Sunday, 29 March 2015

What I've been reading

Image of the book cover

The Heart of the Matter
by Graham Greene
"Scobie is a highly principled officer in a war-torn West African state. When he is passed over for promotion he is forced to borrow money to send his despairing wife away on a holiday. In her absence he falls hopelessly in love with Helen, a young widow, and his life is transformed by the experience."
There's no denying that Mr Greene is a very fine writer. His characters are minutely described, and so real that I can almost understand how a Catholic fears mortal sin. I can see them in my mind's eye, and a pretty unappealing lot they all are. And that's the only problem with this book.

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Moon Tiger
by Penelope Lively
"The elderly Claudia Hampton, a best-selling author of popular history, lies alone in a London hospital bed. Memories of her life still glow in her fading consciousness, but she imagines writing a history of the world. Instead, Moon Tiger is her own history."
I'm puzzled at how good this book is. The narrator is dying. She has lived a full life, and describes some of it. She is not particularly likeable, she has been a poor mother and a challenging individual to friends and family, but for a very brief period during the second world war she is in love, and it is requited, and the reader understands and forgives her the rest.

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Cover Her Face
by P. D. James
"On the same day as the St Cedd's church fete in the grounds of her home, Martingale, Mrs Maxie learns of her son Stephen's engagement. By the next morning, her new parlourmaid, Sally Jupp, is dead."
A proper old school detective story, with clues, suspects, motives, and opportunities to guess the murderer. I thought I had read PD James before, but I don't think I have after all. Maybe I'll try a few more.

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The Lost Duke of Wyndham
by Julia Quinn
"Jack Audley has been a highwayman and a soldier. What he is not, and never wanted to be, is a peer of the realm. But when he is recognized as the long-lost son of the House of Wyndham, his carefree life is over."
Not a challenging read, but fine for the eternity of time between returning starving to the hotel after skiing and the dinner service. I'm nearly done with Julia Quinn, because although she writes quite nicely, the plots of the books I've read so far are awfully similar.

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Homage to Catalonia
by George Orwell
"Orwell volunteered as a militiaman in the Spanish Civil War, and here he describes with bitter intensity the bright hopes and cynical betrayals of that chaotic episode: the revolutionary euphoria of Barcelona, the courage of ordinary Spanish men and women he fought alongside, the terror and confusion of the front, his near-fatal bullet wound and the vicious treachery of his supposed allies."
If there had been such things as blogs in those days, this chronicle would have been published in that format. It is of its time and very political, although he does describe very vividly what it was like to serve in this particular conflict, the vast gulf between idealism and pragmatism, and the role of journalism in misrepresenting everything that occurred. These at least are the messages that I took away; I have to admit to still being somewhat mystified about the different factions: Anarchist, Socialist, Fascist, Communist, and where the Government stood among all these parties.

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A Dark-Adapted Eye
by Barbara Vine

narrated by Harriet Walter
"Like most families they had their secrets, and they hid them under a genteelly respectable veneer. No onlooker would guess that prim Vera Hillyard and her beautiful, adored younger sister, Eden, were locked in a dark and bitter combat over one of those secrets."
The second Barbara Vine book I've listened to, and another good one. It starts by declaring who has committed the murder, and then you spend the rest of the book finding out who was murdered and why. Unlike the classic crime fiction where you don't know who did it until the end, this is more of a 'whydunnit'. High quality narration as well.

Tuesday, 24 March 2015


Union jack bedding, curtains and lampshade
Mamas Inn Boutique Hotel, March 2015
Last weekend was the umpteenth birthday commemorative weekend that Lola II and I have spent together, and this year's host city was Nottingham.

The journey north was fairly straightforward apart from being stopped by a police car - my mistake was turning my headlights off when dropping off Mr M and forgetting to turn them on again. Trying to navigate through the city, Lola II's phone refused to find a GPS signal and my phone insisted on directing us to go the wrong way along one-way streets at every opportunity, which left me thoroughly traumatised, especially given the police incident. Eventually we reached 'Mamas Inn Boutique Hotel', and it was AMAZING.

David and Marina and poster: People who love to eat are always the best people
The owners told us they had bought it less than a year ago and decorated each room in the style of a city - ours was 'London' but there was Venice, New York, Tokyo, Paris and more. In our room there were Union flags on every item including bedding, curtains, dressing gowns, flip-flops, bath flannels, lampshades, waste paper bins and a wardrobe made to look like a red telephone box.

And the food. The food was also wonderful - the best B&B breakfast I've ever had. A bowl of fruit followed by perfectly cooked eggs, bacon, sausage, beans, hash browns and toast, and a tiny little choc chip muffin to finish. We tried the continental breakfast and pancakes next day. I can highly recommend Mamas Inn, and would go to Nottingham again just for the opportunity to stay there.

On Saturday we decided to go to Wollaton Hall and Deer Park. Although this was my first visit, the Hall seemed to me to be one of those places that you get taken to as a child and then becomes part of your childhood lore, drawing you back as an adult to revisit the wonders that made such an impression in those early days. My place of childhood wonders was the Natural History Museum in London, with its dodo and the reconstructed dinosaurs and the blue whale skeleton. Wollaton Hall's wonders, however, were much more eccentric and strange - the wall of animal heads, George the Gorilla, the tiger in the stairwell (or was it a lion? I forget). It seemed to exist in a time warp, slightly scruffy and reminiscent of the 70's.

Although there is no charge for entry to the Hall or Park, we decided to pay for a tour, and what a tour it was. The guide was astonishingly bad - Lola II struggled to actually understand what was being said, and I struggled to keep from laughing most of the time. She would talk about an aspect of the furniture or paintings or stonework or household staff, and we had no idea at all what she was talking about - she would wave in a general direction and we would look desperately around trying to locate the 'bushes', or the 'lions in the style of Venice' or whatever. The two best comments for me were firstly in the kitchen, where she encouraged us to pick up and handle the pies and meat - which were models made of plastic. The other was down in the cellar where she showed us the fresh water spring. "You can drink the water," she told us, "although I wouldn't. There was two girls on the tour the other day, and they drank some, but they was all right afterwards."

Dome and staircase
Council House
The weather was wintry, but we spent an hour or so walking around the Park and its environs before heading back to the hotel to get ready for the evening. I lived in Nottingham for a year and deliberately avoided going to a highly-rated Japanese restaurant just so that Lola II and I could go together. It was very good, and worth the wait.

After that we went to the cinema. I had looked in vain for anything more cultural, but there wasn't a single theatre performance or concert in the whole city on Saturday night, except at Rock City. So we went to the pictures.

On Sunday we decided to visit the city itself, and after visiting the best public toilets I've ever been to we had a tour of the Council House. This time the guide announced herself to be an accredited Blue Badge guide, but there was still a touch of the insane about her - Lola II thought she might be a frustrated actor. We met Mr M and other friends in the Galleries of Justice museum where we declined to take the tour but looked around the free galleries showing stuff about World War I and an confusing account of the detection and trial of a serial murderer. Then we had lunch, and cake, and it was time to go home.

Lola II and union jack picture, cushions and dressing gown

Thursday, 19 March 2015

PDR, VLC group and DUK PC

Tortoiseshell butterfly on pink flower head
Peckover House, August 2014
I haven't written much about work for a while, so here goes.

I had my annual Personal Development Review (PDR), I hosted our monthly Very Low Carbohydrate group, I went to the Diabetes UK Professional Conference in London, and of course there were the usual clinics.

It's going quite well, although I'm having rather too many good ideas. When I have good ideas I tend to get a bit obsessive, the ideas blossom and grow, they expand beyond the available space and instead of a tidy achievable project designed to meet defined goals I end up imagining the biggest, best, most complete and perfect solution to put an end to all conflict in the world. Then I realise it's totally unachievable and start to doubt whether I can do anything at all. I have a good deal of respect for people who can come up with a sensible and successful idea, put together a plan and then see it through into practice.

I'll give a small example - Carbs and Cals. This is a book, and much more. The author is a Diabetes Dietitian who got together with a photographer friend and took photographs of different portion sizes of various foods, then put them in a book with labels showing the amount of carbohydrate in grammes and the calories in each portion. It was the perfect solution to a problem faced by every person with Type 1 Diabetes and a lot of those with Type 2 - how much carbohydrate is in that portion? Carbs and Cals will show you.

The book was so successful that it has expanded to show Carbs, Cals, Protein, Fat and Fibre; there is a website, a phone app, flash cards, teaching resources and much more. One manufacturer in the diabetes world includes a copy of Carbs and Cals in the box with one of its blood glucose meters. Diabetes UK has lent its logo to the cover and sells the book via its online shop. I met the author at the conference last week. He is the nearest thing to an A-List celebrity in the diabetes world - every single person of the thousands in that conference centre would have heard of him and his book, but he seemed pretty modest and unassuming.

The point is, he came up with an idea and saw it through. He probably spent an immense amount of time and money on it, presumably found his own publisher, designer, editor, set up sales channels - and I can't tell you how much I admire and envy the talent and commitment he shows, because I think it is unlikely that he was given much time to do it at work - I don't know for certain, but I'm guessing he did it all in his spare time.

I want to create an online resource to support our patients who have taken on the very low carb lifestyle, and I am in the wild imagining stage. My idea has exploded to include more than a website: I am imagining a discussion forum, recipes, pictures, an app, published research papers, a blog, a secure section where people can record their blood results, live interaction with Dietitians, links to SMS text messages, Facebook, Twitter, Instagram, Pinterest, anything and everything. I need to scale back my ambition and make it achievable. At the moment I cannot access any of these elements from work, due to restrictions imposed by the IT department. Almost everything is blocked and my browser is so old that many ordinary websites can't be used properly.

This project is one of my PDR objectives, so at least I should be supported to do it in work time, although I expect I will have to put in a bit of extra effort if I want it to succeed. My other main PDR objective is to get more involved in pump clinics. Up to now I've concentrated on acquiring the basic knowledge that applies to the majority, but for a number of reasons, this is a good time to focus down on the minority who use CSII - continuous subcutaneous insulin infusion, or insulin pumps.

The number of pump users is increasing as more adults acquire them, and as those who were started on pumps as children transfer into the adult service. Every adult on a pump should be equipped with the skills to use the pump effectively, but it is not so clear cut with children. Anyway, because the general level of diabetes knowledge and skill in the adult population with pumps, I have rather left them alone and concentrated on less able people coming to clinics. But our pump service is set to expand, and there is quite a lot I could be doing to help and support pump users. More on this at a later date, I expect.

The conference. It turned out to be pretty difficult getting funding to attend the conference. I approached the dietetic and diabetes departments and every industry manufacturer and rep that came within two feet of me, which was bordering on humiliating and completely fruitless. In the end, a colleague managed to get a company to pay our attendance fee, but nobody would stump up for accommodation. We eventually had to apply for funding to the hospital's charitable funds, and I got an email 15 minutes before the end of my last working day before the conference letting me know the accommodation cost had been approved. I won't get any reimbursement for travel.

Apart from this, the conference experience was excellent. Being fairly new to diabetes I hadn't been to this event before, but in my old life I had staged a conference with my team and have been to many in this country and in the USA. This one had a lot more money spent on it by the Pharma companies exhibiting and sponsoring the talks than in the world of disability and visual impairment, which shouldn't really have been a surprise.

I saw too much to write about here, but the highlights included:
  • a heated 'debate' between one maverick Dietitian who is promoting a diet high in saturated fat, and the rest of the dietetic community who don't believe that the evidence is strong enough to support this approach
  • a session on exercise and Type 1 Diabetes (this is one of the most complicated areas I've encountered yet)
  • a very useful summary of pump usage given that I'm going to be focusing on this area, and 
  • links with various people who talked to me about whether and how their NHS employer allows them to use state of the art technologies.
So lastly, my low carbers. I started to worry that the group would fizzle out - a few people have left, either because they are successful or because they can't manage it any longer, which is why I'm so keen to create something online to help them. For this month's meeting I bought a cookbook of Low Carb Gluten Free Vegetarian recipes which source their protein mainly from eggs, cheese and tofu, and I reckoned the group probably hadn't cooked with tofu before. So I cooked one of the recipes (teriyaki tofu with broccoli), bought a few different types of tofu (firm, silken, marinated) for the group to taste, and printed a selection of tofu recipes. It was one of the most successful meetings so far. And they are all doing well, still losing weight and maintaining great blood glucose control.

Thursday, 12 March 2015


Serrated leaves
Peckover House, August 2014
It took me a week to publish the last blog post; the whole week after my holiday was a bit too busy with badminton and work and other stuff, and the state of Lola Towers had deteriorated to the extent that when a friend dropped round briefly on Wednesday night (by the way, this NEVER happens) I was very glad indeed that she didn't need to visit the bathroom.

On Thursday I played in a badminton match and I was unexpectedly offered two tickets to the international badminton in Birmingham on Friday night. Having had such a busy time during the week I did think twice about accepting, but couldn't resist in the end. It started at 5 p.m. and I got there at about 5.30, and it went on for ever. I left at 11.30 p.m. before the last match had even started.

The weekend was supposed to be quieter but that didn't happen either. I thought I would have a lie in, but my body clock had other ideas, and because I was awake early I decided to do a Parkrun, followed by house cleaning and a bit of necessary food shopping in town. As I came back from shopping, I glanced at the car, and my heart sank as I saw it had one completely flat tyre. Another job to do - not a difficult one, but it just added to the list of work for the weekend.

It almost turned into the stuff of nightmares. Let me tell you about locknuts. If you haven't changed a car wheel lately, you may not have come across them - one nut on each wheel (the locknut) does not have the usual hexagonal format but is a non-standard shape, and you have an adaptor that converts the special shape into a hexagon so it will fit the wheel spanner. It's intended to prevent the theft of wheels, but I hadn't ever given this much thought in all the time I've owned the car.

I went ahead with changing the flat for the spare wheel and driving up to a tyre repair place in town. As I was discussing the job with the chap there, I realised that I didn't remember storing the locknut adaptor in the car anywhere. I had driven away with it still attached to the wheel, and it had fallen off somewhere along the way.

Have you ever had that sinking feeling when all joy drains out of your heart and an awful doom hovers just over the horizon? Maybe you think you have lost something valuable and essential: a handbag, or a wallet, or the only set of keys to your house or your car, or you realise as you arrive at the airport to check in for a long-haul flight that your passport is at home 3 hours away. It is something that is quite easily misplaced, but maybe you have just looked for it in the wrong place, and if you look in the right place there it will be and everything will be all right, but if you really have lost it or left it at home then you face huge expense and so, so much annoyance and recrimination and disruption to your life.

The man in the tyre place explained what would happen if I really had lost the locknut adaptor. Of course it could be replaced, it is only about £40 for a new adaptor and the four matching wheel nuts, but without the correct adaptor for my current locknuts it wouldn't be possible to take off any of the wheels. He didn't go into detail about how much that job would cost. I just said I was going home to look for it.

It was there, lying in the middle of the road, only a few yards from where I had changed the wheel. When I picked it up, I actually kissed it.

After that the puncture repair proceeded without further incident. By the time I got home and fired up the computer for the first time that day and it reminded me about the monthly clarinet choir rehearsal, it was too late and I'd missed it. Saturday was not a good day. Sunday was better.

I was going to continue with work news of my annual review, very low carb and conference news, but I've run out of time - it will have to wait.

Saturday, 7 March 2015

Ski Italy

Mountain vista with blue cloudless sky
Courmayeur, February 2015
No time for much blogging, I'm still keeping busy but thought I'd just jot down a brief report for those who care what I've been up to. I've been skiing, in Courmayeur in Italy, and it was good. There were a couple of overcast days at the start when it snowed, then a couple of perfectly sunny days, and some that were in between.

Because I'm keen and showed up for the first minibus transfer before the lifts even opened, I met a group of seven Scots staying at my hotel who were happy to have me skiing with them, and equally happy when I peeled off to do my own thing. My own thing was not spending a lot of time having breaks, having small lunches, carrying on skiing for as long as I could manage, then back to the hotel for a shower before settling down for the long, long wait until dinner was served. Last year, when Mr A and I went to Austria, the hotel dished up dinner at six - perfect. This hotel didn't start the dinner service until half past seven, by which time I had been trying to find any sort of distraction for two hours or more in order to prevent me from eating my own shoes.

I got to know the guests at neighbouring tables at dinner as well as my Scottish adopted ski family. It wasn't too bad at all being a solo skier, and I had company when I wanted it, but most of the time I didn't. As well as 6 to 7 hours skiing a day I read five books while I was there... bliss. No injuries, but I don't think my technique improved, unlike the last time when I had three days of instruction included in the package. It did, however, cost half as much this time compared with that trip.

Back home - laundry, badminton, work and more. I should have a relatively quiet weekend, so maybe I'll have time to write about my annual review and the latest very low carb group meeting. Off to a badminton match now - ciao!

Selfie in ski gear with mountains

Saturday, 21 February 2015

Wet walls and Not Very Well

Signs of damp on the wall
Hall wall, February 2015
It's been busy, but when is it ever not busy? There was the 3rd Annual Gulloebl Film Festival (Random Chairs in a Darkened Room) - 1 screen, in 1 venue, across Europe. There has been badminton club, a badminton match, three different health-related issues, car stuff, a trip to the National Exhibition Centre in Birmingham to look at tents, and an evening out with work people. And work, of course, except I had the day off on Thursday for the NEC tent thing and to sit on the sofa feeling poorly watching Seven Psychopaths on DVD (confusing, odd, violent, but ultimately a film worth watching).

Health issue no. 1 is tennis elbow, which is new to me but many badminton players and the Interwebs gave me advice and suggestions which seem to have worked - ibuprofen, strapping, a bigger grip on my racquet, changing my computer mouse to the other hand, and resting the arm (guess which one I didn't do?) I'm about to have a week off badminton, so that may give it a chance to improve some more.

Health issue no. 2 is a small cold or flu which seems to be going around - it was quite bad for about 24 hours but is now just niggling in the background. I thought I was going to be proper ill for my skiing holiday, but with luck it will be gone in a couple of days.

Health issue no. 3 happened at the restaurant where we celebrated a work colleague's 65th birthday. The chair I sat on was broken, and when I pulled it towards the table I found the seat wasn't attached to the frame. I trapped my little finger which is now going purple and giving me problems typing the letter a (and q and z but I don't use them as much. I haven't been to any quizzes. Ouch).

On the bright side, Lola II and Mr M's film festival was a hit - I attended four screenings this time, and the previews, trailers and adverts before each film were of the usual high standard. I even helped to create several of the Chinema classics featured on the two 'Now That's What I Call Chinema' albums. My few moments of stardom are showcased here and here.

Most of the rest of the week was a bit less delightful, what with the elbow, and we lost the badminton match quite convincingly, and the cold/flu, and the finger, and I had to have the car windscreen replaced because of a long and growing crack, and the car is making a new rattling noise, and the burglar alarm has gone wrong so we can't turn it on, and the NEC show wasn't as good as I'd hoped. The show occupied 5 halls of the massive venue, but only one was showing tents and it was geared at the large family and glamping market so there was hardly anything in the smaller scale I was looking for. Sprayway Hood River 3 and Vango Aura 300 are the most likely contenders from the companies that were represented, but I'm going to have to do much more research because there's a lot more out there that wasn't at the show.

And my biggest achievement of the week - I've had the hall roof fixed! The blessed Alf is busy elsewhere, so I have found a substitute whom I shall call Elf. He came and had a look and diagnosed rotten felt, which he has replaced with a rubber membrane. He even provided pictures:

I think that Elf has done a good job, and there is plenty more for him to get stuck into. One of the ideas I have is for him to spend a day as my personal slave, fixing all the indoor things that are wrong, like re-hanging a door, fitting a pane of glass, that sort of thing.

Now it's time for me to get packing - I'll be back in about a week!

Friday, 13 February 2015

What I've been reading

Image of the book cover

The Mysterious Stranger
by Mark Twain

narrated by Don Randall
"The stranger comes to a medieval village in the persona of a beautiful, lovable, yet exasperatingly amoral young man claiming to be the blameless nephew of the devil. Befriending a small group of boys, he expounds on the Moral Sense which distinguishes men from brutes, and changes the lives of many of the villagers."
This seems to be a fairly obscure work - Twain's last, published posthumously. My limited research suggests he'd had quite a bad time in his last few years, and perhaps this book reflects his disillusionment with his fellow man. The Stranger's philosophy is that humans are worse than animals, who do not deliberately inflict pain or death on each other in the name of religion or moral goodness, and that there is no god and all reality is an illusion. The narration is astonishingly bad for a commercial publication - there is an alternative version available so I don't know why I chose this one.

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A Brief History of Time
by Stephen Hawking
"Was there a beginning of time? Could time run backwards? Is the universe infinite or does it have boundaries? These are just some of the questions considered in an internationally acclaimed masterpiece by one of the world's greatest thinkers."
I went to see the film "The Theory of Everything" in between reading the previous science book "In Search of the Edge of Time" and starting this. The film is based on the book written by Hawking's wife and the science content is brief and tangential to the life story, but it made a nice trio. I first read this book not that long after it was published in 1986, and it's difficult to remember whether I found new information in it, but I can't deny the fine writing making the subject extremely accessible. It would be interesting to know how much of the content still holds true, and where our current knowledge of the subject differs.

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by Kurt Vonnegut

narrated by Ethan Hawke
"Billy Pilgrim is a man who becomes 'unstuck in time' after he is abducted by aliens from the planet Tralfamadore. We follow Pilgrim simultaneously through all phases of his life, concentrating on his shattering experience as an American prisoner of war who witnesses the firebombing of Dresden."
Although this was obviously written very much earlier and is set in a very different landscape, there are clear similarities with 'The Time Traveller's Wife', which is one of my favourite books. I wonder if the author of the latter has ever acknowledged the connection? Many of the reviews I've read compare this book to 'Catch 22', another of my favourite books, but that similarity is less clear to me - they say both books are funny, but I don't think they are. I'm sure this is fine literature, and it's certainly well written, but I was looking for meaning in the alien abduction, or some connection with the Dresden fire-bombing, but could find none. I find many 'classics' similarly unsatisfying. But then, 35 years ago I got an 'E' in my English Literature O level, so what do I know?

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On the Way to the Wedding
by Julia Quinn
"Unlike most men of his acquaintance, Gregory Bridgerton is a firm believer in true love - he is just biding his time until the right woman comes along. But when she appears in the rather lovely form of Lucinda Abernathy, Gregory is dismayed to discover that she is set to marry another man."
Another trashy Regency romance - I mooched three of them at once, so another two are on the shelf for easy reading when days are short and nights are long. Not in the least taxing, nicely written and so straightforward that I don't end up feeling that I've missed something. What I don't understand is how I can bear this type of book but can't stomach modern chick lit?

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The Pursuit of Love
by Nancy Mitford

narrated by Emilia Fox
"Longing for love, obsessed with weddings and sex, Linda and her sisters and cousin Fanny are on the look out for the perfect lover. But finding Mr Right is much harder than any of the young ladies thought."
This book is the first of the trilogy - I read the second one first (Love in a Cold Climate), which was a bit of a shame, but still enjoyed this immensely. The characters are so real! I didn't expect to like Nancy Mitford so much, but she does seem to have a habit of bringing the book to an end very abruptly. The story shows no sign of stopping even though the ipod says there's only 20 minutes to go, and then wallop! it ends. We'll see if the third book does the same thing.

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Londoners: The Days and Nights of London Now—As Told by Those Who Love It, Hate It, Live It, Left It, and Long for It
by Craig Taylor
"From the woman whose voice announces the stations on the London Underground to the man who plants the trees along Oxford Street; from a Pakistani currency trader to a Guardsman at Buckingham Palace - together, these voices and many more, paint a vivid, epic and wholly fresh portrait of Twenty-First Century London."
Lola II loaned me this book and it's very readable and rather good. Lots of different people talked to the author and he has simply transcribed their words into short chapters. He could have talked to a million more people and their stories would all have been as interesting as the ones he has chosen.

Monday, 9 February 2015

Continuing professional development

Close up of yellow stamens in a red flower
Peckover House, August 2014
It's blimmin' cold. This is, of course, not unusual in the winter, but it's always at February time that I start to get impatient for better weather. It may be that the house - Victorian, no cavity walls - gently cools so that the heating becomes less effective as winter progresses, but I tend to wear thermals or a duvet if I'm going to be indoors and stationary for any length of time - like when I'm constructing these blog posts, for example.

I have been keeping myself busy with a lot of curricular and extra-curricular activities. I went to a very interesting meeting one evening about the new guidelines on treatment of Type 1 Diabetes that are due to be published this year by NICE. It is fairly esoteric and a bit technical; I thought about summarising the changes for the blog but it really would be of interest to only a very few, so I summarised the changes for my colleagues who weren't at the meeting instead.

This sort of thing is very useful for my professional registration. Every two years, 5% of registrants (i.e. practising Dietitians) are selected for audit of their competence to practice. This is based on evidence of activity during the previous two years that demonstrates that they have kept up to date with best practice through continuing professional development (CPD). Attending meetings is one of the activities that count, but it helps if you can demonstrate that you have reflected on the things you learned and applied them to your practice. Just attending isn't enough.

I am a bit obsessive about my CPD portfolio. I cut out articles from professional magazines, print blog posts, include copies of diet sheets that I have worked on - I assume that pretty much everything that I do could be deemed as evidence of CPD. They are very keen on reflection, so every so often I will consider something that has happened within consultations, and write a short reflective piece: "What happened? So what? What next?" Some of those Dietitians selected for audit have to piece together two years of CPD from looking at their diary and working it out from scratch, which is time consuming and hard work. If I am selected, I'm hoping it won't be too much effort to construct my account of the evidence that's needed.

I digress. One lovely bit of CPD is my DESMOND educator accreditation. As mentioned in the last blog post, I have now had my first Mentor visit, which involved being observed in two sessions, one about activity and the other about food and cardiovascular risk (fats and calories). The observer provided some really good constructive advice that I couldn't have worked out on my own - for example, I was aiming for open questions but kept starting with "Do you know...?" or "Does anyone know...?" which are actually closed questions masquerading as open questions. Very interesting, and I hadn't spotted that I was doing it until it was pointed out. The next phase ends with a final assessment at the end of March, if I can get things together that quickly.

Aside from work, I spent a weekend watching badminton in Crawley - the English National competition. Nowhere near as mind-blowingly good as the international competition that takes place annually in Birmingham, but I left it too late to buy tickets for the internationals and there weren't any good seats left. I booked a cheap last minute room in a very posh hotel and was very unimpressed when the TV didn't work, so they switched me to a room where the TV was fine but the heating didn't work, and when I complained again they supplied a convection heater. On the positive side, they had a little fitness room and I did my first ever run on a treadmill, which was much easier than running outside, so I ran further and for longer than ever before.

I spent Sunday at the falconry centre, helping them to get ready to open to the public again - I applied teak oil to wooden benches and moved large rocks for a few hours. And as I still have a few minutes in my life that aren't full of work, badminton or running, a friend tried to persuade me to join a clarinet choir ("It's only once a month...") I dithered, but remembering that I'd thoroughly enjoyed the workshop that Lola II persuaded me to join, I gave in and signed up. It was good fun; I was by no means the worst despite having played so little over the past 30 years, and... it's only once a month...

Tuesday, 3 February 2015

Outcome measures and service development

Plants and a lantern on a sunny windowsill
July 2013
We have been encouraged for some time to try to establish a measure of the value of the work done by Dietitians. It is part of the ongoing 'modernisation' of the NHS, because we are all aware that if what we do does not appear to be of benefit (and when I write 'of benefit' what I mean is 'cost-effective') then our services will not be commissioned and we'll all be out of a job. For example, the Medicines Management people have latched on to the very low carb lifestyle as something that may help the Trust to save money because some patients with diabetes can reduce their medication, but against that must be balanced the cost of the Dietitian and Nurse time in helping them to succeed with the lifestyle.

With a surgeon or a physician it is sometimes possible to compile statistics on mortality and recovery from acute conditions; with a chronic condition like diabetes then improvement is unlikely - preventing progression is worthwhile, but difficult to measure. How can we tell whether the Dietitian made a contribution that made a patient better or saved the NHS money? Would the patient have got worse without the dietetic input? We have no way of knowing.

The Dietetics department has finally succumbed to the pressure to measure 'Outcomes', and my Dietitian colleagues and I have been trying out a set of four parameters specific to diabetes that have been proposed and are being used elsewhere. They are fairly easy to apply (although a bit of thought is needed), and we could conceivably start to record these Outcome Measures, but the next step is to find out how they will be used, and that subject will be discussed in a forthcoming meeting. It is a meeting that I will not have to attend, thankfully, but there are a number of questions that I hope will be answered - do we do this for every patient? What about those in groups? What will happen to the data that we generate - how will it be used?

There is also a change coming to the way that our services are organised, following the 'consultation' earlier in the year. It was a fairly token consultation given that the patients were not given anything like the information they would have needed to make informed choices, but if they had, most of them would have been unable to understand and process it (I am still not entirely sure what's going on - it's inordinately complicated). But the Clinical Commissioning Group (CCG) can state that it has consulted patients, and proposals for change towards an 'Integrated Diabetes Service' in the community have been made.

I have been to more than one meeting about this (I definitely don't intend to go to any more) and I still barely understand any of it. What does seem straightforward is that many people with well-managed Type 2 Diabetes should be discharged back to the care of their GPs instead of being seen by specialists such as those in the team where I work. Despite the fact that this message was delivered by the consultant who is working with the CCG on managing the change, he himself has failed to discharge any of such patients from his own clinics. So I am about 60% confident that little will change in my particular working area, but that leaves 40% of a chance that I am wrong. It's due to start in the new financial year, so we'll have to wait and see what happens then.

Not much more to say about work, although my full time hours have unofficially been extended to September. I don't yet have the paperwork to support the extension, so nothing is for certain. If it goes ahead, though, it should give me enough time to be fully certified as a DESMOND educator - an external assessor is attending my next course to provide some feedback towards my accreditation. I've also been standing in as an educator on a different course for people with Type 2 diabetes. DESMOND is for people who are newly diagnosed, but the other course is to promote the lower carb approach to people who've had diabetes for some time. It's much shorter in duration, and neither I nor the Diabetes Specialist Nurse who delivered it with me had done one of these before, so we launched ourselves at it and charged through at a gallop to make sure we squeezed everything in. Part 2 is this week, and perhaps we'll be able to moderate our speed. It was quite a ride.

If only I could tell you the details of some of my consultations! They have been particularly interesting in this post-holiday period, as people find different ways to explain how they really let things go over Christmas, but they are definitely going to get going again now. I had one afternoon when my input was more in the way of marriage guidance than dietetics; another appointment with a patient who had a lot to say and hardly gave me a chance to introduce myself. Occasionally I feel I can really make a difference with just one nugget of information.

But there are still a few patients who are baffling - their understanding of diabetes and their ways of managing it have been deeply embedded over many years, and trying to get to the bottom of what is going on can be frustrating, and sometimes futile. For these people it is a question of working within the parameters they set, and trying to find a way to ensure the best outcomes possible. Most of the time I would encourage the patient to plan just one or two small changes, although there is so much that could be done. But it is impossible to know what would have happened if I'd acted otherwise, and I do think that succeeding with one thing is better than being faced with too many challenges and not overcoming any of them.

Tuesday, 27 January 2015

Future holidays

A bench and a doorway in the sunshine
King's Lynn, August 2014
Every so often, I spend a week over the New Year holiday period with a group of friends at a large property somewhere in the UK (although one year we were in Ireland) - I have reported on this before (three times over the lifetime of this and the previous blog). Most of the previous holidays were arranged and booked by one particular couple. This year, during a weekend I spent meeting up with some of said friends including the couple who usually make the arrangements, I nobly volunteered Lola II to arrange another of the New Year shindigs.

Somehow it has turned out that the bulk of the work so far has fallen to me instead of Lola II. This is probably only fair, since she didn't have any say in the volunteering process. So off I went, getting people to commit to joining in, finding properties to house 21 people, discovering that the level of enthusiasm meant that we needed a bigger place, collating preferences for four different properties, and at last I hope we have reached a consensus on a suitable house for us. Now my fingers are crossed that it is still available, although we do have a backup option.

That took up quite a bit of time and headspace this week, alongside the usual badminton and work. So my outstanding jobs that are far less attractive (buying holiday insurance, breakdown cover, changing utility supplier, and - worst of all - clearing moss and mud off the hall roof and gutter) have been neglected, as they are likely to continue to be neglected until I have no choice but to knuckle down. The holiday insurance will probably be first, given that the date of the holiday is set and not far off now.

And on that very subject, I took myself off to the Snowdome to put in an hour's practice, so that my first turns on Italian snow are made with some confidence. It had to be at a weekend, so I thought I'd get in early on Sunday morning hoping to start before the main rush of the day, but no such luck, it was teeming. Quite a few were in groups being taught, so they weren't getting in the way too much, but no full speed zipping down the slope. It was still worth it, even though just for an hour on a tiny slope full of beginners. I came home buzzing with excitement and anticipation for my holiday, which is as it should be.

This holiday activity inspired me to consider what other plans I might make for the coming year, and I have two or three more ideas. One slight difficulty is that the lumbering hulk of bureaucracy that is the NHS manages annual leave for its staff through an electronic interface which deals in hours - in the current year, my allocation was around 273 hours, which includes Bank Holidays. I cannot assume next year will be the same because a) you get a different allocation when you work part time compared with full time, pro rata (last year I worked 6 months on 27 hours a week, and 6 months full time) and b) I have now completed 5 years service with the NHS, which entitles me to a few more days, and I can't remember exactly how many.

So now I have to a) find out how many hours I should get next year b) find out how many of these are taken up by Bank Holidays c) convert the remaining hours to days and thus determine what I can plan for. My current thinking is that it shouldn't make any difference about the part-time vs full-time working, because although my leave hours are reduced because of part time working, I will also need to take fewer hours as annual leave. It's complicated, but it's rather delightful to be considering some lovely trips over the next 12 months at this darkest, coldest time of year.