Vanessa Whitehead Glynis Feerick Barbara Johnson

 Perceived ‘obsession’ with HbA1c  Perceived pointless of clinic  Going through the motions with staff members by telling them what they want to hear  Education would be just like school  Education will tell them what they should be doing instead of helping them incorporate diabetes into their lives

 John is two weeks off sixteen at adult clinic ◦ diagnosed with Type 1 diabetes since 7 ◦ MDI, hbA1c is steadily rising, hates his diabetes ◦ Fairly disengaged, dad brings him to clinic but doesn’t come in to consultation ◦ John doesn’t say much when in the consultation ◦ Admitted in DKA recently – mom visited ◦ John and stepdad rock climb together ◦ Spends a lot of time with his girlfriend and friendly with her parents ◦ College tutor wants to speak to someone as there have been some worrying events

1 – College tutor 2 – Parents (3) 3 – DSN/educator/diabetes staff 4 – Girlfriend (and perhaps her family)

“ Each provider unit can provide evidence that each patient has received a structured education programme, tailored to the child or young person’s and their family’s needs, both at the time of initial diagnosis and ongoing updates throughout the child or young person’s attendance at the paediatric diabetes clinic” “Each provider unit must have a clear policy for transition to adult services. “

 On diagnosis – seen by a senior member of paediatric diabetes team within 24 hours  Each pt is offered a min of 4 apts (and hbA1c) a year with the MDT ie DSN, dietitan, doctor  The doctor/dietitian should have training in paediatric diabetes  A min of 8 additional contacts a year ( check ups, telephone contacts, school visits, e- mails, trouble shooting, advice, support etc)  Annual screening offered (NICE recs) and consider if psychological input is needed

 Participate in the annual Paediatric National Diabetes Audit.  Actively participate in the local Paediatric Diabetes Network. 60% attendance at regional network meetings needs to be demonstrated.  Must provide patients and their families/fellow health professionals with 24 hour access to advice on diabetes  Have a clear escalation policy as to when further advice on managing diabetes emergencies should be sought.  Each unit has a structured ‘high HbA1C’ policy, a clearly defined DNA/was not brought policy taking into account local safeguarding children board (LSB) policies and evidence of patient feedback on the service.