Wednesday, 18 March 2015

Carpe Diem and All That For Local Diabetes Care

So these pages recently have been all about pumping and more specifically the 640G. Whilst I know this interests many, I’m keen to keep a more general feel to the blog now and again and a few hours last night gives me the perfect chance to do this.

The event I attended at my local hospital was about a proposed new diabetes centre for the surrounding area. The ‘Patient Conversation’ was billed as an opportunity for patients to put across what the team currently do well and what can be improved upon. Along with a few others from a local diabetes group I attend, I went along to really try and make a difference. This should be an opportunity for local diabetes care to step back and look at everything they do to see what they do well, what they do badly and what they don’t do at all.

Being the good boy scout that I am I made a few notes beforehand and went along to see what was being proposed.

We were grouped into tables of roughly five to eight and together we put our thoughts down on to paper and answered the four questions of the night.  The questioning was good and open about what we’d like to see from the centre and also what can be improved with current treatment.

Overall a common theme was coming through the evening as we answered the questions and fed back table by table. The healthcare professionals we meet with at every appointment are fantastic (except Barney obviously!) and their hard work and dedication will be what makes any new centre work even better. On the flip of this process and organization needs improving along with taking this opportunity to make some relatively simple changes to improve the lives of people with diabetes locally.

A simple example of what works well and what doesn’t is getting to speak to the people you need to. On appointment day it’s not unusual for me to see the consultant and also squeeze in a meeting with the diabetes support nurse (DSN) and dietician at the same time. However contacting someone when away from the hospital means leaving an answer-phone message with the DSNs that will be listened to the same day (if Monday to Friday 9am to 5pm) and you normally get a call back the same day or the next. But when leaving the message you’ve no idea if or when you will get responded too. Likewise email responses are, what’s the word, ah yes, intermittent. And out of hours; you’re flying solo matey.

Obviously as this is the local NHS, resource is always a constant issue and we were reminded during the night that people are being stretched as far as they can. I fed back that I understood this but this has to seen from the other direction. Whilst the HCP is running around saying “I’m busy, I’m busy” I’m sat there waiting for an hour, looking at my watch thinking of the work building up back at my office and watching the emails come in that I need to deal with urgently but can’t because I’m sat on an uncomfortable chair and don’t have a decent phone signal. Being a person with diabetes takes time as I’ve touched on before and if I had a choice of hobby, this wouldn’t be it!

Through the night some fantastic yet simple ideas were coming out. For example, move the consultants desk to break down that ‘headtecher’ style barrier to communication, put up a noticeboard with posters of local support groups to enable peer to peer support, text alerts for appointments, same day HbA1c tests where currently it takes a few, remote appointments such as via Skype for those who find it hard to travel, a coffee machine in the waiting area with diabetes literature (Balance etc) to generate conversation etc.

I kept bringing up again and again the subject of social media and peer support. It’s hard to judge but I got the feeling the heads were being nodded but the historical fear of ‘nutters on the net’ still exists. The presentations given at the recent Diabetes Professionals Conference show that online support is a significant aid and encouragement to better self-management and to ignore or dismiss it at the stage would be foolish. I really do hope I’m wrong on how I think this will go. There were enough people with diabetes in the room that were there because of meeting others that showed if you can encourage it you will get a much higher involvement and therefore far less ‘did not attends’ on the appointment list. Paired with this I’m sure people in the room (including me) would be also willing to help provide some simple pointers (such as Kev’s great leaflet) for people to connect with other local, national and international people who understand what they are feeling too. On a local level we NEED to engage with those better. Some people don’t want to tweet, Facebook or blog. That’s fine. But they must at least know that these avenues exist.

Throughout the meeting we were asked to write our thoughts down and these would be taken away and fed into the decision making process. This must be applauded as connecting at any level can only help to make the proposed centre more successful going forward. Indeed some of the ideas already on the slides pre-prepared for a summary at the end matched the feedback we gave last night. This shows that the thinking is going in the right direction. Great!

The key question now is what is going to happen next? I have a very real fear that last night was an exercise in ticking boxes and if the decision makers were asked in the future if they had consulted they can say yes.

Some of things discussed don’t need a new centre building; they just need the process tweaking. And by tweaking this process it may help to ease the burden on the wonderful DSNs rather than adding to it.

I hope with a passion that this is just the start of the consultative process and as well as looking locally at what’s desired they can look nationally at other diabetes centres to find best practice and excellence in each strand of the diabetes journey.

This is the chance to redefine local diabetes care for a generation. Let’s do it! Let’s do it together!

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