The 6th Annual Quality in Care Diabetes Award Ceremony

Patient Care Pathway – Children, Young People and Emerging Adults
In this category, the judges were looking for initiatives for children, young people and emerging adults (up to 25 years old) and their families. Entries could be at a local or national level to improve the quality and delivery of effective integrated inpatient and community care. They had to demonstrate successful and effective delivery of new or improved models of care, and give evidence of patient outcomes.

Winner
Introducing dedicated annual review clinics for children with type 1 diabetes
Paediatric Diabetes Team, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire
In 2014, the diabetes multidisciplinary team at Gloucestershire Royal Hospital Foundation Trust introduced a dedicated annual review clinic for children aged 8 years and over with type 1 diabetes. The clinic involves a 3-hour afternoon visit, retinal screening and an on-site, nurse-led phlebotomy service. Children are offered their consultant appointment, foot check, retinopathy screening and annual review bloods. They are also encouraged to participate, alongside other patients and families, in structured education sessions delivered by specialist nurses and diabetes dietitians. The sessions have evolved in response to ideas, experiences and questions from patients and their families, who have indicated they value the service highly.

Highly Commended
Diabetes transition from paediatrics to adult services
Isle of Wight NHS Trust, Isle of Wight
Young people transitioning from paediatric to adult diabetes services at Isle of Wight NHS Trust were largely lost to follow-up, and many found the process intimidating. The healthcare professionals have transformed their service and now work together as a multidisciplinary team to ensure the transition is a smooth, planned and supported process at an age-appropriate time. Joint transition clinics with the paediatric and adult diabetes specialist nurses (DSNs) are provided, allowing patients to meet the DSN to discuss any issues or concerns they have regarding the process. Young adults are communicated with as equals, and information is shared to enable an informed decision. Six months after transition, young adults are invited to meet the consultant in a joint clinic with the DSN. Since this process began in 2010, 94% of young adults have successfully transitioned.

Commended
Diabetes services for adolescents and young adults – transition and beyond
ENHIDE (East and North Herts Institute of Diabetes and Endocrinology), East and North Herts NHS Trust, Hertfordshire
Collaborative working between paediatric and adult diabetes services remains fragmentary, and successful transfer onto adult diabetes services is an exception. To combat this, East and North Herts NHS Trust used two under-resourced teams in separate acute Trusts to create a unified model of transitional care for young patients aged 16–19 years in a single Trust, whose diabetes information systems capture both outpatient and emergency hospital activity. The service’s evolution has taken more than 20 years, but has demonstrably improved health outcomes into adulthood. A telehealth project is planned that will utilise text and Skype technology and will be led by a young persons’ worker and DSN.

Empowering People with Diabetes – Children, Young People and Emerging Adults
This award recognised teams and individuals working to educate and empower children, young people and emerging adults, and/or their families and carers, to self-manage their diabetes and stay as healthy as possible. Programmes could address any element of the care pathway and were welcomed from specialist, primary or community settings. The entries had to demonstrate clear goals that were specific and measurable, with evidence of baseline data, audit and evaluation. 

Winner
YES (Youth Empowerment Skills): A stepping stone for diabetes self care and empowerment
Guy’s and St Thomas’ NHS Foundation Trust, London
The YES programme works with young people with diabetes who have low levels of engagement with diabetes care. It is co-designed and co-delivered by young people and aims to foster self-confidence and strengthen engagement with diabetes care. In contrast to traditional education models for diabetes, it uses novel educational strategies; key features include outreach work and innovative learning styles, including simulations, peer-led sessions and fun activities. It uses social media to keep young people in touch with each other, encouraging social networking and the delivery of peer-to-peer support. A clinically significant fall in HbA_1c has been observed in participants so far.

Finalist
Making Transition better – the Newham Experience
Newham University Hospital, Barts Health, London
Newham, east London, is the borough with the youngest population in the UK, with 40% of its population under 25 years of age and more than 60% from ethnic groups. Consequently, it has a high prevalence of type 2 diabetes in young people. Barts Health found that patients with type 2 diabetes and their carers identified three contributors to poor self-management: poor/inflexible access to care, need for peer support and lack of patient champions. To address this, Barts Health pioneered the use of online diabetes follow-up via Skype, developed a local peer-support group via a social platform and obtained funding for a youth champion to facilitate the peer-groups and help redesign the clinical service.

Other successes on the night
Two other initiatives for children, young people and emerging adults received awards or commendations in other categories, as well as the Judges’ Special Award. Karen Ross, from the Oxfordshire Children’s Diabetes team, received the Outstanding Educator in Diabetes award.

Diabetes Team Initiative of the Year 
Commended
Introducing a specialist diabetes sports service at Oxford Children’s Hospital
Oxford Children’s Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford
Regular exercise is important to maintain physical and mental health for children and young people with type 1 diabetes, but it can be a challenge to avoid potentially disabling hypos and highs, which can adversely affect performance. The specialist Diabetes Sports Clinics are held twice a year at Oxford Children’s Hospital to support young sportspeople. Information is provided on exercise and physiology, diet and food choices, and managing insulin doses, and each patient receives a personalised care summary. Since the clinics were started, there has been a 73% reduction in hypos. Evaluation showed that 93% of families “strongly agreed” or “agreed” that they could improve their child’s care using information from the clinic, while 100% were “very likely” or “likely” to recommend the clinic to family or friends with type 1 diabetes.

Involving the Diabetes Service User and Families/Carers 
Winner, also Judge’s Special Award Winner
Expanding Type 1 Kidz Project and introducing simple telehealth
Investing in Children
Investing in Children (IiC) believe every child and young person should have a say in all matters affecting them, with the result being to encourage positive changes. In 2001, IiC began working with children and young people with type 1 diabetes in County Durham and Darlington to discuss the care they received. It became apparent that they and their parents appreciated the support they got from each other, and so a monthly support group, Type 1 Kidz, was started in October 2012. With more funding, two further Type 1 Kidz groups have been created across four paediatric services. Simple telehealth text messaging has recently been introduced, and there has been continuous dialogue leading to changes within services.

Outstanding Educator in Diabetes
Winner
Karen Ross
Over 20 years ago, one of Karen’s first education events was a residential activity weekend for youngsters with type 1 diabetes. This has since become an annual event highly valued by patients and families. Each year, Karen and the diabetes team take away 35 youngsters to encourage activity and exercise, and to support them with developing skills to self-manage their diabetes.

In 2011, Karen constructed the structured education programme into which all patients at Oxfordshire Children’s Diabetes Service are enrolled, and there are now 23 group sessions each year. These events are tailored specifically to the needs of each patient. Separate events are run depending on the patients’ age, their diabetes duration, insulin regimens and key life transitions (e.g. school). Educational activities are also run for the patients, their family and school. To underpin education, Karen has implemented and audited programmes and practical tools for families to use, empowering them to self-manage their diabetes. Attendance and feedback from young people and families is consistently positive. Increasingly successful education has been significant in achieving a year-on-year improvement to the clinic’s average HbA_1c.

Karen’s dedicated work with the Oxfordshire Children’s Diabetes Service has contributed to the education of thousands of youngsters, families and healthcare professionals. Her role as diabetes educator has expanded and she is an energetic driver in the planning, coordination and delivery of the education delivered by the multidisciplinary team.

All the winners from 2016 can be found at: www.qualityincare.org/diabetes

Further details of each project, including case studies, can be found at: http://bit.ly/2gt4Lzx