The Big Interview – Bridget Turner
Bridget Turner is Diabetes UK’s Director of Policy, Campaigns and Improvement. She is responsible for the development of the organisation’s policy and care agenda, working closely with healthcare professionals, researchers, people living with diabetes, national policy makers and local decision makers, to influence improved care standards. Bridget was diagnosed with Type 1 diabetes in 1977.
What’s been your biggest achievement in diabetes?
Much has changed over the last 10 years in terms of diabetes care and standards of care have improved for many across the board, but still many don’t get access to the care they should. I don’t think any achievements have been down to me, but there have been, over the years, times when I have been involved in a team of others to set up new services, or bring about improvement alongside many others from the diabetes community – clinicians, researchers, policy makers and people with diabetes.
A couple of things I am proud of playing a part in. One was the work to influence the set-up of the NHS Diabetic Eye Screening Programme from 2002 onwards. Based on research showing regular screening of the eye identified problems early enough to be treated, and therefore preventing sight threatening retinopathy. I was involved in making the case, showing evidence where it can work, analysing data and getting commitment to fund it. Prior to this it was completely up to local areas to decide whether they ran a retinal screening programme and diabetes was still the leading cause of blindness. Since then the cases of blindness due to diabetes have decreased significantly and all can, and should, get their eyes screened through digital cameras.
The second is the recent publication of the Long Term Plan in England where diabetes remains as a clinical priority. While having a set of national priorities for diabetes doesn’t change or improve the care that people with diabetes receive directly, it does help to create the momentum for local delivery and improvement to happen. The work teams have done connecting with clinicians, people with diabetes and NHS England has resulted in diabetes having a specific chapter in the plan. With funding allocated to improve care standards in hospital, increase access to education and flash technology, have more trained staff in place to treat foot problems and to increase the number of places on the Type 2 Prevention Programme, for example. There is still much more to do to get these delivered in practice but it means diabetes care treatment and prevention are important priorities for the NHS to improve on.
Tell us about the beginning of your interest in quality improvement at Camden and Islington Medical Audit Advisory Group?
This was a key part of my life when I learned how important clinical audit is to driving improvement in care standards. This was a time when audit was new and up until this point the NHS didn’t really audit the care patients received on a routine basis. It was a time when many GPs were not computerised so I spent time helping teams to create registers to set up automatic call and recall systems for example. There was no such thing as national clinical audit and little data was available to monitor care.
This was a time when I worked with incredible advocates of clinical audit in primary care, including GPs, practice nurses, practice managers on projects to increase awareness and access to care in areas such as contraception, access to methadone treatment and diabetes care. A district-wide audit was established where GPs and specialist care diabetes teams worked together and local standards of care were shown to have improved. I’d like to thank two people in particular, just incase they happen to read this, Dr Peter McCartney and Dr Judith Dixon who gave me a chance in my first health job and first job in London. Without them I would never have got so involved in health, audit or diabetes.
Why, when and how did you join Diabetes UK?
I joined Diabetes UK in 1997 on a temporary maternity cover contract – or as it was then the British Diabetic Association. At the time I was working in commissioning and public health and so it was a natural move to something that was close to my heart. My first role here was as a Healthcare Delivery Officer working with clinical teams to raise awareness of diabetes care, promoting clinical audit and working with people with diabetes to create information about what care to expect to press for better standards of care – an ongoing priority that is maintained today.
What projects are you currently working on?
A big priority area of work is working with NHS England on the NHS diabetes programme – covering improvement of care and treatment of people with type 1 and type 2 diabetes and prevention of type 2 diabetes. Maintaining and strengthening relationships to deliver, monitor and challenge where priorities are being delivered locally. Much of my role here is asking questions, setting challenge, sharing examples of good practice for example– so lots of conversations and connections to others.
I am involved in overseeing the exciting work Diabetes UK does to run Leadership programmes for clinicians working in diabetes care to help give confidence to lead diabetes services locally. And I am closely involved in the campaigns to increase access to flash monitoring and improve food labelling in restaurants to display calorie and carbohydrate content – both important priorities for people with diabetes to help them manage their condition day to day. I don’t seem to spend as much time nowadays working on directly on projects, as there are people a lot better at it than me. Although one project I’m closely involved in is the development of our next five year strategy as we set our ambitions for the future.
What is your current role at Diabetes UK?
Director of Policy, Campaigns and Improvement.
Talk us through a typical day in your professional life?
My days will generally involve meetings, making connections and conversations with colleagues, policy makers or clinicians. It might involve a radio interview if there a media story has been picked up. Or chairing a presentation at an event. I spend a lot of time reviewing plans, asking questions to understand more about issues and listening to hear what opportunities or challenges are being faced by those working in diabetes care or people with diabetes receiving it. This week has involved chairing a meeting between Public Health England, the National Diabetes Audit, and NHS England and working with my team to review together key projects they are working on. Often the plans for the day go out of the window if something comes in that is unexpected, if a new national plan is launched by the NHS or MPs have a debate on a diabetes issue for example. It’s always very different, always involves conversations with different people and I love that.
As someone living with type 1 diabetes, what has been the greatest technological development to improve care you have experienced since being diagnosed with the condition in 1977?
There have been so many changes in diabetes care since I was diagnosed which is fantastic. Diabetes care now is nothing like it was then. Which was when it involved using a replaceable long needle on a glass reusable syringe and which I inserted into a metallic gun like device – to click it so the needle went into my leg. There was no such thing as blood glucose testing until the early 1980s, so it was all about urine testing, using a small test tube and a fizzy tablet which, when placed in the test tube, turned it orange, green or blue. And the test tube became really hot. And whilst there are now insulin pens, pumps and new ways of measuring blood glucose to name but a few, I think the thing that has been the greatest technological development for me was the blood glucose meter, in its many different forms. While still a pain, it has meant that it was easier to use, less fuss, and definitely less mess!
The meters that link up to insulin pumps through bluetooth has meant that I don’t have to think about the numbers so much. I can enter the carbs for what I’m eating and whether I’m stressed and, alongside the blood glucose result, the amount of insulin needed is calculated automatically. It just means less thinking about diabetes and more getting on with life.
Tell us about your GenerationQ Fellowship at The Health Foundation?
This Fellowship involved being part of a health improvement leadership programme for about 18 months. It was focused on how to get change to happen, different approaches to leadership and engagement and the principles of improvement methodology. It was an intense programme where I met amazing commissioners, leaders and clinicians all focused on wanting to find ways to drive change and better care for patients, improving standards and leading with and through others.
It was a time of deep reflection where I was challenged about who I was, what I did and how I approached leadership and change in practice. Something I still learn about and reflect upon it every day. It involved challenging myself, trying out new ways of doing things, reflecting on what worked –and what didn’t and setting my personal goals and ambitions higher to create new and different ways to encourage others to lead change. This resulted in an idea to develop something specific for clinicians working in diabetes and the clinical champions programme was born – which grew into the Diabetes UK clinical champions leadership programme.
What is the future of diabetes care in the UK?
Just as the landscape of society is changing, so too is the landscape of diabetes care. Connections between people, communities and those working in healthcare are evolving. Expectations are increasing and people are seeking new and easier ways to get advice, support, care and information. Diabetes care and the way it is organised and delivered will need to change to meet expectations and needs and I think more and more support will happen digitally. With our busy lives more and more people with diabetes want more flexible and convenient ways to get advice from both healthcare professionals and their peers.
There is a greater need to address emotional wellbeing as well as the medical and physical aspects of diabetes. More new and better technology will I’m sure become available, which will help make living with diabetes easier day to day. This, alongside health services addressing wellbeing needs will play an increasing role in how those with type 1 diabetes and type 2 diabetes are supported to self-manage. I hope that care evolves to be more focused on each individual person’s needs, anxieties and circumstances through effective care and support planning. Everyone is different and it’s only by focusing on what is important to each person that they can be supported to live well.
The NHS has a long way to go to make partnership working between people with diabetes and healthcare professionals happen in practice though. And there will be a growing need for healthcare to be mindful that living with diabetes is not all about medicine – diabetes impacts on mental wellbeing, living day to day, how we feel about ourselves and our lives so living well is more about having the connections, the confidence and the support to live well. As more and more people expect and demand more from the NHS, so we all have an important role to make sure those who don’t find it so easy to manage day to day to be more involved – in a way that works for them – to prevent inequalities in diabetes across different communities and groups from getting worse.
What do you do in your spare time?
My spare time is mostly spent with friends and family – the theatre, gigs and the odd long weekend break. At home I spend time with my wonderful husband who puts up with my highs and lows’ – literally! Doing a bit of gardening in our little back garden which, in the summer, will be filled with loads of flowers and a few tomatoes. The tomatoes are for our five guinea pigs, who seem to love them (more than me). I am getting to be a bit of a dab hand at counted cross stitch and keep saying that I will get back into playing the piano – which I used to be good at but need to find more spare time to practice again to become good again!