Diabetes care - progress against national priorities: commitments - 2021 to 2026

Priority 7 - Improving Information

To ensure appropriate and accurate information is available in a suitable format and effectively and reliably used by all those involved in diabetes care. in diabetes care.

The aspiration within the Diabetes Improvement Plan 2014 was to ensure that improvements in diabetes care are data driven. This required data and information of diabetes to be comprehensive and accurate and for the systems that manage the data to be effective, reliable and responsive.

Action 7.1 Improve access to appropriate and accurate information

Developments to SCI-Diabetes

SCI-Diabetes remains one of the key cornerstones of diabetes care within Scotland. SCI-Diabetes continues to develop and evolve to meet the needs of the multidisciplinary team supporting diabetes care. There is regular dialogue with clinical teams and SCI-Diabetes has been developed in an iterative and dynamic manner to meet the needs of this user. This has included specific type 1 diabetes screens, decision support tools, foot screening tool, foot ulcer monitoring system, prescribing timeline, dedicated pregnancy pages, in-patient domain, improved diagnostic information and links to the Scottish Ambulance service. Central to making the most of this SCI-Diabetes is embedding the need for recording information on the system across all teams. As noted above one area where this is limited data collection is around care taking place whilst in the inpatient setting.

Improving communication across the diabetes community

Communication mechanisms have been strengthened between the Scottish Diabetes Group and the teams supporting diabetes care in Scotland.

The Managed Clinical Networks (MCN) across Scotland are central for communicating information on national initiatives to staff working at a local level and support sharing of best practice in diabetes care. Clinical and Management leads from the Diabetes MCNs come together several times a year to provide an update on what is taking place at a national level and share what is happening within their local areas to inform improvements in other areas. Recommendations and lessons learned from Ombudsman Reports which highlight cases where diabetes care has been compromised are shared to support learning across Scotland.

A Type 1 Leads Network has also been developed to share information relating to type 1 diabetes with a nominated lead from each diabetes centre in Scotland for further dissemination around staff involved in providing care for children and adults with type 1 diabetes.

Action 7.2 Better reporting and use of data at both national and local levels

Scottish Diabetes Survey

The Scottish Diabetes Survey is produced on an annual basis to give a comprehensive view on diabetes care across the whole population of Scotland. Information used to populate the survey comes from SCI-Diabetes and as such the information presented covers over 99% of the population diagnosed with diabetes in Scotland.

To accompany the 2019 Scottish Diabetes Survey a narrative was published to contextualise the key data from the survey against the national priorities set out within the Diabetes Improvement Plan. The annual Scottish Diabetes Survey in tandem with the diabetes dashboard provides information on key diabetes related measures and outcomes and be used to inform progress within the Diabetes Improvement Plan 2014 and drive health improvement initiatives.

The Scottish Diabetes Survey provides a one page health board specific summary outlining individual performance against the national average for some of the key measures within the survey. Health Boards through their Managed Clinic Networks are asked to review the information and use this to inform how best to deliver ongoing improvements in diabetes care.

Audit Reports via SCI-Diabetes

Following the publication of the Diabetes Improvement Pan, SCI-Diabetes provided health boards with quarterly reports on 12 nationally agreed quality improvement and outcome measures to access local performance, target improvement initiative and form the basis of reports health boards to the Scottish Government.

Additional reports have subsequently been added to SCI-Diabetes which provide information and comparative data on glycaemic control (HbA_1c levels) within the local adult and paediatric diabetes centres (type 1 diabetes) and within GP clusters (type 2 diabetes).

Diabetes Dashboard

The diabetes dashboard, launched in June 2019, has been developed within SCI-Diabetes through consultation with the Scottish Diabetes Group, its subgroups and the Managed Clinical Networks. This provides professionals looking after people with diabetes timely access to 'live' data on a continual basis at national, regional, local and individual level.

The dashboard has several diabetes related process and outcome measures specific to the population being reviewed. This allows teams to identify their current performance and supports improvements in real time by providing easy to interpret information with drill down ability to support individual care at practice/centre level. Data available within the dashboard is discussed at SDG and Diabetes MCN meetings to prioritise areas where targeted improvement is required and to support sharing of best practice and learning from others.

Using data to drive innovation and patient care

Scotland has excellent routine data available on people with diabetes and their care. A central aim is to improve use of this data to inform and improve care. We have already noted how routine data has been used to measure improvement in HbA1c in people with type 1 diabetes. At a broader level ongoing work in type 2 diabetes is being undertaken to develop cardiovascular risk engines and to explore how real world data can be presented to policy makers to support assessment of interventions.

Action 7.3 Improve patient access to their data to support self-management

My Diabetes, My Way

My Diabetes, My Way continues to develop its support to patients and now includes a range of patient support information (available in a variety of languages) and e-learning modules to support patients to self-manage their diabetes. In addition to the website, a My Diabetes, My Way app is available and the system can collect information in lifestyle interventions such as fitness trackers.

My Diabetes, My Way now supports standardised diabetes foot screening for private podiatrists in Scotland. At present, as many as 20% of people with diabetes attend private podiatry for their diabetes foot care, and the information recorded is not available to NHS healthcare teams. A new service allows this information to be collected via My Diabetes, My Way and shared with SCI-Diabetes.

My Diabetes, My Way continue to promote their service to patients via providing supplies of patient information practices/clinics, demonstrating system functionality at local patient and professional events, contacting unregistered patients (from SCI-Diabetes) in conjunction with interested GP Practice. All health care professionals are encouraged to ensure that enrolling people with diabetes in My Diabetes, My Way as a key step in their care.

With the increasing use of technologies, people living with diabetes are encouraged to view their available healthcare information to support their self-management e.g. flash glucose monitoring run charts. With evolving care models moving towards a more virtual basis, there will be continued focus of promoting the use of such programmes.