Clinical service redesign

This award rewards those NHS organisations who have successfully implemented service redesign that has enabled them to deliver the standards in the National Service Frameworks for diabetes and more effectively deliver the right care at the right time.

Winner

Bringing specialist care into primary care - Enhancing the team by Nigel Stones, Jackie Price, Ruth Seabrook

The aim of this work was to evaluate the effects of providing specialist diabetes care to a hard-to-reach cohort of high-risk people with complex diabetes in a high-achieving general practice. It found that risk reduction is not optimised in many people with diabetes and that the current one-size-fi ts-all approach frustrates both patients and healthcare professionals. The transferable, novel model that it developed for delivering personalised, complex care demonstrated that improved outcomes can be achieved in primary care with considerable cost savings.

Second place

ThinkGlucose by Royal Berkshire NHS Foundation Trust

The RBFT implemented the NHS Institute for Improvement and Innovations ThinkGlucose project following an unsatisfactory National Inpatient survey (2009) and a worrying Trust point prevalence survey. After just one year of hard work from four dedicated work streams, the project achieved a number of rewarding successes over the last year. Referrals to the diabetes specialist team have increased, staff are now graded as above the national average in “ability to answer questions on diabetes”, length of stay in hospital has reduced for patients diagnosed in secondary care, and patients feel that their diabetes care whilst in hospital has improved since their last admission.

Third place

Year of Care project by NHS Tower Hamlets

In 2007 NHS Tower Hamlets recognised that, if you were living there with diabetes, your experience of care was likely to be poor as were overall medical outcomes for diabetes. This project worked with patients to identify what was needed to improve the experience of care. Findings enabled the team to develop and pilot an integrated care package that has delivered signifi cant improvements in patient satisfaction, delivery of care processes and in the proportions achieving control of their HbA1c, BP and cholesterol levels.

Finalists

Systm One by Newcastle upon Tyne Hospitals NHS Foundation Trust

Newcastle diabetes service has successfully developed SystmOne, a clinical software system that fully supports the NHS vision for a 'one patient, one record' model of healthcare. Moving from old style paper to electronic records highlighted a large number of ineffi ciencies in the delivery of diabetes care, which have now been improved, along with patient safety and quality of care. Signifi cant cost savings have also been achieved with SystmOne.

Diabetes Strategy Pilot by NHS Leicester and Rutland

This pilot identified improvements in the quality of diabetes care and addressed some of the gaps identified in their Diabetes Strategy. Key findings revealed that a significant number of patients with care provided in secondary care could, with adequate clinical support and organisation, have their care provided in primary
care and that the majority of patients fi nd it helpful to be managed in a primary care setting. They found that the joint clinics worked effectively and improved integrated working. Questions were raised about their integrated care clinic and recommendations were made about identifying training needs and mapping a competency framework.

Enhancing the team by Salford Royal Foundation Trust

In July 2009 the Royal Manchester Children’s Hospital (RMCH) in Salford closed and moved to a new site leaving the paediatric diabetes service in Salford with signifi cantly reduced medical staff and no in-patient facilities, with any newly diagnosed children having only 24-hour admission to the new Paediatric Assessment Unit (PANDA). Prior to the closure, a National Service Framework Task Force was set up to look at service redesign. New policies and procedures were developed and have proved successful in ensuring appropriate care at diagnosis and ongoing care close to home. Eighteen months after the move an audit showed a reduction on HbA1c of 1%.

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