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

Diabetes Improvement Plan 2014

The Diabetes Improvement Plan 2014 highlighted eight national priority areas, agreed through consultation with the diabetes community, to improve the experience and clinical outcomes for people living with diabetes. These priority areas were identified to be specific challenges for Scotland; areas where examples of good proactive activity already existed and where a focused effort on improvement could have an impact. These priorities were:

Aim: To improve the experience and clinical outcomes for patients living with diabetes across Scotland.

Prevention and Early Detection of Diabetes and its Complications
To establish and implement approaches to support the prevention and early detection of type 2 diabetes, rapid diagnosis of type 1 and to implement measures to promptly detect and prevent the complications of diabetes.

Type 1 Diabetes
To improve the care and outcomes of all people living with type 1 diabetes.

Person-Centred Care
People with diabetes enabled and empowered to safely and effectively self-manage their condition by accessing consistent, high quality education and by creating mutually agreed individualised care plans.

Equality of Access
To reduce the impact of deprivation, ethnicity and disadvantage on diabetes care and outcomes.

Supporting and Developing Staff
To ensure healthcare professionals caring for people living with diabetes have access to consistent, high quality diabetes education to equip them with the knowledge, skills and confidence to deliver safe and effective diabetes care.

Inpatient Diabetes
To improve the quality of care for people living with diabetes admitted to hospital by improving their glucose management and reducing the risk of complications during admission.

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.

Innovation
To accelerate the development the development and diffusion of innovative solutions to improve treatment, care and quality of life of people living with diabetes.

NHS Boards, through their Diabetes Managed Clinical Networks (MCNs) were asked to commit to implementing activity to improve the quality of care and outcomes for people living with diabetes within these priority areas. The Scottish Government, through the Scottish Diabetes Group (SDG), sponsored a number of national initiatives to achieve the priority aims and support local improvement activities. The SDG and its subgroups developed an action plan to identify and deliver specific actions which would lead to improvements with the goal of addressing all of the priori areas by 2020. Significant progress has been made against the priority areas in the Diabetes Improvement Plan 2014 and this report outlines these achievements.

The diabetes landscape has changed radically in recent years with greater emphasis on self-management, use and choice of technology and risk stratification for prevention and remission of type 2 diabetes. In addition to this there is a wide range of government policy which fits with improving the health of people with diabetes. The response to the ongoing COVID-19 pandemic has required everyone supporting diabetes care to work differently and as we continue to respond to this it is vital that we revise care models to ensure they meet the challenges of healthcare delivery with the restrictions that we now live with.

It is timely therefore to take this opportunity to reflect on the priorities agreed previously, outline the breadth of activity that has taken place against the actions agreed to support improvements and consider ongoing and new areas of focus for 2021 – 2026 to support continued improvements in the experiences and outcomes of people living with diabetes. This report covers the progress to date and is published in conjunction with the refreshed Diabetes Improvement Plan 2021 – 2026.

Interaction with other Scottish Governmsent Policies

This report sits alongside a wide range of government policy. In particular, this report should be read alongside our diet and healthy weight policies, our mental health strategy, our Technology Enabled Care programme and the Scottish Access Collaborative and Modernising Patient Pathways Programme. We seek coherence with a range of other policy areas and we will continue to work collaboratively across the Scottish Government to ensure that appropriate links are made and maintained.

Successes in healthcare which have resulted in people living longer have brought about new challenges; such as older people living with multiple conditions and additional complexity, both in their experience of illness and care. People working in health and social care and people who use services are encouraged to consider the values and the behaviours that underpin good experience. The ethos of Realistic Medicine is to support meaningful conversations with people to plan and agree care around what matters most to people with a shared understanding of what healthcare might realistically contribute to this.

Tackling unwarranted variation is essential to improving outcomes derived from healthcare across Scotland. Unwarranted variation is variation in healthcare that cannot be explained by need, or by explicit patient or population preferences. We need to ensure the prevention of harm and waste from overuse and overtreatment, freeing up resources currently used without benefit to clinical outcomes in order to address under-provision of care. The Scottish Atlas of Healthcare Variation, produced by Public Health Scotland, aims to highlight geographical variation in the provision of health services and associated health outcomes.

Sitting above all of these policies is Scotland's National Performance Framework. Two of the aims of the Framework are to increase the wellbeing of people living in Scotland and to reduce inequalities. The new national diabetes priorities will contribute to the National Performance Framework and its outcomes. We will know this by measuring progress against the following performance indicators: Healthy life expectancy, Health risk behaviours, Quality of care experience, Premature Mortality.

The Scottish Government's Programme for Government 2020/21 has been launched and there are many parallels between this programme and the commitments outlined in this refresh of the diabetes improvement plan. This includes the commitment to the Type 2 prevention work stream to increase access to weight management services for all adults living with obesity and commitments to improve the lives of young adults, focus on mental health issues, digital exclusion and health inequalities.