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A specialty in crisis

Around half of diabetes specialist nurses are expected to retire in the next decade, and one third of hospitals now have no specific diabetes inpatient specialist nurses.

Around half of diabetes specialist nurses are expected to retire in the next decade, and one third of hospitals now have no specific diabetes inpatient specialist nurses. Yet the NHS is not recruiting enough of these clinicians to keep pace with the growing numbers diagnosed with diabetes – now increasing by more than 100,000 annually.

The 2014 analysis titled Diabetes specialist nurses: improving patient outcomes and reducing costs, sets out evidence that diabetes specialist nurses (DSNs) can reduce the risk of health complications, which account for 80% of the £10 billion the NHS spends on diabetes. It warns that the profession is in crisis and the future of DSNs is now in doubt. The report is published by Diabetes UK, the RCN and the working group Training, Research and Education for Nurses on Diabetes (TREND-UK).

‘DSNs are the lynchpin of quality diabetes care,’ says Diabetes UK chief executive Barbara Young. ‘Ultimately, their work helps to shorten hospital stays and prevent devastating diabetes-related complications. So whether you are looking from the point of view of people’s health or the NHS’s finances, the stagnating DSN staffing levels is deeply worrying.’

One in six people in a hospital bed has diabetes. Largely avoidable hypoglycaemic episodes in hospital are common, and more than one third of inpatients who should be referred to a diabetes team are not seen by a specialist, according to the National Diabetes Inpatient Audit published in June 2014.

There is also concern that the DSN role is changing: the 2014 analysis found 20% of the DSNs surveyed were spending less time with patients as they had more administrative work. About half struggled to access training to improve skills, and 40% reported their posts were being reviewed or had been downgraded.

‘The loss or freezing of posts when the numbers of people with diabetes is escalating is short-sighted,’ says TREND-UK spokesperson June James. ‘This will lead to significant gaps in direct patient care, clinical expertise and training for the future generations.’

There is a plethora of evidence that investment in DSNs is cost-effective. A Norfolk and Norwich University Hospitals NHS Foundation Trust trial calculated that a 1,000-bed hospital, employing a diabetes specialist team including DSNs at an annual cost of £170,000 can save between £1.5 million and £4.4 million annually on other NHS costs.

Ruth Miller: saving money as well as lives

Now lead diabetes nurse at the Royal Free Hospital in London, Ms Miller joined a small specialist team in 2003. She set up pilot projects that were introduced trust-wide, developing intravenous insulin protocols, a diabetes management chart and a hypoglycaemic treatment algorithm. As a large transplant and vascular centre, one quarter of the trust’s inpatients have diabetes, with huge implications for length of stay, morbidity and mortality.

The team now examines a trust-wide database of blood glucose readings every morning, visiting those patients who have had a hypoglycaemic episode overnight to review their treatment.

Ms Miller, who is a Diabetes UK clinical champion, says hard-pressed nurses and doctors might be unable to attend conventional training sessions on diabetes, so she is developing a concise ten-point training programme. ‘As a specialist team we can make a huge difference,’ she says.

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