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How we did it

The multi-disciplinary team at Warrington and Halton Teaching Hospitals NHS Foundation Trust developed a proposal requesting funding from the Diabetes Health Inequalities Programme funding (DHIP) for a youth worker, which was submitted to Northwest Coast Diabetes Clinical Network. As a result, a youth worker was employed by the Trust in June 2021. The project aimed to demonstrate and evidence the effectiveness of employing a youth worker to thereby obtain recurrent youth worker funding for the service.

Youth worker participation in Paediatric Diabetes is shown to contribute to enhancing the care and experience of young people with diabetes. Employing a youth worker as a part of a diabetes MDT helps in treating young people with respect and promote voice of young people. The annual NPDA data showed 41% of children and young people in Warrington and Halton with diabetes live in either most deprived or second most deprived areas. Research highlights that diabetes patients living in deprived areas have poorer short and long-term health outcomes. We hired a youth worker at Warrington and Halton in order to help mitigate this risk. 

Objective of the project

To assess the impact of a youth worker on diabetes care in children and young people (CYP) with type 1 diabetes over a 12-month period.

What did the youth worker do?

Our youth worker led a wide range of appropriate recreational activities for young people aged 11-18 years living with diabetes. The youth worker initially worked on improving the clinic environment for young people, establishing a stimulating and friendly atmosphere. Following this, the youth worker conducted relevant workshops in the community and engaged CYP in activities and sessions as follows:

• Received a wide range of resources with the support of the hospital charity to complete engaging activities with the patients.
• Attended Next Steps Training with CAMHS to provide mental health support to patients.
• Carried out online cooking sessions with young people for healthy eating and positive relationships.
• Hosted a Halloween party in which 10 young people and their families attended.
• Introduced a Youth Buddy Champion system which is now underway, our buddies have been attending the group to provide support to the younger children.
• Works with local schools/colleges to support individual young people.
• Held a superhero day in clinic for 100 years of insulin celebration, to build self-confidence and self-esteem in young people.
• Created a private Facebook, Instagram, and Twitter account for young people going through transition.

Results and impact of the youth worker

• Improved confidence and reduction in anxiety of CYP.
• Demonstrated an increase in young people attempting diabetes management technology after working with the youth worker. The intervention built young people’s confidence in using the Libre sensors with ease.
• Increased number of young people engaging with the service resulting in improved experience and outcomes.
• Achieved 50% reduction in diabetes related admissions and DKA.
• Reduction in clinic DNA rate.
• Improved quality of life indicators in select patients and better engagement of patients in clinic.
• Improved HbA1C in 7 out of 10 targeted patients.
• The youth worker has been awarded the “Star of the Future” Award 2021 and the Paediatric Diabetes Team received silver award for the ‘Excellence in Patient Care’.

Feedback from young person:

I like the Youth Service because it makes me feel normal

How did this project address areas of inequalities across prevention, treatment, or care of diabetes?

• Building young people’s self-esteem and self-confidence and encouraging positive group atmospheres.
• Developing young people’s ability to manage personal and social relationships.
• Treating young people with respect.
• Promoting the voice of young people.
• Seeking to develop young people’s skills and attitudes. 
• Creating learning opportunities for young people to develop new skills.

What did parents and young people say?

Young people stated that since the youth worker post has been implemented in the diabetes team, they have enjoyed having someone to text about personal concerns as well as having someone who checks in on them.

Parent 1:

I honestly can’t thank the diabetes team and the Diabetes Youth Service enough for all of the support we have had throughout our daughter's diagnosis and obviously her recent Mental Health episodes. The support has been amazing, and we are so grateful. 

Parent 2:

The youth worker has been a breath of fresh air for us at a time we needed her. My daughter really responds to her. She’s taken part in the movie night and the meet up and it’s a good sense of community and belonging for her. 

Youth worker:

After attending one of our movie nights, one young person thanked me for setting up the movie night and said that she couldn’t wait to come to clinic next time so she could see me. Mum text me and said, “thank you for setting this up, the kids are loving it”. Our young person arrived at clinic on her next appointment excited to see me. 

By better connecting, listening to, and understanding young people it benefits their health outcomes, improves confidence, and encourages independence of CYP which supports their self-management of diabetes. The project demonstrated benefits of the youth worker role to our service. The youth worker supports the needs of young people, addresses health inequalities, and has helped our patients achieve better outcomes. This evidence may enable replicating the youth worker service across other hospitals in the network.

�ʼһ��� the programme

Update - The RCPCH National Diabetes Quality Programme ran for five years until March 2023.

We worked with paediatric diabetes units (PDUs) in England and Wales to improve multidisciplinary care for children and young people with diabetes in the NHS, reducing unwarranted variations and involving families in service improvement in a developmental way. 

As part of the Quality Assurance (QA) stream, all participating PDUs received a peer review. A multidisciplinary team of peers spoke with the service team, relevant colleagues, patients and families to determine compliance against the standards and to identify areas of good practice for sharing more widely and recommendations to improve outcomes.

The peer review process

The peer review workstream built on the Department of Health’s Diabetes Quality Improvement Network System.

It was the process by which professionals, including a paediatric consultant, paediatric diabetes specialist nurse, dietitian, and psychologist, and supported by members of the RCPCH Diabetes Quality Programme staff team, examine the PDU's processes, team working, governance, outcomes and engagement with patients and families.

The approach was developmental, encouraging teams to share their achievements so that good practice could be disseminated, as well as highlighting challenges so that barriers can be explored.

The peer review team

The peer review provides an opportunity for a team of peers to meet with members of the PDU, facilitating discussion and questioning with the aim of determining compliance against a series of NDQP measures, and identifying a broader set of themes concerned with the delivery of a high quality and safe service, including patient experience.

The interaction at the review and the resulting report and recommendations will provide PDU teams with the tools and evidence to plan their improvement, supplemented by the opportunity of the Quality Improvement Collaboratives within the overall programme.

The peer review team typically includes at least two clinical colleagues (doctor, nurse, dietitian, psychologist). The team is supported by a Review Manager – this may be a RCPCH staff member or an external consultant acting on behalf of the RCPCH – and additional staff members to facilitate virtual delivery.