How our Clinical Champions are improving diabetes care – by Suraiya Chowdhury

Suraiya Chowdhury

We are constantly hearing about how the NHS is in crisis. Not enough staff or money and huge waiting lists are just a few of the headlines we see on an almost daily basis. While some of this might be true, we know there are really passionate healthcare professionals out there who are looking to change the way we do things – from podiatrists to diabetes specialist nurses and consultants, our Clinical Champions are doing just that.

At our staff conference this year, some of our Clinical Champions came and spoke to us about how they are making local changes that are impacting on diabetes care. We asked them to sum up what they thought about the current state of the NHS – and gave them the challenge of using one picture to tell the story. As ever, they didn’t disappoint.

‘Doc’ Liz Martin, a GP from Leeds chose an image of a run down and broken Rolls Royce, a memory of something renowned, respected and envied – doesn’t that sound like the NHS of the past? And now – it needs time and investment to improve. Will it ever be the same again?

Sarah Gregory, an inpatient diabetes specialist nurse (DSN) from Margate (the a*** end of Kent – her words not mine, I promise!) chose an image of Snakes and Ladders –  signifying the constant changes that surround the NHS currently. It’s constantly a game of one step forward, two steps back when trying to bring improvements in the system.

Alex Bickerton, a Consultant from Yeovil, chose an image of pushing a very large snail up a steep hill to show how he felt about driving improvement in the NHS – a slow, tedious journey with a very sharp tipping point, and no one waiting to catch you on the other side.

Justin Warner, a consultant paediatrician from Wales chose an image of a creme egg, a nod to ‘how do you eat yours?’ implying the NHS is what you make of it. That message was evident throughout the talks – each of the clinicians were from a different discipline, a different geographical area, and were working to improve very different parts of the problem.

With all the challenges you would think that there wasn’t any point, but no, our Clinical Champions don’t give up that easily.

Providing integrated care for people living with diabetes

Alex started with a plan to reduce variability in quality of care in his hospital by improving knowledge and bringing together a fully integrated service. He highlighted the importance of working together as a diabetes community. As a result Alex and his team have been able to establish peer support groups and health coaches, virtual clinics and skype clinics. However, for him, these are only the first steps. Amongst other things, he is currently working to develop a single point of access to specialist advice.

Improving podiatry services 

Doc Martin discovered that there was a significantly higher rate of minor amputations (amputations below the ankle) in comparison to the national average. This was partly due to staff shortages, lack appropriate training and information for patients. Liz developed a plan to provide training for staff and provide better patient information. Working with her colleagues, both in primary and secondary care as well as her CCG and Leeds council they put forward a successful bid for the NHS Transformation Fund for an extended multi-disciplinary team into Community Podiatry. This has allowed them to introduce new training programmes for staff, run more clinics, recruit more podiatrists and improve screening of feet in primary care annual diabetes check.

Leading change 

Sarah moved into Diabetes Care in 2000, working initially as a community DSN. Since  2009 she has been an inpatient DSN – she set up the inpatient DSN service in East Kent, developing an electronic referral system, improving diabetes care in the acute setting and auditing and identifying areas  for improvement. She also actively delivers healthcare professional education.

Sarah spoke about her personal journey as a Clinical Champion…through…wait for it…a game of snakes and ladders that she made herself for people to play at the event. The snakes were the shortages in staff and funding, frustrations, and so on. The ladders highlighted peer support – the mentoring, the collaborating with colleagues via the Clinical Champions programme and the support that helps her deliver her many strands of improvement work.

Providing better diabetes care in school

Finally, Justin. His work has involved improving the quality of care for children and young people with diabetes, not only in his own locality, but also across Wales. Driven by the lack of appropriate care for one of his patients at school, Justin has worked to make it a legal requirement for schools to provide better care for pupils with diabetes. Through engaging with Diabetes UK Cymru, parents, colleagues, the Welsh government and other organisations, Justin has been working on the Additional Learning Needs and Education Tribunal (Wales) Bill. We’ve just heard that Justin and team have managed to get an amendment into this bill to include children with medical conditions. This is a huge step forward, and we’re all keeping our fingers crossed the bill gets passed.

Final thoughts…

So how does all of this translate into saving the NHS? Alex’s image (left) of how he feels now having been a champion, summarised it best for me, “I’ve got a team pushing the snail up the hill, and if it tips over I’ve got a team to catch it.”

You can’t do it alone or all at once, “Break things down to allow other people to own it” – Liz.  The more people that are inspired, empowered and involved in improving services, the more likely you are to succeed.

Stay positive, and set boundaries on what you can and can’t compromise on. Empower other people and lead by example” – Sarah. The positive energy came through from every single champion – you could feel their enthusiasm and passion to improve care in the face of everything as you walked into the room and more so as you left at the end – it was contagious.

Finally our role, “As long as Diabetes UK continues to support the programme, it is a really good way forward for Diabetes.” – Alex. All four champions hugely appreciated the support they receive from Diabetes UK. It made me realise how important it is for us to continue to engage and empower healthcare professionals through our work as we are able to reach far more people with diabetes through their healthcare professionals than we are on our own.

This is a Diabetes UK project in collaboration with Novo Nordisk who are providing support and funding.

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