A collaborative in south London gave participating trusts the tools and techniques to streamline patient pathways and improve services for type 1 diabetes sufferers

With an expected 13 per cent increase by 2020 and an annual NHS bill of £10bn a year, it’s little wonder diabetes is rarely out of the news. However, in south London, the Type 1 diabetes community has seen a radical shake-up following the Health Innovation Network’s Diabetes Improvement Collaborative.

Type 1 diabetes usually presents in children and adults under the age of 30 and develops when the insulin-producing cells in the pancreas have been destroyed, making them totally reliant on insulin. It affects more than 370,000 adults in the UK.

Insulin pump therapy enables a person with Type 1 diabetes to gain better glycaemic control with fewer hypoglycaemic incidents, which reduces long term complications related to diabetes such as blindness, amputation and kidney disease.

The collaborative challenged us to focus on the service we were providing and identify what we could do to improve the take up of insulin pumps

The first clinical trial of insulin pump therapy took place at Guy’s Hospital back in 1978; however, far fewer UK adults use pumps than in comparable countries. In parts of Europe, insulin pump uptake is 15 per cent and in the US around 40 per cent.  

Here in the UK, approximately just 6 per cent of adults with Type 1 diabetes use an insulin pump, this is despite evidence cited by the National Institute for Health and Care Excellence that 15-20 per cent would benefit.

Streamlining pathways

The Health Innovation Network, which is the Academic Health Science Network for South London, undertook an audit of all the insulin pump services in south London to better understand the services being offered to people with Type 1 diabetes to explore the challenges they were facing.  

Dr Natasha Patel, joint clinical director (diabetes theme) at the Health Innovation Network, and consultant diabetologist at Guy’s and St Thomas’ Foundation Trust, who led on the collaborative, said, “Having spoken with clinicians at the 10 trusts across London and considered the issues and barriers to increasing pump uptake, we decided to bring the teams together in a collaborative.”

The Diabetes Improvement Collaborative workshops launched in November 2014 and brought together 10 secondary care diabetes teams including over 60 doctors, nurses, allied health professionals, managers, administrators and service users over a ten-month period.

We know that as patients are able to take greater control of their condition they become less anxious, and so an insulin pump becomes a very powerful tool for people with diabetes

The trusts which took part included Guy’s and St Thomas’ Foundation Trust, King’s College Hospital Foundation Trust, St George’s University Hospitals Foundation Trust, Epsom and St Helier University Hospitals Trust, Lewisham & Greenwich Trust, Croydon University Hospitals Trust, and Kingston Hospital Foundation Trust, and three North London trusts, the Royal Free Foundation Trust, Imperial College Healthcare Trust and Whittington Health.

Through workshops and tailored on-site support, the collaborative gave the trusts the service improvement tools and techniques to help them streamline patient pathways and improve services including staff training.  

It was important for pump users to have their voices heard and they worked alongside clinicians in designing improvements - their strong voice in the collaborative ensured a holistic approach to service changes brought about by the collaborative.

Progress and Sustainability

Dr Andrew Rodin is consultant endocrinologist at Epsom and St Helier Hospital Trust, which is a two-site trust with St Helier Hospital in Sutton and Epsom Hospital a few miles up the road in Epsom.

“Before the collaborative, St Helier saw a large number of patients but the insulin pump service was almost at a standstill,” he said.

Dr Rodin said the collaborative has helped “bring home” what needed to be done and the workshops formed the basis for a lot of work, such as updating the patient databases, developing a new nursing role and employing admin staff to free up clinical staff to do clinical work.

“The collaborative challenged us to focus on the service we were providing and identify what we could do to improve the take-up of insulin pumps. With concerted effort, we were able to organise our service quickly and remove some of the obstacles. That included recruiting for a specialist pump nurse and the support of a pump administrator – a new role that means we can organise the logistics of providing someone with a pump but freeing up time for our doctors and nurses.

It was important for pump users to have their voices heard and they worked alongside clinicians in designing improvements

“Our patients almost universally agree that insulin pumps improve their quality of life. We know that as patients are able to take greater control of their condition they become less anxious, and so an insulin pump becomes a very powerful tool for people with diabetes.

“We have seen a significant increase in the number of patients who use a pump, and expect to reach 18 per cent next year. We are really pleased with the progress so far, but know there is more we can do to ensure every patient who could benefit from, and is suitable for, a pump can have one. We have to make sure we are doing all we can to help people manage their condition – after all, diabetes doesn’t give you a day off.”

He added, “The ability to reflect on our own pathways and to get those aligned across the trust has been absolutely brilliant.”

Since June 2014 pump uptake in south London has increased by 31 per cent – meaning 370+ additional patients now access pump therapy.

Trusts participating in the collaborative have sustainable plans in place to continue this increase and reach at least 15 per cent of the Type 1 population by 2018.

 

What is insulin pump therapy?

Insulin pump therapy is a cost-effective intervention providing people with diabetes with a pump which is a small device, roughly the size of a pager, attached to tubing and a cannula. The pump supplies insulin instead of injections. When used appropriately, pumps provide significant improvements in clinical outcomes and reductions in long-term complications through far superior stability in blood sugar levels. Insulin pump therapy has NICE approval for use in Type 1 Diabetes.

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The Health Innovation Network is the Academic Health Science Network for the 12 boroughs of South London