Saturday, November 18, 2017

Trial and Error





Do digital interventions in the world of diabetes work? Come to think of it, what defines what digital intervention is? The NHS has a fascinating approach to it all, ultra cautious to technology ( EVIDENCE shouts the detractors in a Len Goodman style) yet utterly oblivious to the clownish approach towards how we deal with governance or indeed evidence issues by sending letters via the Royal Mail. Who knows how much is acted upon, followed up etc.
Our zeal to be evidence focussed comes with a fascinating double edged sword...while entirely appropriate towards new medications..when it comes to technology and digital means, the approach is sloth like, cautious, defensive, suspicious.

Which is why I like the whole idea of disrupting the status quo- and watching the type 2 diabetes prevention digital strategy land has been fascinating to see. A very hard working team has gone through many a rigorous process and finally landed on 5 providers to see what they can achieve. There's a clear commitment to evaluate the results and see what impact it has- not only on usual things like weight, glucose but also, for me, access issues, socioeconomic determinants.
The approach is very simple...in 2017, having a digital platform to complement a face to face programme is about choice, it's about modernising...it's also about saying "I don't know whether it will work- but am happy to road test it and find out". The problem I have with folks who oppose every single thing is that as individuals who pride themselves on their prowess to interpret data, they also quickly succumb to their own confirmation bias. Very few are open enough to say..."do you know what? We are willing to look at this with an open mind". There is indeed the place for assessment of data, independent review before national roll outs...and more importantly business model which makes sense. However tweeting your outrage about something or anything digital from your slick smartphone takes irony to a whole new level, doesn't it?

If you want to know more about the digital type 2 diabetes prevention plan, have a look here. It gives you all the info you need, the process gone through, the areas where this will happen, the follow up plans and what comes next. There is no massive secret plot...just like the allocation of the diabetes transformation funds ( I repeat 42 million £ actually) it's transparent and based on one fundamental principle.."We are trying different things- as the status quo isn't working". As I have said multiple times, the best education programme is the one the patient attends, not the one which feeds on glories of the past. I will be very honest, if I develop any type of diabetes, as things stand with the education courses, I would find it difficult to attend them all. Not because I don't want to, but there is also this thing called life and I would like the system to fit around my busy life, not me fit in with the system. In the modern digital era, if anyone suggests so, it gets the boot and I find another provider who fits my needs. That's the way I do my banking, that's the way I do my shopping or my check in for my flights...why should my health be any different?

So we are here. The Type 2 diabetes prevention digital stream has landed, the Type 2 diabetes one will follow as will the Type 1 diabetes. That is the strategy and we shall find out what it delivers. If the face to face programmes are better, then there's nothing to fear, is there? Time should, in that case, show the digital ones to have failed and we will be the first ones to admit it didn't work. Heck, we should take pride that the NHS is doing something not many are trying- a digital programme nationally with a decent evaluation behind it too. The thing with innovation is exactly that...not everything works...we need to test, adapt, amend and find the one that does work...so we shall try.

The NHS England diabetes team have been clear about its direction:
Strategy and areas of high priority: NHS RightCare Pathway
Money and investment: Nearly 65 million £ into spread of NDPP & improving care
Reducing variation: working with GIRFT team to improve safety etc
Digital strategy: the first one has landed, more to follow
Access to technology: Libre on tariff and national guidance

No doubt we have much more to do - not to mention we have a fair few exciting things in the pipeline- so let's see what the future holds!

The encouraging thing is that we i.e. the NHSE diabetes team spent 2 days at a national conference of diabetes, attended by health care professionals from many quarters- and it was heartening to hear the words of encouragement and overall positivity. Maybe the detractors are just those who love being behind keyboards....to them? My request is bear with us, be patient..I can assure you there's no lack of effort on our part. Feel free to be a constructive critic rather than rage against the machines.

And if you can't, at the very least, don't sit in judgement on those who lives you do not live.You want to have a polite discussion about something you don't agree with? We are very easy to find.



4 comments:

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