NHD clinical - - diabetes in Hackney
by Loretta Cox Loretta Cox has worked as a Diabetes Specialist Dietitian for 16
Diabetes Specialist Dietitian
years, both in Manchester and in East London. Loretta is particularly
Hackney Diabetes Centre
interested in promoting patients’ self-management skills through
Homerton University Hospital
structured education.
Diabetes in Hackney: a growing challenge for a growing team
In common with the rest of the UK, diabetes rates in Hackney are increasing. There are 10,428 patients on the local
Diabetes Register (at May 2009) and with a total population in the borough of 209,656, this equates to a five percent
prevalence of diabetes in Hackney. With 293 new cases added to the Register in the four months June -September 2009 (an
increase of 2.8 percent in this period alone), there seems to have been an exponential rise in the condition recently. This is
the growing challenge that the local Diabetes Service is striving to meet.
A brief description of Hackney
In 2004, the London Borough of Hackney
in East London was ranked as the most socio-
economically deprived borough in England,
ahead of Tower Hamlets (Hackney’s neigh-
bouring borough in East London) ranked
second most deprived and Manchester (3rd),
Islington (4th) and Liverpool (5th). The rank-
ings are based on seven Indices of Depriva-
tion: income; employment; health deprivation
and disability; education, skills and training;
housing; crime; and living environment.
In 2007, the unemployment rate in Hack-
ney was 7.9%, compared with 4.1% for the
whole of London and 3.2% for England.
Hackney has a culturally diverse popula-
tion, the largest minority ethnic groups being
from the Caribbean, Turkish, African, Asian
and Orthodox Jewish communities. Around
100 languages are spoken in the borough,
with many households having languages
other than English as their first language at
average glycosylated haemoglobin (HbA1c) (a Principal Diabetes Dietitian and five DSDs)
home. Predominant among these are: Turk-
test results for the diabetes population as a all work in both Secondary and Primary Care.
ish (in 5.5% of households); Yiddish (5.2%);
measure of diabetes control, the QOF data As well as the DSNs and DSDs, there are
French (including French-speaking African
for Hackney GPs indicate that unfortunately, three Diabetes Lay Educators in the Team,
households); Gujarati; Bengali; and Yoruba.
Hackney patients have been doing the least some new posts having been created in the
Such a diverse population has a greater bur-
well in the national rankings since 2004. This 2008 expansion. In addition, there are close
den of diabetes, with the known higher prev-
situation required some action to be taken. links with the Specialist Podiatry Team based
alence of the condition in Caribbean, African
in the Primary Care Centre in Hackney and
and South Asian communities. Improving diabetes outcomes in Hackney
some Clinical Psychology input at the Hack-
In line with national guidance adopted in In order to improve the poor diabetes
ney Diabetes Centre.
London (1), diabetes services in Hackney outcomes, the Hackney Primary Care Trust
are increasingly being provided by Primary (PCT) decided in 2007 to invest more re- Primary and Secondary Care
Care. The majority of people with diabetes in sources in the local Diabetes Service, in par- Hackney Diabetes Centre, located in
the borough receive almost all of their care ticular to support the service in Primary Care, Homerton University Hospital, provides a
from their GP. There are 45 GP practices in as well as offering more patient education. base for all members of the Hackney Diabe-
Hackney, whose Diabetes Registers range When I joined the Hackney Diabetes Team tes Team, although the Team works both in
from around 100 patients in the smaller in 1996, it comprised just three Diabetes the hospital and in the community. The Dia-
practices, to 475 patients on the largest GP Specialist Nurses (DSNs) and two Diabetes betes Team has thus taken on the character-
Register. The role of the Secondary Care Specialist Dietitians (DSDs). With the PCT’s istics of an intermediate diabetes team, as
Diabetes team has increasingly come to recent investment, there has been a signifi- outlined in the Healthcare for London docu-
support all the local GP practice teams in cant expansion in the number of posts since ment, Diabetes Guide for London (1), which
delivering the very best diabetes care with 2008 and the Diabetes Team has grown to its states that, ‘Every PCT should have an in-
support from the Specialist team. current size of 14 DSNs and six DSDs. The termediate diabetes team to facilitate and
This change has been driven forward by DSN team comprises a Lead Nurse for Dia- support primary care, ensure co-ordinated
the poor outcomes for diabetes in Hackney betes, a Consultant Nurse for Diabetes, two community services and aid integration with
in recent years, as noted in the Quality and Secondary Care DSNs (exclusively hospital- secondary care.’ The fact that there is just
Outcomes Framework (QOF) data (2) that based) and 10 Community DSNs (new posts one team providing diabetes services across
all GP practices submit annually. Using the created in 2008). The Diabetes Dietetic Team both Primary and Secondary Care sectors,
18 NHDmag.com Mar '10 - issue 52
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