Thursday, July 27, 2017

Sweet Sixteen?

April 2016...took the step of joining the NHS England diabetes team. Here we are in July 2017...sitting by a seaside in Corsica perhaps offers the best chance to look back and reflect. Many had encouraged, some had warned about the dark side, some had been openly hostile, some had said its a treacle which will frustrate. So how has it been? 

To start with, I am going to say the positives. There are some people the world of diabetes won't see much or even be aware of...folks like Mathew Fagg, Jeff Featherstone,Ben McGough and Nin Pandit etc but in my experience and view, the world of diabetes will always owe them much. The shiny public relations and blustery side is easy..I have always revelled in that space, but without these guys working their magic in their quiet, non-obtrusive way, little would happen. To me, respect is always earned- and it doesn't matter what your title says, whether it be the Chief Executive of the NHS, a trust or indeed the HCA helping you run your clinic- and these folks have certainly earned mine. It has been a learning experience and surrounded by such folks just reinforces my eternal don't have to be perfect as a simply have to have folks around you who will complement you, look after your deficiencies. 
Which brings me to my compadre, Jonathan Valabhji. We didn't know each other much but over the course of time, it is my privilege to call him my friend. We have laughed and joked together, planned together ...and in parts, learnt how to work with each other. It's been simply an amazing experience. The external facade of me can do no wrong...internally, I know that throughout my career, I have always worked with others without whom I wouldn't have delivered anything.

Other folks within NHS England...the few times I have met Simon Stevens, I have never failed to be impressed with his vision and thoughts..I haven't always agreed but that's life- what has been fascinating to see is the respect towards colleagues and unquestionable desire to make changes. Bruce Keogh has always been a favourite, and although within a sphere, he will never be seen with respect, to me, he has always been a support who I will miss when he goes- as will the wider NHS. I appreciate this may not fit some folks narrative, but that's mine- as simple as that. 
Finally, it would be amiss not to mention Simon Enright...sparkly twinkly eyes, the Lord of communications- there's always that cool banter where he knows I am someone whose ego needs pandering to...and I know he is doing it too...effortlessly. The man knows what he is doing...and I respect that...he has enough experience of handling loose cannons- and respect to him for doing that...perhaps the only one who has done so with me with such élan. 

So, what about the other side? Well, bureaucracy is always an issue as is the vast maze of NHS England. Beyond the top tier, there has always been a thin veil of "who the heck are you?" laced with a generous dollop of patronising when you come with new ideas. There's always been that bit where you have to go and prove yourself again...sort of a repeat of what the career has been throughout my life- and NHS E has been no different...perhaps it's just ingrained in the NHS DNA. 
Beyond that work wise, the layers confuse me as do the multiple chains of process- which to me, does halt progress to an extent. Perhaps I am too harsh...the last 15-16 months have seen a fair few things delivered and maybe I am just a man in a hurry. Beyond NHSE, in general, the reception has been positive- amongst the clinical community, you have the usual mixture of admiration, support, jealousy, disdain...there's always someone who believe they know better- such is life I suppose. There has been a degree of academic arrogance - I suspect bound to happen when you challenge existing bastions- but in my mind, when you have strong support from Steph Amiel, Melanie Davis or Andrew Hattersley about "approach", the wannabes can be ignored. This isn't exactly a popularity contest....Big Brother has never been a programme I have watched.

So where next? Folks asked for money - the transformation funds were delivered; folks asked for clear national strategy - the right care pathway with its 7 priorities was released; folks wanted digital interventions- it's in the starts the delivery for all, not just us at NHS England. Benchmarking is the next big thing- more on that in future blogs- but in my last sixteen months, I have had a mixture of all sorts of emotions...mostly it's been one of satisfaction. NHS England hasn't felt like the dark side, more like a body trying its best within the financial rules set - and keen on improving care. I would encourage others to consider joining in whatever role to help things improve- if my experience has anything to say, it's certainly a roller-coaster worth getting on to.

Finally, I personally hope that some of the requests folks living with diabetes have made, are being listened to- whether it be in directed use of funds or indeed in strategies outlined. And I would ask you to keep the advice coming- because that's what matters, not some clinicians individual view or an academics notion of evidence. What matters is what makes a difference to YOU and is one of the reasons why I keep myself open to ideas whether it be on social media platforms or elsewhere. I don't know how much longer I will do this role- balancing out a full time job, while doing all this over half a day a week is not the easiest juggling act to do. But till I do, always willing to try- point out mistakes with respect and I will keep trying.

That's about all I can promise. Let's see what the future brings