Doing diabetes differently with integrated psychological therapy Milton Keynes Hospital NHS Foundation Trust

Milton Keynes Hospital NHS Foundation Trust made brief psychotherapeutic interventions an integrated part of diabetes treatment, to aid treatment adherence among patients of all ages. The team introduced psychological screening questionnaires into routine clinic appointments and consultants chose which patients to refer for brief solution-focused psychological therapy.

The psychological therapies service was provided by a small social enterprise which was established as part of the project and integrated with the hospital team. The project tested a new model of outcome-based contracting using a ‘social impact bond’, an innovative contract between commissioners and providers which meant that the trust paid for psychological therapy services in arrears, with payments based on results.

Who was involved

The project was based in Milton Keynes Hospital NHS Foundation Trust and was managed and evaluated by clinical psychology company LifePsychol Ltd along with social enterprise Evolving Families. Diabetes treatment was led by a consultant endocrinologist.

Outcomes

• Before therapy, 64% of adult participants and 33% of child participants were suffering from clinically significant symptoms of depression. Following therapy, this halved to 30% of adults and 17% of children.
• Significant reductions in suicidal and self-harm ideation.
• Reductions in follow-up appointments, A&E attendance and emergency inpatient admissions.
• The intervention produced a net saving of £218 per adult and £187 per child.

Challenges

The intervention did not produce significant change in patients’ glycaemic control. The team felt that more time could be needed for these changes to be seen. For example, the intervention enabled some adult patients to begin regular blood glucose testing, so changes in blood glucose levels would not be seen immediately.

Supporting dissemination

This project has been given further support through a Spreading Improvement award to help disseminate learning and maximise the impact of the approach across the health service at a local, regional or national level.

Funding will be used to host an event to highlight the achievements of the original project, and to promote the need for ongoing psychological support services to local and regional health care providers, professionals, commissioners and service users. A video about learning from the project will also be produced.