During the past year, NHS Leeds CCG has been working with colleagues from other parts of the NHS and public health to improve outcomes for people with diabetes.

There are currently around 44,000 people in Leeds with diabetes, and a further 32,000 at high risk of developing it. By 2034, it’s estimated that 1 in 10 will have the condition. Katie Smith, Commissioning Manager at Leeds Clinical Commissioning Group explains how they have transformed diabetes services in Leeds…

We currently spend £116million annually in Leeds with £87million of that treating complications from diabetes. Furthermore if type 2 in particular continues to increase as predicted, treating it may account for 15% of our total budget by 2030.

To help change that, in 2017, we successfully bid and were awarded £629,000 NHSE Transformation Funding in Year One (and a further £677,000 for Year Two) to improve the uptake of structured education for patients with Type 2 Diabetes, increase capacity within our Diabetic Inpatient Specialist Nurse Team (DISN) and expand our Multidisciplinary Foot Care Team to improve the timeliness of referrals and ultimately reduce the number of amputations. This has resulted in creating 15 additional whole time equivalent posts in these areas.

Expanded structured education programme for people with Type 2 diabetes

Effective self-management is the cornerstone of good care for people with diabetes, and high quality structured education that prepares people for a lifetime with the condition is a key enabler of self-management.  Transformation funding enabled us to increase our structured education programme, both in terms of staff resource and sessions offered, with an emphasis on 75% of participants newly diagnosed within the last 12 months and a targeted groups of men over 40 years of age, BAME groups and those from the highest deprivation areas of Leeds.

We increased the sessions from 34 to 125 per year, including the introduction of evening and weekend sessions as well the option to complete in one day. This increased flexibility means that we are better able to meet patient need.

View our 2 minute film and patient case studies.

Expanded multi-disciplinary foot team (MDFT)

Diabetes is the most common cause of non-traumatic limb amputation, with foot ulcers preceding more than 80% of amputations. We wanted to reduce the number of preventable amputations by improving the timeliness of referrals from primary care to an MDFT for people with diabetic foot disease which includes an expansion to this team (Foot Protection Service) with a focus on high and moderate risk patients and ulcer prevention.

As well as expanding the MDFT service, we have enhanced our communications and engagement regarding Diabetic Footcare. We refreshed foot care literature for people with low, moderate and high risk feet, adding a new leaflet for people with ulcers. These have been produced in easy read versions and translated into Urdu and Polish (as the top two languages requested) which are all available on the Leeds Clinical Commissioning Group’s website

We have carried out an extended multi-channel awareness campaign using hyperlocal magazines, targeted social media and outdoor advertising in areas with high proportion of targeted groups. In addition, we organised two free interactive foot care workshops for patients and carers. Both were fully subscribed, highly rated and we now have a waiting list for future sessions.

We have also produced a Diabetic Foot screening and competency assessment training programme for Primary Care (LEEDS FEET!) which commenced in 2017/18 and continues during 2018/19 alongside delivery of awareness training to other healthcare professionals including private podiatrists

Diabetes inpatient specialist nurses (DISNs)

Around 15% of all hospital beds in the UK are occupied by people with diabetes, and they tend to spend longer in hospital than patients who don’t have diabetes. We used transformation funding to increase the number of specialist nurses and dieticians within Leeds hospitals to improve health professionals’ knowledge, reduce length of hospital stays and improve patient care and treatment, reducing the risks of readmission

Lessons learned

• Strong partnerships are essential – the success of the enhanced services hasn’t just been because of additional investment but because of a shared drive and determination to get things done
• Robust governance is essential to drive forward service change – this isn’t just project management, it’s transforming care. Related to that, defining clinical roles is essential.
• Communications and engagement are extremely important so they need to be budgeted for from the outset. Having a joint plan that’s shared by all partners, including providers, NHSE, public health and third sector, helps maximise efficiency and opportunity.
• Last but not most definitely not least, we’ve been reminded of the importance of the patient and carer voice and that we can always do more.

What’s next?

To build on the progress we’ve made, we’re currently working with health care professionals, patients, carers and third sector partners from across the city to develop a five year diabetes strategy. We expect to finish this work later in the year.

Conclusion

It’s still early days, but initial results suggest that the additional investment made possible by NHSE transformation funding is paying off and improving outcomes for people with diabetes. Crucially for future service development, our work so far has engendered further collaboration between providers and commissioners, including more flexible working arrangements, integrated service arrangements and single leadership in clinical teams – and that’s good news for patients and carers.

For more information

Watch a short video about how we’ve improved diabetes services in Leeds. If you’d like to know more about any of our work in Leeds or access our resources, please contact me at Katie.smith29@nhs.net