Wednesday, August 28, 2013

Chance and focus

So there comes a time when you take a fresh guard. And school holidays are always a good time to take a break and reassess. 4 years as Clinical director in the Portsmouth Diabetes centre has been a rewarding time..but thats now all in the past. Maybe its just the circumstances, maybe its just the season- but I spent some time, forgetting the politics for a bit,as to what could be done for patients with diabetes either locally or even on a broader scale- what works, what doesnt?

For starters, there's the emergency admission side of things- we feel we have a 5 day service in the NHS but stories abound where the diabetes team haven't even been involved on weekdays, let alone anywhere else. Huge amount of variabilty about what diabetes teams deliver around the country. Why don't we look at models that work, learn from each other, borrow each others business cases...I don't know..but its an enigma that has forever baffled me. Is it ego? Is it the reluctance to believe that someone "else" could have come up with a good idea? Either way, thats certainly an area of debate but one that doesn't need necessarily investment but better coordination, better sharing of ideas, better understanding in the ethos that we are in the ever shrinking economy together.

And then there's "7 day working" ever increasing clamour - quite rightly - to provide better care over weekends. We know care is poor over weekends- and I can assure you that as swashbuckling I would like to portray our department as, we fail our patients on the weekends. I have some thoughts and ideas to resolve this- and in all fairness to the national organisations, they have given the opportunity for organisations to "earn" revenue which in turn would support the building of teams to deleiver 7 day cover. Best Practice Tariff for diabetes patients admitted is a great innovation...the question is how many are building business cases around that? And is it always about investment? Or is it about specialists working more smartly? So many little answers.

There's also the area of more people being more on pumps..knowledge at the front door about what to with such patients? Not good at all...partly it is about education, partly its what the specialist team have done to improve the knowledge about pumps to their colleagues...but the challenge with education is also about sustainability. Does it work in an environment with such fast turnover? Again, questions with variablity of answers.
So the targets for me is to throw myself into those areas of challenge...can't tell the world what to do if I can't get it sorted in my own backyard. I have some ideas which i think will be able to crack the nut....lets see whether it can be done or not.

Finally, a break also gives you a moment to take pause and see whats also so close to you. Too many evenings spent socialising, trying to "crack a deal", negotiate the next innovation, spend time on thing seemed to be losing I will take on the above challenges but also want to do so with an eye on whats dear. So, more time for the family..more time to see the kids, hug them a bit harder..and perhaps more focussed areas as above to concentrate on for folks with diabetes. I hope I can always have the opportunity to do that.

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