More than a quarter of acute sector sites in England and Wales still have no dedicated diabetes inpatient specialist nurses, according to a national snapshot of care quality in hospitals.
Findings from the National Diabetes Inpatient Audit 2017, published today, revealed that 28% of hospitals lack a dedicated inpatient specialist nurse for the condition.
“While the improvements are notable, there is still a large variation in care”
The research also showed that just 9% of hospital sites provided seven-day diabetes inpatient specialist nurse provision.
In addition, while there had been an improvement in the proportion of diabetes patients being seen by a specialist diabetes team, where appropriate, a further 28% still did not receive this level of care.
Based on the audit, the charity Diabetes UK called for NHS England’s so-called “transformation funding” to continue paying for diabetes specialist inpatient nurses beyond April 2019.
The national body has previously allocated around £44m via its diabetes transformation fund to support improvements in the treatment and care of people with the condition during the period 2017-19.
Overall, the findings from the 2017 audit, published by NHS Digital with input from Diabetes UK and other bodies, showed that around 18% of hospital beds are occupied by a person with diabetes.
In addition, the research revealed that 20% of hospital sites do not have a multi-disciplinary footcare team, though this proportion has reduced from 42% in 2011.
“We need to do more to support diabetes teams to help their colleagues provide safe and appropriate care”
The audit was carried out during 25-29 September last year and involved 16,010 patients being treated across 208 hospital sites.
Diabetes UK highlighted that patients were still receiving poor care in certain areas, despite positive changes being made across some hospitals, and “years of hard work” by diabetes inpatient teams.
Referring to figures from the latest audit, it highlighted that 31% of hospital patients with diabetes experienced a medication error, and 18% had a hypo during their stay.
The data also revealed there has been no improvement in the number of inpatients with type 1 diabetes affected by diabetic ketoacidosis, said the charity.
The charity warned that the number of beds occupied by diabetes patients was “putting notable pressure on staff and hospitals”.
It was important that diabetes was viewed as a “priority for all hospital trusts, and staff receive the training they need to support this increasing number of patients”, it said in response to the audit, which is one of a number of similar pieces of research regularly carried out on care linked to the condition.
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Diabetes UK warned that the “stark variation” identified by the latest audit results across hospitals showed that more needed to be done to help teams learn from one another.
The charity highlighted that it gathered examples of good practice in hospital care for teams to access, which it had published online in a “shared practice library”.
It added that in the summer it would release an “ambitious roadmap” outlining the challenges facing inpatient teams, the solutions being introduced and calls to actions for various stakeholders.
Data from the national audit was also presented today at the charity’s annual Professional Conference in London.
Dr Gerry Rayman, NHS England’s national clinical lead for inpatient diabetes, said: “Diabetes teams are doing fantastic work to improve diabetes care, as evidenced by the audit.
“Since 2010 there has been a 30% reduction in severe hypoglycemic rates, a 40% reduction in foot pressure ulcers occurring in hospital and reduction in all medication errors,” he said.
But he said: “While the improvements are notable, there is still a large variation in care across England and Wales and harm arising from DKA due to insulin mismanagement remains a worrying problem.
“Thus, there is still a lot more work to do be done across England and Wales, if people with diabetes are to receive first class care and have confidence in their healthcare teams,” said Dr Rayman.
David Jones, assistant director of improvement support and innovation at Diabetes UK, said: “It is essential that people with diabetes feel safe when they stay in hospital.
“We have spoken to too many people who don’t,” he said. “We need to do more to support diabetes teams to help their colleagues provide safe and appropriate care.”