Sunday, February 5, 2017

Wry smiles

In my last blog, I touched upon the last 8-9 months- the projects which have taken fruition, the ideas which have taken shape while doing the NHS England role- and its been fun…really good fun- while being an amazing experience to chalk up. But a query has been from a few quarters via emails etc- "what about any obstacles?"

And it brings to the fore the question- how open can one be while doing the role that I do? Well…if leadership is about openness and honesty, its worth a try- bearing also in mind sensitivities and bigger picture too …whats the point in saying some facts which may be a bit too close for comfort…you end up losing the job- and the opportunity to benefit many others. 

So…here goes…

Organisations: This has always been one of bemusement for me. We always talk about the importance of working together, criticise acute or community trusts and GPs not "working together"- yet in the world of diabetes, theres a separate organisation for specialists, primary care, nurses…all of whose views have to be taken into account- and rightly too. 
Then amongst specialists, theres one for adults and one for paediatrics….excuse me while I have a wry smile. I suspect this is where my co-conspirator Jonathan comes in- pretty amazing at trying to get everyone together…but I must admit to looking at this all with a degree of amazement….all for patients, right? So why the silos - I can only dream of- I suppose - of a united healthcare professional body championing the cause of diabetes. Some battles, you learn with age, to let pass…and perhaps uniting them is beyond ones power…but for sake of patients, it would be nice..No?

Are patient organisations any different? Well…theres Diabetes UK, JDRF, INPUT, Diabetes.co.uk - and I see nothing but amazing, motivated, passionate folks trying to improve care. Togetherness would be nice…yes, I know, naive…but a wry smile is all I can offer- while one tries to negotiate the myriads of patient needs

Patients: No- don't worry- I am not that brave to say anything ill-advised about patients. They are who I do this job for…but I do have an appeal for expert patients., or patient leaders. Don't forget that there are many who you may not represent…there is no absolute as regards  needs of patients. Be respectful of pressures and multiple pulls on the NHSE team too- and we are trying to work in extremely tough circumstances. So, yes, do engage, do put your views forward- but with respect. I do this job because it's something I want to do…but the job specs never said abuse would come with it. So- do allow me a wry smile, when an expert patients view has to be the "only one". No, it isn't- there are many others whose views we miss..and it is the silent majority whose lives we need to improve too..

Condescension:I suspect this always evokes the best wry smile of them all. Maybe its my age, maybe its me…but you pick up a degree of condescension which is pretty fascinating. I get it from some specialists - (Heres a comment: "what exactly does he know about Type 1 care- he wasn't trained in London, you know" Another? "I suppose we have to accept someone like you is developing diabetes plans")- and the thinly veiled mask of disdain sometimes slips. I suppose the position I hold makes it necessary for some to hold that mask- but its bemusing nonetheless. 
Perhaps time will change that perspective and for now, one can only offer a gallic shrug. Sometimes its just like being a Registrar again but then again, if I never felt I had to prove myself as a trainee, why would I start now? 
Beyond colleagues, it has also been seen in some NHSE/NHS quarters- while steeped in irony has been the respect shown by folks such as Simon, Bruce, Jane, Samantha et al. But among some quarters…"do you know enough, do you know what to say" has been an interesting if not slightly painful experience. Best example till date? Someone reading a document to me- which I had written,,,but really, it couldn't possibly be me, could it? So young….
The pressure to conform - blissfully unaware that I was asked to join because of my maverick self, not the ability to conform.

System: And finally, the system itself. I am still trying to understand what roles of some organisations are - bar actually- at least, in my view, possibly slow down progress. People always ask "what's the hurry?"…well, I have no idea whats around the corner for me, so I want to get things moving NOW, not sit and wait. So the time is now- not later. we talk about variation, yet all CCGs have their own way of doing diabetes, own pathways of treatment- why? I don't know. But I certainly intend to find out. So when I see yet another email from someone with a title I have no idea what that means, a wry smile passes ones lips for sure. And to be honest, its now started prompting emails such as "Sorry, can you clarify your role?" Bar those who live or care for diabetes- or indeed those who have an understanding of the pathophysiology…aren't the others simply to facilitate rather than obstruct?

So there you are….some issues- put as politely as feasible. Maybe someday if I write a book, I may say more- free of the complications of the role one holds.
Its not been plain sailing at all- and if there is one thing I could change- it would be the ability to quicken things up. Will it happen? I intend to try- and I can absolutely assure you that I indeed have the "license" to do exactly that.  Lots of wry smiles over last 8-9 months- as I said, its been a fascinating experience.

Lets see what the future brings..would I recommend it to someone else? Absolutely 100%. All things considered, I would do it all over again- and the team that I work with makes it all worth while indeed. 




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