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Mantra for promoting patinet care

PROMOTING PROFESSIONAL EXCELLENCE AND LEADERSHIP

SUSHRUTA

THINK GLOBALLY, ACT LOCALLY

IN THIS EDITION... Message from PM of India

Local Healthwatch: Working with doctors

Be the Best Doctor Good Governance: Duty of Candour Immigration and The Elderly Leadership Change The Dominance of White Men at the Very Top Shames NHS JUNE 2015 VOLUME 7 ISSUE 2

International Health Challenge at the United Nations

Dukhi Atma !


SUSHRUTA - VOL 7, Issue 2

SUSHRUTA Sushruta Editorial Team Guest Editor Dr Kailash Chand OBE Managing Editor Buddhdev Pandya MBE Advisory Editors Dr J S Bamrah Dr Joydeep Grrover Dr M Hemadri Special Editorial Advisors: Dr Anand Despande Dr Hasmukh Shah Consultants Mr Shyam Kumar

In this issue.... Note from the Guest Editor...................................3 Message from Prime Minister of India................. 4 Foreword from the President of BAPIO.................5 Message from the President of GAPIO..................6 Be the Best Doctor You Can Be..............................7

SAS Mr Victor Babu

Immigration and the Elderly .................................9

Young Doctors Dr Ankur Khandalwal

The Dominance of White Men at the Very Top Shames the NHS...................................11

Women Doctors Dr Vinita Manjure Research D Arvind Shah Regulator and Standrads Dr Satheesh Mathew International Prof Rajan Madhok Sponsorship Buddhdev Pandya MBE Director of Policy and Promotion Editorial Support ProofScience www.proofscinece.com Publicatio Policy Dr Ramesh Mehta Dr Praag Singhal Dr Satheesh Mathew Mr Buddhdev Pandya MBE Published by BPIO Punlications Ltd 281-285 Bedford Road Kempston Bedford MK42 8QB Tel: 01234 212879 Email: office@bapio.co.uk

Dr Kailash Chand OBE Guest Editor

Buddhdev Pandya MBE Managing Editor

Promoting Ethics and Professionalism: A global initiative ................................................12 International Health Challenge at the United Nations....................................................14

Dr J S Bamrah Editor

Local Healthwatch: Working with doctors..........15 Good Governance: Duty of candour...................16 Leadership Challange......................................... 17 Dukhi Aatma.......................................................19

Dr Joydeep Grover Editor

BAPIO Awards ....................................................22

Dr M Hemadri Editor

Sushruta is published on behalf of British Association of Physicians of Indian Origin. Disclaimer:The opinions and views exressed by the authors in this magazine are not necessarily yhose of the editors or publishers. Although, care is taken in prepartion of this publication, the editors and publishers are not resonsible for any inacuracies in the articles. Great care is taken with regards to artwork supplied, the publisher cannot be held responsible for any loss or damage incurred.

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SUSHRUTA - VOL 7, Issue 2

A Note from the Guset Editor “Since the inception of the NHS, Indian origin doctors have provided a range of essential services, including care and support, for some of the most vulnerable sections of our community, often working in areas of high socioeconomic deprivation and in less popular areas of healthcare. By the 1960s, a time of significant expansion for the NHS, the government was proactively recruiting doctors and other clinical staff from Indian subcontinent.. Today, the contribution made by 1st and 2nd generation Indian doctors and

Dr Kailash Chand OBE Guest Editor

other BME clinicians continues to grow across the NHS, with more than a third of the workforce now coming from BME backgrounds. We have seen the vital role those from overseas have played in the key services, where there has been a historic shortage of UK trained doctors, including in consultant posts in emergency care, hematology andold age psychiatry and general practice. Overcoming barriers However, we must continue to break down any barriers that stand in the way of a successful medical career for people from International backgrounds. It is essential we provide a health service underpinned by equality where talented professionals are given the support and development opportunities required to create a lasting impact. The BAPIO is committed to equality and the elimination of unfair discrimination in all its forms, and works to ensure that medical students and doctors are treated fairly and equally in their education and career. The BAPIO would like to see fairness, transparency and equity regardless of whatever stage people are at in that career. Our focus is to guarantee that all doctors have the opportunity and support to choose and progress with equity throughout their careers. We believe that talent and contribution must be valued for themselves, no matter a person’s background”. May I welcome you to this specail edition of Sushruta

Dr Kailash Chand OBE is deputy chair of the British Medical Association (BMA) and as a GP since 1983.

Kailash Chand

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SUSHRUTA - VOL 7, Issue 2

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SUSHRUTA - VOL 7, Issue 2

Foreword from the President of BAPIO I am delighted that this special issue of Sushruta is being published at the occasion of Joint GAPIO & BAPIO conference. Doctors from across the world gathering to discuss the improvement in Global health is an occasion to celebrate the contribution of Indian doctors to health care. BAPIO as a voluntary organisation has been working hard to break the glass ceiling that has been stopping ethnic minority doctors in UK to achieve their potential. Although thing are slowly but steadily improving, lot more needs to be done. I am pleased for the support we are getting from establishment in this endeavour. BAPIO is proud of its contribution to the Global health care and its assotion with GAPIO. Amongst us we have stalwarts of huge international stature like Dr Gautam Bodiwala, Prof. Dinesh Bhugra, Prof Raman Bedi, Prof. Davinder Sandhu, just to mention a few. I am pleased to announce that we are on the verge of launching an education and training academy of BAPIO. This will be another feather in BAPIO’s cap after the success of Medical defence Shield (MDS). The academy will promote knowledge share and add further value to our principle of Supporting doctors achieve professional excellence. We plan to increase our voluntary work in India where enormous effort is required in the health care sector. Many of our members are keen to contribute to this work. We are in process of ensuring that this work is well organised and effectively channelled. We are also collaborating with various other organisations. I thank Dr Kailash Chand and Mr Buddhdev Pandya for their hard work in producing this edition of Sushruta. I hope you will enjoy readning this issue.

Dr Ramesh Mehta is a consultant paediatrician. He is President of BAPIO and Vice President of GAPIO.

Ramesh Mehta 5


SUSHRUTA - VOL 7, Issue 2

Message from the President of GAPIO On behalf of the Global Association of Physicians of Indian Origin (GAPIO), I would like to thank BAPIO for allowing me the opportunity to be a part of this edition of Sushruta magazine. GAPIO represents ~1.2 million Indian physicians across the globe with the mission to improve healthcare, especially in India. Since its inception, it has undertaken various projects to help the underserved population in India receive quality health care. BAPIO has been integral in supporting GAPIO and its various projects.

Dr Sanku Rao

President, GAPIO

The Joint Mid-Year conference is bringing both organisations together this year on the 27th and 28th of June in Leicester, UK. The theme of the conference is “Think Globally Act Locally – The Mantra of Promoting Patient Care”. Experts from various specialties will discuss topics involving the global burden of chronic disease including diabetes, cancer, paediatric diseases, and mental health disorders. There will also be a panel on the global curriculum for medical education and training. The conference will provide an excellent opportunity to connect members of BAPIO and GAPIO in the historical city of Leicester. I look forward to meeting you at the conference. Dr Sanku Rao, President, GAPIO

ABOUT GAPIO: It is estimated that there are 1.2 million physicians of Indian Origin

discussions it was decided to formally set up Global Association

working in India and other countries of the world. There are 125,500

of Physicians of Indian Origin (GAPIO). GAPIO was constituted

Physicians of Indian Origin working in the English speaking

in 2011 under the Societies Registration Act, 1860. There is a

Western world (USA, UK, Australia and Canada combined), with

need for greater visibility and cohesion of these physicians. Their

the major constituent being from USA and UK. Between 10-30%

combined intellectual and technical strength can also be a vital force

of the physicians working in USA, UK, Canada and Australia have

in the development of the Indian healthcare sector. It is with these

their roots in India.

There are also significant number of Indian

objectives that Global Association of Physicians of Indian Origin

Physicians working in Middle East, South East Asia and Africa. This

(GAPIO) has been formed. This body will have representation from

substantial workforce of physicians is a valuable resource, which

all the countries where physicians of Indian origin are settled. GAPIO

can help to mobilize significant developments in the health field

is a nonprofit organization and its vision is "Improving Health

globally. This strong Diaspora of Indian doctors who are highly

Worldwide". GAPIO stands to empower physicians of Indian origin

respected and powerful, need a common professional platform.

to achieve highest professional standards, to provide affordable good

The idea of GAPIO was originally conceived in January 2009 at

quality healthcare, to contribute to local and regional community

Chennai between Dr. Prathap C Reddy, Dr. Sanku Rao, Dr. Ramesh

development and thereby help to reduce health inequalities and

Mehta & Mr. Anwar Feroz. With further

alleviate suffering globally.

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SUSHRUTA - VOL 7, Issue 2

Be the Best Doctor You Can Be “I would say be best doctor that you can be, look to the future, embrace a positive agenda. Excellence is within the reach of all of us. Your voice can count. In all your deliberations, always be on the side of your patients.” Professor Mayur Lakhani CBE To coincide with the BAPIO/GAPIO’s excellent conference to be held in Leicester in 2015, I want to share some of my thinking about leadership and how to be the best doctor you can be. It is about ‘rediscovering lost values’ and a comeback for medical professionalism. This is particularly addressed at younger doctors. Whatever stage you are at in your career, I am pretty sure that you will be wondering what is in store for you in the future. Medicine is not a happy place right now. Maybe you are in doubt of your choice of career to become a doctor. When you look at all the news, it all seems like doom and gloom. There is constant change, a sense of struggle. You will be worried whether you will achieve the career you want, how successful you will be, and whether those student debts have been worthwhile. Let me say straightaway that you have done the right thing. You have made a fantastic choice. It will be a great time to be a doctor with opportunities to do even more with the advent of personalised medicine and genomics. I love my work; I look forward to going into work. There is so much more we can do for patients with epoch-making treatments, diagnosis, teamwork, better informed patients and digital strategies. Here are some values that have guided me. 1. Values and commitment to excellence. Not accepting the average. High standards and regular clinical practice and medicine have been an important part of my career, one that I am constantly working on. 2. Keeping up-to-date. To have a strong strategy for lifelong learning and professional development.

3. Reflection and learning from mistakes (mea culpa). Be open to feedback and get a mentor. 4. Take care of yourself. Guard against burnout. Burnout is caused by excessive workload, difficult/challenging patients, and especially from complaints and the inability to influence your working environment. Burnout is preventable, so know how to recognise the signs and take action. 5. Understand what it means to be a doctor in a modern healthcare system. The three-part role of a doctor: to give clinical/technical care; to be a leader (making decisions and moving things forward); and to be a partner with patients and other staff (teamwork). Conferences like this are not only occasions to celebrate our undoubted achievements in medicine, but also to reflect on the challenges ahead. Lord Michael Howard famously said: “A glorious past is no guarantee of a glorious future”. We have more work to. As a practising doctor, I want to do more for my patients. There is much more that we can, and need to do. As we speak, new discoveries are being made. The motto of the RCGP is Cum Scientia Caritas. Who better than doctors to translate new scientific knowledge and advances into everyday practice? There are two things to guard against: Firstly, people who adapt to a changing world will flourish. Our number one enemy is cynicism. I hope you make positive choices and choose a progressive agenda rather than resist change and improvement. Through medical leadership we shape the future; we have more control and power than we think.

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SUSHRUTA - VOL 7, Issue 2 Secondly, avoid the trap of entitlement and victim mentality. You have to work hard to be the best doctor you can be. Do not expect everything to be handed to you on a plate! Medicine is a stressful and demanding career. You made that choice. Make the most of this opportunity As we look to the future, your futures, let us remember Sir William Osler, on this the 100 year anniversary of his death. What can we learn from his legacy? Osler is renowned for advancing science, humanity and professionalism in medicine. His message was simple: how we practise medicine guarantees our professionalism. His love for his profession was undoubted. Using the pioneering spirit of our founders like Osler, we can get the highest possible standards everywhere by bringing back professionalism. Help us make all our

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health and care systems the best they can be.

I would say be best doctor that you can be, look to the future, embrace a positive agenda. Excellence is within the reach of all of us. Your voice can count. Use your influence. Counter anything that works against excellence. In all your deliberations, always be on the side of your patients.

Professor Mayur Lakhani (CBE FRCP FRCGP) is a practising GP in Leicestershire. He was Chairman of the Royal College of General Practitioners from 2004 to 2007. For two years (2006– 2007), he was listed in the Health Services Journal’s (HSJ) Top 50 Most Influential People. He was the youngest elected Chairman at the age of 43. He was born in Uganda, East Africa,


SUSHRUTA - VOL 7, Issue 2

Immigration and the Elderly “At the same time, as an elderly person I am sensitive to being described as a strain on the state with a generous pension, receiving free prescriptions and a free bus pass.” Mr Nikhil C Kaushik, Consultant Ophthalmologist The 2015 election is over, and the new government is in place. The focus of public debates is shifting to the EU referendum, but let us not forget that the great British nation still remains concerned about the ageing population, uncontrollable migration, and of course, the National Health Service (NHS).

attraction for those who use it and equally for those who work in it.

Such issues of migration, an ageing population and the NHS concern immigrants like me who are getting old and serve in the NHS.

With all these things good and great, I wonder why the nation is still unhappy with the NHS; why we question people wanting to migrate to the UK; and why the elderly still feel that they are neglected.

A job opportunity in the NHS was the reason for me to migrate to the UK. The career opportunities the NHS offered me are much cherished. I have enjoyed a good life, both professionally as well as personally. It cannot be forgotten that the government is The NHS has helped many of my patients live longer committed to tackling these issues. and I look forward to a long retirement too!

I am sensitive to migrants being blamed for unemployment and the rising welfare bills, while as an NHS doctor I am concerned that it consistently receives bad press. At the same time, as an elderly person I am sensitive to being described as a strain on the state with a generous pension, receiving free prescriptions and a free bus pass. The NHS, I believe, is both the cause and solution to many of Britain’s problems. The British NHS is unique in that as a healthcare worker one is blinded to the financial status of one’s patient; this does not happen anywhere else. This alone is the principle

The human desire to want more, and not to value what we have, might explain some of this. The current government has to be seen to be doing something to curb excessive migration to the UK, to address the ever rising demands on the NHS, and indeed to cater to the needs of an increasing elderly population. The public debates during the election campaign have affirmed that the British people are ready to talk about the cost of care. They would be happy with

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SUSHRUTA - VOL 7, Issue 2 information about the cost of their operations and medicine that they receive free, but pay indirectly as tax-payers. The average citizen is ready to face up to the economic reality of life. The nation cannot provide a service of this magnitude without having a balanced economy. That must be earned, before it is spent!

A citizen can only do the job that is available, and it is the role of a government to allocate resources in the right places and to create meaningful jobs. An opportunity in the armed forces makes one interested in becoming a soldier, while the same person is happy to become a teacher or a healthcare worker where such a job exists.

The main highlight of the last year (2014) has been the end of a prolonged and costly British involvement with the war in Afghanistan. This experience must lead us to examine Britain’s role in the affairs of the world. The peace dividends from the Afghanistan war might be better realised if we were to engage in helping countries improve their conditions so that people there do not feel compelled to migrate.

The current government should look for opportunities in selling the British expertise in healthcare and education to other European nations, as well as to the developing world. In this way, we can help improve conditions in places from where the current wave of migrants are originating, so that they do not feel compelled to migrate.

The ethos of the NHS should be promoted to countries across the world.

This will help reduce the queue at the UK Border Agency, and open up opportunities for the elderly British to consider retiring in sunnier places as well.

The great British nation must engage in its efforts Britain attracts people from other countries because to make the world a better place through peaceful it offers them so much, whilst their own countries means. Enlightening other nations to make remain challenging. healthcare a high priority is certainly one way of achieving this! Established immigrants in the UK have a role in urging their home countries to follow Britain’s example in Nikhil C Kaushik Consultant Ophthalmologist delivering health and welfare to their citizens. BCU Health Board, Wrexham Maelor Hospital, Wrexham doctornikhilkaushik@gmail.com

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The Dominance of White Men at the Very Top Shames the NHS Alastair McLellan

Editor in Chief, Health Service Journal It is unacceptable and unsustainable that of the 23 most senior health service positions, all are white and only four are held by women – with one of those being an interim. The sight of six chief executives from the main NHS arm’s length bodies on stage at last week’s NHS Confederation conference was an unsettling, even embarrassing one. Everyone was a white male, creating an impression even the fustiest private sector business would work hard to avoid, let alone an institution that should be striving to reflect the population it serves. ‘It creates an impression even the fustiest private sector business would work hard to avoid.’ In fact, the situation is even worse. The organisational leadership of the NHS now consists of the Department of Health (DH), together with seven arm’s length bodies: the Care Quality Commission (CQC), Health Education England, Monitor, the National Institute for Care and Health Excellence (NICE), NHS England, Public Health England and the NHS Trust Development Authority. Unacceptable and unsustainable Of the 14 arm’s length body chair and chief executive posts, the 12 substantive positions are all filled by white

men. Of the two interim chairs, one – Monitor’s Baroness Hanham – is a (white) woman. The face the DH presents to the world is only a little better. All of its six ministers are white, and only one is a woman. ‘We urge the health secretary to appoint them.’ A small mercy is provided by the gender of two of the three senior DH officials – permanent secretary Una O’Brien and chief medical officer Dame Sally Davies. Long serving DH finance director Richard Douglas was replaced another white man, David Williams. In total, of the 23 most senior positions only four are held by women, and one of those is an interim. All are white. This is unacceptable and unsustainable. With vacancies at the CQC, Monitor and potentially NHS England, should Malcolm Grant not wish to serve a second term as chair, the DH has an ideal opportunity to address this situation. This not a question of favouritism or quotas – most HSJ readers can think of women and leaders from a black and minority ethnic community background with the expertise and nous to fill these roles effectively and with distinction. We urge the health secretary to appoint them and make 2015 the high water mark for white male dominance of NHS leadership.

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SUSHRUTA - VOL 7, Issue 2

Promoting Ethics and Professionalism - A global initiative “The most urgent and important current requirement is to create something for 'front line' and busy clinicians. Something that would appeal to clinicians at all stages of their careers.” Mr CR Chandrasekar

Consultant Orthopaedics, RLBUHT, Liverpool, UK In January 2014, a workshop to promote professionalism and ethics in medical practice in India was held in Kolkata – the details of the workshop are available at www. leadershipforhealth.com. There was a consensus that there were significant challenges in promoting this agenda in India, while there was also a growing awareness that things had to change. The workshop participants agreed to work together to take a number of initiatives forward. One of these initiatives is to provide knowledge of medical ethics, a subject not often taught in the medical curriculum, and hence the awareness of ethical dilemmas is either low or practitioners do not know where to seek advice and help. Based on the experience of creating a successful British Medical Journal e-learning module on ‘lumps, bumps and sarcomas - a guide’, which has been accessed by over 4,000 doctors with positive reviews, I volunteered to lead the initiative with guidance from Prof Madhok. There was also some experience from conducting UK national sarcoma awareness projects for junior doctors and medical students in 2013, 2014 and 2015.

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The big question, however, was what would be useful in the Indian context? What sort of resource could be created and delivered, and which would add value, given that there are many readily available courses and e-resources already? There was also the issue of the target audience, and ultimately, the view that has been taken is that the most urgent and important current requirement is to create something for 'front line' and busy clinicians (all and not just doctors), and something that would appeal to clinicians at all stages of their careers; a rather daunting, but possibly a pragmatic and necessary development. Prof Madhok from the UK, Prof RF Heller from Australia and Dr Amar Jesani from India have spent considerable time and effort in helping to launch the initiative in June 2014. After much reflection, it was decided to create this facility via ooc.peoples-uni.org, whereby we decided to provide a number of things: 1. Signpost to key e-resources on medical ethics for those who wish to learn more- The site has links to a number of existing e- packages.


SUSHRUTA - VOL 7, Issue 2 2. Describe key topics in ethics- We have been fortunate in getting the offer of support from a number of very senior and knowledgeable international colleagues: Dr George Thomas, India; Dr Harpreet Kohli, UK; Dr Nikhil D Datar, India; Dr Anu Rose, India; Dr Clarence Samuel, India; Dr Ananta Dave, UK; Dr Sujeet Jaydeokar, UK; Dr Abhay Shete, India; Dr Nilima Shah, India; Dr Mrinal Jha, India; Asso Prof Bebe Loff, Australia; Dr Animesh Jain, India; Dr Rashmi Jain, India; Mr Abishek Bharatia, India; Dr Suparna Kanti Pal, India; Dr. Rhyddhi Chakraborty, India; Prof Mukesh Yadav, India; Ms Afsan Badalia, USA; Dr Prabhakar Maurya, India; Dr Amit Mukherkee, UK; Dr Medha, India; (Major) Shishir Basarkar, India; Dr Pranab Chatterjee, India; and Dr Ritesh Menzes, KSA. 3. Provide commentary on specific ethical problems in the Indian context 4. Create a quality online learning course working in partnership with UK, Indian and global organisationsThe Indian Journal of Medical Ethics has kindly agreed to support this initiative.

Many of the above experts who offered their support are actually helping in the development of the online resource. With Dr Nobhojit Roy and Prof Roger Worthington’s recent offer of help and guidance, we hope to make further progress with the resource development and delivery. Hard work, good will and international collaboration will result in the creation of a quality resource, which we hope will be widely used, evolve with time and stand the test of time. Further discussions are planned at the BAPIO/GAPIO conference in Leicester in June 2015. If you are interested in joining the team, please contact: crc12@hotmail.com

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SUSHRUTA - VOL 7, Issue 2

International Health Challenge at the United Nations Mr Mike Farrar CBE Former Chief Executive of the NHS Confederation and Awards will take place at the UN Headquarters on the 18th October 2016. This event is one part of a continuous programme of activity. The International Health Challenge Forum will take finding solutions to one critical challenge each year as its mission. It will seek high-impact solutions from around the world for consideration at the annual forum. Here,

The Challenge

decision-makers including the most powerful political

Health is a major issue in every part of the world. New

and corporate leaders will commit to implementing

challenges are emerging just as new possibilities are

these solutions. The next annual forum will hold them

opening up. Every nation is different, but everywhere

to account as well as repeat the approach for the next

health systems are wrestling with how to harness

‘challenge’.

new innovations and approaches to meet the health challenge posed by changes in demographics, diseases,

The forum will use a global social media and conventional

expectations and resources. These challenges are

media campaign to enlist widespread support and

placing enormous strain on health systems worldwide.

active participation from citizens, leading academic

Yet the world stands on the cusp of a new era in health

institutions, healthcare professionals and experts to

as new technologies bring the promise of better value,

identify and support solutions.

greater access and higher outcomes. The International Health Challenge Awards will recognise There has never been a better time to pool knowledge in

and share the very best practices, innovations and

order to drive forward change. Yet, currently no action-

solutions from across the globe. In front of an audience

orientated forum exists to bring together leading health

of global health leaders, proven solutions from all major

practitioners, NGOs, corporations, organisations and

aspects of health ranging from public health to the latest

governments to focus on pooling solutions to global

technology will be judged by the world’s best health

problems.

experts. Worldwide, health is at an inflection point. In every

The International Health Challenge has been created to

country and every continent the search is on for the best

fill this void.

means of realising the new opportunities that innovation is creating to promote better access to high quality care

It will actively encourage, share and promote solutions

and to improve the health of citizens. The International

to the global challenge through its Forum and Awards.

Health Challenge will celebrate and share success and

It is not a talking shop or an academic conference, but

mobilise and pool action. It is intended to help the world

instead is geared to create impact and outcomes.

make the next leap forward in health and care.

The first annual International Health Challenge Forum

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SUSHRUTA - VOL 7, Issue 2

Local Healthwatch: Working with doctors Mr Peter Denton, Manager of Health Watch, Tameside and Oldham Local Healthwatch is the independent voice of people

about the services they access. Sometimes this can be

who use health and social care services in a local area.

as simple as answering questions like, “How do I register

Local authorities in England have a legal duty to fund

with a GP? – I’m new to the area and don’t know how

Healthwatch to do this.

to choose.”

What does Healthwatch actually do? There are three

It could be something more complex. For example,

main things. First of all, local Healthwatch gathers

one local Healthwatch is working with a patient, their

insight from people who have used services. People

GP and consultant to navigate through commissioners’

will often tell Healthwatch things that they are anxious

Effective Use of Resources processes to help them to

about feeding back face-to-face to their doctor or

receive specialist treatment that the clinicians agree is

hospital. It’s an unfortunate reality that some patients

necessary but which isn’t routinely funded. Initially, both

are afraid of giving negative feedback in case this results

the local CCG and NHS England had turned the patient

in them getting worse care in the future. We hear about

away, saying that it was the other commissioner’s

good experiences too, and feed these back to services

responsibility to fund it. Healthwatch has helped to get

whenever we can.

clarity about which commissioner should consider the application for funding, and also enabled the GP and

Our second activity is to use the insight we have gained so

consultant to make the strongest case on behalf of the

that we can influence service improvements or changes.

patient.

This could be because we’ve spotted a pattern and want to talk to a service provider about it or because a service

Local Healthwatch has powers to escalate concerns to

is thinking of making a change and wants to know what

Healthwatch England, the Care Quality Commission and

people have told us.

local Overview and Scrutiny Committees if it feels this is appropriate.

For

example,

across

Greater

Manchester

local

Healthwatch organisations were receiving feedback

As a Healthwatch manager, I am passionate about

that patient transport services were causing problems

partnership working. I firmly believe that patients,

for some patients. Local Healthwatch worked with the

doctors, nurses, patients all want the same thing:

transport provider to survey patients across our area and

for patients to have the best outcomes and the best

also had informal conversations with hospital outpatient

experience of care that can be delivered within the

departments. As a result of this, the information patients

resources available. If we don’t spend time listening

received about the service has been improved and

and talking with doctors we will never be as effective

patients have had a direct input into the contract for the

as we can be – we need to understand your challenges

tender for the new service that will start in April 2016.

and priorities just as much as we need to understand

The third main activity is to provide information

patients’ experiences.

signposting to help patients to make an informed choice

Peter Denton Peter.Denton@cvat.org.uk

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SUSHRUTA - VOL 7, Issue 2

Good Governance: Duty of candour “The common experience and indeed the perception among the majority of international medical graduates is that the management is failing to provide ‘good governance’ to support the fair and just treatment of this workforce.” Buddhdev Pandya MBE Director of Policy and Promotion -BAPIO The current buzz words central to the NHS are the

candour. Implemented with more serious commitment

quality of patient care, and indeed, patient safety. The

it can be a step towards nurturing an open, honest and

recent creation of the Care Quality Commission (CQC),

transparent culture in the NHS trust, thus addressing

an independent regulator of health and adult social

the main causes for the shoddy state found at the

care in England, is aimed at making sure health and

Mid Staffordshire NHS Foundation Trust, and also the

social care services provide people with safe, effective,

failures at Winterbourne View Hospital. The core to

compassionate and high-quality care that aids in

these shortcomings was the absence of any levers in

improving the care services.

the system that could hold the ‘controlling mind’ of organisations to account.

One of the critical roles of the CQC is to monitor, inspect and regulate services to make sure they

The burden of accountability of directors of NHS bodies

meet fundamental standards of quality and safety.

through the fit and proper persons requirements places

It is important in the sense that the Commission is

additional emphasis on ensuring the accountability of

also empowered to publish what it finds in terms of

directors of NHS bodies. Perhaps, this is crucial for the

performance ratings to allow the patient to choose

CQC to exercise the new powers to encourage a culture

care. Many consider this as a new start that is proposing

of openness and to hold providers to account.

to bring radical changes to the way the health and adult social care services are regulated.

The common experience and indeed the perception among the majority of international medical graduates

The new regulation that came into force sets out

is that the management is failing to provide ‘good

fundamental standards of care. It contains two new

governance’ to support the fair and just treatment

requirements – the fit and proper persons requirement

of this workforce. From the point of recruitment and

for directors, and the duty of candour (‘NHS bodies’, 27

retention, right up to promotion in their career, the

November 2014). The term ‘NHS bodies’ implies the

discrimination – both subtle and indirect – has its mark

NHS trusts, NHS foundation trusts and special health

across all specialities. Despite a number of reports

authorities.

highlighting the practices that impact disproportionately on the BME doctors, the culture of fear of victimisation

In terms of policy, this can be seen as a major milestone.

has bred insecurity among this group of professionals

Particularly the imposition of it as a statutory duty of

who are known to be the backbone of the NHS.

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SUSHRUTA - VOL 7, Issue 2

Leadership Challange “There is a degree of a ‘them and us’ feel factor that is mainly related to the treatment by the management. The experience of the International Medical Graduates (IMGs) over the years has been both unsettling and with insecurity in our environment.” Mr Shyam Kumar Chair of BAPIO, Lancaster unit In recent years, the new buzzword in the NHS is all about

implementing ‘good medical practice’ norms affecting

‘patient safety and patient care’. It is all about the quality

our working environment. In this context, it is fair to say

of service that the NHS provides and better outcomes for

that the concept of leadership is often misunderstood in

the patient.

most professions.

As professionals we are the NHS, upon whose shoulders

The central theme of BAPIO is ‘Promoting Professional

it rests the ownership to provide that leadership to make

Excellence and Leadership’, which points to our moral

it happen.

responsibility in empowering our own colleagues for the purpose of them becoming fit for the challenges

We often, understandably, are the critics of the NHS,

that may face them. I believe that the ‘leadership’ is not

since we are those who are a stakeholder in delivering

about heading a large department or managing a large

the services.

number of people, but how we conduct ourselves in our profession.

There is a degree of a ‘them and us’ feel factor that is mainly related to the treatment by the management.

The BAPIO Northwest Division & Patient Safety

The experience of the International Medical Graduates

Forum have ventured into organising a symposium on

(IMGs) over the years has been both unsettling and with

‘protecting patients and supporting the clinicians’ on

insecurity in our environment.

the 3rd of July, 2015. We are supported by the Clinical Leaders Network.

There are estimated to be over 50,000 doctors of Indian origin working in the NHS. Their place in the NHS, both

This symposium is more relevant to the debate about

in running the day-to-day services and future of it, is

‘leadership’, since the Francis Report has given a whole

extremely valuable to the system.

new meaning to improving patient care. Its emphasis on influencing the culture in the NHS, where individually

The sheer size of the number of doctors gives a huge

and collectively the role of all those responsible is for the

opportunity to exert influence on the decision-making

decision-making process and implementing measures,

process, as much as on those who are responsible for

reminds us of the relevance of responding to the

17


SUSHRUTA - VOL 7, Issue 2 leadership challenge. In recent years, the new buzzword in the NHS is all about ‘patient safety and patient care’. It is all about the quality of service that the NHS provides and better outcomes for the patient. As professionals we are the NHS, upon whose shoulders it rests the ownership to provide that leadership to make it happen. In acquiring the leadership qualities, we must equip ourselves with the knowledge about the potential and limitations of the new avenue that is being debated: ‘protected disclosures or raising concerns’. I believe that it is double-edged sword that if used without support from the system, can also prove to be a disaster for an individual, since the NHS is still not prepared to embrace the concept fully. This is one of the main themes of our programme on the 3rd of July, 2015. I also place significant weight on the new standards that are being introduced, with reference to the requirement for ‘fit and proper person’ (FPPR) test for directors and the duty of candour which has come into force for all NHS bodies. These tools are at our disposal, and I believe that in our quest for providing leadership we should be familiarising and learning about them to put into practice where appropriate. Unable to raise grievances that may affect their career and ability to deliver services with confidence, most would suffer in silence or look for an avenue to risk the double-edged sword – the ‘whistleblowing’ opportunity. But, that is a high risk strategy for an individual, even if they are able to reach the ears of the CQC inspectors! Nevertheless, as long as the Secretary of State is committed to encourage that all who work in health and care should feel confident about speaking out when something has gone wrong, and a willing to put appropriate new protections in place to make that

18

possible, there is still hope! For the voluntary sector organisations such as BAPIO, the relevance of the new regulations would be a new game changing opportunity. It has two specific areas: 1. Responses of the NHS trusts in implementing measures that meet their obligation under the new requirements – the fit and proper persons requirement for directors, and the duty of candour. 2. Seek assurances that that CQC integrates an effective policy of measuring and highlighting those aspects that are likely to have a disproportionate impact on the working environment of ethnic minority workers (The channel for whistleblowing may be integrated with an independent body within the CQC to provide much wider evidence). It is not clear at this stage that the role of the GMC as a major regulatory body, and the implementation of the legal framework for our Fitness to Practise procedures as set out in the Medical Act (1983) and the Fitness to Practise Rules (2004), can be brought under the CQC. It would be wise to look for the consolidation of outcomes of the complaints and grievance management in relation to determining the fairness afforded to an individual and the cost impact on the NHS. This is particularly relevant to the management of complaints or grievances where the trust is seen to be over reporting cases to the GMC, outside settlements or becoming restrictive to ethnic minority doctors – in recruitment, training and promotion. The evidence of the link between the treatment of staff and patient care is particularly well evidenced for BME staff in the NHS, so this is an issue for patient care, not just for staff. Agreeing with the NHS CEO, the “business case” for race equality in the NHS, and for the Standard, has been a powerful one to provide for delivering the commitment of tackling race discrimination and creating an NHS where the talents of all staff are valued and developed – not least for the sake of our patients.


SUSHRUTA - VOL 7, Issue 2 “Whistle Blower, Whistle Blower, Oh Dear Dear Whistle Blower� Whistle blower, whistle blower, never ever be a whistle blower

Whistle blower, whistle blower, now think again to be a whistle blower

Never voice a financial fraud, as management will make it human error

Carefully you need to steer, while government brings the measure

Unleashed will be a reign of terror, making you day & night quiver

Arise, Awake, And Stop Not, till these gloomy times are over

Whistle blower, whistle blower, never ever be a whistle blower

Whistle blower, whistle blower, you must be a whistle blower

Bribing peers will jeer & cheer, while your family cries with tears

City of 9 gates disseminates here, as life is never forever

Is it worth upholding moral gear, which brings stress, pain & fear?

Serving the humanity further, will bless your virtuous spirit to soar

Whistle blower, whistle blower, never ever be a whistle blower

Whistle blower, whistle blower, you must be a whistle blower

Never raise service concerns, as consequences will be very severe

Regulators & unions work together, to restrict the bullying forever

You will be in every county and shire, mercilessly ripped & torn with ire

Embracing these changing horizons, inspires for the brightest future

Whistle blower, whistle blower, never ever be a whistle blower

Whistle blower, whistle blower, you must be a whistle blower

Bullies rule with sickest desires, their manipulations will make you tired

Humanity and society will grow, if all blow the whistle without fear

At risk are your zest, life and fire, with all the consequences dire

Whistle blower, whistle blower, oh dear dear whistle blower Dukhi Aatma ....

Duty of candour 19


There is no better time to be who you’ve always been Like they say “The more you celebrate your life, the more there is in life to celebrate”. And what better than to be in an ecosystem where each day is spent celebrating wonderful moments and living a lifestyle that is healthy, active and engaged; giving you an opportunity to be who you’ve always been! Just picture this: The morning view from your window is mountainous and charming – it’s a wonderful way to start your day. You don’t give the messy bed and undone dishes a second glance as you leave your spacious apartment for a freshly prepared breakfast at the restaurant in the clubhouse. You pass an inviting heated indoor pool on the way there and promise yourself a refreshing dip after a robust post-breakfast yoga class with your personal fitness instructor. A lush putting green sprawls in the distance – you know you will find your friends there. The day is spent at the expansive clubhouse, playing cards and unwinding after an active morning workout. After a long, lazy lunch with friends, you return to your delightful apartment and if need be have someone manage the daily chores in an attentive yet unobtrusive manner. And all of this in the most picturesque location of Dehradun where the oxygen rich clean air promises a much healthier life! Wouldn’t you love to be in an ecosystem where you live an enriching and enjoyable life amidst like-minded folks on your own terms? And that is what Antara Senior Living offers: a safe and healthy environment, impeccably designed, rigorously serviced, integrated with nature and in a community of evolved, joyous individuals whose zest for living reflects and reinforces your own. A part of the Max India Group, Antara is bringing to India the first ever world class senior living residential community in Dehradun. Spread over a sprawling lush green 14 acres and set against a magnificent view of the Mussoorie hills, Antara has an evergreen, protected Sal forest reserve to one side, and the river Tons on the other.

Striving for perfection and relentless improvement, Antara Senior Living makes it possible to immerse yourself with like-minded people; motivated on living a purposeful and remarkable life. Over time, people are learning that the time leading up to one’s sixties is a time that people can focus completely on their own needs and desires. Antara Senior Living allows you to do just that, by taking the stress out of ‘running’ your life and letting you enjoy your choice of pleasures in your own time at your own pace. You can enjoy hassle free living and an unparalleled service-oriented experience provided by a team of over 200 professionals. Antara thus is a beautifully conceived and crafted continuous-care proposition-a comprehensive ecosystem that embraces and encourages the idea that life can stay magical. With Antara’s perfect blend of lifestyle, lifecare, hospitality and sound financial thinking, you could discover a new chapter in a well-lived life, another milestone on a well-trodden path.

All Day Dining Rendering, Clubhouse, Antara Dehradun

As Tara Singh Vachani, CEO, Antara Senior Living, says, “The road to Antara started in 2010 with a question: what would it take to give people the best life they could possibly have as they got older? The quest for the answer took us around India and the world, to study best practices that would eventually become the foundation of Antara. What we learnt was powerful. A learning that encompassed a new

way to think about later life. A life that radiated hope and energy, along with the promise of a decrease in worry and an increase in the quality of life. The vision of a community of like-minded people that makes every one of its residents feel significant, healthy and enriched, is what gave life to Antara. A community that is both impactful and holistic, where our genuine spirit of care is expressed through careful attention to every detail, to craft a space where life is lived openly and joyously”. Every Antara apartment is individually crafted, built with the finest materials and finished with meticulous attention to detail. The exploration of life-enhancing ideas combined with an obsessive attention to detail that goes into each feature makes the Antara apartments beautiful, perfect and timeless. Recognizing that each and every resident has individual likes and dislikes, needs and demands – the Antara experience is a precisely tailored one. You have innumerable choices, from over 200 beautiful apartments at 1400 - 6000 square feet ranging in price from INR 1.50 cr – 6 cr. To ensure that you are well looked after, there are a host of services that have been designed under the ‘Antara Comprehensive Benefit’, ranging between INR 32,000 – 1,04,000. These monthly charges are levied depending upon the size of your apartment. Subscribing to this allows us to look after your home and life at Antara in the manner you are accustomed to. All residents will have an essential services plan that includes a certain set of services that we feel are vital to the well-being and quality of life of our residents. Antara is a celebration of life lived to its fullest. We believe that for the progressive few, age is just a number, and with the ecosystem we provide, you can stay active, vital and fulfilled for years to come. All it takes is a different point of view, what we call the Antara Way.

Garden Verandah Rendering, Clubhouse, Antara Dehradun

To discuss your life at Antara Senior Living, SMS ‘ANTARA BAPIO’ to 54242 or visit www.antaraseniorliving.com or call +91 8860076464/+91 8006323252.


SUSHRUTA - VOL 7, Issue 2 BAPIO AWARDS

For Support to Indo – UK Collaboration in Health Prof. Ged Byrne For Excellence in Leadership Prof. Mayur Lakhani

For Academic Excellence Prof Sir Nilesh Samani For Contribution to International Collaboration & Education Prof David Warrell

For Promoting excellence in Patient Safety and Quality Prof Anupam Sibal

For Excellence in Diabetic Research Prof Kamlesh Khunti

For Contribution to International Health care Dr Nandakumar Jairam

For Contribution to health care in India Dr Suresh Dubhashi

22


BRITISH ASSOCIATION OF PHYSICIANS OF INDIAN ORIGIN

BAPIO Northwest Division & Patient Safety Forum - (Supported by Clinical Leaders Network)

SYMPOSIUM ON PROTECTING PATIENTS AND SUPPORTING CLINICIANS Moving forward after the Francis report: ‘Freedom to Speak Up’ 3rd July 2015, Christie Hospital, Manchester, UK

6 CPD Points Applied

On 11 February 2015, Sir Robert Francis QC published his final report following the Freedom to Speak Up review which looked at the raising concerns culture in the NHS. This report is the result of a landmark inquiry into perhaps the greatest NHS scandal – the failure of the health service to take heed when its own doctors and nurses warn that patient safety is at risk. Sir Robert was appointed by the Health Secretary to lead the review last June. His review took two months longer than expected, after he was deluged with more than 18,000 submissions. Senior doctors and nurses told how their careers were left on the scrapheap, after they tried to alert NHS managers of unsafe practices and cost-cutting risking lives. The report makes a number of key recommendations under five overarching themes with actions for NHS organisations and professional and system regulators to help foster a culture of safety and learning in which all staff feel safe to raise a concern. Sir Robert’s report, however, is only one of the recent reports, the others being the GMC review into suicides by doctors and the ‘Hooper’ review apart from the seminal inquiries into the ‘Mid-Staffs’ and ‘other hospital failures. The Clinical Leaders Network also undertook an in depth analysis of support for second victims (http://www.cln.nhs.uk/ourwork/supp/).

Keynote address by Sir Anthony Hooper - Recently published the Hooper review for the GMC on whistleblowing. This meeting is the first solution themed programme since the publication of the Francis and Hooper reviews.

This event organised by BAPIO Patient Safety Forum with support from the Clinical Leaders Network will take stock of the issues and explore how to organise a system for protecting patients and supporting clinicians.

Learning Objectives: Who should attend? This workshop is open to all clinicians (including trainee doctors and nurses), NHS managers and given the limited space available, places will be offered on a first-come-first-serve basis.

Event fee: £70 (Includes lunch & refreshments) To register & pay the course fee, please visit the link below:

doctorsacademy.org/Course/BapioSymposium/Home.html

At the conclusion of this CME activity, the attendee will have learnt about: ➢

The lessons from raising concerns about patient safety.

The findings of various reports.

Support available for those wanting to raise concerns.

What arrangements are proposed to support clinicians in the northwest?


Profile for The Physician

Sushruta June 2015  

Sushruta is published for British Association of Physicians of Indian Origin (BAPIO, a voluntary organisation in the United Kingdom. This is...

Sushruta June 2015  

Sushruta is published for British Association of Physicians of Indian Origin (BAPIO, a voluntary organisation in the United Kingdom. This is...

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