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Making Diabetes Self-Management Accessible Across South London

Published and last updated by Alex Chafey

As part of Type 2 Diabetes Prevention Week, Faye Edwards, Senior Programme Manager for diabetes at the HIN, writes about the HIN-backed services which are helping improve access to essential support for people living with diabetes.

For those working in the NHS, particularly primary care, the ever-increasing number of people diagnosed with type 2 diabetes can feel like an uphill climb that just keeps getting higher. Across south London around 180,000 people are living with diabetes, over 120,000 have non-diabetic hyperglycaemia (pre-diabetes), and many more people are undiagnosed.

"For those newly diagnosed with diabetes it can feel overwhelming, confusing and even isolating."

For those newly diagnosed with diabetes it can feel overwhelming, confusing and even isolating. As with any new diagnosis it can take a while for people to understand the implications, and how they should manage their future health. Diabetes education and personalised, supported self-management are vital in the prevention and long-term management of type 2 diabetes, which is why they are priorities for the NHS.

The Health Innovation Network has had a focus on diabetes since 2014 and during our work with local people the importance of access to diabetes education and peer support became really clear. In 2017 the HIN convened the 12 south London clinical commissioning groups to collaborate and create Diabetes Book & Learn, a service to help people access diabetes education wherever they choose in south London. This cross-boundary working is a great example of how commissioning can enhance patient care and deliver a wide choice of options, achieving an economy of scale that would be impossible to deliver alone.

Across south London the Diabetes Book & Learn service provides people with type 2 diabetes with a wealth of education options, including group sessions led by a specialist diabetes dietician or nurse, delivered in person or online, depending on individual preference. These group courses include the DESMOND and X-PERT HEALTH programmes, both of which are well established, quality assured  type 2 diabetes education programmes delivered by trained educators. It also includes HEAL-D, which is a culturally-tailored type 2 diabetes education course for people of African or Caribbean heritage, created in partnership with members of the African and Caribbean communities in south London.

Book & Learn Digital also has a range of options that provide diabetes education and self-management support via a mobile app or telephone. These include the Low Carb Program, which provides structured education, coaching and support on how to self-manage your type 2 diabetes and uses AI to provide personalised recipe and exercise suggestions; and Second Nature, which uses behavioural insights to support people with type 2 diabetes to make lifestyle changes and gain knowledge of self-managing the condition.

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Screenshot of diabetes book and learn homepage. Large header image of South London overlaid with a search box. Main text reads: delaying your diabetes education means delaying better health. Book your covid-friendly type 2 course today.


Since the launch of Diabetes Book & Learn in 2018 the we have continued to support its development. During the pandemic we support the ICBs with the procurement of new digital services and facilitated the switch of in-person sessions to online delivery, keeping the service going when many other similar services in the NHS had been temporarily stood down. Since Diabetes Book & Learn began, over 14,000 people with type 2 diabetes have been booked into a diabetes education course, with over half of these people choosing our digital or online options.

The establishment of Diabetes Book & Learn at scale across south London provides an unrivalled choice of education options for people with type 2 diabetes. It is playing a vital role in simplifying access to key self-management support and encouragement, and is equipping people with type 2 diabetes to take control of their future health and wellbeing. No one with a diagnosis of type 2 diabetes in south London should feel overwhelmed, confused or isolated by their diagnosis: Diabetes Book & Learn is here to help.

Find out more

People with type 2 diabetes who are registered with a south London GP practice can self-refer at the link below or call our friendly call centre team on 020 3474 5500. Any health care professional can make a referral via our website, call centre or via their practice IT system.

Diabetes Book & Learn

Applications Open for the HIN’s First Diabetes Quality Improvement Programme

Published and last updated by Alex Chafey
Think-Diabetes

The Health Innovation Network has launched a new Diabetes Quality Improvement Programme to develop clinical skills and knowledge to help improve outcomes for patients in south west London who have or are at risk of developing type 2 diabetes.

The South West London (SWL) Diabetes Quality Improvement (QI) Programme offers GP practices help to make improvements to their diabetes care, by providing practices with practical support from a facilitator with a clinical background, to review their approach to diabetes care, and create an action plan for quality improvement.

Did you know?

  • The average practice spends £1m on patients with diabetes every five years

  • A fifth of type 2 diabetes patients can account for almost half of all practice type 2 diabetes patient consults

  • On average only 35 per cent of diabetes patients in SWL achieve the three NICE recommended treatment targets (HbA1c, cholesterol and blood pressure)

This will be supplemented by a series of webinars to refresh clinical knowledge around diabetes and update on local guidelines and referral pathways. The webinars will also share examples of excellent practice from south London and beyond.

This programme builds on work that has been developed with the involvement of healthcare professionals across South West London, and tested locally at a small number of practices. Recognising the interconnected nature of cardiometabolic disease the ambition is to scale this as a multiple long term conditions approach in future years, and within the programme this year we will also provide access to learning and tools which are applicable to support all people living with cardiometabolic health conditions.

We are in the process of applying for CPD accreditation for this programme.

“We are delighted to be working with South West London to help them scale and spread the great work they've been doing in diabetes care through this new Quality Improvement Programme. This initiative will call on local clinical experts and facilitators to help practices improve care for the population and access the latest innovations in the area."Oliver Brady, Programme Director for Long Term Conditions and Mental Health

Benefits to practice:

  • Efficiency – a reduction in the cost of diabetes care through improved processes
  • Refreshed clinical knowledge and improved staff experience of care
  • Support achieving financial incentives, eg QOF targets for diabetes
  • Exploration of new models of care

Benefits to the diabetes population:

  • Patient satisfaction through streamlined processes
  • Better health and quality of life outcomes for people with diabetes and other long-term conditions
  • Increased engagement of patients with their healthcare

Requirements

  • Applications for this programme have now closed.
  • The programme is open to all SWL GP practices. There are 40 places available which will be allocated on a first come, first served basis.
  • There is no cost but participating practices are asked to commit to:
    • attendance at learning events and webinars
    • formation and meeting of a practice ‘diabetes working group’ (DWG)
    • meeting with your improvement facilitator
    • practice senior support and sign-off

Details

  • The programme starts on 21 June
  • The programme consists of:
    • five learning events and webinars;
    • practical support for your practice from improvement facilitators;
    • six optional clinical webinars
See the full schedule here
Applications for this programme have now closed.

Questions?

Get in touch for more information about our Diabetes Team and their projects.

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Community-led health clinics – mass screenings across south London

Published and last updated by Simon Ellery

This video provides an update on a 2019 Innovation Awards grant funded project to host community-led health clinics.

Called ‘Stroke Busting Health Checks’, the project aimed to provide various health checks for up to 1,000 people at greatest risk of stroke and other conditions in Wandsworth.

This co-produced, community-led scheme saw the NHS partner closely with faith and community groups, led by Wandsworth Community Empowerment Network, to use mobile ECG devices to test people for irregular heart rhythms (a warning sign for stroke) and offer wider health advice.

The health checks included Atrial Fibrillation (AF) checks using innovative mobile ECG devices, diabetes testing, blood pressure, cholesterol, and body mass index.

It also provided an opportunity to talk about the risk of smoking, including the direct link to stroke.

Hard to reach groups have greater health inequalities and poorer health outcomes, with Black, Asian and minority ethnic communities at substantially higher risk of poor health and early death, including due to stroke.

Traditional NHS approaches aren’t working well enough – these communities are less likely to attend NHS health checks, despite being the most at risk. Therefore, this team worked in an innovative new way to go to these communities and work alongside local leaders to engage people.

It is widely recognised that hard to reach groups have greater health inequalities and poorer health outcomes, with Black, Asian and minority ethnic communities at substantially higher risk of poor health and early death, including due to stroke.

Get in touch with the project team

Contact the NHS South West London CCG project team directly here.

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Find out more about HIN Innovaton Grants

See the webpage on the link below.

See the webpage here

Scaling up diabetes services in south London through partnerships, innovation and supporting choice

Published and last updated by Simon Ellery
Headshot of Neel Basudev
 

The story of how south London transformed diabetes care for up to 300,000 people is one of care moving from niche to mainstream. The HIN’s Diabetes theme Clinical Director Dr Neel Basudev charts successes across 12 boroughs.

Here is a letter I recently received in the post.

I want to change and transform the care for a disease across a vast geography. I have about 180,000 people that I need to improve things for and probably a further 275,000 who are at risk of this disease. I need to get things moving from an almost non-existent baseline across the entirety of south London. I need to improve lots of things like outcomes, pathways and patient experience. I have tried calling the A-Team but they were engaged, who can I contact to make this happen and has this ever been done before? Help!

Okay, so I made the letter bit up, but if you want to know how this can be done, then I may be able to help. I am always singing the praises of the diabetes workstream at the NHS’s Health Innovation Network (HIN). Apart from the obvious bias of being Clinical Director, I think that the story of diabetes transformation is one that needs to be told. I was lucky enough to get the chance recently at our flagship conference – Diabetes UK Professional Conference.

Scaling up services for the whole of south London

My role here began in 2016. There was already good work happening at the HIN, but it never got the traction it deserved across the vast geography of south London. I was lucky that my starting coincided with regional and national transformation work and funding. The HIN acted as a glue for south London and helped with much of the bid writing, coordination and then onward management. We soon moved on from niche to mainstream.

The kick-start to a lot of this was type 2 diabetes prevention which brought together south east and south west London colleagues in a unified way. We started from the non-existent baseline I have already mentioned in my fictitious letter. That was the partnership, networking and contacts ticked off. We built a strong base of relationships and people got a sense of what we could do and what we could bring to the table.

It was a no brainer when national funding trickled its way into south London that the HIN would help transformation work and build on this impressive start. The next big thing was structured education. This required a complete revamp: a new system, new referrals, a referral hub, make things easy, better data gathering and flow. It was a big ask, but we did it and launched in October 2018 with Diabetes Book and Learn.

Choice in the NHS is a rare commodity

Geographical boundaries were broken and people were accessing support by exerting choice. Choice can be a rare commodity in the NHS. We don’t like choice. What if people choose the wrong thing? That’s like me saying to the kids “listen to me, I’m your dad” – so instructional rather than offering advice and choice. It turns out that people with diabetes like choice and choice helped them get more support for their diabetes.

Building on that, we then moved a bit more into innovation with our NHS Test Bed project called You and Type 2. This married up several different innovators and their offerings to plug a vast care and support planning hole in diabetes care. It has been going strong since 2018 with six boroughs involved, hundreds of health care professionals trained and thousands of care plans done. There is much more that we can do with it and as you can hopefully see, we are not ones to rest on our laurels. We are looking into better integration across primary and secondary care and remote monitoring.

I am really proud of everything the HIN has helped to do for diabetes care in south London and equally excited about the future. For those of you old enough to remember…the future is bright, the future is green. Or is that lime green? With a bit of blue and purple. Watch this space.

HIN Diabetes theme

See a full list of our projects.

Click here to see our Diabetes theme webpage.

Get in touch to find out more.

Contact our Diabetes theme for more info on any of our projects.

E-mail us here.

Two HIN-supported projects announced as HSJ Value Awards finalists

Published and last updated by Rita Mogaiji

This week the shortlist for the HSJ Value Awards was announced with two HIN-supported projects included.

The nominated projects were:

‘Diabetes Care Initiative of the Year‘ for Diabetes Decathlon, run by South West London Health and Care Partnership, which is another HIN Innovation Grants funded project. The Diabetes Prevention Decathlon is a ten-week structured education prevention programme. Decathletes attend weekly and within their teams collaborate to discover how to best reduce the risks through theory sessions, games, discussion and a weekly 45-minute physical activity session including a variety of sports.

‘IT & Digital Innovation Award’ for OneLondon, a HIN-backed collaborative partnership to transform health and care services through joining-up information to support fast, safe and effective care.

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TfL and London Ambulance Service trial workplace diabetes education to improve staff health

Published and last updated by Simon Ellery
Image of map of London with diabetes cases

Two major London employers embedded clinically-proven Structured Education for Type 1 diabetes to tackle one of London’s biggest health challenges.

The stats

671K Londoners live with diabetes and employers in the capital lose an average £250K due to ill health each year.

An initiative with two major London employers has shown that face to face and virtual diabetes education can be successfully embedded into the workplace to improve the health of staff with Type 2 diabetes.

This comes as the NHS faces increased pressure due to the condition with over 671,000 Londoners living with diabetes and employers in the capital losing an average £250,000 due to ill health each year.

An evaluation of a project by the NHS’s Health Innovation Network with the London Ambulance Service and Transport for London (TfL) has found significant behaviour change in staff toward healthier lifestyle and eating.

Over 60 staff members from the employers attended either online or face to face structured education courses, which is recommended as a vital part of care for people with Type 2 diabetes by the NHS’s clinical standards guardian National Institute for Health and Care Excellence (NICE).

Structured Education (SE) is clinically proven to help people living with diabetes to make changes to their diet and lifestyle that help them to self-manage their condition. It also offers peer support after being diagnosed with the life-changing condition.

Staff were offered a choice to attend a course delivered remotely either by Second Nature or Oviva, which both offer programmes for people with Type 2 diabetes ranging between eight and 12 weeks. Course sessions were delivered through a trained coach with access to online advice, support and information which participants could access through their phones, tablet or computer.

An in-house session to improve self-management was delivered by trained diabetes education experts from Kingston Hospital NHS Foundation Trust. They delivered face-to-face group education using the DESMOND Type 2 Management Module, used widely across the NHS, for up to 14 people in a one-day session and a variety of resource materials were provided to participants at the session.

Twenty five staff members completed the Oviva programme and clocked up an average weight loss after eight weeks of 2.3kg, with evidence showing that participant weight loss continues up to 12 months after the programme.
For the 37 staff who completed the Second Nature programme, the average weight loss after three months was 5.7kg.

Staff taking part in this evaluation overwhelmingly welcomed the offer, and to attend, SE courses at their workplace. There was also very high approval of the three programmes from participants. Those completing either the in-house DESMOND programme or one of the remote programmes said their diabetes education needs had been met.

TfL staff who made use of the programmes said: “I think it’s a good thing that TfL are actively promoting this sort of thing. It’s a positive thing in terms of awareness around health and the impact of different health conditions. It’s good that workplaces are doing more to make people aware [of people with different health needs].”
“It’s a powerful message to send to the employee: we’re not just interested in your productivity, but also your health and how to look after yourself.”

TfL was due to start another round of the programme in September 2020 but brought it forward to May. TfL’s Health and Wellbeing Improvement Programme Manager Fernanda Siusta said:
“It was great to be involved in this work which has had such a positive effect on so many participants’ lives. While the pandemic led us to bringing the work forward, we know that for some this has been key to ensuring they stay on track if they had to shield or if they were unable to see their usual medical teams while the NHS handled the response to coronavirus.”

Head of Healthy Workforce at London Ambulance Service Gill Heuchan said:

“As someone with type 2 diabetes I know how difficult it can be when you are first diagnosed and have to attend diabetes education courses. We started the initiative at London Ambulance Service because we are very aware that we have staff whose lives do not fit the norm. Call handlers, medics and support staff are often working busy 12-hour shifts and during unsociable hours, so they can find it even harder to attend courses on learning how to manage their diabetes.

“It has been a fantastic opportunity for staff to have flexible support, not just about diabetes, but about lifestyle choices and general health on a tablet device, which they can utilise easily to fit their lifestyle. Staff who have signed up have fed back positively and many have been able to achieve personal goals because of the support they have received. This initiative has also helped form part of our ‘Wellbeing at Work’ support package for staff which aims to help them manage their own health and wellbeing in and outside of work.”

“We started the initiative at London Ambulance Service because we are very aware that we have staff whose lives do not fit the norm. Call handlers, medics and support staff are often working busy 12-hour shifts and during unsociable hours, so they can find it even harder to attend courses on learning how to manage their diabetes ”Head of Healthy Workforce at London Ambulance Service Gill Heuchan

Health Innovation Network Diabetes Programme Manager Rod Watson said:

”Diabetes is one of our biggest health challenges. Not only is it a leading cause of premature mortality with over 22,000 additional deaths each year, but it doubles an individual’s risk of cardiovascular disease and costs over £10 billion every year to manage.

“The HIN has successfully sped up the spread and adoption of a range of evidence-based programmes both face to face and digital to help prevent and treat the condition.
“We spend a third of our time at work so it makes sense for us to work with employers to help embed programmes directly into the workplace. This project shows that this is possible and I would urge all employers to read through our findings.”

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Self care is vital to help tackle the country’s biggest health challenge

Published and last updated by Faye Edwards
Think-Diabetes

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Diabetes is one of the country’s biggest health challenges with more than 3.1 million people diagnosed with Type 1 and Type 2 diabetes in England. It’s a condition that can ruin lives and cause deadly complications but as Faye Edwards argues, it’s never been easier to access support to self-care.

Not only is diabetes a leading cause of premature mortality with over 22,000 additional deaths each year, but it also doubles an individual’s risk of cardiovascular disease. The cost of diabetes to the NHS budget exceeds £10 billion every year and this is expected to grow dramatically over the next 20 years. Recent research has shown that people with diabetes are at a higher risk of complications should they contract Covid-19.

But as we celebrate National Self Care Week, the good news for people with diabetes is that it has never been easier to stay in control of their diabetes and prevent life changing complications. The key to this is supportive, holistic diabetes education.

Learning how to lead a healthy lifestyle through diet and exercise, manage medications, maintain good mental wellbeing and how to prevent long term complications is fundamental to ensuring that people feel confident in managing day to day life with diabetes, and to ensure improvements in terms of weight loss, glycaemic control, and general wellbeing.

An innovative new service from the NHS in south London, Diabetes Book & Learn, allows people with diabetes access to education support courses at the click of a mouse. If you have diabetes you can refer yourself to the service via the website, or you can ask your GP or practice nurse to refer you. The Diabetes Book and Learn Website has a wide range of courses available to suit all needs, including a variety of language preferences and delivery modes including face to face or via a mobile app. Once referred, you can choose the most suitable option for you, or if you are unsure, our call centre team are on hand to help you decide.

Since the start of the Covid-19 pandemic it has been crucial to ensure that the service continues to provide high quality support and education for people with diabetes. We have all had to adjust to receiving healthcare via digital means, whether that is online or over the phone. The Diabetes Book and Learn service has been agile in its response to the situation, moving face to face courses online and delivering them via video conference, and increasing the access to 1:1 diabetes education support delivered via telephone and mobile application.

The Diabetes Book and Learn service is the first of its kind, uniting diabetes education providers from across our region to offer a wide range of educational support options for people with diabetes, that would be impossible for one single organisation to achieve alone.

Now more than ever it is vital that all of us strive to live as healthily as possible, especially if we have a long-term condition such as diabetes. Receiving such a diagnosis in the current pandemic can be frightening and isolating – likewise, living with diabetes can feel physically and mentally exhausting. Education and support are key to providing a fresh perspective and confidence to people for whom living with diabetes is tough. It can help with weight loss and mental wellbeing, provide much needed peer support, reassurance, and guidance.

The key to better health and diabetes control starts with education and good self-care – and all of this is available at the click of a mouse.

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Explore our Diabetes projects to learn more about how we support self-management to minimise the impact of diabetes on the lives of people with the condition.

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Self-management could help ease the high demand on GPs

Published and last updated by Rita Mogaiji

Self-management could help ease the high demand on GPs

To help ease the high demand on GPs across south London, self-management is a priority in the NHS 10-Year Plan and focuses on key areas like diabetes prevention and management, cardiovascular, asthma and respiratory conditions, maternity and parenting support and online therapies for common mental health conditions.

Individuals need support to build the skills and confidence necessary for effective self-management of longstanding conditions, and health professionals need to be aware of and trained on the available supportive tools, taking account of any inequalities and accessibility barriers their patients may face.

Research presented by Self Management UK[1] shows that, on average, people living with a heath condition spend just three hours per year with their healthcare team—the rest of their time is spent self-managing these conditions. NHS organisations need to work closely with local authorities and other partners to provide the support and guidance to help south Londoners self-manage properly.

There are many interventions available to help support the self-management of common conditions, some of which are:

  • education for specific health conditions;
  • peer-led courses;
  • online self-management tools;
  • telephone support and telehealth; and
  • self-monitoring of medication and symptoms using digital technology.

How can innovation help? 

You can help respond to our local needs by addressing the following challenge statements:

  1. How might we maximise digital solutions to support self-management of health risks and chronic conditions?
  2. How can digital solutions emphasise patient responsibility and, acting in conjunction with the provider community, move beyond education, enabling individuals to actively identify challenges and solve problems associated with their illness?
  3. What are the barriers to public awareness and successful patient uptake of these self-management solutions?

We’d love to collaborate with you on these challenges. Please get in touch with Karla Richards karla.richards@nhs.net if you have a digital solution for health and care self-management, including for long-term conditions, mental health, heart disease, COPD etc.

Contact Karla

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New tech: Diabetes Book and Learn launch self-referral

Published and last updated by Rahel Gerezgiher

Technology-led service gives thousands of south Londoners quicker access to free NHS diabetes education

Today, World Diabetes Day, the NHS in south London is launching a new service for people living with Type 2 diabetes to make it easier than ever to access vital support. An innovative new service from the NHS, Diabetes Book & Learn, will now allow people to self-refer for diabetes support courses rather than go through their GP. These courses will help them manage their condition better and significantly decrease their risk of serious complications (such as blindness and amputations). The service also increases choice for south Londoners, who will be able to access expert support through face-to-face courses or online programmes and book themselves onto their choice of course via the website or by phone.

There are over 165,000 people living with diabetes in South London (QOF 18-19).

Dr Jonty Heaversedge, NHS England, London’s Medical Director for Primary Care and Digital Transformation, said: “It’s great to see south London’s NHS, GPs, hospitals and innovators working together to bring access to practical healthcare into people’s lives using everyday technology. Diabetes Book & Learn is enabling people to not only live better, healthier lives but to stay ahead of their condition and reduce their risk of serious health complications. It couldn’t be easier to learn about how to manage your diabetes if you live in south London thanks to this service.”

Dr Neel Basudev, local south London GP and Diabetes Clinical Director of the Health Innovation Network, said: “We know lots of people who are living with Type 2 diabetes across south London either weren’t offered a place on a course when they were originally diagnosed, or for many reasons, couldn’t attend one of the limited courses that were available locally.

“We expect easy booking and online services in all other areas of our lives: we order food, arrange our home insurance, do our banking, you name it, through our smartphone. In south London, we are leading the way in making sure that people can access vital support for their diabetes just as easily – it’s just a few clicks or a phone call away.

“We have opened up support for people with Type 2 diabetes. Now you can book yourself onto any one of the courses available across all 12 south London boroughs or online. I’d encourage anyone living with Type 2 diabetes to book onto a course today and find out how to better manage their diabetes and avoid serious complications.”

Roz Rosenblatt, Head of London Region at Diabetes UK, said: “Thousands of people in the south London community can book on to a course which offers significant benefits. All it takes is a few clicks on the Book & Learn website or by phone and anyone living with Type 2 diabetes in this area can join a course that will improve their knowledge and confidence, plus help them take control of their diabetes and live well for longer.”

The aim of these specifically designed courses is for people living with Type 2 diabetes to improve their knowledge, skills and confidence, enabling them to take increasing control of their condition and integrate effective self-management into their daily lives. These courses help people to take control of their diabetes through learning more about their condition and they also provide valuable peer support.

The courses have been clinically proven to have a positive impact on individuals including:

  • Lowering average blood glucose levels, thereby reducing the risk of complications
  • Reducing cholesterol and blood pressure levels
  • Improving levels of physical activity
  • Improving understanding of diabetes and self-management skills
  • Weight reduction.

Despite these benefits, attendance across south London is low. The National Diabetes Audit data shows in 2017-18, 77.3 percent of people diagnosed with Type 2 diabetes were offered a place on a structured education course, but only 9.4 percent of those people attended.  There are many reasons for this major gap between those eligible and offered a place and those attendance including; limited choice in location and timing of courses being offered. Allowing people to self-refer via Diabetes Book & Learn means that people can book onto a course when and where suits them, including an option to complete a course entirely online.

Read more about this vital service at www.diabetesbooking.co.uk/about  and for more information please contact hin.southlondon@nhs.net.

 

Cutting-edge technology transforms diabetes care across south London

Published and last updated by Rahel Gerezgiher

Cutting-edge technology transforms diabetes care across south London

L-R: Tara Donelly, Chief Digital Officer, NHSX; Oliver Brady, Head of Diabetes Transformation, South West London Health and Care Partnership; Karen Broughton, Director of Strategy and Transformation, South West London Health and Care Partnership; Vicky Parker, Programme Lead, London Diabetes Clinical Network and Ben McGough, Workstream Lead – Digital, NHS Diabetes Programme.

South London clinicians and partner organisations gathered together at Guy’s Hospital last night (30 October) to launch a brand-new diabetes service called You & Type 2.

After receiving over £500,000 funding from the NHS Test Bed programme, the You & Type 2 service is now being piloted across south London. The service combines innovative technology, improved access to services and a personalised approach.

The ambition of the project is help people living with Type 2 diabetes to have happier and healthier lives by enabling them to have more control over their care.

Designed to provide a range of further education, support and resources, You & Type 2 enables patients to work with their healthcare provider to produce a unique care plan. Part of the service is an app that will allow patients to access and update their care plan when it suits them and receive personalised videos containing recent test results, which will prepare them for informed discussions with clinicians.

Healthcare professionals using the service can update the app in real time, offering tailored support to patients. This means they are equipped to deliver the best patient-centred care, with the support of innovative technology that is linked to personal health data and individual goals.

Thirty-five GP surgeries across south London are now piloting the service, which is expected to be rolled out more widely in 2020. Clinicians who are already using the service have reported improved knowledge and skills, alongside greater job satisfaction and increased levels of team work. So far, over 1000 patients have already created their own care plans, working closely with their healthcare professionals to make something personal and meaningful to them.

A group shot of the partners involved in the You & Type 2 service

Speaking from the service launch event last night at Guys Hospital, local GP Dr Neel Basudev, Clinical Lead for You & Type 2, said: “This is such an exciting and different way to treat people living with type 2 diabetes. We know that being diagnosed and living with a long-term condition can feel overwhelming, but by using innovative technologies and working collaboratively with patients, this service helps them to overcome difficulties and improve their overall health and happiness.

“This is an exciting opportunity and I can’t wait to see how this develops and the impact it has on people’s lives, not only in my practice, but in practices across south London.”

Victoria Parker, Programme Lead for London Diabetes Clinical Network, NHS England, said: “This is such an innovative digital service and I’m happy to be here for the launch. The NHS long term plan speaks of personalisation and patient centred care.

“This service captures the essence of the long-term plan but also pushes it to a new level, offering better care and support for those with Type 2 diabetes as well as creating a model of care for any long term condition. I am excited to see where this project goes next and for the opportunities it presents for spread and adoption across London.”

For more information on the programme visit youandtype2.org

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Making it easier for employees with Type 2 diabetes to access diabetes education courses at work

Published and last updated by Rahel Gerezgiher
People in the workplace

Making it easier for employees with Type 2 diabetes to access diabetes education courses at work

In the second phase of the ‘Think Diabetes’ project, we have partnered with two London-based employers to promote diabetes structured education for employees diagnosed with Type 2 diabetes. Written by Don Shenker, Diabetes Senior Project Manager

Our Think Diabetes Summit held on 14 June encouraged employers to promote diabetes structured education to their workforce to support employees living with diabetes to be better informed about how to manage their condition. Our Think Diabetes report noted that less than 10% of individuals diagnosed with Type 2 diabetes who are offered structured education from their GP actually go onto access the course. One of the reasons may well be a reluctance from employees to take time off work – or not having the flexibility to fit in education around work hours.

We have recently teamed up with Transport for London (TfL) and the London Ambulance Service (LAS) to pilot access to both remote/online courses and face-to-face on-site courses for employees diagnosed with Type 2 diabetes. This means any employee living with diabetes will be able to complete a course either remotely or during work time, without having to take time off. The courses will be promoted via LAS and TfL’s internal wellbeing newsletters and are being funded through the NHS Diabetes Transformation Fund.

There is good evidence that attending a structured diabetes course improves health and reduces complications by focusing on understanding diabetes, improving diet and stressing the importance of a healthy lifestyle. The pilot courses will be delivered by NHS approved providers OurPath, Oviva and Kingston NHS Foundation Trust.

In order to evaluate the pilot, we will be conducting a survey and focus group for course attendees and tracking anonymised BMI and weight data. It is hoped that around 100 employees will access a course either remotely or on-site. Key questions will focus on whether this approach via the workplace made it any easier to attend a course and what further steps employers could take to promote education for employees living with diabetes. We will also evaluate the level of demand for the courses and which category of workers have attended or asked for a course.

The pilot went live on 1 October and results will be available in March 2020.

For further information, contact Don Shenker, Diabetes Project Manager (don.shenker@nsh.net)

 

Diabetes prevention decathlon

Published and last updated by Rita Mogaiji

Diabetes prevention decathlon

Diabetes Decathlon at-a-glance

Diabetes Prevention Decathlon to increase choice and prevent diabetes

A new Diabetes Prevention Decathlon programme will be funded by the HIN Innovation Grants. This project will pilot a new type of diabetes prevention programme over 10 weeks that offers patients more choice and encourages them to work together as a team, by introducing different types of physical activity while learning key information that can help prevent the onset of Type 2 Diabetes.

There are currently five million people in England at high risk of developing Type 2 diabetes, which is largely preventable through lifestyle changes. If current trends persist, one in three people will be obese by 2034 and one in 10 will develop Type 2 diabetes. About 10 per cent of the entire NHS budget is spent treating complications from diabetes. Reducing this would have a major impact both on people’s well-being and on resources.

The new pilot programme will include all of the diabetes education and self-management aspects included in a typical programme but will be marketed as a combined education and fitness programme for diabetes prevention. It will be designed to offer choice to patients who can only currently access the NDPP.

The Diabetes Prevention Decathlon will:

• allow participants to try a different sport each week, and with their teams achieve goals based on activity levels and weight loss and participate in organised team activities at the end of every session;
• hold sessions in sports centres, overseen by qualified coaches;
• pilot the benefits of gamifying weight loss, while incorporating key messaging about diabetes prevention, psychological support, and healthy cooking advice;
• provide every applicant with a basic activity tracker, to encourage them to continue to remain active between sessions, and reward those who meet their goals with points for their team;
• integrate with mental health support from a psychologist;
• be considerably shorter in length than the national diabetes prevention programme: 10 weeks compared to nine months.

The diabetes prevention space is well represented by the National Diabetes Prevention Programme, which is the largest of its kind in the world and includes both digital and face-to-face providers. While it’s a proven programme, the dominance of a centrally funded programme has led to a lack of choice as CCGs/Public Health teams are under no pressure to seek alternative local solutions. This new programme seeks to offer more choice and test new ways of combining curriculums and activities for patients in south London.

All diabetes prevention programmes, both digital and face-to-face, need to align to the same NICE guidance and provide broadly the same advice, and this programme will be no different in that respect. The course will be designed by expert diabetes clinicians and will align to NICE guidance to ensure it provides the best possible health advice to people at risk of diabetes. The programme will also be designed with input from local people in Merton.
Its key innovation is to pair the usual behaviour change advice with a truly engaging physical activity programme, psychological support, and live cookery classes to provide a more holistic experience in the one programme.

The funding will help the team co-design and deliver this course.

Find out more about our work in diabetes

Innovator Spotlight

Chris Gumble, Project Manager, South West London Health and Care Partnership, said:

“Often, Type 2 diabetes can be prevented and we’re passionate about helping to do that in south London. At the moment we’re asking everyone to take up a one-size-fits-all prevention programme, rather than offering a range of options. The Decathlon will add something new and exciting, combining physical activity with diabetes prevention over a fun, interactive 10-week period.”

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Innovation to reduce diabetic foot amputations in south London

Published and last updated by Rahel Gerezgiher

Innovation to reduce diabetic foot amputations in south London

Every day 23 people in England have a toe, foot or leg amputation as a result of diabetes related complications, according to NHS England. Through faster diagnosis and treatment this shocking intervention can be reduced.

In south London specialist new diabetic foot clinics known as Multi-Disciplinary Foot Teams (MDFTs) have been set up to deliver faster, local treatment to help reduce the number of people facing amputations.  Located in Queen Mary’s Hospital in Sidcup; Queen Elizabeth Hospital in Woolwich and Princess Royal University Hospital in Bromley, these services are providing urgent specialist care (within 24 hours) to people who have active foot disease. Research shows that if left untreated for long, diabetic foot infections can lead to further complications and in increasing number, amputations, which could be avoided. “Time is tissue’ when it comes to this disease.

The new clinics are being supported by consultant diabetologists, vascular surgeons and specialist podiatrists from Kings College Hospital, Guy’s and St Thomas’s and Lewisham and Greenwich NHS Trust, in order to improve the care that patients receive and bring it closer to their home. This also supports the existing community podiatry teams that can develop relationships with their local MDFT to streamline plans and treatment.

This innovative approach recognises it is not just podiatrists who come into contact with diabetic foot problems. It’s vital that other primary care clinicians can diagnose the condition and refer individuals to specialist treatment quickly.

The new MDFT clinics are for active foot disease only– including:

  • Any foot Ulceration
  • Acute Charcot foot (hot/swollen/painful foot)
  • Necrosis
  • Any foot Infection.

To refer, please use eRS for Diabetic Medicine (Speciality), Podiatry and Foot (Clinic Type) and Urgent (Priority) to see the spoke MDFT clinics at QEW, PRUH and QMS.  You can see the Directory of Services here, a video about the new clinics here and learn how to conduct a foot screening in primary care here.

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Further information

To learn more about Allied Health Professional programmes in this area, visit the NHS England website.

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We're here to help

If you have any questions or would like more information, please contact Don Shenker, Diabetes Project Manager.

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ITV’s Dr Zoe Williams Joins Alison Barnes for VLCD Event

Published and last updated by Rahel Gerezgiher

ITV’s Dr Zoe Williams Joins Alison Barnes for VLCD Event

Last week the Health Innovation Network’s diabetes team hosted an event at St Thomas’s Hospital to speak to dieticians, GPs and other clinical professionals about the role of Very Low-Calorie Diets (VLCD) in putting Type 2 Diabetes in remission. 

The event brought together experts including; Dr Zoe Williams resident GP on ITV’s ‘This Morning’, Alison Barnes Research Dietitian for the Diabetes Remission Clinical Trial (DIRECT) as well as Alastair Duncan, Principal Dietitian at Guy’s and St Thomas’ hospital. We heard some impactful stories from patients who trailed the diet. Some spoke candidly on the positive difference it has had made to their quality of life, as well as the difficulties they faced, especially during specific times of the year. 

Social and cultural events involving food were one of the difficulties discussed. Eid, Christmas and weddings were all flagged as being possible obstacles on these diets. Results showed that patients felt a sense of anxiety when it came to returning to their normal diets. Dr Rabbani, MD at Sutton GP Service Ltd also flagged that lifestyle changes can be incredibly hard, so simply changing your eating habits after a substantial time will not happen overnight. 

The event gave rise to the complexities many people have in their relationship with food. Although positive results were seen for the individuals who used VLCD diets speaking at the event, the message was clear that it is important to take into account the many barriers that exist for others.  

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Further information

To learn more about Allied Health Professional programmes in this area, visit the NHS England website.

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If you have any questions or would like more information about Very Low Calories diets, please contact us.

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Think Diabetes Report calls on London employers to better support staff living with diabetes

Published and last updated by Rita Mogaiji

Think Diabetes Report calls on London employers to better support staff living with diabetes

London employers are being urged to ‘Think Diabetes’ in the workplace in a new report published by the Health Innovation Network. Figures in the report show a major gap in the number of with people living with Type 1 and Type 2 diabetes attending free educational programmes to help them learn about their condition and live healthier lives.

There were more than 3.1 million people  diagnosed with Type 1 and Type 2 diabetes  in England in 2017-18 and it is estimated that in London over 671,000 people of working age (over the age of 16) have  either Type 1 or Type 2  diabetes. But the Think Diabetes Report shows less than 8 percent of eligible Londoners living with Type 2 diabetes are attending these courses (this figure is less than 9 percent of eligible people across England).

Reasons for people not attending these courses are varied, but previous reports have cited ‘time off work’ as one of the key issues.  Given the potential for employers to support staff with health, the Think Diabetes report makes a series of recommendations on how employers can help support their staff to take advantage of the education opportunities available to them, or even provide education for staff themselves.

To celebrate the launch of the report, we partnered with Diabetes  UK  to deliver the Think Diabetes Summit. The event brought employers, diabetes experts and patients together, to discuss ways in which organisations can support their staff including; running education sessions in the workplace, sharing new digital approaches to education with their teams so staff can complete these courses online and by making sure staff are supported to take time off work for education to help them live with a long-term health condition.

Diabetes is covered by the Equality Act 2010 as a long-term condition that has significant impact on individuals’  lives and employers are therefore obliged to make reasonable adjustments, although these adjustments are not defined. The case for employers adjusting their policies and supporting individuals to attend structured education is overwhelming.

The event was chaired by Dr Neel  Basudev, Diabetes Clinical Director of the Health Innovation Network and GP in Lambeth, who said:

“Employers have huge influence over the lives of the working population and a unique opportunity to help with what is arguably the greatest challenge facing our nation’s health: diabetes.

“There are more ways for people to access vital education about diabetes than ever before, with many parts of the NHS innovating with digital courses and new approaches to offer support. We now need to raise awareness of what’s on offer and remove as many barriers as we can. Workplace barriers are some of the simplest to address and changes can be made to support staff that will increase the health and productivity of the workplace.”

As well as hearing from diabetes experts and representatives from the organisations who were case studies in the report, Deputy Leader of the Labour Party and Shadow Culture Minister Tom Watson MP shared how he self-managed his own type 2 diabetes into remission. A passionate advocate for helping people learn to self-manage, he said: 

“By changing my diet and lifestyle I’ve put my Type 2 diabetes into remission. I feel fitter, faster, and healthier than ever before and this has given me a new mission to help others get healthy.

“Supporting people who live with diabetes is a major challenge facing our society, and one in which we all have a part to play. Employers in particular can play a key role in supporting people in their journey to learn more about their condition, and how best to manage it.

“It is time employers think differently about diabetes in the workplace and the Think Diabetes Summit is bringing together key leaders from across businesses and organisations to do just that.”

The Think Diabetes Summit was attended by organisations that collectively employ thousands of Londoners. TechUK attended the event and their CEO Julian David said: “techUK represents the companies and technologies that are defining today the world that we will live in tomorrow. I feel passionately that our members should also be leaders in supporting and developing the workforce for the future.  Diabetes is an increasing problem in our society and employers should be engaging with innovative ways to help support staff living with Type 1 and Type 2 diabetes to better manage their condition.”

Download the Think Diabetes Report and Toolkit here.

Think Diabetes for World Diabetes Day

Published and last updated by Simon Ellery

Think Diabetes for Diabetes Day

HR managers are working in partnership to revolutionize the workplace in a move which could improve employees’ health, save money for the NHS and boost productivity, argues Health Innovation Network Senior Project Manager Linda Briant (pictured below) who is driving forward Think Diabetes.

Employees with a diagnosis of both Type 1 and Type 2 diabetes (and carers of people with diabetes) will be supported and encouraged to take time off work to learn about their diabetes. The insight and knowledge gained at these Structured Education sessions will empower individuals to self-manage their condition and improve their long-term health outcomes.

How big a problem is diabetes?
Diabetes costs the NHS more than £10 billion per year and this constitutes roughly 10 per cent of the entire budget. We know that Structured Education is part of the solution. People with diabetes benefit from being able to self-manage their condition and make changes to diet and lifestyle. Structured Education helps them to do this and is clinically proven. It also provides much needed peer support after being diagnosed with a life changing condition. What’s more, it is recommended as a basic and crucial part of care for an individual with diabetes by the National Institute for Health and Care Excellence (NICE), the NHS’s guidance on clinical standards.

Despite this, uptake rates of diabetes education are low and one of the reasons commonly cited is that it is difficult to take time off work. Diabetes is covered by the Equality Act 2010 as a long term condition that has significant impact on individuals’ lives. Employers are therefore obliged to make reasonable adjustments, although these adjustments are not defined. The case for employers adjusting their policies and supporting individuals to attend structured education is overwhelming.

What must change?
The working population in Britain spends roughly a third of their life at work. Yet all too often, the role of employers in creating and maintaining healthy workplaces, or supporting their staff to be healthy, is overlooked.
The workplace is a great setting for reaching people with messages that promote and encourage healthy lifestyles and many businesses are already taking action by promoting healthy initiatives. The benefits to them are higher staff morale and lower rates of sickness absence.
Evidence shows that employers that invest in appropriate workplace health initiatives to support the health and wellbeing of their employees have the potential to see a significant return on investment (1) A review of academic studies shows that the return on investment for some workplace health initiatives can range from £2 for every £1 spent (1:2) to £34 for every £1 spent (1:34) (2).

How is the Health Innovation Network influencing change?
Human resource (HR) professionals, alongside people living with diabetes have worked with the Health Innovation Network to develop and test strategies that could easily be adopted by organisations to support people living with diabetes attend structured education. These include:
1. HR policy and strategy changes to facilitate taking leave to attend courses
2. Structured education delivered in the workplace
3. Healthy lifestyles awareness-raising sessions at work with a focus on diabetes prevention

The learning from this feasibility study is being incorporated into a ‘how to’ guide, which provides examples of good practice, along with recommendations for undertaking this initiative in your workplace.

This guide will be published and available in January 2019.
How can you make change happen for your workforce?
• Sign up to receive a free copy of the ‘how to guide’ for supporting people living with diabetes in the workplace
• Implement the recommendations
• Tell us about the impact
• Grow the UK’s healthy workplace community
If you are an HR professional interested in receiving more information, contact me on linda.briant@nhs.net.
Citing the evidence

Evidence informs us that working age adults and younger people with diabetes are less likely to complete Structured Education, which can result in poor health outcomes.
The All Party Parliamentary Group for Diabetes’ report: Taking control: Supporting people to self-manage their diabetes (March 2015) highlighted that many structured education courses require substantial time off work during the week; and that this is a major disincentive to attendance as people often do not wish to use annual leave for this purpose.
A recommendation from the report states: “The clear benefits to people’s health of attending education courses mean that the Government should give people a legal right to time off work to attend education courses about their diabetes that their healthcare team believe are appropriate to their needs.” (3) NICE recommends that well-designed and well-implemented structured education programmes are likely to be cost-effective for people with diabetes and should be offered to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review.
References:
1 Healthy Work – Evidence into Action 2010 page 46
2 BUPA, Workplace Health – A Worthwhile Investment, 2010
3 Taking Control: Supporting people to self-manage their diabetes, page 20 – APPG Diabetes Report

It’s time to put digital diabetes tools in the real world, with south London leading the way

Published and last updated by Rahel Gerezgiher

It’s time to put digital diabetes tools in the real world, with south London leading the way

Laura Semple, Programme Director for Diabetes and Stroke Prevention, on person-centred care planning and digital in the real world.

When it comes to diabetes, we all know that the statistics are both enormous and increasing. In south London alone there are an estimated 230,000 people living with diabetes. Nationally, the NHS spends £14 billion a year treating people with diabetes. That’s an astonishing £1.5 million every hour. And, as many of us working in diabetes treatment and Type 2 diabetes prevention in south London know, the vast majority of this is not on preventative care that will reap future benefits. It is spent treating complications, many of which are preventable if people receive the right support during the early stages of the condition.

It’s against this backdrop that we set about working with our partners, led by the South West London Health and Care Partnership, earlier this year to bid to test a new model of support for people living with Type 2 diabetes. The full team includes South London NHS commissioners and clinicians, Healum, Citizen UK, Year of Care partnerships and Oviva. Just this week, we’ve found out that our innovative bid to co-design a new support system with patients, maximising the opportunities from digital to support behaviour change as we do, has been successful and will receive more than £500,000 of public funding over 18 months.

One option would have been to try and find a digital substitute for the current way of working, insert it into local care plans and call it self-management. But too often, substituting with digital tools ticks boxes without radically improving care, because the digital tool doesn’t work seamlessly within the wider system of care.

We believe digital health tools workbest when there is a partnership between the patient, their GP and where necessary a team of specialist clinicians or coaches supervising results, coaching and encouraging. When this mix is in place the results can be powerful – weight loss, healthy blood glucose levels, increased physical activity, improved self-care because people feel more empowered and self-confident. These are just some of our biggest goals. And of course all of these bring savings in the longer term to the NHS thanks to fewer complications.

For that reason, the new south London Test Bed focuses just as much on training and care planning with primary care professionals as it does on new digital solutions. Our intervention starts by working with the wonderful Year of Care Partnerships to train GP practices to use a truly collaborative approach to care and support planning with their patients. New, co-designed care plans will be available to patients via an app and accessible to professionals across all care settings.

At this point, when the training and planning has taken place, digital can shine. Following their appointment patients receive an innovative video that presents their personal health data in an intriguing animation, explaining their individual results and what these mean for them as an individual. Using the app, patients will then access a wide range of support and resources to help them reach their goals, including with the helping hand of a dietitian coach from Oviva.

This fully integrated approach, that works with EMIS, considers the needs of primary care professionals as well as the needs of patients, right from the off. It’s not using digital as a simple substitute but placing digital as part of a wider mix in real world clinical settings.

We hope that by testing this model we’ll break down existing barriers to ‘self-management’ and show the power of brilliantly supported self-management. At its core, our aim is simple – real, lasting improvements to the lives of people living with Type 2 diabetes in South London, so that they can live the lives they want to lead without their condition getting too much in the way.

Read more about the Test Bed programme here

More support and choice for south Londoners at risk of Type 2 diabetes

Published and last updated by Rahel Gerezgiher

More support and choice for south Londoners at risk of Type 2 diabetes

A new collaboration will mean more choice and expert support for south Londoners at risk of Type 2 diabetes. The Health Innovation Network, NHS England, Public Health England and Diabetes UK have confirmed a new contract with ICS Health & Wellbeing (ICS) to offer 4260 free places on Healthier You: the NHS Diabetes Prevention Programme across south London.

Healthier You is a nine-month behaviour change programme that helps local patients at risk of developing Type 2 diabetes to significantly reduce their chances of getting the disease. Local doctors and nurses refer people to be part of this course so that they can receive support to change their lifestyle in a friendly and supportive group environment. The behaviour change programme runs for nine months and consists of a mixture of 1:1 and group sessions delivered by specially trained Health and Wellbeing coaches, advising individuals on how to prevent diabetes by incorporating healthier eating, physical activity, problem solving, stress reduction and coping skills into their daily lives.

Across south London it is estimated that approximately 275,000 are at risk of developing Type 2 diabetes. Under the new contract, over 4000 people are expected to benefit and choice will be improved because they will be able to access courses in any part of London including evenings and weekends.

Neel Basudev, south London GP and Clinical Lead for south London Healthier You, said:

“I am delighted that ICS will be providing Healthier You in south London for local people who are at risk of developing type 2 diabetes.   This will be an opportunity to make positive, lifestyle changes and take more control of their health and ultimately help prevent them developing what is a potentially life threatening condition.” 

Operations Manager for ICS, Megan Baird, said:

“We are now the only provider across London – this means more patient choice and flexibility to attend services across multiple locations and timings to suit individual needs. We are extremely passionate about the delivery of our service to support those at risk of developing type 2 diabetes and look forward to implementing a successful programme across South London.”

ICS is the largest provider for the NHS National Diabetes Prevention Programme. With 19 delivery areas across the UK, ICS has a wealth of experience in delivering the nine month intervention effectively. Across the UK to date, ICS has received over 63,000 referrals, delivered over 30,000 face-to-face initial assessments and run over 1,200 courses. 95% our service users rate the service as Very Good or Good at 9 Months, 79% of service-users lose weight and 66% of service users accessing the service across London are from BAME groups.

Ten thousand people have already been referred to Healthier You under the previous provider, Reed Momenta.

Reducing diabetes is a priority for the NHS. It is estimated that the condition currently costs the NHS £8.8 billion every year. People wishing to be part of the programme should speak to their GP or Practice Nurse who can make a referral into the service if the person is eligible.