Champs make their voice heard

As part of the first cohort of Diabetes UK local clinical champions, Claire Neely and Ruth Miller have been supported by the charity to develop as leaders and improve care for people with diabetes. The champion role – created last year and open to all clinicians – has ‘turbo-charged’ their influence.

Diabetes specialist nurse Claire Neely has always wanted to do her best for patients. The problem was how to go about it.

Claire Neely (left) and podiatrist Margaret Kavanagh work as a team

Picture credit: Tim George

She wanted to push diabetes up the agenda while working for Kingston Hospital NHS Foundation Trust in south west London and at a community interest company, but says that she lacked the necessary confidence.

‘I was a small voice in a large community, trying to put diabetes on the radar,’ she says.

‘Being a diabetes specialist nurse, working for two providers, I felt I wasn’t being heard. I knew I wanted to change that but wasn’t sure what I could do.’

That was more than a year ago. Today, Ms Neely is integral in the redesign of services for people with diabetes across her local health and care economy. Among other things, she has helped bring together all providers of diabetes care within the Kingston Clinical Commissioning Group area to begin the process of developing a more integrated approach to care. She is also working to improve the patient voice.

The catalyst for this transformation was a national initiative set up by Diabetes UK. Following a rigorous selection process in early 2014, Ms Neely became one of only two nurses to be appointed to the first cohort of ten Diabetes UK local clinical champions, along with Ruth Miller (see box).

‘People with diabetes are complex patients’

Ruth Miller (pictured below) says that one of the best things about being a Diabetes UK local clinical champion is meeting other people who share her determination to improve diabetes care.

She was lead diabetes nurse with the Royal Free NHS Foundation Trust in London when she applied to be a champion, but has since moved to fill the same role at Poole Hospital NHS Foundation Trust in Dorset.

She has worked hard at both organisations to improve services for patients, wherever they happen to be in the system. She has done this by developing tools for training non-specialists about the needs of people with diabetes.

‘I find it indefensible that patients experience poor care, particularly when that’s a result of ignorance among health professionals,’ says Ms Miller. ‘People with diabetes are complex patients, and need complex care, but most of the time they will be seen by generalists and by people who have little enhanced training in diabetes. Not everyone can be a specialist, but everyone must have a set of core competencies to keep patients safe.’

She has developed ten-point training programmes with sets of instructions that cover areas such as blood glucose monitoring and listening to the patient. There are modules aimed at community nurses and at staff caring for inpatients, and she is working on a programme for people with diabetes who also have serious mental health problems.

Ms Miller drew up her recommendations for inpatients literally on the back of an envelope, she says, with a key focus on preventing errors.

‘There’s lots of education available on diabetes, but that requires interest, engagement, and time, so it tends to be a self-selecting group who do it.’ She was keen to reach ‘people who wouldn’t do that training – like foundation doctors, and agency nurses.’

Ms Miller suspects the roll out of the modules has been made easier by her champion status. ‘It’s made a difference because my authority is more assured,’ she says.

‘As a nurse your authority gets questioned more than when you’re a doctor, so I’ve always had to be tenacious. But the champion role helped – there was an understanding that what I was doing was sustainable. It was almost like it gave me a kitemark.’

The charity supports champions (a role open to all clinicians) to drive change and enhance diabetes care across local health systems. This can involve being advocates for people with diabetes, promoting their needs with commissioners, service managers, and front line health and social care professionals. But it can also include leading improvement projects to deliver tangible improvements to local services.

Diabetes UK head of healthcare professional engagement Amy Rylance says that the local clinical champions are already making a difference. With the second cohort about to start this summer, she hopes the initiative will continue to expand.

It was set up, she says, to see if focusing on leadership skills in diabetes professionals would make a difference to care and services. ‘We’ve been so thrilled with the programme. Our hunch about clinicians being key to service improvements turned out to be true,’ she says.

What we all had in common was a desire to improve diabetes care

There have been personal benefits for the champions too, says Ms Rylance. ‘Some have had pay rises since they became champions – it’s been a way of demonstrating their potential in the local system.’

Skills and support

She would like to see more nurses apply for future cohorts, and advises anyone interested to join the Diabetes UK diabetes specialist nurse network (tinyurl.com/DSN-group).

‘Nurses can be seen as agents of service change, but they need the skills and support to do this,’ she adds.

Ms Neely has found the role empowering. ‘The whole process has opened doors for me. It has built my confidence so I can act to improve diabetes care,’ she says.

‘One issue was that I didn’t want to step on anyone’s toes. But because I was acting as a Diabetes UK champion, rather than wearing a “hat” from any one provider organisation, I could act in a completely non-biased way.’

With the support of Diabetes UK, she has brought together a cross-section of providers to launch a new network group. ‘It’s been about bringing all our best practice together to begin the process of a more integrated approach to care,’ she says.

‘I have also been invited to be part of the service redesign for diabetes services, working on how we can better join primary and secondary care together. We are also re-establishing the patient forum so that we can improve patient representation in the entire process.’

Ms Neely says that being a champion has helped her personal development, giving her the opportunity to have a one-to-one consultation with organisational psychologist Guy Lubitsh, the principal consultant at Ashridge Business School in Hertfordshire. She has also enjoyed meeting and working with the nine other champions. ‘What we all had in common was our desire to improve diabetes care. It’s been helpful to share views and ideas.’

She would strongly recommend other diabetes specialist nurses to apply to become local clinical champions. ‘As nurses sometimes we feel that we don’t have the power, but being a champion has turbo-charged my role. It’s strengthened me and I now feel that I can support other people too’.

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