditch from present QoF, what would you keep to improve care? An honest debate? Lets start it now. You want more investment- well- tell me what that translates to- whats the plan? Which primary care group has a plan for diabetes care?Bring it along- lest chat. I don't have all the answers but am sure as heck ready to listen

So you know what? I am with you about "saving the NHS". But lets do it as a system- shall we? From a diabetes perspective, I will try my darned hardest to improve care (whether I stay in this job or not)- but give me a system plan- not what just 1 care need or just acutes need.
As one of my patients always likes saying…"I don;t really care who works where- as long as I am seen by someone who knows what they are doing- and on time". 

An honest debate? Lets start it now.Email me, talk to me, phone me..heck even use Twitter if you want- but lets  have that debate,shall we?

Tuesday, September 6, 2016


Enough. Just enough. This has now gone far too long- yup- its the whole junior doctopr fracas- and we are now at yet another crossroad - of perhaps an I am going to use this blog to implore- NOT my junior doctor colleagues but to many others within the NHS to get a bit more involved to help resolve this.

Lets get something pretty straight. A 5 day strike with less than 2 weeks notice wasnt the brightest idea- and forget about the points to be made to the government- this was more about testing the seniors as regards what they can do to keep patients safe. Those 5 days would have been tough- would it have been unsafe- well, its all areas of conjecture- there is no precedence for it- and in Star trek speak- its indeed a bit like "Going where no doctor has gone before". Anyway, we can criticise the BMA for all we want but lets also laud them for making the right decision on this instance. It's a moment in time, an opportunity- or one more opportunity to resolve this ugly acrimonious fracas.

So this blog is to all NHS leaders or even media with influence in "higher circles" ( yes thats you HSJ)- yes- those ones who make their way on to lists, attend the glitzy award ceremonies, tweet, write blogs, run organisations...drop the cuddly chat, drop the theorising about compassion, empathy- and get a bit more involved. You are important enough, know enough people- well, go and say to NHS Employers and DH- please, do go back to the table with the BMA. Did you say "why? Well- at the very least, to give peace a chance, ask the BMA what they want, have an adult conversation behind closed doors, try again- do whatevers needed to stop a 5 day strike in October.

Be a bit less biased- drop that chip on your shoulder about doctors or your hate towards a union- and be a leader. Powerpoints, degrees do not make a leader- if you GENUINELY believe in patient safety, forget the circular debates about who has the better argument- just try to help resolve this- altogether ask both parties to get to a table- yes- again- yes, one more time- for sake of patients.
The GMC, rightly were worried about patient safety- well I do ask them too- they were accused of bias by many juniors- well, show to them that your worry extends to asking NHS Employers to resolve this. Health Education England were rightly worried about training being compromised- well, extend that to DH and ask them to ensure our generation nexts future is not compromised

Am I a  leader? Don't know- haven't made any lists - but I work in circles where I can ask the powers that be to engage with the juniors. So I will try. I will ask.
If YOU  are someone who can influence that- then do it too. Please. An FMLM fellow? A Keogh fellow? A Chief Executive? A Medical director? You know enough people- do the necessary. Stop being political and trying to protect your job- a 5 day strike is a month away- do what you need to do for patient safety.

I will be honest- I have never done a leadership course - so I don't know what they teach on those courses...but let me finish with a quote regards leadership..

Remember that. And go do the needful.