Wednesday, December 27, 2017

The 2017 Chronicles

2017. Nearly done- and from a professional perspective, its been a year of getting to prefixed targets set- nothing more, nothing less.
No point in beating about the bush- the NHS is in turmoil- with a swirl of politics, elections, more changes beating an incessant drum which has made life suffocating, difficult to concentrate on the job at hand. Yet…albeit from a biased point of view, we in the NHS England diabetes team- can perhaps look back at 2017 with a bit of a smile.

Landing the Transformation funds was a big step forward- with the process of allocation of money-perhaps being…character-building. Either way, at the end of it all, 62 odd million £ were distributed out- with a further roll out of the National Type 2 Diabetes Prevention programme; about 5 million £ specifically to increase specialist nurses in hospitals to tackle hospital safety issues; about 11 million £ to improve uptake of structured education etc. Will money solve it? Nope- but it certainly goes a long way to answering some critics- as well as kickstarting some of the much needed processes that diabetes care needed.

Next step was the landing of the Diabetes NHS RightCare pathway. Blessed by eminent personalities such as Sir Muir Gray, it arrived with 7 key priority areas being focussed on- at a population level. The message coming out has been loud and clear- the days of a "community diabetologist" and a "hospital diabetologist" must be coming to an end. It has been of much personal satisfaction to see I have always believed in…one is a specialist for the system- not of one particular bit of it.
The digital versions of the Type 2 diabetes prevention programme arrived too- a roll of the dice- to gather evidence, to test the theory that digital approaches may work- a preference of a nimble approach towards technology- in an effort to encourage innovation- yet with markers around it. The recently published data also showed the growth in numbers in the face to face T2D Prevention programme

The landing of the FreeStyle Libre was big news- an unconventional approach- yet- in my opinion- a much needed one to share up the status quo- it certainly has caused a stir- and for me, the big thing- apart from the technology- was the whole process of seeing what could be achieved if all forces joined together for the right thing. For me? Getting it to even one person beyond the capability to buy (which is what it was for 2-3 years)- thats a win. As was showing that when we negotiate, we do so for all 4 countries, not for one. We do so for adults and children, not for one segment. Diabetes does not stop at certain ages, nor at boundaries of countries….THAT is created by us as health care professionals- and this year- to me- was about setting the tone for changing that.

The year closed with updates to the DVLA rules for those living with diabetes. Some important first steps- especially removal of the legal barrier to change how glucose levels are to be looked at during driving. Much to be done yet- but this is a big step forward- just as Libre could be potentially opening the door to further technology in type 1 diabetes in the NHS. And finally, the opportunity of brining a Scottish piece of work (My Diabetes My Way) to England- and invest with an aim to develop it further- explore the possibilities of Artificial Intelligence & Diabetes

So whats up in the pipeline? Truckloads…will all of them land? Unlikely- but no harm in seeing where it takes us. I will list them below- to give an idea of what we are up to/ have in pipeline/on drawing board- in no particular order of preference:

  • Type 1 diabetes Digital platform
  • Type 2 Diabetes Digital education offerings
  • Accreditation of Education programmes
  • Discussion around QoF; individualised care- and especially frailty
  • The UK version of "Language Matters"
  • A focus on better technology uptake especially CGM access
  • Possibly Out of Hour support across the country
  • Liaison with pharmacist/ dietician/psychology organisations regards their roles
  • Collaboration with ABPI (umbrella organisation of all diabetes Pharma companies)
  • A possible Dragons Den style Innovation Day
  • Working with ambulance services regards treatments etc
  • Developing something for SE Asian people regards education in T2D management

Enough? I think so- and as mentioned, the NHSE Diabetes team is busy with ideas/thoughts/possibilities- working closely with Diabetes UK , JDRF et al

Personally, apart from all of the above, there's the TAD event, the T1D: Rise of the Machines; Episode 2 of the T1D Comic book….so much on plate- and so much fun to be had. 2017 has been a bit of a blitzkrieg, 2018 could be one step further- who knows. Throw in the GIRFT role to come..touring all hospitals around the country, discussing safety, care, data- and yup, it will be busy, won't it?

Regrets from 2017? Very little. I never came into this role with any expectations- apart from having a bit of fun- and as long as it continues to be- we keep at it. The NHSE Diabetes team are laced with characters who have guided and supported me- yet let me run at my pace- which has been much noted and appreciated.

Resolutions for 2018? Not much to be honest- but maybe smile a bit more, try a bit more charm. I am perhaps a bit more relaxed, a bit more chilled - and the supporters have been far more than the detractors- which is always a good barometer. You can't satisfy all- trying to do so is probably the biggest error anyway. However, more than all? The biggest strength has been the folks who live with diabetes or care for those living with D. Very rarely, if ever, there has been any criticism from them- and I can't thank all of you enough for that. THAT is what has made 2017 so special.

Let's hope 2018 brings us more cheer- as we try different approaches and things- and we are always happy to listen- and hopefully, our work in NHSE shows- we have been trying our best. I wish you all a happy new Year- and look forward-as ever- to your support- as we try to make diabetes care…just that bit better.
Personally I always worry when my interest flags or wavers…or when I feel the challenge isn't there anymore. Not quite done yet to be honest in diabetes…the fire still burns well…lets see if we can make 2017 the warm up act for 2018, shall we?

                    Partha Kar & Jonathan Valabhji….The Maverick & The Statesman 😊


  1. Love your list for next year! But feel driven to comment from a very personal perspective as am very involved with much of the transformation work in London but there’s one thing that continually bugs and upsets me: feel v fortunate to get the best care there is, but see on a daily basis that the quality of services and care varies massively.
    There are so many who don’t yet get the basics - type 1 & Type 2 - and from where I sit the answers lie at least partially in strong but sensitive clinical leadership and mentorship of colleagues, plus mandatory annual CPD (& patient education of course!). Training, education and motivation can move mountains and they don’t have to break the bank. There are fantastic clinicians across the country but many areas don’t APPEAR, from what patients say, to keep up, stay on top of diabetes developments and stay motivated to do the best for themselves and their patients.
    You’d hope Rightcare could help by highlighting gaps and weaknesses, but I think it will take a a great deal of additional help and support to improve services everywhere. Maybe that’ll never be achieved, but between the maverick and the statesman, you’ve a set of skills that can hopefully help. I wish you both the very best of luck and good judgement in continuing your work to improve patient care and outcomes in 2018. ����

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