NHS Must Step Up To Challenge Of Better Diagnosis Of Diabetes, UK

Main Category: Diabetes
Article Date: 12 Mar 2007 - 0:00 PDT

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Diagnosis of diabetes is improving, and the NHS must step up to the challenge of providing high quality care for each individual, according to a new report looking at the delivery of diabetes services.

The Way Ahead: The local challenge, published today, looks at the progress made in improving diabetes care four years after the National Service Framework (NSF) was launched. The Insulin Pumps Working Group also published their report helping to clarify NICE guidance on the use of pump therapy today.

The Quality and Outcomes Framework (QOF) is helping GPs to reduce the 'missing million' people with diabetes who have not been diagnosed. In the last twelve months alone, over 100,000 extra people have been diagnosed with diabetes and have started getting NHS treatment and support.

The report looks at many examples of good practice across the NHS - for example, weight management programmes in Cleveland and screening vulnerable communities in Bradford.

During a visit to the Westminster Diabetes Centre to meet staff, Health Minister Rosie Winterton said:

"With GPs identifying more people with diabetes, patients are now getting the care, advice and support to enable them to manage their condition more effectively, and reduce the risk of the complications associated with diabetes, such as heart disease.

"But as more people are diagnosed with diabetes, the NHS must step up to the challenge of continuing to provide high quality services that are convenient for patients. The NSF Progress Report demonstrates that excellent work is already underway and I would urge PCTs to look at how they can best provide services for people with diabetes in their local area."

In March 2003, NICE published guidance on the use of insulin pumps, but variation in access highlighted that the guidance was not being implemented consistently. The Insulin Pumps Working Group, set up in November 2005, has today published their report helping to clarify NICE guidance.

Although not suitable for everyone, insulin pumps can make a huge difference for some people and it is important that their use is built into a comprehensive and coherent diabetes service. The Insulin Pumps Working Group's findings include:

-- commissioners of diabetes services should ensure that pump therapy is included as part of a comprehensive service for Type 1 diabetes, as required by the NICE guidance
-- commissioners, clinicians and patient representatives should carry out a needs assessment for insulin pumps and further work should be done to understand current use of pump therapy and potential future use
-- there needs to be a robust and efficient supply chain from procurement to home delivery
-- clinical communities and partners should agree a national curriculum with appropriate links to accreditation bodies for staff training and patient education

Douglas Smallwood, Chief Executive of Diabetes UK, said:

"The NSF report quite accurately reflects that diagnosis of diabetes is improving, that people with the condition are receiving better services and that there is more information than ever before on the care that people are receiving. It pulls no punches in acknowledging that there are still many gaps in service provision and that much more needs to be done until we meet all the NSF standards. The challenge is for the NHS to grasp the opportunities provided by commissioning and other changes to deliver a truly patient focused service.

"We also hope primary care organisations will take on board the recommendations in the report on insulin pumps to improve the lives of people with diabetes, particularly young children, who have been unable to access pump therapy."

National Clinical Director for Diabetes, Dr Sue Roberts said:

"This report makes it clear that frontline staff have made considerable progress in improving diabetes services. At a time when the increasing numbers of people being diagnosed are presenting greater demand on services, the response from the diabetes community has been magnificent. They have used the information, tools and techniques made available by the Department of Health, the National Diabetes Support Team and other partners to identify what needs to be done, and have gone and done it. Although we can be justly proud of what has been achieved, we must also recognise that there is still much to be done before everyone in England receives diabetes services the NHS can be truly proud of.

"Today we are also publishing a report to clarify existing NICE guidance on the availability of insulin pumps. This is the result of a working group established in November 2005, and we hope it will help to reduce variation in access to pump therapy around the country."

1. Work initiated by the Insulin Pumps Working Group has led to the development of:

-- an extension of the PBS prevalence model to include specific information on insulin pumps
-- a generic specification for insulin pump care - best practice model
-- a national framework contract for supply of pumps and consumables
-- a home delivery service for consumables
-- recommendations for future research
-- identification of issues for NICE to consider when it revisits its guidance on pump therapy in 2007.

2. If not properly managed, diabetes can result in a range of long term complications heart disease, stroke, kidney disease, blindness and foot problems that may lead to amputation.

3. The Diabetes NSF was launched in 2001, with the Delivery Strategy published in 2002, and implemented in April 2003.

4. The Diabetes NSF: Standards contains 12 standards in nine areas:

-- Prevention of Type 2 diabetes
-- Identification of people with diabetes
-- Empowering children, young people and adults with diabetes
-- Clinical care of adults with diabetes
-- Clinical care of children and young people with diabetes , including the transition from specialist paediatric diabetes services to specialist adult diabetes services
-- Management of diabetic emergencies
-- Care of people with diabetes during admission to hospital
-- Diabetes and pregnancy
-- Detection and management of long-term complications of diabetes and the provision of integrated health and social care

5. The Way Ahead: The local challenge, the NSF Four Years On report and the Insulin Pumps Working Group's report will be available at here.

http://www.dh.gov.uk