It’s the small things

A couple of small things before I start.

I am learning about blogging all the time.  Recently I have learnt that you can get an email notification when I publish a blog (isn’t technology clever).  So if you want to register just scroll down and on the right and there is a little box that looks like this:

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Bottom ofAnother small thing is that in my last blog I mentioned that there might be a 5th area for the Diabetes Funding from NHS England called “Enhancing Pathways”.  This is not correct.  Serves me right for being impatient and not waiting till the actual bidding guidance comes out.

The Diabetes Funding bidding process announcement has been delayed so we all a wait with eager anticipation.

So with those small things tidied up I wanted to write about another small thing.

If you’ve read my blog before you will probably have noted that I am particularly passionate about diabetes patient education.  See my previous blogs – Brick Dust and Diabetes Patient Education – A Moral Imperative?

There are so many things in diabetes care to feel strongly about. I wonder why this one continues to bubble to the top of my personal interest?

I think it is partly because whilst working for NHS Diabetes I was given this as my key lead area so that exposed me to a more detailed understanding and it easy to be interested in something you get to learn quite a lot about.  Another reason is the people I meet.  The people who are so dedicated to good quality patient education.  They are just so flipping inspirational that I can’t help but be infected by them.   Also meeting patients who say how patient education has made such an enormous difference, is so powerful. 

But mostly - it just makes sense.  When we know that diabetes patients only see a health care professional for an average of 3 hours a year;  how else do we expect to manage the rising need without enabling, supporting, encouraging and allowing people with diabetes the opportunity to help themselves?

So, no one is more delighted than me that the CCG Improvement and Assessment Framework Indicators for Diabetes and the funding bids strongly focus on ATTENDING education.  Yes I know.  It’s not for everyone. I know it can be a struggle for people with diabetes and health care professionals to attend and provide courses.  I also know that education is a complement to everything else and not the panacea.  But when patients do attend a well-run, quality course it can be transformational.

Currently the data for ‘attendance’ is not being captured correctly.  A smashing piece of work was done by York and Humber Diabetes Clinical Network shows that 25% to 30% of people with diabetes do attend education which is 5 times higher than the nationally reported figure. 

It’s sad where services are getting good attendance rates at patient education that this is not being shown in national statistics.  It’s hard to justify, sustain, get a pat on the back, and show what an amazing job is being done by diabetes teams without good quality data. 

That is why I am delighted that Diabetes UK, with the support of the 11 national Clinical Networks, education providers and many others have produced some guidance on improving data capture for “attendance” at patient education so that we properly capture and recognise the work that is going on out there and also can have a more informed understanding of where gaps need to be addressed.

The guidance has 4 simple Read Codes (The explanation of Read Codes can be found here)

If Diabetes Structured Education Providers can ensure that they let Primary Care practices know these codes further to their referral then this can be entered into the patient record and then captured through the annual National Diabetes Audit. Simple.

I know that little bit of guidance won’t change the world.  It is such a very small thing.  But it is a baby step in the right direction.

Beyond Money

I’ve not said this before but I should say that all opinions in my blogs are my own.  For some reason I particularly feel obliged to say this before I go on and write.  I welcome challenge to my thoughts.  It is where I get my learning from.  The NHS is so big and complex that no individual person can possibly have a completely confident overview and for a middle manager like me that is certainly true.

So with my disclaimer said, I will carry on.

As we continue to wait for more detail on the process to access the £40m announced in the NHS England Operating and Contracting Framework it is giving rise to some interesting observations.

We are expecting bids for be for the following 4 areas:

1.       improving uptake of structured education

2.       improving access to specialist inpatient support to reduce length of stay for people with diabetes

3.       improving access to a multi-disciplinary foot team for people with diabetic foot disease to reduce amputations

4.       improving the achievement of the NICE recommended treatment targets.

 But also potentially a 5th category will be included called:

5.       Enhancing Pathways

The expectation of the need to quickly mobilise to submit robust bids has given rise to lots of interesting discussion.

During one such discussion it was agreed that clinical time would be needed to support the implementation of the planned work should a bid be approved.  In response one of the group said: “You can give me £1million, £2million, £3million but we still will not have the capacity; the available staff or the trainees in the pipeline to implement the work and increase capacity”. 

It made me pause.

Has the NHS gone beyond money?  We may have money to give to diabetes, which is a wonderful and exciting opportunity at this time of austerity but are there the people out there with the right skills and training?  With the potential implications of Brexit; the removal of grants for student nurses and no significant rise in NHS funding are we likely to see a dramatic increase in the wider pool of clinicians currently available to us?

These are competitive bids.  There is potential that not everywhere will receive funding.  We know, for example, that we have shortages of nurses and podiatrists in general.  In proposals looking to hire staff, even in the short term, could we end up just pinching staff from each other potentially de-fleecing other departments or neighbouring services who did not win funding? 

There certainly is a weight of responsibility for those who will be reviewing and approving bids and although tricky to ascertain, it may be reviewers need to check that they are not robbing Peter to pay Paul.  Just a thought.

A bit like Sir David Attenborough, sitting in the jungle and observing interesting behaviours, I have also witnessed other phenomena arising from the funding bids.

I recently attended a meeting where GP diabetes leads were introducing themselves, for the first time, to their neighbouring GP diabetes leads.  It was delightful to see.  There was a huge richness and shared learning in the conversations had.

So maybe there is something else this funding provokes beyond just money.  Something just as valuable as pounds and pence.  The opportunity to review where services are at; across boundary discussions; galvanising shared learning and new relationships.

All of value - beyond money.