Hartlepool and Stockton on Tees CCG DISN service – improving treatment and care for patients with diabetes

Dr Sony AnthonyNHS England invested £44 million of diabetes transformation funding to improve treatment and care for the 2.8 million adults and children diagnosed with Type 1 or Type 2 diabetes across England.

For Hartlepool and Stockton on Tees Clinical Commissioning Group (CCG), this funding has enabled the delivery of a dedicated Diabetes Inpatient Specialist Nurse (DISN) service provided by North Tees and Hartlepool NHS Foundation Trust.

Dr Sony Anthony, Consultant in Diabetes at Hartlepool and Stockton on Tees CCG, tells us about the new service: “It went live in July 2017 and was initially provided by existing Diabetes Specialist Nurses whilst recruitment for two DISNs took place.

“The service focussed on identifying those patients with diabetes who, following admission to hospital, would benefit from an intervention and suitable patients were then reviewed by a DISN within 24 hours. Various systems were cross-referenced to ensure that the maximum number of patients who would benefit from the service were reviewed.

“Initially this service was delivered Monday to Friday however by October 2018, following successful recruitment to the newly-formed DISN posts, the service is now being provided over six days.”

What are the benefits of implementing the new service?


Since the service was implemented, integration between the ‘in-hospital’ and ‘out-of-hospital’ teams has improved the understanding of cross-service requirements. This has included rotation of staff between ‘in-hospital’ and ‘out-of-hospital’ care and across Stockton and Hartlepool localities which provides resilience.

Increased education for patients in hospital means they can be discharged with better understanding of their disease and management of their diagnosis. The DISNs have close links with the Consultant Diabetologist and Specialist Registrars for advice, support and clinical supervision. This dedicated input helps to promote the pathway between primary and secondary care services

Length of Stay

Data collected has identified a reduction in the length of stay (LoS) in hospital for patients admitted with a diagnosis of diabetes. The average LoS for patients admitted due to diabetes has reduced from 5.23 days in early 2018 to 4.0 days at end of March 2019.

Care Home Education Alliance

Care homes with high hospital admissions due to diabetes have been identified to receive targeted support and training and additional training and contact details for extra support if required is offered to staff. The aim of this is to improve care delivered to people with a diagnosis of diabetes who require 24-hour nursing or residential care.

Diabetes dashboard

A dashboard has been developed to inform ongoing service development and decision-making across diabetes service providers including Diabetes Specialist Nurses, Dietetics and Nutrition and Podiatry. The dashboard will collect from the multiple interfaces and provide monthly analysis of data of patients with diabetes for use across different diabetes service providers within the Trust.

Education / training

On reviewing the numbers of inpatients referred for review by the DISN, it was identified that some ward areas appeared more likely to refer than others. This information was used to develop a targeted education delivery plan to encompass both inpatient wards and community staff. A structured education package has been developed and commenced within both ‘in-hospital’ and ‘out-of-hospital’ care directorates for nursing teams, and link nurses have been identified in each ward area and community team. Training is now incorporated into mandatory training.

Training has also been offered to district nursing services. There are dedicated study days and district nursing staff shadow DSNs for the day.  We continue to work with community staff to facilitate early discharge and prevent admission to hospital.

Education by the DISNs now includes a quarterly education course for Type 1 diabetes HATT1E via a structured MDT delivered over three days with input from psychology, podiatry, medics and dietetics and addresses carb counting, six-day rules and diabetes management. Education is also delivered to staff caring for patients with special needs, some of whom live in supported living. This ensures carers have access to education who may otherwise struggle to attend a formal programme.

What are the next steps?

  • Continue with education programme for the ‘out-of-hospital’ care clinical directorate teams and ‘in-hospital’ teams
  • Collect data via diabetes dashboard and review data collected because of weekend working to ensure improved outcomes can be evidenced
  • Track improvements and develop sustainability plans
  • Continue to explore the numbers of patients who are identified by the Specialist Nurses but not referred by the wards
  • Continue to develop community teams to support early discharge and prevention of hospital admission facilitated by cross-service working
  • Produce local instructions that underpin the patient journey through their contact with the DISN service. The instructions will chart the referral, response and contact through to discharge from the service, thereby improving systems and processes for the management of patients with diabetes
  • Evaluate admissions from care homes across the locality and cross-reference patients admitted with diabetes to identify any themes in admissions from individual care homes
  • Evaluate primary and secondary care training sessions provided by the DISN using Trust standard feedback form

For more information about Hartlepool and Stockton on Tees CCG Diabetes Inpatient Specialist Nurse service, contact Dr Sony Anthony, Consultant in Diabetes at Hartlepool and Stockton on Tees CCG, on sony.anthony@nth.nhs.uk.