Thursday, 1 May 2014

Quality

Garden view
National Botanic Garden of Wales, May 2013
Tuesday was a real throwback to my university studying. It's officially my day off but I've agreed to write an article about gastroparesis for a professional journal. I had thought the deadline was the end of May and had been procrastinating wildly, but decided it was time to start. When I checked the previous correspondence, I found that the original deadline I'd been given was 21st March...

Anyway, I settled down to get started on writing last week, and found all manner of distractions at home. Then I was told about a meeting on Tuesday. The Quality people (this is shorthand for all manner of administrators whose job it is to make sure that health professionals and associated personnel provide the best service possible to the public) recommended that the Diabetes Service in this Trust should have a multi-disciplinary meeting. Despite being another potentially tedious and time-wasting get-together, I actually think that this is a necessary evil, as change and improvement is very challenging when you don't know who the decision-makers are in your own service. It helps that a couple of new consultants have joined the team, who are young and dynamic and seem to be open to new ideas.

So the meeting was on Tuesday, my day off, in the main hospital of the Trust (not where I work), and I needed to get some work done away from the distractions at home. It made sense to work in the library at the hospital, which would give me the opportunity to go to the meeting too. I set my alarm for 'early', because my Couch to 5k run schedule usually includes a Tuesday morning.

The only problem was that I'd signed up for a badminton competition that took place last Sunday. It started at noon so I'd made some sandwiches, and then left them on the kitchen table. The teams were divided into groups, and we'd played everyone in our group by half past two, been soundly beaten by all but one team, and I was getting very hungry, so I was looking forward to going home without waiting to see the semi-final and final at the end of the competition (played by the top team in each group). Then they announced that we would be playing everyone in our group for a second time...

Needless to say we were beaten all over again (even by the team who had lost to us in the first round), and it was four o'clock and I was starving. I found out when I went to club night on Monday that the only team we had beaten were the eventual winners of the tournament, which was annoying. Having played six hours of badminton over the previous two days, it should have been no surprise that I decided not to respond immediately to my 'early' alarm heralding a 25-minute run on Tuesday morning.

An hour later I managed to get up and head off for the library, except that I had a couple of jobs to do first. One was straightforward, involving a signature on a form applying for a memory stick that is encrypted so that it can be used in Trust computers - obviously the risk of downloading and exposing confidential patient information means that ordinary memory sticks are not allowed. The Diabetes team in the hospital where I work is not particularly interested in technology, so we don't have a laptop or computer projector, and the old-style overhead projector with acetates is still used extensively. A laptop/projector combination can be borrowed from the Learning Centre, which I have done on a couple of occasions, but came up against the problem of transferring the file containing my presentation to the non-networked laptop.

The other job I had to do was around verifying my previous NHS service, which was a two year stretch in the 1990's. The only reason to bother with this is because length of service is one factor that determines how much annual leave you get, and those two extra years should give me an extra two days (or is it an extra five days? I can't remember any more). I had managed to extract a letter from the NHS Trust where I had worked, confirming the correct start date, but for some reason my record showed that I had worked there until 2006, which was clearly not true. Unfortunately, my contact in the HR department was still insisting that I get confirmation of the correct dates, and suggested that I use pension records (I didn't pay into the NHS pension in the 1990's) or tax records. I thought I would take the opportunity to visit the HR department in person, and see whether they could be brought round.

It was an interesting meeting - my HR contact had never personally dealt with the tax people, but seemed to accept my view that this was not going to be a desirable line of enquiry. It then transpired that a) she had thought we were talking about my previous employer rather than something that had happened two decades ago, and b) she hadn't realised I was asking for fewer years to be taken into account than were stated in my letter, rather than more. She is going to think again, and I hope that common sense will prevail.

So after all of this, I reached the library mid-morning, then found out that I couldn't access any work information from the library (again because of concerns that patient information might be left somewhere electronically insecure), then worked out (with assistance) how to get my laptop to access the Interwebs, and then, instead of knuckling down to work, I thought I'd do a bit of blogging. Just like my old student days.

The MDT meeting was a bit of an ordeal, all about how we can collect data to show whether we meet the 13 Quality Standards set out by NICE. Obviously it is important to provide patients with a service that includes all the things that contribute to high quality patient care. It is, however, an immense amount of work to record and then collate data to prove that we offered people structured education, foot clinics, retinopathy screenings and blood and urine tests even if they don't turn up for their appointments or provide samples and we can't actually deliver the structured education within current resourcing levels. Apparently, the Diabetes team in the community has a waiting list of 560 people for their structured education programme, which isn't actually being delivered due to lack of staff, or funding, or both.

We also have Quality Standards for clinical results like blood pressure and cholesterol levels as well as average blood glucose (HbA1c). Although I don't quibble with the targets, which are set at levels that ought to reduce patients' risk of cardiovascular disease, stroke and microvascular damage, I don't think the service should be held to account if patients don't achieve the targets - there's only so much that medications and health professionals can do. At the end of the day, if patients want to eat pies and burgers and drink Lucozade then the targets won't be met even if their doctors have dosed them up with as much medication as they dare, and done their best to let them know they're not doing themselves any favours.

I managed to do the run on Wednesday morning instead.

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