Diabetes and Children and Young People Networks
 NHS England and NHS Improvement have launched the DigiBete app to support children and young people with Type 1 diabetes.
The free video platform and app is now being rolled out across the North West of England, with the GM SCNs’ diabetes and children and young people teams working on its implementation.
They are working together with the North West Coast team to support the roll-out and implementation of the app across Cheshire and Merseyside; Greater Manchester and Eastern Cheshire; and Lancashire and South Cumbria. This will contribute in Greater Manchester and Eastern Cheshire to the continuing work to establish a comprehensive sustainability and transformation partnership-wide digital education offer for all people living with diabetes.
DigiBete is a free video platform and app designed to help support children and young people and their families to self-manage their Type 1 diabetes. It offers a wide range of clinically approved, age appropriate resources to help with education and support self-management. The app has been developed/co-designed by parents, clinicians, and the Type 1 community and has over 200 different film and infographic resources to support care.
When in the app, you can save the films you find most useful to your device, store insulin ratios/doses and pump settings, add appointments, add a school healthcare plan, learn more about sport and exercise, emotional wellbeing, issues specific to teenagers, healthy eating and much more. It also allows diabetes clinical teams to send relevant information and resources about managing Type 1 diabetes at home in the form of clinic newsletters and bulletins.
Children and young people and their families can access DigiBete by downloading the free DigiBete app and asking their local care teams for a unique clinic code. The app download instructions and training can be found here.
Margot Carson, children and young people’s North West diabetes network manager, said: “The Children and Young People’s North West Diabetes Network has supported the Greater Manchester SCNs team and the North West Coast Clinical Network team in ensuring the smooth rollout of the DigiBete App across the North West of England.
“The app will give children, young people and their families across the region continued contact and support not only with their hospital team but will also provide them with national and regional information on, for example, upcoming Type 1 Diabetes events and official NHS England advice on Covid-19, which will hopefully improve their Type 1 diabetes journey culminating in improved outcomes and quality of life for their long-term future.”
Rachael Bowker, paediatric diabetes specialist nurse from Salford Care Organisation said: “Digibete has been a great help especially during Covid-19. It has been very easy to setup and the uptake with our families quickly got moving.
“We found some families needed a few gentle reminders or a helping hand along the way but now the majority of our clinic are up and running we are using the app to its full potential.
“The key thing for us in Salford is feeling like we are still connected with our patients, even during lockdown. We are able to get information out to the whole cohort, very quickly and easily. If we relied on the post this would have taken days, and some of the information would never have been sent in the first place!
“We feel our families are more connected and are accessing more opportunities for virtual networking. On top of all of this we have been able to direct families to key videos, such as exercise management and their sick day rules. Knowing everyone has access to vital information on their phones, whenever they need it is great, and with the next app update, we are able to personalise our clinic even more to further meet the needs of our families.”
To find out more about this project and its roll out phases, please contact the Clinical Networks project leads below:
Greater Manchester & Eastern Cheshire Strategic Clinical Networks
Sarka Grayson
Stephanie Roocroft
North West Coast Clinical Network (Cheshire & Merseyside, Lancashire & South Cumbria)
Laura Crompton
Recent statistics published by NHS England show that a third of those that have sadly died from Covid-19 also had diabetes.
For this reason, it is now more important than ever that those people at risk of developing diabetes stay well and healthy.
The Diabetes Team is pleased that in response NHS England has introduced an additional referral route for people to fast-track onto the Healthier You: NHS Diabetes Prevention Programme.
This is in response to present capacity and clinical pressures faced by GPs and the reduced capacity within phlebotomy services.
The programme can now be accessed if you have a risk score of 16+ after using the Diabetes UK Know Your Risk tool.
To find out if you are at risk of developing Type 2 diabetes complete the Diabetes UK risk tool found here. It only takes a minute and it could be the most important thing you do today.
You will need to answer a series of basic questions including age, weight and ethnicity and the tool will calculate your risk. If you have a risk score of 16+ you will be directed to contact ICS Health and Wellbeing, which runs the free Healthier You programme and refer yourself onto it.
The programme provides guidance on improved quality of diet, increase in physical activity and successful weight loss, and is currently being offered by group-based telephone or group video conferencing, or online through a smartphone app.
If you know people that could be at risk and could benefit from the programme, please use the above link to signpost them to the risk calculator.
The Diabetes Network would like to encourage GPs to continue referring their patients into the Healthier You Programme using the referral form found within the clinical system.
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In our next blog from clinicians who work with the SCNs, Professor Martin J Vernon, Consultant Geriatrician, Tameside & Glossop Integrated Care NHS Foundation Trust, and GMEC SCNs’ clinical advisor for frailty, asks if the Covid-19 pandemic lockdown exposed vulnerable adults to increased risk of death from other causes and what we should do about this in Greater Manchester. |
"The Covid-19 pandemic has thrown into sharp relief the cumulative unease many of us have shared for decades arising from historic under-resourcing of health and social care for people with complex conditions. This is especially true for older people who may be living with frailty or dementia.
To be clear these are people living amongst us in our communities and who may be our family members, friends and neighbours.
Between 7th March and 1st May 2020 the Office of National Statistics reports there were 46,380 excess deaths compared to the five-year rolling average. Of these over a quarter did not involve Covid-19. Many will be aware that almost 11,000 more deaths were registered in care homes, an increase of 60.5%.
However, of equal concern are over 8,000 more deaths registered in private homes in this period compared to the five-year average, an increase of over 40%.
The largest increases in non-Covid-19 deaths have been seen in deaths due to "dementia and Alzheimer disease" and "symptoms, signs and ill-defined conditions". In the main this relates to older people living with frailty, dementia and/or multiple long-term conditions.
In addressing this, it is first important to note that undiagnosed Covid-19 may have contributed to excess mortality, particularly given the increased likelihood of ‘atypical’ presentation of coronavirus infection in older people with frailty and cognitive problems.
An underlying principle of specialist old age health care is that disease may present atypically among older people. While not initially factored into national policy decisions it does highlight the ongoing and pressing need for much greater diligence and specialist knowledge to be applied when clinically assessing older people with underlying complex conditions who are acutely unwell.
Only a minority of older people with any infection, including coronavirus, present with raised body temperature, making the primary symptoms of cough and pyrexia publicised by Public Health England potentially insensitive to picking up coronavirus infection among this group. For those living with frailty and/or dementia it is more likely that they will present with acute confusion (delirium), falls, lethargy, functional decline, poor appetite, diarrhoea or vomiting. It is entirely possible therefore that such problems, especially without quick access to comprehensive and specialist assessment, could have been wrongly attributed to ageing or dementia.
None of this is new knowledge to those with expertise in the care of older people.
But if we are to reduce the risk of further excess deaths among older people, there is a pressing need for this to be understood more widely by care providers, clinicians, commissioners, policy makers, government advisors and NHS leadership as the pandemic response continues.
While no firm conclusions can be yet drawn, there are other equally important reasons why older people with complex needs may have been at greater risk in their own homes during the pandemic lock down. These include a reluctance to seek care, organisational delays in receiving care and lack of access to sufficient expertise and care for complex conditions. These issues can be expected to persist even as lockdown is eased.
Crucially, the increased likelihood of physical, cognitive and mental health decline as a result of social isolation is already known to increase risk of death among older people and those with complex conditions and may have contributed significantly to the observed excess mortality among people locked down in their homes.
For policy and local decision makers seeking to save lives, these factors are of huge importance to consider for as long as the likelihood of localised or generalised lock down persists. In particular, among vulnerable groups including older people with frailty and dementia, the benefits of avoiding coronavirus infection must be very carefully weighed against the potential harms of shielding through enforced isolation.
This means ensuring there is an inadequate balancing community support offer to the most vulnerable people in our communities if we are to avoid a second peak in excess community deaths as the pandemic response progresses.
During the pandemic there has already been considerable innovation focused on improving care for older people, including in Greater Manchester.
We already have new funding and a clear national plan to address the needs of older people in their communities set out in the NHS Long Term Plan, the tools with which to implement this and a Greater Manchester plan. In the midst of a pandemic there is not a moment to lose in implementing all of this."
Martin trained as a Geriatrician and General Internal Physician in the North West and London. He currently works for Tameside Integrated Care NHS Foundation Trust and is a Senior Clinical Advisor in both Greater Manchester and London. He has a MA in Medical Ethics and Law from King’s College London, teaches these subjects at Salford University and was appointed as Visiting Professor at the University of Chester in 2016.
Between 2016 and 2019 he was the National Clinical Director for Older People at NHS England and Improvement.
He has led multiple national work streams including development of the 2019 NHS Long Term Plan Ageing Well Programme.
The Palliative and End of Life Care team has been working closely with the locality commissioners on invaluable work to improve the quality of life for people approaching or in the last year of life, as part of the ongoing work and to support the Covid-19 response and recovery.
Weekly engagement with the palliative and end of life care commissioners started in response to Covid-19 and there is now established meetings to take forward the delivery waves as identified by the draft Greater Manchester Palliative and End of Life Care Framework and Commitments (see the table left).
A shared ambition of the commissioners, which is being taken forward by the network team and the Greater Manchester Business Intelligence leads, is to create a high-level GM dashboard that will focus on services and point of need for the person in the last year of life.
The aim is to inform future commissioning decisions that will improve the quality of life for people in the last year and days of their lives.
Here’s an example of the appreciation of the closer working relationship with commissioners:
“Sincerest thanks for the organisation and facilitation of the SCN Palliative and End of Life Care calls over the past 14 weeks. It really has been an invaluable source of information and updates that have really enabled us to not only get a wider understanding of national guidance, updates and advice, but, I personally feel, has also enabled us all as a GM team to come together during the most challenging of times.”
Nicola Caffrey, Palliative, End of Life and Cancer Services Commissioning Manager
NHS Bolton Clinical Commissioning Group
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