Summary
The Health Innovation Network (HIN) is the Academic Health Science Network for South London. Established across 10 multidisciplinary acute diabetes teams and with three industry partners, the Diabetes Improvement Collaborative had the aim of increasing the uptake of insulin pump therapy for adults with type 1 diabetes. Research cited by NICE stated that 15-20% of people with type 1 could benefit from pump therapy, however a local South London audit undertaken by the Health Innovation Network (HIN) in 2014 revealed that in South London this figure was between 3-15% depending on borough and the average was 8.8%. Results have shown that since the project started in June 2014 there has been an increase of over 370 people accessing insulin pump therapy from sites in South London, equating to a rise from 8.8% to 11.9% of the South London adult type 1 population.
Results
HIN achieved 100% participation and commitment to the project from all multidisciplinary diabetes teams within South London and three from North London, with attendance at each workshop in excess of 60 participants including provider teams and insulin pump users. Between June 2014 and April 2016 insulin pump uptake at South London trust grew by over 30%. This increase was delivered through improvements such as improving access to structured education, sharing and standardising service protocols and ensuring tasks are undertaken by the most appropriate person. Within South London, over 370 more people are now using an insulin pump and uptake among the South London type 1 population has increased from 8.8% to 11.9%. Across London it has led to greater equity of care, reduction of waiting times, the creation of several new roles within participating sites including Diabetes Specialist Nurse and administration posts, and directly influenced local commissioning decisions. Acute diabetes teams have been empowered to discover how their services could be improved and provided with the skills and knowledge to deliver positive change. Recommendations and findings from the project have been presented to the All Party Parliamentary Group for Diabetes, following an invitation from Diabetes UK.
Challenge
Type 1 diabetes affects more than 370,000 adults in the UK. People with the condition are wholly reliant on insulin delivered through multiple daily injections or an insulin pump. Evidence indicates that between 15-20% of adults with type 1 diabetes would benefit from this technology and in comparable countries outside the UK the uptake figure is between 20% and 40%. However in June 2014 data supplied to the HIN from South London service providers indicated that the uptake of this technology in South London was between 3-15% depending on borough. Barriers to insulin pump therapy included lack of capacity within services - including adequately trained staff – and lack of access to type 1 NICE-approved structured education (usually a pre-requisite for starting pump therapy).
Objectives
Increasing insulin pump uptake to at least 15% of the type 1 population in South London by 2018. To create an effective and sustainable network of providers, to identify and develop opportunities for collaboration across the network. To engage local teams in service improvement activities, by providing training and skills in relevant techniques, and to develop an effective collaboration between the NHS and industry to deliver the above aims.
Solution
The Diabetes Improvement Collaborative was established under joint working arrangements with three industry providers - Roche Diabetes Care, Boehringer Ingelheim and Johnson & Johnson. Workshops were launched in November 2014 and brought together ten secondary care diabetes teams including over 60 doctors, nurses, allied health professionals, managers, administrators and service users. Over a ten-month period participants attended four workshop events and received tailored on-site support in learning the service improvement tools and techniques required to streamline patient pathways and tackle the barriers. This approach created opportunities for new collaborations to improve services. Between each of the workshops the participating teams were supported by an online platform established to provide resources, ideas and a forum to share action plans.
Learnings
This project has managed to achieve a significant lasting impact on service delivery for individual trusts with a strong emphasis on the importance of access to high quality structured education, and has encouraged a holistic, whole pathway approach to pump therapy. Success has been primarily down to uniting local service providers in a better understanding of local demand and how to work smarter to enable their local pathways to meet this demand more efficiently. There has been no additional central or CCG funding for services themselves.
Evaluation
The HIN Diabetes Improvement Collaborative has delivered a substantial increase in uptake, putting South London as a region on track to deliver at last 15% uptake by 2018, with associated significant benefits to local people with type 1.
