The UK rates for insulin pump therapy are extremely low, despite evidence that use of pumps keeps blood sugar more stable and can therefore prevent complications. The Diabetes Improvement Collaborative worked across ten London-based healthcare trusts, involving people with Type 1 diabetes, clinicians and industry partners – and achieved over 30% increase in pump uptake, since June 2014.

“I’ve really enjoyed being involved over the last year and I think real progress has been made already which is a great result.”NDPP

Claire Williams, Patient Representative

“Our patients almost universally agree that insulin pumps improve their quality of life. We know that as patients are able to take greater control of their condition they become less anxious, and so an insulin pump becomes a very powerful tool for people with diabetes.”

Dr Andrew Rodin, Consultant Endocrinologist, Epsom and St Helier University Hospitals NHS Trust

What was the problem?

Type 1 diabetes is an autoimmune disease, which causes the loss of insulin production and affects more than 370,000 adults in the UK. For patients with diabetes, managing insulin is a major daily task – people with Type 1 diabetes are wholly reliant on insulin, delivered either through multiple daily injections or a pump. If insulin is not delivered correctly and safely, people can suffer serious complications, coma or even death.

Recent data highlights that £1 in every £10 of NHS funding is spent on diabetes, across Types 1 and 2, with 80% of complications being preventable.

The UK national insulin pump audit (2013) showed that only 6% of people with Type 1 diabetes used pump therapy, despite evidence from NICE that 15 to 20% of Type 1 patients could benefit from it. In parts of Europe pump uptake is far higher, at 15%, and at around 40% in the United States.

Our aim was to trigger a sustainable increase in insulin pump therapy uptake.

What we did and why

An audit of south London trusts in 2014 indicated that local uptake of insulin pumps was between 3% and 15%. We found that the key barriers to increasing pump therapy uptake in London included variable access to patient education, operational issues in outpatients, and a lack of available data on the size and characteristics of local Type 1 populations.

HIN DIC 30percent increaseWe set up the Diabetes Improvement Collaborative in November 2014. This collaborative of ten secondary care diabetes teams includes over 60 doctors, nurses, allied health professionals, managers, administrators and service users, working together over ten months to improve outcomes for people with Type 1 diabetes across south London. The collaborative focused on improving access to appropriate technologies for people with Type 1 diabetes, starting with insulin pump therapy (NICE TA151).

Using workshops and tailored on-site support, the collaborative gave participating trusts the service improvement tools and techniques to help them streamline patient pathways to improve services, including staff training.

Our key enablers included: strong clinical leadership of the collaborative, involving the full multi-disciplinary team (including pump users and manufacturers) in designing improvements, taking a whole-pathway approach, collecting and sharing data for improvement, and the provision of practical on-site support at participating trusts.

Clinicians and service users say they have greatly valued this collaborative working, and agree it has driven significant change. The collaborative’s programme inspired participants to start sharing outcome data, which will support care planning and prepare diabetes services for value-based commissioning.

Which national priorities does this work address?

  • Adoption of technology
  • Diabetes care
  • Working in partnership with patients

Results

Between June 2014 and April 2016 insulin pump uptake in south London increased by 30.8% thanks to the Diabetes Improvement Collaborative. Over 375 more patients gained access to pump therapy.

We estimate that the current level of insulin pump usage across south London is now 11.9% – significantly higher than the UK average of 6%.

CSII Patients Projected

“Congratulations on this great work. We have an AHSN flying the flag for diabetes. Type 1 is a really important area and I am hugely grateful for the focus you are bringing to the diabetes space.”

NHS England Diabetes Clinical Director, Professor Jonathan Valabhji, on the achievement of the Diabetes Improvement Collaborative.

Tips for implementation

  • The collaborative methodology worked well for this type of adoption challenge.
  • Understand the size and characteristics of your local Type 1 population.
  • A high-quality insulin pump service always resides within a high-quality diabetes service: take a holistic, whole-pathway approach and ensure patients have access to high-quality, NICE-compliant structured education.
  • Involve the whole multi-disciplinary team, including clinical staff, managers, administrators and service users. Service users know the service best.

Next steps and spread

  • Participating trusts have sustainable plans in place to continue this increase, and reach at least 15% of the south London Type 1 diabetes population by 2018.
  • The collaborative has proven so successful that it is now continuing, and has evolved into a very active broader Type 1 diabetes pan-London network, with quarterly meetings.
  • Attendance remains a collaboration of clinicians from the MDT as well as patient representatives and commissioners.
  • The Type 1 Network is continuing to improve the quality of care for people with Type 1 diabetes, by introducing a Type 1 care planning tool and helping teams implement the London Type 1 service specification.

Find out more

Visit the HIN website to find out more.

Contact for help and advice

Alison White, Interim Programme Director, Diabetes and Stroke Prevention
alison.white20@nhs.net

Programme duration: June 2014 to April 2016, with subsequent data collection to monitor sustained improvement