Risks Must Be Assessed

Stilt walkers, Munich, December 2019

I've been on holiday again, and when I go away, blog continuity suffers. I'll do my best to remember what happened before my holiday and see how we go. This post is about work, and there ought to be another blog at some point about what happened outside work and on my holiday, which was significant.

There were two students. After a lull when students were withdrawn, they're back with a vengeance - we have four, but they can't all be accommodated in the dietetic office over at the main hospital. In fact the dietetic office at the main hospital has been transformed by the introduction of screens, a one-way traffic system and all sorts of other efforts to allow safe distancing without everyone having to wear masks in the office all of the time. I haven't been there, and I hope not to have to go there (ever), but I read the emails that come round. Anyway, students. I had a different one with me for two Mondays in a row.

What with my patients as always being on the complex end of the spectrum, there is never much opportunity for a student to do much more than observe. Now we've got no patients coming in person for face to face consultations either, so all they can do is listen. We use a telephone with two handsets that's designed to be used for the telephone interpreting service. To make it a bit more interesting I asked the other team members (Doctor, Nurse) if they would mind having the students spend a bit of time listening to their consultations as well as mine, and asked the student to write a piece about multidisciplinary working, or diabetes, or really whatever they like, I don't care (I didn't tell them the last bit). It's hard work, though.

Then along with all this there was a meeting - online, with my new headset and camera - to talk about Structured Education. The Clinical Commissioning Group and DSNs and Dietitians from three NHS Trusts are working together under the leadership of a Dietetic Manager (not from my Trust) to sort out the mess that is our Diabetes Education. Actually, our Trust is not in a mess, in fact the consensus has been to pretty much adopt all of our admin processes, educational materials and methods of delivery, which a) is flattering and b) means I don't have to worry about checking through everything to make sure that I agree with it. Although I'm pretty sure that I wouldn't have done that anyway, not now. I might have done a few years ago.

The meeting took two and a half hours, plus the time afterwards for me to do a few things I'd been volunteered to do, and then we had to arrange a smaller follow up meeting to tidy things up, all of which used up an enormous proportion of my two-day week and put me well behind with the 'talking to patients' work that I like to do. There were a number of other frustrations too, but I did manage to make the point to the Commissioners that it is all very well coming up with amazing ideas for delivering education, but we don't actually have the staff to deliver it (particularly Dietitians and admin). I've made the same point up my management chain and will just leave it there.

Since then I've managed to catch up with most of my clinical work, until today when I made the mistake of opening my mouth instead of keeping it firmly shut. Last week in the multidisciplinary clinic, the doctor was quite keen to talk about bringing some people in to the Centre to be seen in person, and we came up with a possible plan for the following fortnight. My mistake was to mention this to my Team Leader, who thought it would be fine until she mentioned it to her Manager, who said, "What about the Risk Assessment?"

So in order for me to see patients face to face, the risks have to be assessed and there are Procedures That Must Be Documented and Carried Out, I gather mainly around cleaning and PPE. Of course none of these risks has been assessed nor procedures documented or carried out, so I don't know what I'm supposed to do. If we all come down with Covid-19 and sue the Trust somebody will end up in trouble, but it would have been a great deal easier if I'd said nothing and just got on with it. Anyway, I told the DSN in charge that my Manager wants a Risk Assessment and Procedures, there was much rolling of eyes and then thankfully it was the end of my working week and I went home.

For the record, our Trust has two Covid-19 cases at present, both of them in the other hospital, and neither one in Intensive Care. We have to wear face coverings when patients are in the building (which they increasingly are), and add gloves and plastic aprons when patients are in the same room, and use hand sanitiser and/or wash hands a lot, and keep socially distanced from one another. When I finish on Tuesday I wipe down all the surfaces in my room as it's used by other people when I'm not there. There are many official signs up now with 2m markings on the floor and a perspex screen for reception, and some kind of classification of Green and Blue Zones which I confess I don't understand. Luckily the Diabetes Centre is a building in the car park so we don't get mixed up in the zoning and restrictions that are in place within the main hospital building.

So that's work. I'll try not to leave it so long before writing about Not Work.