Recently, two unrelated publications, one an Australian blog and the other a UK peer-reviewed medical journal, have given voice to the same topic. Their different and highly complementary views combine to offer a powerful message, close to the heart of many with diabetes as well as ours here at SD.
On 7th August, Renza Scibilia wrote her daily blog about living with diabetes as if it were a letter to a diabetes doctor in a new clinic. It started with the words ‘you and I are on the same side. My side’, then continued expressing the hope of partnership, of mutual understanding and the absence of judgement about her life with diabetes. Above all, she expressed the desire for recognition that even when diabetes isn’t going too well in her life, that she is always doing her best.
Her message is clear: respect my expertise and I’ll respect yours, so we can have a great and useful relationship. This post attracted a number of comments, including one from a diabetes educator who said ‘you have helped me become a better clinician’. It occurred to us that the idea of a ‘letter of introduction’ such as this, should perhaps be an option in all clinics, to help break down the assumptions, myths and negative judgements that, however inadvertently, often underlie the consultation words from a health professional towards and about the person with diabetes.
Which helps to introduce the second publication, from the respected journal ‘Diabetic Medicine’. In the first study of its kind, the authors interviewed parents of children with Type 1 diabetes about the challenges of keeping their children’s blood glucose in range, in the context of their everyday lives.
Apart from the surprise that such a qualitative study had not been undertaken before now, there were two major new findings in this paper – one being that parents often had ‘home’ and ‘away’ blood glucose targets – the latter being more relaxed than the former. This reflects the desire to ensure their child was safe from hypoglycaemia and able to enjoy the event they were attending without their parents. It also showed their recognition that other care givers at events would not have the detailed knowledge that they had about the intricacies of diabetes-related actions and their own child’s condition. This in itself was hugely moving, the parents wishing ‘a normal life’ for their child and reassurance for themselves that hypoglycaemia, an ever present fear for parents, was unlikely outside of their direct care.
The second finding was in relation to consultations with health professionals, who, although excellently reviewed in terms of knowledge of diabetes and its treatment, were universally found to expect a ‘text-book’ achievement of recommended HbA1c levels, without apparently realising the realities and complexities of life with diabetes that the parents had to face. It seemed to be summed up in the comment by one parent ‘you’ve tried really hard…and you get ‘oh their HbA1c is not good enough, you need to do better’. In this single sentence, the sense of demoralisation, frustration and unrecognised effort rings out.
Unsurprisingly, one of the conclusions of the paper is that health professionals need to be more empathic, more recognising of effort as well as results and have a training that engages in the everyday detail of living with diabetes as well as the medical and scientific knowledge which currently prevails.
What are we saying here by bringing these two pleas together? Quite a simple message really, one for health professionals as they invite people living with diabetes into their consulting rooms, and one which is really quite easy and cheap to achieve. It’s summed up by something a colleague of ours said many years ago ‘always remember to honour effort as well as outcomes’.
It’s only the sheer effort and doing their best by people who are in the complex maelstrom that diabetes can present in life, that gets any outcome at all. And the only judgement that effort deserves, is a massive ‘well done’ at each and every visit. Please, just do it.
References
Diabetogenic: Dear Doctor: 7 August 2015
Lawton, J., Waugh, N., Barnard, K., Noyes, K., Harden J., Stephen, J., McDowell, J., Rankin, D. (2015). Challenges of optimizing glycaemic control in children with Type 1 diabetes: a qualitative study of parents’ experiences and views. Diabetic Medicine , 32, 1063-1070
Tuesday, 18 August 2015
Wednesday, 29 July 2015
Type 2 - Time to Test?
Self monitoring of blood glucose (SMBG)for people with Type 2 is currently restricted, in both local and national recommendations, to those in all but very specific circumstances. We believe this is, at best, unfair and at worst, in complete contravention of current health policies which promote self-responsibility for health, self-management of long term conditions and individualised approaches to care. We believe that all people with Type 2 diabetes should be given the opportunity for SMBG. Here's why:
Type 2 diabetes is a progressive, serious condition which requires for many, considerable lifestyle changes if its dire consequences are to be avoided or detected promptly. For everyone, success in managing their condition depends on daily medication, physical activity, attention to timings, amounts and content of food and drink. Also required is effective and prompt action in the face of stress, illness, driving, holidays, work and social life, short-notice schedule changes, family responsibilities and more. In short, every aspect of daily life.
If people with Type 2 diabetes are to take their condition seriously by doing all this, as many in healthcare say they should, then they need the only practical tool available to them to help, namely SMBG.
1. But this is expensive, say health economists and budget holders: to which we say - but losing 20 years of your life to uncontrolled diabetes is also expensive, as is heart failure, amputation, kidney dialysis and blindness, which are among the most costly and avoidable consequences of not self-monitoring.
2. But people don't know how to use SMBG properly, say health professionals: to which we say - that's your fault for not explaining how it needs to be used and how serious a condition Type 2 diabetes is, and the need for rigorous self management, right from the start.
3. But there's no evidence it improves diabetes control or HbA1c, say researchers and medics: to which we say - most people with Type 2 diabetes aren't solely interested in their HbA1c, indeed many don't even know what this level is. What they are interested in is their everyday life and making this as hassle-free as possible, avoiding hypos and high blood glucose levels which can be inconvenient, embarrassing and even dangerous (e.g. when driving, as most people do). They also wish to see for themselves the positive effects of their strenuous efforts to make lifestyle changes and the choices they make daily, not wait 3 months for the health professional to order a repeat HbA1c.
If we are truly committed to a population of people with Type 2 diabetes effectively self-managing, they must have the tools to do this vital, cost-effective job. It's time to get people with Type 2 testing - or at least give them the choice.
Type 2 diabetes is a progressive, serious condition which requires for many, considerable lifestyle changes if its dire consequences are to be avoided or detected promptly. For everyone, success in managing their condition depends on daily medication, physical activity, attention to timings, amounts and content of food and drink. Also required is effective and prompt action in the face of stress, illness, driving, holidays, work and social life, short-notice schedule changes, family responsibilities and more. In short, every aspect of daily life.
If people with Type 2 diabetes are to take their condition seriously by doing all this, as many in healthcare say they should, then they need the only practical tool available to them to help, namely SMBG.
1. But this is expensive, say health economists and budget holders: to which we say - but losing 20 years of your life to uncontrolled diabetes is also expensive, as is heart failure, amputation, kidney dialysis and blindness, which are among the most costly and avoidable consequences of not self-monitoring.
2. But people don't know how to use SMBG properly, say health professionals: to which we say - that's your fault for not explaining how it needs to be used and how serious a condition Type 2 diabetes is, and the need for rigorous self management, right from the start.
3. But there's no evidence it improves diabetes control or HbA1c, say researchers and medics: to which we say - most people with Type 2 diabetes aren't solely interested in their HbA1c, indeed many don't even know what this level is. What they are interested in is their everyday life and making this as hassle-free as possible, avoiding hypos and high blood glucose levels which can be inconvenient, embarrassing and even dangerous (e.g. when driving, as most people do). They also wish to see for themselves the positive effects of their strenuous efforts to make lifestyle changes and the choices they make daily, not wait 3 months for the health professional to order a repeat HbA1c.
If we are truly committed to a population of people with Type 2 diabetes effectively self-managing, they must have the tools to do this vital, cost-effective job. It's time to get people with Type 2 testing - or at least give them the choice.
Tuesday, 30 June 2015
When is Structured Education not Structured Education?
Back in March we praised a report by the All Party Parliamentary Group on Diabetes for their timely and important report on the state of diabetes education. We asked ‘what difference will this report make?’
It would appear that the jury is still out on that question, if Diabetes UK’s latest briefing report is anything to go by. Entitled ‘Diabetes Education: the big missed opportunity in diabetes care’, it explains that although diabetes education is recommended, it is hardly provided or attended. In a separate Diabetes UK survey, released for the recent Diabetes Week, 42% of people with Type 2 diabetes reported themselves to be unconfident about managing their condition.
It’s pleasing to see these messages being highlighted again, much as we and others have done many times in this blog and in other publications. We await the updated NICE guidance on Type 1 and Type 2 diabetes, to see if there is any emphasis at this level which could improve the situation for so many people with diabetes who are lacking the ‘tools to do the job’ of looking after a complex and at times, complicated, condition. Although, having seen the drafts of these guidelines, to be honest, we are not holding our breath here at Successful Diabetes! Diabetes UK are also campaigning for people to lobby their MPs about the issue, so we can hope that this personal approach brings much needed attention instead
So, whilst Diabetes UK’s briefing and its echo of many other calls to action in respect of the parlous state of diabetes education is welcome, we are bound to say that unfortunately it doesn’t tell the whole story in relation to the definition or availability of structured education. Here’s why:
It defines level 3, or structured, education solely in terms of group education. To our knowledge, there is nothing in the definition of structured education that says it has to be provided to groups of people. In fact, one of he earliest definitions of structured education, from the 2003 Technology Appraisal from NICE, says that it is ‘a planned and graded programme that is comprehensive in scope, flexible in content, responsive to an individuals clinical and psychological needs, and adaptable to his or her educational and cultural background’ (p 14). To be fair, the Appraisal mentions group education as being a principle, but also states ‘unless group work is considered unsuitable for an individual’ (p 4) and that ‘the aim of education for people with diabetes is to improve their knowledge and skills, enabling them to take control over their own condition’ (p 7). In defining structured education in this way, Diabetes UK have themselves missed an important opportunity to consider and acknowledge successful 1-1 structured education programmes, such as our own Diabetes Manual Programme.
As we’ve mentioned before, it’s rare that the Diabetes Manual Programme, a fully evidenced, educational intervention based on self-efficacy (otherwise known as confidence) principles, gets a look in, in such august reports. This needs to change, as the world has done so much since these early-cited documents were published.
Diabetes UK Briefing
Diabetes Manual Programme
Tuesday, 19 May 2015
Got diabetes? Welcome to the family
Our latest guest blog is from Joe Griffiths, on how finding the diabetes online community changed his life - and work!
I went 10 years before I started to look for outside help with my diabetes. Whilst I would keep my doctors and specialist nurses in the loop with how things were going sugar-wise, I kept the emotional side of things close to my chest. This was a mistake. Without realising, I was living with my diabetes like it was an embarrassing little brother. The kind you don’t want to bring to the party but feel like you have to because someone needs to look after him. He’ll pull on your arm when he needs attention or make a huff if you haven’t introduced him yet. He’s basically a needy little douche bag.
However, one day I randomly decided to take it upon myself to do some googling about online help for diabetes. What Google spat back at me was way more than I had anticipated. It wasn’t just the regular government supported sites taking up the first 10 spaces, instead there were links to blogs and online magazines. Unbeknown to me, there’s a whole community out there.
I immediately took to Twitter and searched for diabetes. Once again I found myself doing my best impression of a deer in headlights. I literally couldn’t believe my eyes! People were actually talking loud and proud about their diabetes, even mentioning it in their Twitter profiles. Once I had gotten over the initial shock, I began my own transformation…
In the space of a few weeks, I had more than doubled my Twitter follows and followers; connecting with my fellow pancreatically challenged brethren. I was instantly welcomed by several members of DOC (diabetic online community), introduced to different hashtags and tweet chats to help connect with others. Feeling like a member of an elite group; I even added ‘type 1 diabetic’ into my own Twitter profile!
After feeing inspired, I wanted to get it all off my chest. I put forward the idea of writing an article on diabetes, to my boss. As the lone diabetic at our company, Voucher Codes Pro, I’ve been at the butt of every sugar-based joke. It was time to clear a few things up about my condition and roll out some banter of my own...
The result?
One of the best pieces of content I had ever written. By injecting my own sense of humour, experiences and thoughts on diabetes, I had created a mammoth blog-type post on the dreaded D. I wanted to highlight how brilliant the DOC is and help educate those who may be newly diagnosed or completely clueless. By the time I had finished, it felt like a huge weight had been lifted from my shoulders. I was interacting with people who understood what I’d been going through the last 10 years, making them laugh while doing so.
The online community is fantastic. If you can take anything away from this, just give it a go and embrace your diabetes rather than seeing it as a curse (or an annoying younger sibling who you’re forced to take everywhere). I personally feel like a better person since having to take more responsibility for my well-being and I plan on continuing to improve myself well into the future.
We’re all in this together.
See Joe's website here
Tweet Joe @VCP_Joe
I went 10 years before I started to look for outside help with my diabetes. Whilst I would keep my doctors and specialist nurses in the loop with how things were going sugar-wise, I kept the emotional side of things close to my chest. This was a mistake. Without realising, I was living with my diabetes like it was an embarrassing little brother. The kind you don’t want to bring to the party but feel like you have to because someone needs to look after him. He’ll pull on your arm when he needs attention or make a huff if you haven’t introduced him yet. He’s basically a needy little douche bag.
However, one day I randomly decided to take it upon myself to do some googling about online help for diabetes. What Google spat back at me was way more than I had anticipated. It wasn’t just the regular government supported sites taking up the first 10 spaces, instead there were links to blogs and online magazines. Unbeknown to me, there’s a whole community out there.
I immediately took to Twitter and searched for diabetes. Once again I found myself doing my best impression of a deer in headlights. I literally couldn’t believe my eyes! People were actually talking loud and proud about their diabetes, even mentioning it in their Twitter profiles. Once I had gotten over the initial shock, I began my own transformation…
In the space of a few weeks, I had more than doubled my Twitter follows and followers; connecting with my fellow pancreatically challenged brethren. I was instantly welcomed by several members of DOC (diabetic online community), introduced to different hashtags and tweet chats to help connect with others. Feeling like a member of an elite group; I even added ‘type 1 diabetic’ into my own Twitter profile!
After feeing inspired, I wanted to get it all off my chest. I put forward the idea of writing an article on diabetes, to my boss. As the lone diabetic at our company, Voucher Codes Pro, I’ve been at the butt of every sugar-based joke. It was time to clear a few things up about my condition and roll out some banter of my own...
The result?
One of the best pieces of content I had ever written. By injecting my own sense of humour, experiences and thoughts on diabetes, I had created a mammoth blog-type post on the dreaded D. I wanted to highlight how brilliant the DOC is and help educate those who may be newly diagnosed or completely clueless. By the time I had finished, it felt like a huge weight had been lifted from my shoulders. I was interacting with people who understood what I’d been going through the last 10 years, making them laugh while doing so.
The online community is fantastic. If you can take anything away from this, just give it a go and embrace your diabetes rather than seeing it as a curse (or an annoying younger sibling who you’re forced to take everywhere). I personally feel like a better person since having to take more responsibility for my well-being and I plan on continuing to improve myself well into the future.
We’re all in this together.
See Joe's website here
Tweet Joe @VCP_Joe
Monday, 27 April 2015
Listening to a Diabetes Diet – Food for Thought?
Radio 4’s ‘Food Programme’ focused yesterday on diabetes and food. A very welcome focus, stimulated in part, says the blurb, by the large number of people diagnosed with diabetes, contacting Diabetes UK to ask ‘what can I eat?’
The programme brought together an impressive line up of experts to discuss the answer to this question, including representatives from Diabetes UK, a media doctor whose own son has Type 1 diabetes, a specialist dietitian and a radio presenter with longstanding Type 1 diabetes. Together they were able to explain what diabetes is, how common is Type 2 diabetes and gave some good messages about what a healthy ‘diet’ consists of, including ways that less healthy options can be improved (with, generally, extra vegetables added). Particularly welcome was the news that Boots and Thorntons are phasing out their ‘diabetic’ food ranges and the emphasis by Diabetes UK on trying to get away from the idea of ‘a diabetic diet’
Although the focus was on food, as ever from an SD point of view, the most interesting aspects were the personal stories alluded to by those there to discuss actually living with diabetes. The media doctor described the challenges of helping a young child learn to live with daily injections and how even as a doctor, the emotional burden was the same as any parent would experience. He sounded clearly very proud of his now grown up son, (who has in turn become a GP) and relieved that he is living a very healthy life, something that will have resonated loudly with many parents of young children, and perhaps given them some consolation
JP, the radio presenter with Type 1 diabetes, described a huge family history of diabetes, much of it also Type 1. Even so, upon his own diagnosis, it had come as something of a shock to him what a juggling act it really was to live with this condition. He wasn’t so keen on eating out, he said, because historically it hadn’t been so easy to match his insulin timings to the food arriving. Even though times had changed, he still tended to follow what he’d been taught at the beginning, for example, eating as little sugar as possible
An item towards the start of the programme focused on someone newly diagnosed with Type 2 diabetes who in a relatively short interview, was able to reveal a range of concerns about having diabetes. This included finding unexpected amounts of sugar ‘lurking’ everywhere, for example, in tonic water, but more poignantly, the worries about passing on poor health to her sons and not wishing to ‘be a burden’ if she developed complications.
None of the personal aspects and emotional effects of living with diabetes were meant to be part of this programme, but they ‘leaked out’ anyway. Perhaps this is because food itself is an emotional issue for many people or perhaps, whatever the official topic under discussion, these are the aspects that matter most, as living with diabetes is so intricately bound within family and social relationships and our very identity. A programme putting this centre-stage would be a recipe for a very tasty listen.
BBC Radio 4: The Food Programme. 26.4.15
The programme brought together an impressive line up of experts to discuss the answer to this question, including representatives from Diabetes UK, a media doctor whose own son has Type 1 diabetes, a specialist dietitian and a radio presenter with longstanding Type 1 diabetes. Together they were able to explain what diabetes is, how common is Type 2 diabetes and gave some good messages about what a healthy ‘diet’ consists of, including ways that less healthy options can be improved (with, generally, extra vegetables added). Particularly welcome was the news that Boots and Thorntons are phasing out their ‘diabetic’ food ranges and the emphasis by Diabetes UK on trying to get away from the idea of ‘a diabetic diet’
Although the focus was on food, as ever from an SD point of view, the most interesting aspects were the personal stories alluded to by those there to discuss actually living with diabetes. The media doctor described the challenges of helping a young child learn to live with daily injections and how even as a doctor, the emotional burden was the same as any parent would experience. He sounded clearly very proud of his now grown up son, (who has in turn become a GP) and relieved that he is living a very healthy life, something that will have resonated loudly with many parents of young children, and perhaps given them some consolation
JP, the radio presenter with Type 1 diabetes, described a huge family history of diabetes, much of it also Type 1. Even so, upon his own diagnosis, it had come as something of a shock to him what a juggling act it really was to live with this condition. He wasn’t so keen on eating out, he said, because historically it hadn’t been so easy to match his insulin timings to the food arriving. Even though times had changed, he still tended to follow what he’d been taught at the beginning, for example, eating as little sugar as possible
An item towards the start of the programme focused on someone newly diagnosed with Type 2 diabetes who in a relatively short interview, was able to reveal a range of concerns about having diabetes. This included finding unexpected amounts of sugar ‘lurking’ everywhere, for example, in tonic water, but more poignantly, the worries about passing on poor health to her sons and not wishing to ‘be a burden’ if she developed complications.
None of the personal aspects and emotional effects of living with diabetes were meant to be part of this programme, but they ‘leaked out’ anyway. Perhaps this is because food itself is an emotional issue for many people or perhaps, whatever the official topic under discussion, these are the aspects that matter most, as living with diabetes is so intricately bound within family and social relationships and our very identity. A programme putting this centre-stage would be a recipe for a very tasty listen.
BBC Radio 4: The Food Programme. 26.4.15
Monday, 13 April 2015
A suitable image for diabetes?
The news today carries an item about imagery for mental illness, with the organisation ‘Time to Change’ advocating a new way to portray those experiencing mental health issues, distress and despair. They suggest more neutral, supportive pictures, rather than the traditional ‘head in hands’ approach.
Being in total support of this, it made us think of the imagery that is used for portraying diabetes. Back in 2008, when Successful Diabetes was launched, we searched for a logo to show what our company aimed to achieve. You can see the finished article on our blog here, and also on our website. We’ve (thankfully) had many compliments over the years, especially in the vein of ‘it is so different to show diabetes as success story, it’s so often one of failure’.
But the logo wasn’t like this to start with. When we gave our name and ideas to the people designing the logo, the first suggestions focused on diabetes, complete with syringes, needles, finger pricks, plasters and doctors with stethoscopes round their necks. The ‘successful’ part of our name was pretty much ignored. After we gently pointed out that we didn’t want to focus on the medical, each new draft gradually featured such images less and less until, finally, there were none – which is just the way we like it!
Reflecting on this experience, it seems to show how ‘hardwired’ the images representing diabetes, seemed to be then. In turn, this made us wonder what images are tending being used to ‘show diabetes’ today. So, we had a (very unscientific) ‘straw poll’ of a few websites, and here is what we found:
Rather pleasingly, it looks like things have changed: even on the most ‘diabetes’ of websites (mentioning no names of course!), the images of people, whether living with diabetes or health professionals are really positive and realistic, with not a stethoscope in sight! Families are shown doing everyday activities, to represent coping with diabetes in the mix, happy groups of people on holidays seem to show that it is possible to enjoy life as well as having diabetes. There’s even a picture of people smiling, under the heading ‘hypos and how to cope with them’!!
A couple of aspects were noticeable, however. It seems that where research is discussed, there’s a universal tendency towards pictures of test tubes and white coated scientists with goggles on. Perhaps this stereotype hasn’t quite been attended to yet? and images of food, either under the banner of healthy or unhealthy, quite often feature a large burger and fries! This seems to be an extremely enduring, and all-purpose, image – we wondered if continuing to use it does more harm than good, but that is probably a blog for another day!
One website does deserve a mention because it seemed to use imagery consistently neutrally and successfully throughout. The International Diabetes Federation has a series of outline figures in different poses which give some really clear messages without any assumptions, and also showing that imagery can be made understandable in whichever language the website is accessed in.
What’s your image of diabetes? do you prefer the medical or the personal? The detailed or the vague? Do put us in the picture below!
Reference
Hawkins, K. Mental health and the death of the ‘headclutcher’ picture. ‘Ouch’ blog, 13.4.15
Being in total support of this, it made us think of the imagery that is used for portraying diabetes. Back in 2008, when Successful Diabetes was launched, we searched for a logo to show what our company aimed to achieve. You can see the finished article on our blog here, and also on our website. We’ve (thankfully) had many compliments over the years, especially in the vein of ‘it is so different to show diabetes as success story, it’s so often one of failure’.
But the logo wasn’t like this to start with. When we gave our name and ideas to the people designing the logo, the first suggestions focused on diabetes, complete with syringes, needles, finger pricks, plasters and doctors with stethoscopes round their necks. The ‘successful’ part of our name was pretty much ignored. After we gently pointed out that we didn’t want to focus on the medical, each new draft gradually featured such images less and less until, finally, there were none – which is just the way we like it!
Reflecting on this experience, it seems to show how ‘hardwired’ the images representing diabetes, seemed to be then. In turn, this made us wonder what images are tending being used to ‘show diabetes’ today. So, we had a (very unscientific) ‘straw poll’ of a few websites, and here is what we found:
Rather pleasingly, it looks like things have changed: even on the most ‘diabetes’ of websites (mentioning no names of course!), the images of people, whether living with diabetes or health professionals are really positive and realistic, with not a stethoscope in sight! Families are shown doing everyday activities, to represent coping with diabetes in the mix, happy groups of people on holidays seem to show that it is possible to enjoy life as well as having diabetes. There’s even a picture of people smiling, under the heading ‘hypos and how to cope with them’!!
A couple of aspects were noticeable, however. It seems that where research is discussed, there’s a universal tendency towards pictures of test tubes and white coated scientists with goggles on. Perhaps this stereotype hasn’t quite been attended to yet? and images of food, either under the banner of healthy or unhealthy, quite often feature a large burger and fries! This seems to be an extremely enduring, and all-purpose, image – we wondered if continuing to use it does more harm than good, but that is probably a blog for another day!
One website does deserve a mention because it seemed to use imagery consistently neutrally and successfully throughout. The International Diabetes Federation has a series of outline figures in different poses which give some really clear messages without any assumptions, and also showing that imagery can be made understandable in whichever language the website is accessed in.
What’s your image of diabetes? do you prefer the medical or the personal? The detailed or the vague? Do put us in the picture below!
Reference
Hawkins, K. Mental health and the death of the ‘headclutcher’ picture. ‘Ouch’ blog, 13.4.15
Monday, 30 March 2015
Is coming 4th out of 10 good enough for diabetes?
Late last week, NHS England published its business plan for 2015/16. It includes 10 priorities, of which ‘tackling obesity and preventing diabetes’ comes 4th, after improving, upgrading and transforming care for, respectively, cancer treatment, mental health & dementia and learning disabilities. It’s ahead, in the list of priorities, of urgent and emergency care, primary care, elective care, specialized care, whole systems care and foundations for improvement.
Of course, the list isn’t really about priorities of decreasing importance, all of these issues are of equal importance and will, we hope, receive equal attention, not to mention equal share of the some £2bn budget. Having a list of 10 makes it easier for people, including presumably NHS England staff and politicians themselves, to read and remember. It’s unarguable that all these issues need to be acted upon and also that system change is badly needed to address the early 21st century health ‘state of the art’. On that note, the business plan is to be welcomed and being 4th doesn’t mean losing out.
The targets for ‘tackling obesity and preventing diabetes', focuses on Type 2 diabetes (a detail unfortunately left out of the title) are ambitious for a year’s work. By March 2016, a prevention programme will be ‘available’ for 10,000 people at risk of Type 2 diabetes. NHS England will be working with Diabetes UK and Public Health England to develop the programme and roll it out, partly via the NHS Health Checks system. The plans are to ‘enroll’ people identified onto a lifestyle management programme to address their ‘smoking, alcohol intake, nutrition and physical activity’. The latter also applies to plans in priority 4 to also encourage these factors to be addressed by NHS staff themselves. It’s not clear if the latter will be among the 10,000 initial 'enrollees' or if there is to be a separate programme for healthcare staff.
While the forthcoming programme sounds admirable, we have a concern, based on the old saying ‘you can take a horse to water, but you cannot make it drink’. That is, it is one thing to ‘refer’ or ‘enroll’ people onto a lifestyle programme, but quite another to ensure attendance or participation. These the only things that are likely to make a difference to the health of the 10,000 souls to be identified. So, in the spirit of ‘4s’, we hope that the prevention programme in development includes this ‘top 4’ of evidence-based, vital components for success in encouraging lifestyle change:
1. ‘Invite’, ‘encourage’ or ‘welcome’ people to take part, rather than ‘refer', ‘enroll’, ‘send’ or any other paternalistic term that removes any suggestion of free choice
2. Focus on success and the future in interactive and participatory, enjoyable activities
3. Scrutinise the programme for, and remove any evidence of, judgement, tellings off, compliance-orientation, school or classroom-like environments
4. Prize autonomy, choice and personal decision-making
As we have said before, we wish this programme well and sincerely hope that this time next year, despite the election and our reservations, our blog will be trumpeting the success and ongoing delivery of type 2 diabetes prevention.
Reference
NHS England Business Plan
Of course, the list isn’t really about priorities of decreasing importance, all of these issues are of equal importance and will, we hope, receive equal attention, not to mention equal share of the some £2bn budget. Having a list of 10 makes it easier for people, including presumably NHS England staff and politicians themselves, to read and remember. It’s unarguable that all these issues need to be acted upon and also that system change is badly needed to address the early 21st century health ‘state of the art’. On that note, the business plan is to be welcomed and being 4th doesn’t mean losing out.
The targets for ‘tackling obesity and preventing diabetes', focuses on Type 2 diabetes (a detail unfortunately left out of the title) are ambitious for a year’s work. By March 2016, a prevention programme will be ‘available’ for 10,000 people at risk of Type 2 diabetes. NHS England will be working with Diabetes UK and Public Health England to develop the programme and roll it out, partly via the NHS Health Checks system. The plans are to ‘enroll’ people identified onto a lifestyle management programme to address their ‘smoking, alcohol intake, nutrition and physical activity’. The latter also applies to plans in priority 4 to also encourage these factors to be addressed by NHS staff themselves. It’s not clear if the latter will be among the 10,000 initial 'enrollees' or if there is to be a separate programme for healthcare staff.
While the forthcoming programme sounds admirable, we have a concern, based on the old saying ‘you can take a horse to water, but you cannot make it drink’. That is, it is one thing to ‘refer’ or ‘enroll’ people onto a lifestyle programme, but quite another to ensure attendance or participation. These the only things that are likely to make a difference to the health of the 10,000 souls to be identified. So, in the spirit of ‘4s’, we hope that the prevention programme in development includes this ‘top 4’ of evidence-based, vital components for success in encouraging lifestyle change:
1. ‘Invite’, ‘encourage’ or ‘welcome’ people to take part, rather than ‘refer', ‘enroll’, ‘send’ or any other paternalistic term that removes any suggestion of free choice
2. Focus on success and the future in interactive and participatory, enjoyable activities
3. Scrutinise the programme for, and remove any evidence of, judgement, tellings off, compliance-orientation, school or classroom-like environments
4. Prize autonomy, choice and personal decision-making
As we have said before, we wish this programme well and sincerely hope that this time next year, despite the election and our reservations, our blog will be trumpeting the success and ongoing delivery of type 2 diabetes prevention.
Reference
NHS England Business Plan
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