Setting the standard of diabetes care in hospitals

Diabetes UK have been working with The Royal College of Physicians to establish the Diabetes Care Accreditation Programme (DCAP), the first programme of its kind in diabetes.

DCAP outlines requirements for high quality diabetes care in hospital during an admission and supports hospital teams in their mission to transform and improve the lives of people living with diabetes. 

We spoke to DCAP clinical experts and assessors, Esther Walden (Senior Clinical Advisor at Diabetes UK) and Dr Daniel Flanagan (Clinical Lead) about their motivation for supporting the programme and the impact it will have.

1. How did you get into your chosen field? Why did you choose to specialise in endocrinology/diabetes? 

Esther: "As a student nurse, I became interested in diabetes for two main reasons: firstly, I had an excellent district nursing placement with someone who was passionate about improving the quality of blood glucose monitoring in the community. Her enthusiasm and encouragement to understand more about the physical aspects of diabetes and its management is where it all started for me.

"A few months later, I accidentally discovered my partner of 11 months had had diabetes since childhood but never mentioned it, which really piqued my interest in the psychological aspects of living with diabetes. Since then, improvement of diabetes care and services has always been my working passion."

Daniel: "I was always interested in medicine as you really get to know people with diabetes and endocrine problems over a long time, which is very rewarding.

"Over the course of my career as a doctor there have been huge advances in diabetes care. I like that the speciality combines advanced science and physiology with the need to look after the individual. When I was a junior doctor, looking after people with diabetes in hospital as a subject did not exist. There were no specialists thinking about how to provide the best care for diabetes in hospital in 1999. It has been incredibly rewarding to see the standard of care improve so much in the past 20 years."

2. What drove you to launch an accreditation programme for inpatient diabetes care?

Esther: "Around the turn of the century, there was an increasing focus on the importance of and the need for high quality inpatient care for people with diabetes. This had been highlighted by several high-profile cases of poor care leading to devastating outcomes for people with diabetes in hospital.

"After the launch of the National Diabetes Inpatient Audit, it became clear that inpatient diabetes care was variable, and that people were routinely suffering harm such as insulin errors and preventable hypoglycaemia. Therefore, it was essential to act in a meaningful and sustainable way that can be implemented anywhere."

Daniel: "Establishing an accreditation programme to make diabetes care in hospital better, is the natural next step. Diabetes UK and the Joint British Diabetes Societies for Inpatient Care (JBDS) have championed the cause of improving hospital diabetes care for many years.

"Accreditation combines all the work that has gone before in describing what a good service looks like. It combines an element of benchmarking together with peer support in the best way to make improvements. The ability to network and learn from other hospitals will make the process easier for hospitals at an early stage. For those hospitals with established teams this will validate their work with hospital senior management teams and commissioners."

3. What are the biggest issues in the world of diabetes now? 

Esther: "The prevalence of type 2 diabetes continues to rise dramatically, and we know that people living with diabetes are potentially at risk of developing diabetes-related complications. Audit data shows us that people with diabetes are still experiencing harm in hospital and both inpatient priorities and quality of care vary from hospital to hospital."

Daniel: "It often feels like there is a tension within diabetes teams to decide which aspects of care are the most important. We have seen a move to provide care for most people with diabetes closer to where they live. The old model of a specialist diabetes team working from an outpatient department in a hospital and asking people with diabetes to come to a clinic in the hospital is now starting to disappear. Specialist support is provided to primary care in various ways that do not involve the person with diabetes attending the hospital.

"Having said that, diabetes care is now driven by new technology and a much wider choice of diabetes medication. Providing individualised care requires some complicated decisions that will then need regular review."

4. What do you think will be the programme’s long-term impact on services/patients? 

Esther: "I am extremely hopeful that this accreditation programme will standardise the quality of diabetes care across the UK. I also hope that it will ensure diabetes teams, who are doing excellent work in their hospital systems, feel supported as they strive for excellence, and have the evidence required to make the case for further investment in diabetes services as needed."

Daniel: "The hope is that establishing an accreditation programme will improve diabetes care by allowing specialist teams to benchmark themselves against national standards and share the best ways of doing this with other teams.

"We are often asked why we are restricting this to hospital care. The answer for now is that this is already a very large clinical programme. It will be the largest clinical programme that the RCP is working on so it’s important that we make it work. Hopefully when this is established and becoming a routine part of care we can look to expand into other areas."