THE SERVICE

In July, England experienced the biggest legislative overhaul of the NHS in a decade when 42 area-based Integrated Care Systems (ICSs) were created to bring together hospitals and primary care in a bid to improve outcomes in population health and healthcare.

Healthcare practitioners struggling to achieve the partnership working required by the new system may want to look to Norfolk’s award-winning diabetes clinical champions and leaders who have spent the past two decades developing a strong infrastructure that bridges secondary and primary care.

The team at Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH) strive to work seamlessly with the county’s leading Elsie Bertram Diabetes Centre and fellow diabetes healthcare professionals in primary care.

Around 40 diabetes consultants, nurses, dietitians, and pharmacists provide acute inpatient diabetes care, specialist outpatient care, and diabetes outreach support in community hospitals and GP practices to ensure services are accessible to people in even the most isolated areas.

The support is tailored to fit the needs of each specialist teams, GP practices, as well as the needs of individuals. A comprehensive 7-day hospital in-reach service are available to support hospital ward staff looking after people living with diabetes. Regular clinics are held in person in hospital outpatient clinics and GP practices; also via telephone or video calls and surgeries also receive advice on how to improve their overall diabetes care. 

As a result, NNUH has consistently been recognised in the National Diabetes Audit as one of the country’s best performing centres with a good track record for outpatients and for its partnership with primary care.

CHALLENGES

Norfolk is a large region with a demography unlike anywhere else in the country. It is often perceived as being affluent, however it has pockets of poverty and there are often huge differences in income between its neighbouring communities.

As the picture in Norfolk is complex, the county’s diabetes healthcare professionals have made their services as flexible as possible.

For example, in Norfolk an elderly person with type 1 diabetes, who lives a long distance from their nearest hospital, may have their care managed instead by a local GP who has been trained to look after people living with type 1 diabetes, with the support from the diabetes care facilitator nursing team and community district nursing team.

Norfolk also uses public data, such as the National Diabetes Audit (NDA), to inform how it tackles diabetes.

The county’s practitioners then actively engage with national projects to help them tackle the challenges they have uncovered in their research.

For example, Norfolk has been involved in Diabetes UK’s social innovation programme, ChangeLab, which aims to improve outcomes for people with diabetes who experience inequalities in their diabetes care. As part of the project, the team from NNUH is working closely with three GP practices in Thetford, which has been identified as facing socio-economic challenges.

They also monitor patient feedback carefully to identify how diabetes care can be further improved.

Most recently, this has led to several diabetes community healthcare practitioners focusing on how to help people living with diabetes from the county’s Polish population. Educational information about diabetes has been translated into Polish and Polish interpreters are being used to reach out to the community and improve outcomes for individuals.

The project has been running since the winter and going forward the team in Norfolk hopes to be able to share its resources with colleagues around the country to further improve patient outcomes elsewhere.

SUCCESSES

Norfolk is a centre of excellence for diabetes care and its in-hospital care has received numerous awards.

In the latest NDA report, Norfolk came top out of the 29 trusts with over 3,000 patients for the way it manages the eight care processes for people living with type 1 diabetes and seventh for its BP <140/80 results.

The NNUH specialist In-patient Diabetes Services Team from Elsie Bertram Diabetes Centre also recently won the Royal College of Physicians 2021 Excellence in Patient Care Quality Improvement Award.

This was for an 18-month programme aimed at delivering a superior diabetes support service to the hospital’s thousands of patients with diabetes and ward staff, so that issues affecting people with diabetes could be better addressed.

The specialist team empowered people to better manage and monitor their own condition while in hospital and dedicated training opportunities on good in-hospital diabetes care were created for hospital staff.

The team also implemented various in-hospital diabetes modern technologies and developed different ways to deliver the support care to suit the needs of individuals and staff through a choice of bedside visits, telephone advice and guidance or remote consultations.

KEY FIGURES

Norfolk is home to many of the leading lights in the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) which means county practitioners are involved in leading national work and the organisation’s ground-breaking diabetes inpatient guidelines.

Leading figures in the organisation include its Chair, Professor Ketan Dhatariya, as well as Professor Mike Sampson and Dr Jason Cheung, all of whom are from NNUH, and Esther Walden, of Diabetes UK.

Dr Jason Cheung is also a Diabetes UK Clinical Champion alongside Dr Clare Hambling who is Chair of the West Norfolk Diabetes Network and Clinical Lead for Diabetes and Long-Term Conditions in West Norfolk. Through her membership of EAHSN Diabetes Project Group, Dr Hambling is improving pre-pregnancy care for women with diabetes and helping the East of England ambulance service to improve the care of people with severe hypoglycaemia.

NNUH also boasts Professor Helen Murphy, who is a Professor of Medicine (Diabetes and Antenatal) at the University of East Anglia. She serves as clinical lead for the National Pregnancy in Diabetes audit and is on several research committees, the editorial board for Diabetes Care, Diabetologia, and is a regular contributor to national and international scientific meetings. Supported by JDRF, Diabetes UK, and the NIHR, Professor Murphy’s research is changing the management of diabetes in pregnancy.

Two diabetes specialist nurses from Norfolk, Debbie Holder and Wojciech Stelmaszczyk, have also recently been appointed to the DISN-UK national committee.

Dr Sankalpa Neupane, member of Eastern Clinical Research Network, was a leading co-author of the recent FLASH-UK diabetes technology clinical trial.

COMMENTS

“We have built a solid infrastructure that bridges primary and secondary care. There are multiple options available in Norfolk, both inside and outside of hospital, to support the needs of the person with diabetes, their caregivers and those delivering diabetes care.

“We get involved in national projects and continuously look for ways to improve our service and help our colleagues around the country wherever we can.”

Dr Jason Cheung, Clinical Lead for the Inpatient Diabetes Service at NNUH and Diabetes UK Clinical Champion for the East of England