Waiting Well

When you have diabetes, you are entitled to certain checks, tests, and services to help you get the care you need – like your HbA1c blood test. These checks help to prevent serious diabetes complications, so make sure you keep up to date with your yearly tests. 

For all types of diabetes, it is important to keep your blood sugars well checked and keep them in your ideal target range.

The surgical team will ask questions about your diabetes and how it is treated to ensure you are well looked after and appropriately managed during and after your surgery. Depending on the type of surgery the team may manage this may be different to how you normally would, but they will be available to answer questions if you are concerned. 

To prepare for your surgery and minimise complications or post operative infections keep your blood sugars in your ideal target range and avoid hypos or hypers. Make sure you engage well with your diabetes service and follow their instructions on how to take your medication or insulin as recommended. 

Self-referral

When you have diabetes, there are huge benefits to losing weight if you're carrying extra weight. You’ll have more energy and you’ll reduce your risk of serious complications like heart disease and stroke. Losing weight can help with your diabetes control too. And if you have type 2 diabetes, losing weight could even mean going into diabetes remission.

You can self-refer yourself into weight management programmes.

• Healthy You: Local virtual and face to face physical activity programmes, health trainers etc​
• NHS Better Health: Digital weight loss app, Couch to 5K, general healthy lifestyle tips​
• Know Your Risk: Patient self referral.  Provides patients their risk of developing type 2 Diabetes and a self referral pathway to access the National Diabetes Prevention Programme.

It is very important to safely reduce the amount of alcohol you drink before your operation. Alcohol can weaken your immune system, putting you at risk of developing complications and prolonging your recovery. 

Reducing how much you drink can improve your health, boost your energy, help you lose weight and save money. Get help to drink less Drink Aware.

Further advice on reducing the amount of alcohol you drink can be found on the NHS website. Healthy You Alcohol Health Trainers can provide local one-to-one support.

You should aim to be alcohol free for at least 24 hours before your operation.

There's lots of things you can do around your diet to help you wait well and the best way to keep a healthy weight is to eat a healthy, balanced diet. Here's some of our top tips

• Eat a healthy, balanced diet - you need to eat a variety of foods from the main food groups, including: plenty of fruit and vegetables; plenty of starchy foods such as bread, rice, potatoes, pasta; some milk and dairy foods or non-dairy alternatives; some sources of protein, such as meat, fish, eggs and beans. The Eatwell Guide has more information about the types of food you should include in your diet and how to get the right balance between them all. 

• Keep well hydrated - you should aim to drink six to eight cups or glasses of fluid a day. Water, milk, milkshakes and soft drinks, including tea and coffee, all count. Find out more about keeping hydrated from It All Counts.

• Don't forget about vitamin D - most people should get all the nutrient they need by having a varied and balanced diet. It's worth knowing that vitamin D is important for musculoskeletal health, bone and soft tissue healing but unlike other vitamins, most of our vitamin D does not come from food. Instead it is made by our bodies when we expose our skin to Ultraviolet B (UVb) rays from sunlight. These rays make the vitamin D for us when our skin is exposed to them from April to September in the UK. It's recommended that all adults and children over 4 years should consider taking a daily multivitamin or vitamin D tablet or capsule that contains a small vitamin D dose of 10 micrograms (400IU), particularly in autumn and winter (October to March).

• Make sure you get enough vitamin B12, calcium and iodine if you're vegan or vegetarian - lots of vegans and vegetarians are getting all their nutrition needs directly from food, but some vitamins and minerals are harder to get enough of from plant sources, such as calcium, iodine, and vitamin B12.

• Keeping a healthy weight - Eating a varied and nutritious diet as well as keeping a healthy weight has been shown to improve outcomes of treatment and reduce complications after surgery. Being heavier or thinner than is recommended for your height can also have long term consequences on other aspects of your health such as blood pressure, heart health and quality of life. 

• Check your BMI (Body Mass Index) - BMI is a way of using your weight (in Kg) and your height (in m) and gives you a number in (Kg/m2) to help understand if you are a healthy weight for your height. You can use the BMI calculator, using your most recent height and weight (in stones and feet or Kg and meters) to see what category you fall into. If your BMI is the higher risk category, or your waist measurement is more than half your height, losing weight could be beneficial for your health. Even a small amount of weight loss or preventing extra weight gain can help reduce the risk of complications and improve healing after any surgery or intervention.  

If you're feeling worry and/or anxiety while waiting, there’s local help available: 

• Keep Your Head: Cambridgeshire & Peterborough’s flagship mental health signposting and support website providing reliable advice and signposting to mental health support available both locally and across the country. 

• How Are You (H.A.Y.) How Are You (H.A.Y.) Cambridgeshire & Peterborough is a family of websites that bring together everything in the local community that boosts wellbeing. H.A.Y. is all about helping you look after you. From yoga to singing, sports clubs to arts groups, or perhaps somewhere to talk or get a cup of tea, H.A.Y. tells you all about local things to do to get a wellbeing boost. Plus a wide range of local professional support. 

• Lifeline –  Free, confidential helpline that you can call anonymously to talk to a trained volunteer. Lifeline is available daily 11am-11pm, 365 days a year and can be reached by calling 0808 808 2121. 

• Mind - CPSLMind, www.cpslmind.org.uk  - A mental health charity providing a range of services and support for people suffering with mental health problems and promote positive mental health across Cambridgeshire and Peterborough.  

• Qwell and Kooth - Free online wellbeing services offering chat-based counselling, peer support and self-help.  Qwell is for ages 18+ Kooth.com is for ages 11-25. 

• Crisis support – If you feel you are in a mental health crisis, urgent support is available in our area 24/7 through 111. Simply dial 111 and select the mental health option. You will be put through to a trained advisor who will speak to you and discuss your current mental health needs. 

• NHS Talking Therapies - this service provides local help to people aged 17 and over who are experiencing common mental health problems such as low mood, anxiety, depression and loneliness. You can access NHS Talking Therapies through this link:  

• Every Mind Matters - Get expert advice and practical tips to help you look after your mental wellbeing and make them part of your daily routine. 

Stopping smoking is one of the best things you will ever do for your health. Quitting is much easier when you get the right support and there are lots of options to choose from.  

Even if you’ve tried before, maybe more than once, you can still succeed. What you’ve already learned will help you reach your goal of becoming an ex-smoker. 

Will smoking it affect your operation?

Smoking (tobacco or other substances) causes harm to your body in many different ways. This can all affect your anaesthetic and your surgery with increased risk of complications around the time of your operation. These complications include chest infections, poor healing and wound infections, or even heart attacks or strokes.

To gain maximum benefit, stopping for up to eight weeks is ideal and will put you on a good track for quitting permanently. However, even stopping for a short while before your operation can be beneficial. These benefits include:

• Reduced risk of lung problems after your operation such as chest infections.
• Reduced risks of heart attacks during and after your operation.
• Better, bone and wound healing and a decrease in the risk of wound infections.
• Reduced risk of skin or tissue grafts from failing.

All these benefits usually mean a reduced length of hospital stay, meaning you will be home faster after your operation. If you can stop smoking permanently, then you reduce your risk of heart disease, stroke, cancer or premature death in the future.

If you live in Cambridgeshire or Peterborough, Healthy You can provide stop smoking support. Visit Find Your Local Stop Smoking Service (LSSS) - Better Health - NHS (www.nhs.uk) it you live outside these areas.

1. You GP should be your first point of call. 
2. If necessary the GP will then refer you to the most appropriate service for your health condition.  
3. Your waiting time starts from when the hospital or service receives your referral letter, or when you book your first appointment through the NHS e-Referral Service. 

During this time period, you may: 

• have tests, scans or other procedures to help ensure that your treatment is appropriate for your condition 
• have medicine or therapy to manage your symptoms until you start treatment 
• be referred to another consultant or department

Your waiting time ends if a clinician decides no treatment is necessary, if you decide you do not want to be treated, or when your treatment begins. 

This could include: 

• being admitted to hospital for an operation or treatment 
• starting treatment that does not require you to stay in hospital, such as taking medicine 
• beginning fitting for a medical device, such as leg braces 
• agreeing to have your condition monitored for a time to see whether you need further treatment 
• receiving advice from hospital staff about how to manage your condition 

Source: Guide to NHS waiting times in England - NHS (www.nhs.uk) 

Preoperative Assessment (Pre-assessment Clinic)

Before any planned operation or procedure under general anaesthetic all patients must attend our department for a pre-operative assessment. During this appointment a specially trained nurse will review your medical and surgical history, current medications, and provide your pre-operative instructions. We take a variety of pre-operative tests based on your medical history and pending procedure. Our aim is to ensure patients are safe for surgery, and that we have a comprehensive plan for the day of admission.

Pre-assessment clinic is designed to optimise patients for surgery, to avoid cancellations on the day, and allow time for appropriate plans to be implemented to ensure patient safety. The screening is to identify patients at risk under general anaesthesia and usually occurs a minimum of 1-2 weeks ahead of surgery.

As the Preoperative Assessment team see so many patients this is not the best time to ask questions related to your specific procedure.

Can I bring a relative/friend?

Yes, we allow you to bring relatives, friends, or carers to your pre-assessment appointments. Our rooms are fairly small, so we would ask this is limited to 1 person if possible.

Do I need to bring anything?

We ask all patients to bring a copy of their current prescriptions. If you are having surgery under the urology, gynecology, or orthopaedic teams, you will need to provide a urine sample on arrival.

How long will my appointment last?

Surgical preadmission time will depend on which trust you are being treated at – averaging around an hour.

Do I need to starve for my appointment?

No, please eat and drink as normal.

What tests will I have?

We may need to conduct a variety of tests, depending on the type of surgery you’re having and your medical history. These could include;

• MRSA swabs
• Height/Weight/Blood Pressure
• ECG
• Urine
• Bloods
• X-Ray 

Cambridge University Hospitals Foundation Trust:

Pre-assessment | CUH

There are some health parameters that could lead to your surgery being delayed whilst your health is optimised. To help you be aware of these we have included them below:

• Blood Pressure above 160/90mmHg
• Diabetic HbA1c above 69mmol/mol
• Hemoglobin >130g/l

These parameters are specific to elective surgery, this does not apply to patient’s on Urgent, Cancer or Emergency pathways. Should your medical history be relevant to these parameters we recommend talking to your GP, ensuring your health is fully optimised ahead of your assessment to not cause any delays to treatment.

North West Anglia Foundation Trust:

Pre-Operative Assessment Patient Leaflets | NW Anglia Website (nwangliaft.nhs.uk)

Royal Papworth Hospital Foundation Trust:

My Planned Care at Royal Papworth Hospital