Difficult decisions

Art deco hotel, Borovetz, February 2016

I don't want to write much about last week because it's been dominated by family stuff that's not particularly suitable for public airing. I haven't felt like doing much in the evenings, which is unlike me. On Thursday I decided to go for a run anyway, but two thirds of the way round my usual route I decided to stop because I just wasn't enjoying it. I haven't even started sorting the stamps and envelope collection.

I have started to clear the loft and took a couple of boxes of books to Oxfam. There's a load of old papers from the loft in the downstairs hall that need to be sorted and shredded or recycled, which will leave quite a few ring binders and suspension files that I can't bring myself to throw out, so I'll have to find a good home for those. I also responded to a conversation on the local website Streetlife, offering the trampoline to a good home, so now I need to get that down from the loft too.

Getting the tenor sax serviced was on the list as a priority for this week. I was given contact details for a local chap who came highly recommended, and so far I have sent an email, left a voice message and sent a text without any form of response. I think this suggests either he isn't that interested in the work or is on holiday. There is an alternative but it's in the centre of Birmingham, so nowhere near as convenient.

At work there's been an interesting discussion about my job. I trained to deliver the 'DESMOND' education for people with Type 2 diabetes when there was a huge waiting list in the neighbouring city, and got some extra paid hours to help clear the backlog, and since then I've continued to deliver a course there about every two months. However, in the town where I actually work the course is delivered by two nurses once a month and a waiting list has now built up there, so we enquired about whether I could be paid to help them clear the backlog too.

This has opened a can of worms. It has exposed my ignorance of how the whole edifice of NHS funding operates. I find it very frustrating, but I had pretty much come to terms with the fact that there seems to be no way to find out, let alone understand, how our diabetes services are paid for, apart from the fact that ultimately the funding is allocated by the Clinical Commissioning Group. But are we paid per consultation? Do they give us a fixed amount for all we do in a year? How is my salary allocated between the Dietetic department, the Diabetes department, the hospital where I work and the Trust that employs me? Does the Diabetes service pay the Dietetic department for my support, and if so, what exactly am I supposed to be doing? What exactly are my responsibilities within the Diabetes service? Should I be delivering DESMOND at all, and if so, how often, and where?

This is further complicated by the fact that I am aware there are circumstances where I shouldn't see someone - if they are referred by their GP to a Dietitian but not to a Consultant then it ought to be a Dietitian from a different service, despite the fact that the Nurses in the same building can accept these referrals. And recently one of our Diabetes Consultants asked me to see someone for dietary input who doesn't actually have diabetes - should I accept that referral? Apparently I shouldn't, but what if I do? What difference will it make? Who will care?

Our Diabetes service is going to be reviewed, and I don't want it to appear as though I'm not fully occupied simply because I've been recording my activity wrongly. I'm not in the least bit interested in any of this but it looks as though I'm going to have to ask some more questions. The NHS is a wonderful institution, but it is mind-bogglingly complex.