Sunday, June 3, 2018

Ugly,Bad & Good

In a world of fast changing news cycles, its difficult to keep up with whats actually worth paying attention to…but some invariably do…and I think I am starting to compartmentalise them basically into the Good, Bad and Ugly. Yup- there's always some Good- its a question of finding them too.

So lets start with the Ugly. 
Well- some report has suggested that re-admission rates in hospitals have gone up. I mean..No way, really? How is this possible, huh? Its frankly unreal that some folks find this remotely surprising. As I have said many time before, the 4 hour target is now an industry- a marker of all thats good- and the gearing of processes across the NHS has made this into a simple quest- get it better. Cos- as you know, a good 4 hour target result suggests there is little to worry about the hospital.
Once upon a time I used to love being on the wards- now I mostly try do my bit, help the juniors and try my best to bite my tongue. Inane processes abound, multiple events- al designed at one simple thing- get the patient home. Most medics will tell you the risk they now take- the edge of reasoning they hover on- and if not sure, ask our GP colleagues. They will smile wryly- and mention the patients coming back without enough time or support needed to look after them.
Turn medicine into a tick box process? Some day it will come back to bite you. We have gone from one extreme to another- and lets be honest- we send patients home quicker than most of us would do to our own loved ones- whether that be based on acuity or indeed support in the community. Thats simply…Ugly.

What about the Bad? 
Well- in my personal opinion, all this visa outcry- is indeed one. The desire to fill rota gaps - seems to have airbrushed the second class citizen treatment plenty of folks from the Indian subcontinent have- and continue to have. We just now need someone to somehow fill those gaps- those gaps created by us-as a system due to poor workforce planning, treating the workforce like children and labour..cue? Gaps- so where do we turn to? Somewhere else. This is a repeat of the 90s- when gaps existed- the doctors were wooed by all concerned- with the promises of much- with many turning up and then realising that it wasn't quite cracked out to be as suggested. You had to go and prove yourself twice over- you weren't "local" enough for that training post- until- obviously- there was a gap. Fast forward to 2018- and here we are again. No visas? What a blinking outrage- how dare the system stop us from filling gaps.
3/300 CEOs in the NHS- I hear- are of BME background. 1%. ONE percent. ever heard of the NHS getting visas to hire CEOs or equivalent folks from other countries? Naah- these are important posts- got to be filled locally. Rota gaps- to do the basic work- or bring them in as trust grades with lesser training privileges than local folks- oh yes- we are all over it. Was a close call as to what category this gem fitted in…Bad or Ugly…but went for the Bad on this occasion.

Anyhoos- lest finish with the Good. 
A release of the list of providers who can look at digital education in the sphere of Type 2 diabetes within the NHS. An eclectic mix- and simply with an effort to collect data across the country- using different means- and see how things go. Its not a roll out -or even replacing traditional face to face - but giving another option on the table.
In an environment where <25% folks attend their education as offered (whatever be the reason)- options need to be there to help many who cant find time to do face to face education sessions in groups. There are 10 of them- and the ask is simple- commission some of them (money within transformation funds- plus extra money via test beds to come)- and lets see what the results are as regards uptake and completion of them. Its 2018- and providing simply more of the same isn't really an option. To all those who don't like digital - well, its happening- BUT in parallel with existing programmes- with clear aim at collecting data. Its not your academic ego that matters but whether the person living with diabetes has found it useful or not.

So there we go- a bit of the Ugly; a bit of the Bad….and a bit of the Good. Maybe thats what I should go for in future blogs- a round up of the headlines that capture the eye!
Hope you all have a fabulous week ahead.





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