Diabetes nurses are going above and beyond their call of duty to provide psychological support to struggling patients who are unable to access timely treatment elsewhere, according to a leading nurse in the field.
Lesley Mills, consultant nurse in diabetes at Warrington and Halton Hospitals NHS Foundation Trust, told Nursing Times the role of a diabetes specialist nurse was “evolving” to plug gaps in mental health services.
“Some of my patients won’t take their insulin and that’s why they end in hospital very ill or potentially could die”
A study conducted by Diabetes UK found that three in five people with diabetes experience emotional or mental health problems.
Just last week Nursing Times reported on a new study that revealed diabetes patients are more likely to die from suicide and alcohol-related causes than those without the condition.
However, Ms Mills said psychological provision was “variable” across the country resulting in diabetes patients facing a “postcode lottery”.
Diabetes specialist nurses were therefore widening their remit to help their patients deal with issues such as depression, anxiety, eating disorders and needle phobia, said Ms Mills, who has been a diabetes nurse for 24 years.
Ms Mills, who is also a Queen’s Nurse, leads a diabetes service covering a population of around 300,000 across the North West of England, but she said there was no psychologist on the team.
Diabetic patients therefore had to go down the standard route to access mental health support, which meant they often faced a long wait for treatment, she added.
“There are not enough psychologists, psychiatrists, counsellors and all these people do need that help so it’s evolved to often the work of the nurse specialist to do at least some of that work,” Ms Mills told Nursing Times.
“There are things like NICE guidance that say they should have access to those people but if those people don’t exist or the waiting list is six months before they can be seen then we have got to do something,” she said.
Ms Mills said diabetes nurse specialists were well placed to take on this role and that they were already equipped with some of the skills to help tackle some of the common mental health issues experienced by diabetics.
She highlighted that diabetes nurse specialists were allocated longer appointments with their patients compared to a general practice nurse and were therefore able to form a relationship with them.
“I think as nurses we need to do something”
Personalised patient programmes implemented by diabetes specialist nurses could be essential in both prevention and management of mental health problems, she noted.
She highlighted that diabetes nurses were qualified to provide education to patients around food and how to have a healthy relationship with it.
A key role of these nurses was to show patients how to properly self-inject insulin and help to alleviate fears associated with it, Ms Mills added.
However, Ms Mills said recruitment of diabetes nurse specialists had become more difficult.
She also highlighted a report from Diabetes UK in 2016 that revealed that almost 60% of diabetes nurse specialists were eligible to retire within 10 years.
“The thing is you’ve got a big bunch of people at senior level who are retiring and whereas years ago you would just recruit into post and that’s been at a standstill for quite a long time, so as this big chunk of people are retiring we haven’t got people coming up from the bottom so to speak growing into those posts and positions,” she said.
She added: “We alone advertised for four specialist nurse posts and there’s just not the people out there at that level, so what we have had to do is sort of home grow over the last two years a bit of an in-house training programme for ward nurses who perhaps want to specialise in diabetes but that takes a lot of times and lot effort.”
Ms Mills said demand for diabetes services was growing “phenomenally”, while recourses have been squeezed. Giving one example, Ms Mills said the number of women with gestational diabetes accessing her clinic annually had risen from 80 to 400 in just five years.
“It costs the NHS phenomenal amounts of money dealing with the complications of diabetes”
She said: “So the recourses haven’t developed but the amount of women developing diabetes during pregnancy has gone up more than four-fold and that’s just in our own area.”
Meanwhile, Public Health England estimates that the number of people with diabetes nationally will increase from just under 4 million people in 2017 to almost 5 million in 2035.
“We have just got to look at working smarter and working in different ways,” Ms Mills said.
She highlighted the value of the Toujeo Coach scheme. The programme is run by pharmaceutical company Sanofi and gives patients who are prescribed Toujeo insulin access to a diabetes nurse specialist, psychologist and dietician via phone and email.
Ms Mills said: “Some of my patients won’t take their insulin and that’s why they end in hospital very ill or potentially could die and this gives them access to a psychologist who would phone them every week or every day or whatever for up to a year, which we do not routinely have access to.”
She pointed out that mental health was included within the competency framework set out by TREND (Training, Research and Education for Nurses in Diabetes).
However, Ms Mills said training was variable across the country and she wanted to see it given greater focus during the education of diabetes nurses. She also called for more routes to be made available into specialist diabetes nursing.
“We are putting money into advanced practitioner roles and I suppose that needs to be looked at as well from a diabetes point of view,” said Ms Mills.
“It’s a national issue and I think unless you are nurse it’s not going to be top agenda, that’s what my personal feeling is, so I think as nurses we need to do something and we need to say something and campaign for that,” she stated.
Ms Mills said in the future there needed to be greater focus on preventing people developing type 2 diabetes.
She said: “It costs the NHS phenomenal amounts of money dealing with the complications of diabetes, it’s billons a year, and it’s about trying to prevent those complications in the first place.”