New ways of working with people with diabetes in Tower Hamlets

In Tower Hamlets, East London, the diabetes service has been developing a number of new initiatives and ways of working to empower people with diabetes and to improve their care.

The service was chosen as one of only three national pilots from twenty-three applicants for the Year of Care project. The project, supported by Health Secretary Alan Johnson, Diabetes UK, the Department of Health, the National Diabetes Support Team and the Healthcare Commission, is about people taking charge of their condition and working in partnership with healthcare professionals to plan their care. Year of Care describes all the planned care that a person with diabetes should expect to receive (usually over the course of a year), and includes support for self-management in line with national standards and, where appropriate, planned specialist referrals. Our pilot project aims to find out how this will work in practice.

Traditionally, consultations have been conducted using a didactic approach – leaving many patients feeling dissatisfied as they consider that they have not been listened to, have been told what to do and, in some cases, reprimanded for not achieving goals. A significant number have failed to attend subsequent appointments as a result of this. This changed under Year of Care, when the annual review appointment became a care planning discussion where the person with diabetes is on equal footing with the healthcare professional. The individual and the healthcare professional jointly decide upon the right options for care, and the plan arrived at will form the basis of their individual ‘Year of Care’. This will have implications for commissioning, and the pilot study will test whether it is feasible for the system to work around individual needs in this way.

We chose eight practices in the southwest locality to pilot the project as they are representative of Tower Hamlets as a whole, with areas of significant affluence and pockets of high deprivation. The project has been set very tight deadlines, and we are now in the process of launching this new way of working having completed baselines for each practice, developed practice tools (letters and care plans) and finalised the IT systems. We have also held a number of patient forums to explain how the ‘Year of Care’ will work and to listen to patients’ views about this proposed new way of working. The project will run for another 2 years and will be evaluated externally upon completion to determine its effectiveness.

Recently, the service has successfully completed the Ocean New Deal for Communities diabetes project which was linked with the Ocean Estate, an area in Tower Hamlets identified in the 2000 Indices of Deprivation as being one of the most deprived areas in the country. The project looked at improving diabetes care in a community in which large numbers of people with diabetes historically had little or no input into their diabetes management. It was estimated at the commencement of the project that there were approximately 1000 people with diabetes living on the Ocean Estate and, with over 50% of the community being of Bangladeshi origin, many more at high risk of developing diabetes and its complications.

The aim of the project was to develop and test an innovative model of diabetes care, involving a partnership between patients and healthcare professionals, using a multi-agency approach. The project had two components:

• The employment of a Senior Diabetes Nurse Specialist (DNS) and a Bengali Link Worker who would be based on the estate and work with local healthcare professionals, community groups, and the Diabetes Self-Management team to improve the education and knowledge of people with diabetes.
• The development and evaluation of a Diabetes Self Management or ‘Expert Patient’ course as previously used by Social Action for Health – a community development charity, which works alongside local people and their communities promoting better health and well-being.

Overall, the model of care used was very successful in educating people about how to manage their diabetes, and also by supporting and training healthcare professionals and other stakeholders in how to support people with diabetes in the community. This model has subsequently been successfully replicated throughout Tower Hamlets.