Tackling diabetes and creating a healthy place

Diabetes is a key priority for the Merton Partnership's Health and Wellbeing Board. A new Health and Wellbeing Strategy has been launched, including a focus on tackling diabetes. We're proud of the work done so far with our whole systems approach and the Diabetes Truth Programme, but it is important to maintain momentum, by developing:

• Clinical oversight and service improvement
• Holistic individual care
• Healthy places.

Time for action

Around 6% (11,160) of adults registered with a Merton GP have been diagnosed with diabetes, while a further 2% (2,585) are though to be undiagnosed, and 11% (18,450) are 'pre-diabetic', with an increased risk of developing Type 2 diabetes.

We take a life-course approach to tackling diabetes and it is worrying that nearly 35% of Year 6 pupils in Merton are overweight. In the East of the borough this figures rises to 40% and compares to just over 26% in the West.

Merton Health and Wellbeing Board takes a 'whole system approach' to tackling diabetes, across the life course, developing holistic care hand in hand with creating a healthy place. Both involve a strong focus on understanding what most matters to local people and actively engaging all partners across Merton.

What happens if we do nothing?

If nothing changes, it is estimated the number of people with diabetes in Merton will rise by 5,000 to more than 18,000 people or 9% of the borough's population during the next 10 years.

Diabetes currently consumes around 10% of the overall NHS budget, and this is also projected to rise.

What would success mean?

Our innovative Tackling Diabetes Action Plan aims to create a healthy place where clinical services and prevention work effectively together to provide truly holistic care. Partners will work proactively to address wider issues, including mental health and healthy environments, and collaboratively to ensure real community ownership.

You told us

The Diabetes Truth Programme involved every member of the Health and Wellbeing Board 'buddying up' with a Merton resident who had a lived experience of diabetes. Through a series of one-to-one conversations, we gained an insight into the life and challenges that people at risk of, living with or caring for someone with diabetes face on a daily basis. Issues raised included:

• Type 1 diabetes is really different to Type 2 and this needs to be clear.
• Diabetes is not just a physical illness – it also requires mental health resilience and support.
• Food choices are often influenced by environmental factors.
• There is plenty of information but we need to make better connections between those who produce the information and those who need to use it.
• Physical activity is important to help prevent and manage Type 2 diabetes. We need to promote our assets, including parks and open spaces.
• Peer and community support has a huge role to play.
• Pressures relating to lifestyle, working hours and lack of sleep mean that just knowing the causes and risks of diabetes is not enough to change behaviour. Instead, healthier choices need to become easier choices.

Further work with young people in our Children and Young People's survey 2018 also identified issues making it harder for them to lead healthy lives in their area as:

• Too many fast food outlets (52%)
• Too much advertising of unhealthy food (52%)
• The cost of healthy food and drink (54%)

This insight helped us identify the most important areas to focus on and played a part in shaping the Tackling Diabetes Action Plan.

We aim to

The Tackling Diabetes Action Plan has some actions that when delivered together are expected to have the most impact in Merton. Good progress has been seen with key highlights including:

• A number of new services, including those for key communities e.g. Tamil and African Caribbean communities.
• An increase in people taking part in the National Diabetes Prevention Programme, with Merton having the highest number of first appointments (285) across South London in 2019.
• A council-backed revised advertising policy to introduce restrictions on unhealthy food and drink.
• Development of the Merton schools super zone SNAP (Schools Neighbourhood Approach Pilot) which aims to improve the physical environment around school sites to support health and wellbeing.

What can I do?

• Support World Diabetes Day and the #MertonCan physical activity campaign.
• Employers can support colleagues with diabetes. Find out more at 'Think diabetes in the Workplace.
• Support Sugar Smart Merton by signing up to our Fizz Free campaigns and using the #GoFizzFree hashtag on Twitter.
• Become more active by trying 20 in 2020. Find out more at Merton Can.

Spotlight on...

Social Prescribing

It's estimated that 20% of people who visit their GP have a non-medical problem – be it bereavement, isolation or unemployment.

Instead of a traditional prescription, they might need to meet others, learn new skills, try different activities, make a few lifestyle changes or simply get out and about more often to improve their health and wellbeing.

Now adult patients across Merton can be referred by their GP to a Social Prescribing Coordinator, who will help them access non-medical options that can work alongside existing treatments to help them feel better faster as well as making life more enjoyable.

Ray Hautot is Merton Social Prescribing Team Lead and he explained:

 "There are lots of community services in Merton that people can access which will benefit their health, but patients often don't know what's out there, and we are here to help."

After an appointment with a Social Prescribing Coordinator, some of the community services people have been informed about or referred to have included:

• Support groups (e.g., diabetes)
• Where to get benefits advice
• Budgeting
• Befriending
• Bereavement support
• Employability support programmes
• Exercise sessions
• Health walks
• Informal carers support
• Social activities
• Transport (e.g., dial-a-ride)
• Volunteering.

Ray said: "Some of the patients are pre-diabetic and while we are not medical professionals, we will talk about diet and activity levels."

Following the initial appointment, patients will have two further follow-up sessions with their Social Prescribing Coordinator to chat about how things are improving and their progress will be measured.

Ray added: "Once people start seeing an improvement for themselves, they are usually motivated to carry on with the changes. I've seen patients make significant improvements, with some losing weight which helps their overall health.
Three quarters of the patients seen by Social Prescribing Coordinators reported better health and wellbeing. As well as patient benefits, the service has seen a reduction of GP appointments by 33% and a reduction in A&E attendance by 50%.
One patient said: "I knew I should exercise more, but it's hard to motivate yourself on your own and I hate the gym. The Social Prescribing Coordinator gave me information on health walks and a friendly beginners' running club. I am finding it easier to get motivated."

Merton's Social Prescribing Service is a project of Merton Voluntary Service Council working in partnership with the Merton Clinical Commissioning Group, Merton Council, Merton GP practices and the voluntary and community sector.

The Diabetes Truth Programme

The Diabetes Truth Programme, launched in April 2019 by the Merton Health and Wellbeing Board, is a new approach to working with the community to help tackle the growing problem of diabetes.
This involved each Board member being paired up – or "buddied" - with a Merton resident living with, at risk of, or caring for, someone with Type 1 or Type 2 diabetes. Each Board member met their buddy over the following three months for a series of one-to-one conversations.

Fred Springer, who had been at risk of Type 2 diabetes, buddied with Merton Council's Director of Community and Housing, Hannah Doody. What emerged was a real insight into the challenges that people living with diabetes face on a daily basis.

Evidence from the Diabetes Truth Programme then helped shape Merton's Tackling Diabetes Action Plan. Fred and other Diabetes Truth volunteers also shared their experience of living with diabetes when they helped launch the Action Plan.

Fred, a 79-year-old retired welding engineering lecturer who lives in Morden, had discovered he was pre-diabetic, despite feeling he was in "pretty good health" and playing regular cricket for Surrey Seniors.

Here's his story in his own words…

"I attended my doctor's surgery at Central Road Medical Centre to get my usual yearly over 70s check-up - as I call it, Human Medical Overall Test (MOT). When I went back for my results, the doctor told me I was in good health, but my glucose blood count was a bit high and close to diabetic level.

"The doctor suggested I go to the Pre-Diabetic Programme, which is 26 classes spread over weeks, held at Wimbledon YMCA. I am pleased this course was offered, and I found it to be very useful and informative. I'm grateful for what I learnt about diabetes.

"Many on the course made improvements, and it spurs you on when the doctor says are out of the 'Red Zone'. The lifestyle changes and adjustments I had to make were not that great at all. Firstly I observed that the time of my blood test was in the 'off' cricket season. In that period I slack off from physical exercise and was more likely to put on weight, and that was exactly what took place.

"I later found out my Dad had diabetes and my second older brother was pre-diabetic too. I was also very surprised to hear when, talking to other family members and friends, how many of them had known people who had been diabetic.

"I had genuinely thought beforehand that only unwell, obese, and unfit people suffered from diabetes - how wrong I was! I was shocked to then discover how common this condition was – and it is worldwide."

He also said he appreciated the chance to have his voice heard through the Diabetes Truth programme, and was pleased to see action being taken on what he and others taking part had said. Here are Fred's tips:

"I set myself constructive, achievable, exercise targets

"Good balanced diets are the key for me in keeping blood count down and – especially for me - being active, playing cricket and occasionally table tennis.

"Regular walks - making sure I dress warmly, and have worked a good sweat - you feel so much better with your body.

"Most of our food comes from shops and supermarkets, these are well packed and labelled, including colour-coded and measured potions. We can read the calorie count, volume, weight and the ingredients for ourselves."

For more information see Merton Can.