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

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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Think Diabetes for World Diabetes Day

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
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.
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