Pump training

By | 22 October, 2009

A needling problem

Avid readers of your soaraway Shoot Up will know that I’m currently on an 18-month long NHS waiting list for a pump. You’ll also recall I’m not too chuffed about this for obvious reasons. As, on the whole, I’m generally a pain in the arse I’ve been writing polite letters to everyone concerned about this sorry state of affairs.

I’ve generally had sympathetic replies from my MSP, the chief pump honcho at the hospital and the Chief Executive of the health board wrote to me the other day to say he’s asked someone to investigate and report to him about pump provisioning. It does seem that people are generally supportive, which is nice to know but – of course – not actually of any practical help to diabetics.

Certainly in my area the main sticking point appears to be the lack of funding – not, as you might expect, for the pumps and supplies themselves but for the training required for new pump users. I do agree that pumps are slightly more complicated than administering MDI, as there seems to be a greater possibility of complete cock-up with a pump compared to MDI. Though, as we all know, it’s very easy to utterly mess up with MDI – I do it quite often!

My health board undoubtedly has some great DSNs and the training I received when I was first diagnosed was relatively brief but was of a very high standard. But, unfortunately, there just doesn’t seem to be enough of them to go around. Currently their policy is to train about 5 or 6 new pump users every two months. This just isn’t enough throughput to increase Scotland’s woefully low number of pump users up to levels that are on a par with the rest of the country, let alone the rest of the western world.

If training genuinely is a bottleneck (and not just a slightly cunning feint to avoid funding new pumps without breaking the rules) then there seems to me to be a possible solution in the form of a public-private initiative in which everyone could win.

So here it is – what about the NHS partnering with the pump manufactures to provide training? The pump manufacturers will, obviously, know exactly how their pumps work, how they’re best used and will have a wealth of experience in supporting their customers in using their products. Everyone knows that diabetes is a nice earner for our favourite pharmaceutical companies and so the cost of training could be recouped on a cost-recovery basis or even as loss-leader set against the ongoing purchase of pumps and supplies.

Pump manufactures would surely have a reasonable amount of available resource to chuck at training (especially if it benefited them through long term and ongoing sales) and such an arrangement would free up NHS staff to do what they do best – supporting diabetics.

But might this lead to reduced patient choice? If, for example, Small Manufacturer A wasn’t able to supply training while Large Manufacturer B did, then might there be an inherent bias in the NHS to encourage diabetics to get a pump from Large Manufacturer B as they could then save on training costs?

I don’t think so, as any such arrangement would necessarily reduce the training overhead for the NHS allowing them to concentrate their resources on supporting patients who wanted, for whatever reason, to use a pump from Small Manufacturer A.

In this scenario everyone wins – patients get training and pumps quickly; the NHS’s training costs are reduced; the pump manufacturers get a loyal and going supply of lucrative diabetics.

But what about the issue of the bifurcation of training? After all, training from a pump company might not be at the same standard as NHS training? (Of course, it might be better). But given that standards of training and pump provision vary wildly around the UK, I can’t see that this would make any significant difference from the current position.

9 thoughts on “Pump training

  1. Mike

    Hey Tim.. Low and behold I was just watching a video made by Accu-Chek/Roche featuring none other that Steve Dixon from Sky News.

    Training at his local “Public/NHS” hospital involved not only his DSN but also The “Pump guru” from Roche!! Now how about that??

    check out the video on you tube here = http://www.youtube.com/watch?v=YKlEdHWbCqU

  2. Aileen

    I totally agree Tim, this sounds like the way forward. I know many people who had training with the pump company and it worked very well.

    Unfortunately in Glasgow the problem seems to be pump/consumable funding AND staffing and others things too. Lothian’s current policy to start 5 or 6 pumpers every 2 months is far superior to Greater Glasgow & Clyde’s (largest Health board in Scotland) funding for 7 pumps between now till 2011 over 2 clinics! It’s all very complicated and they all blame each other so actually getting to the root of the problem is very difficult.

    We are reliably told we have to lobby MSP’s as ultimately they are the ones who can keep pressing the government to change the dire situation in Scotland. The government think this is a minority issue and are brushing it aside. If Health Boards don’t have the staff required to train prospective pump users, presumably that’s because they don’t have the money to employ the staff they need?

    We need people all over Scotland to write to MSP’s and Health Boards, and keep at it so they get fed up with us and do something about it. Freedom of Information requests are another way to find out what is actually happening in the board.

    Scotland say they follow NICE guidance )for now at least) but they don’t seem to realise it is not happening. I wonder if those who can make a difference really know the reality of the situation.

    A very nice consultant had a long chat with me and Marc in the summer. She has 40% of her patients on pumps and says she will double number, even with massive budget cuts… it can be done.

    We need to find others having similar experiences and encourage them to contact their boards, the government and MSP’s too. We just need to keep at it!

  3. Tim

    Aileen :

    Greater Glasgow & Clyde’s (largest Health board in Scotland) funding for 7 pumps between now till 2011 over 2 clinics!

    Seven pumps? Is that all? Oh my God.

    The salient point, in my view, is that poorly funded diabetes care is a really, really short-termist measure. Study after study has shown that better control = fewer complications. And it’s obvious that fewer complications = less cost in twenty years time.

    In other words, a £3,000 pump now saves £30,000 on dialysis in 2029. However, I suspect that NHS trusts and the government have relatively little interest in health care so far in the future.

  4. Aileen

    Yeah, it seems pretty obvious and logical. We hear they only think 1-2 years ahead. However Diabetes UK Scotland argue a saving of £23,000 could be made over 2 years, but even their argument seems to fall on deaf ears. Grrr!

  5. Heather

    Hi Tim, the training for childrens pumps at Ninewells, Dundee is done by the Medtronic rep, with nurses in attendance.

    Re your point about pumps saving money in the future – this government won’t be around then, so they don’t give a ***** about what happens then, they just want as much money as they can to claim their expenses now!

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