Diabetes Improvement Plan

3. Priorities for Improvement

34. All aspects of diabetes care are important and matter to people living with diabetes. Therefore, whilst the improvement plan focuses energy and attention on specific areas for improvement, it is vital to recognise that many areas of activity which are not highlighted here are nevertheless issues which will continue to require sustained effort to maintain and continuously improve outcomes for patients.

35. The scale of the cost and the challenge means that diabetes is a priority for all NHS Boards. However, it is also clear that NHS Boards must balance finite resources against many pressing demands and important issues. Therefore this Plan is built upon an assumption that the changes envisioned will be largely enacted through a strong focus on improvement methodologies and collaboration, working within existing funding and investment mechanisms. This needs to be underpinned by a strong infrastructure (e.g. robust clinical data, effective MCNs) and supported by strategic investment in national initiatives to nurture and energise new tools and developments.

36. This improvement plan identifies as a national priority a limited number of topics. These priorities follow on and build upon actions identified in the 2010 Diabetes Action Plan. They have been identified as specific challenges for Scotland and areas where examples of good proactive action already exist and where focused effort can deliver real improvements. The priority areas are:

• Prevention and Early Detection of Diabetes and its Complications
• Type 1 Diabetes
• Person-Centred Care
• Equality of Access
• Supporting and Developing Staff
• Inpatient Diabetes
• Improving Information
• Innovation

37. Having worked with the diabetes community to identify the priorities, the expectation is that over the coming years NHS Boards, through their diabetes Managed Clinical Networks (MCNs) will commit themselves to implementing a programme of work to improve the quality of care and outcomes within these identified priority areas and undertake to provide evidence of the improvements made. It is for MCNs to initiate work in line with their local circumstances and pressures, but with the goal of addressing all of the priority areas by 2020.

38. This plan sets out the national projects that the Scottish Government, through the Scottish Diabetes Group (SDG) will sponsor to achieve the priority aims and support local improvement activities. These actions will be delivered through a wide range of activity detailed in the work plan for the SDG and its subgroups. Patient engagement is critical to the implementation of all these priorities and an important first step is to ensure that the voice of people living with diabetes is part of the Scottish Diabetes Group and its sub-groups.

Diabetes in Scotland: Priorities for Improvement

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

Priority 1. Prevention and Early Detection of Diabetes and its Complications

Aim: 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.

Overview

The 2010 Action Plan recognised the need to implement the range of population strategies to address primary prevention of cardiovascular disease and type 2 diabetes. This plan further recognises the important role of the diabetes community working alongside public health colleagues in developing and supporting practical approaches to the challenge and, crucially, signposting people at risk of developing diabetes towards relevant information and services (e.g. weight management services).

Diabetes Scotland roadshows identified that 51% of those accessing a risk assessment were found to be at high risk. Supporting people to understand the risks and learn what can be done to manage them can delay or even prevent the onset of type 2 diabetes. There is uncertainty about how many people have undiagnosed diabetes and also about the estimation and value of the term "pre-diabetes".

The 2010 Action Plan highlighted research showing the long asymptomatic phase of type 2 diabetes. This remains frequently undetected and during this period complications may develop and be present at diagnosis. Previous evidence from the UKPDs indicated that 35-39% of people diagnosed with type 2 diabetes had retinopathy suggesting that diabetes was likely to have been present for at least five years before diagnosis. Recently in Scotland we have found 19% of those^[6] diagnosed with type 2 diabetes had some retinopathy within 1 year of diagnosis. This suggests an improvement, but there is need to improve this further.

Type 1 diabetes presents more acutely, but early identification and urgent treatment can prevent the development of life threatening diabetic ketoacidosis. As many as 1 in 4 children and young people are diagnosed with type 1 diabetes when they are in diabetic ketoacidosis. For children under 5 it is as many as 1 in 3. Understanding the signs and symptoms of type 1 diabetes is critical for early identification and treatment of type 1. [See "Type 1 Diabetes".]

Approximately 80% of diabetes complications are preventable or can be significantly delayed through early detection, good care and access to appropriate self-management tools and resources. Even when managing care well, maintaining engagement with NHS services enables early detection of complications, and treatment to prevent or delay further deterioration. Register information relating to screening for complications is useful in identifying individuals or groups of people who are not receiving the recommended screening.

Actions:

1. Enhance strategies to support people at risk of developing diabetes and early identification of those with diabetes

• Engage with the Public Health Observatory to seek information to improve the understanding of data on undiagnosed diabetes.
• Develop and implement an appropriate framework for assessing risk of diabetes for people currently undiagnosed to support early identification, diagnosis and treatment of those at risk of developing type 2 diabetes.

This framework is required to facilitate targeted lifestyle advice for those at highest risk and will be developed in line with the current evidence base including Scottish Intercollegiate Guideline Network (SIGN) 115 and 116 guidelines.

Areas which will be considered include follow up of outcomes of those diagnosed with Gestational diabetes [See also "Priority 3 - Person-Centred Care".]; implementation of the Hyperglycaemia in acute illness risk calculator tool - an aide for clinicians to identify at risk patients following hyperglycaemia during an acute hospital admission^[7] ; and ways to improve local recording and monitoring of Impaired Glucose Tolerance (IGT) and Impaired Fasting Glucose (IFG).

2. Earlier identification of the diagnosis of diabetes and its complications

Early diagnosis strategies need to include increasing public awareness of diabetes, support for education campaigns of healthcare professionals and building a structured public health plan to support both high-risk/targeted and population approaches. The 'Health Promoting Health Service: Action in Hospital Settings' Chief Executive Letter (CEL 01 - 2012) explicitly states the crucial role of MCNs in championing preventative action and engaging the workforce to deliver on this with a focus on inequalities.

• Develop and roll out education campaigns and guidance aimed at primary care staff on diagnosis of diabetes. This will include the national rollout of Diabetic ketoacidosis (DKA) campaign; improving the recognition of the risk factors for type 2 diabetes; and developing guidance on the use of HbA1c for diagnosis of diabetes.
• Improve the use the clinical register to identify and encourage all individuals with diabetes to engage with screening and care services.

Effective screening for complications enables care to be further optimised when complications are developing. Better use of available diabetes data and improving communication with people with diabetes will help to reduce non-attendance rates, ensure that people receive the recommended 9 processes of care [see page 29] and encourage self-management.

Priority 2. Type 1 Diabetes

Aim: To improve the care and outcomes of all people living with type 1 diabetes.

Overview

The 2010 Action Plan highlighted the growing prevalence of type 1 diabetes and the need to deliver quality care to reduce the associated morbidity and mortality. It aimed to promote an increase in good glycaemic, blood pressure and cholesterol control - actions that reduce the risk of complications. Provision of quality assured structured education and supported self management were key actions of the plan. Improving care for all people with type 1 diabetes remains a priority. It is essential that NHSScotland supports innovation in the ways of delivering type 1 care, especially closer working between paediatric and adult teams to optimise education and improve self management skills.

The 2013 Scottish Diabetes Survey has demonstrated that only 22% of individuals with type 1 diabetes have optimal glycaemic control, defined as an HbA1c <58 mmol/mol. Intensive glycaemic control improves the short, medium and long term outcomes of type 1 diabetes and is one of the key goals of care. When compared internationally, Scotland has a poor record in glycaemic control. We therefore need focussed activity to improve glycaemic control for all ages, aiming to support NHS Boards to increase the number of people with HbA1c <58 mmol/mol and reducing the number of people with HbA1c>75 mmol/mol.

The beneficial impact of starting well in diabetes is increasingly recognised. Therefore, improving care at the onset of type 1 diabetes is important and improves an individual's ability to adjust to living with diabetes. Supporting individuals with diabetes in the early years including early intensification of therapy and access to high quality education is vital. In addition, supporting children and young adults during the educational years and during transition from paediatric to adult care settings minimises disengagement and the risk of deteriorating glycaemic control. Provision of services for young women requires a specific focus because although diabetes is associated with an additional risk of death at all ages and in both sexes the relative risk (by comparison to the general population) is greatest at younger ages and in females.

The diabetes community in Scotland has already started work in this area by reviewing diabetes control in different units across the country with a view to shared learning and improvement. We also wish to build on the progress made by the Childhood and Adolescent sub group, by outlining specific measures for targeted activity to enhance the care and treatment of children and young adults, including addressing the issues associated with disengagement from health care.

Actions:

1. Improve the care of children and young people

• Develop and implement strategies (including education, awareness of complications, the particular healthcare needs of young women and care planning) that support children and young adults to improve their management of diabetes, ensuring early identification and referral of new onset type 1 diabetes.
• Minimise the impact of adolescence and young adulthood on diabetes care by utilising the available resources aimed at transitional care and by up skilling healthcare professionals in youth engagement.

2. Improve glycaemic control

• Develop and implement strategies that promote good glycaemic control in the early stages post diagnosis including: an early glycaemic intensification strategy; and national structured education resource for use within 6 months of diagnosis.
• Timely access to structured education at 12 month post diagnosis.
• Implement a national improvement programme to increase the proportion of people with type 1 diabetes with optimal glycaemic control, including timely and appropriate access to insulin pumps.

Priority 3. Person-Centred Care

Aim: To ensure people with diabetes are 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.

Overview

The 2010 Action Plan pointed to the range of policies setting out our approach to and need for person-centred care and well supported self management, as being critical to ensuring good health outcomes and improved quality of life. These are supported further through the Route Map to the 2020 Vision.

We know that good self-management can be achieved through access to education. This can take many forms, however many people with diabetes have never been on a formal structured education course. We wish to build on the work of the education subgroup to ensure the quality and improve the availability of structured education. We also need to embrace innovative solutions that can support self management and Priority 8 sets out our intentions to achieve this.

Through the Scottish Diabetes Group (SDG) we will also ensure that the learning and outcomes from person-centred strategies including the House of Care are shared and disseminated through the diabetes community. Individualised care planning enables patients and healthcare professionals to respond to changes in people's lives and circumstances and as such they should be kept under review. Changes can happen for a number of reasons: life events that affect our ability to cope and manage our day to day health, transition from school to higher education and work, starting a family and so on.

Feedback from patient groups has also identified other issues that are important to patients. These include challenges around sharps disposal, management of access to blood glucose strips and navigating appointment systems.

National audits in Scotland, Northern Ireland, England and Wales have highlighted the risks of pregnancy in women with type 1 and type 2 diabetes. Critical findings of these audits are an increase in birth weight, rates of caesarean section, congenital anomalies and perinatal mortality in children born to women with diabetes. We want to ensure that women with pre-existing diabetes have pregnancy outcomes comparable with the best population outcomes worldwide.

To achieve this we need to improve uptake and quality of pre-pregnancy and pregnancy care for those with established diabetes and the screening for and management of those with gestational diabetes. The quality markers are known. By improving the capture, analysis and feedback of these markers and through sharing and implementing best practice and innovation, units will be able to work towards the reduction of rates of congenital anomaly, admission to special care baby unit and perinatal mortality for women with existing type 1 and type 2 diabetes.

Randomised control trial evidence supports improvement in outcomes with identification and treatment of gestational diabetes (GDM). While controversies remain around precise definitions of gestational diabetes it is clear that all health boards need to have in place an identified, implemented and audited pathway for gestational diabetes to ensure that women - particularly those who are over 40 and/or overweight - are offered timely screening for and treatment of gestational diabetes.

Actions:

1. Timely and appropriate access to high quality patient education and self management support

• Ensure access to appropriate high quality education resources [See also structured education identified at Priority 2]
• Ensure that during consultations healthcare professionals actively support self management by providing relevant information and appropriate signposting to third sector and community resources.

2. Improve care planning

• Ensure that people with diabetes are at the centre of the agenda/goal setting process and the creation of mutually agreed care plans that meet their specific needs. This will include current work to implement the House of Care framework and maximising the use of MyDiabetesMyWay.

3. Empower and engage people living with diabetes

• SDG and MCNs will actively involve people living with diabetes in decision making processes enabling their experience to be recognised and used to drive service change for improvement. This includes recognising what matters to people living with diabetes and acting upon their feedback.

4. Improve the outcomes in pregnancy

• Establish a pregnancy workstream of the SDG in order to more systematically address the challenges of pregnancy for women living with diabetes.
• The SDG Pregnancy workstream will work with NHS Boards to improve pregnancy related data collection and work with MCNs to link existing datasets to generate data for improvement.
• Develop and improve the pathway for the diagnosis and care of women for who develop gestational diabetes (GDM).

Priority 4. Equality of Access

Aim: To reduce the impact of deprivation, ethnicity and disadvantage on diabetes care and outcomes.

Overview:

Tackling health inequalities is recognised by the Government as the great challenge for public health today and will be one of the main issues to be addressed in the review of public health policy which is expected to report in Summer 2015.

Despite improvements in life expectancy and health outcomes significant differences still exist for people with diabetes depending on deprivation, where they live, ethnic group and their life circumstances. Ensuring equality of access to health services for all people living with diabetes is an important thread that should run through all efforts to improve the quality of services.

Deprivation rates vary across Scotland from 7.9% to 26%. Those in the most deprived areas have reduced life expectancy, higher smoking rates and less engagement with health care services. Type 2 diabetes rates increase with deprivation level and the likelihood of hospital admission with stroke and ischaemic heart disease is 52% and 57% more likely in those in the most deprived areas compared to those living in the least deprived areas. Morbidity resulting from diabetes complications is three-and-a-half times higher in people in social class V compared with those in social class I^[8]. Those who are socially excluded may experience a sense of hopelessness that will militate against them developing confidence to manage their diabetes and create a further barrier to accessing services and navigating NHS systems that are not sensitive to the impacts of deprivation on the population.

One fifth of the Scottish population live in rural areas and a significant number live in remote areas. This presents a significant challenge to diabetes teams which service these areas. The main healthcare issues relevant to geographical location relate to accessing services out of hours, maximising specialist resources locally and retention of skilled and competent health care professionals. An integrated transport system is also a key determinant to accessing services and minimising the impact of remote and rural living.

Health inequalities also exist for those individuals requiring additional support such as those who are housebound, resident in care homes or 'looked after' children and young adults. Accessing services can be challenging and ensuring health care provision that meet specific needs requires individualised care planning.

Those with lower levels of health literacy are more likely to experience poorer outcomes, finding it more difficult to communicate with healthcare professionals, understand medications labelling and find it more difficult to look after long term health needs.

Actions:

1. Minimise the impact of deprivation, ethnicity and geography

• Establish a Health Inequalities workstream of the Scottish Diabetes Group to review the effectiveness of current approaches to tackling inequalities. This will include identifying and promulgating best practice (e.g. in the delivery of culturally sensitive approaches) and making recommendations on what steps might be taken to make improvements.
• Utilise MyDiabetesMyWay to target action towards disadvantaged groups by assessing the uptake of MyDiabetesMyWay based on: deprivation status, ethnicity and geographical location enabling targeted action to reduce disengagement from services.
• Explore and support the development of alternative models of care (e.g. community based specialist diabetes services) in particular for deprived and remote and rural communities in order to improve diabetes outcomes.

2. Improve outcomes for individuals requiring additional support

• Maximise the health literacy of people living with diabetes by promoting and improving access to health literacy tools and resources.
• Ensure that the needs of 'hard to reach' groups, such as 'looked after' children and young adults, are considered in service plans.
• Support the use of personalised care plans for housebound individuals and people living in care homes.
• Roll-out relevant inpatient safety initiatives and develop a training package for care home staff.

Priority 5. Supporting and Developing Staff

Aim: 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.

Overview

Many different health care professionals will interact with a person living with diabetes and each interaction or consultation is an opportunity for the HCP to work with individuals to enhance motivation and optimise self management. General Practitioner trainees are given specific training in consultation skills but this type of training has not been readily available to most other health care professionals (HCPs). The actions described below support the provision of person-centred care covered in Priority 3 and will be supported by current activity to implement the House of Care.

Improving person-centred care requires a combination of high quality education packages delivered by trained educators and HCPs trained in goal setting and behavioural change. Currently there are about 25 patient education programmes which run throughout Scotland and a programme for assessing and approving structured education packages. The recent National Education Day highlighted the rich tapestry of education throughout the various regions in Scotland and also the enthusiasm of staff and people with diabetes to improve their person-centred care and education. Future success requires the nurturing of local courses responsive to the local need but also the harnessing of these courses which should be available to "lift off the shelf" by any MCN as an approved national programme.

In Scotland, we have an excellent track record of innovation, and effective and efficient service provision which reflects key aspects of the Scottish Government 20/20 Vision. Where services have employed psychologists, the range of services available to people with diabetes has substantially increased; some aspects of services have been redesigned using care pathways and protocols; greater support and training has been available to staff, and a psychologist has been readily available to deliver evidence-based treatments to those with significant diabetes-related difficulties.

Actions:

1. Increase the level of consultation and patient engagement skills

• Promote through MCNs the awareness and use of currently available training packages and consider in collaboration with experts in the field of consultation skills, what additional resources should be developed for different health care groups.

2. Increase the level of educator skills and confidence in delivering diabetes education

• The Scottish Diabetes Group will engage with local MCN education leads and embed the skills required to develop or use national education programmes.

3. Increase the level of psychological assessment skills

• The Scottish Diabetes Group will encourage the development of psychological services as part of the care and management of people living with diabetes in line with national guidance, building on the PiD-PaD project to increase the availability of psychological support.

Priority 6. Inpatient Diabetes

Aim: 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.

Overview

The estimated annual cost of inpatient care for people with diabetes in Scotland was £301 million between 2005 and 2007, 12% of the inpatient budget.^[9] The total annual cost is likely to have increased since then. At any one time 15-20% of inpatients have diabetes. There is clear evidence that inpatient diabetes care is sub-optimal. Issues identified in national inpatient diabetes audits in England and Wales^[10] include prescribing and medication errors resulting in hypoglycaemia and hyperglycaemia. Out of target glucose levels (high and low) are not being recognised or addressed leading to serious complications (diabetic ketoacidosis and hypoglycaemic coma). Hyperglycaemia has been associated with increased infection rates^[11] and hypoglycaemia with an increased length of stay and subsequent mortality (ref 4).^[12]

The Scottish Diabetes Group, along with the Quality Improvement and Efficiency Support Team, Healthcare Improvement Scotland and NHSScotland Quality Improvement Hub has developed and piloted improvement packages that have sustainably improved diabetes care in a range of wards in three NHS Boards. These projects have resulted in improvements in the identification of patients as having diabetes on admission resulting in better care planning, a reduction of insulin errors and improved management of hypoglycaemia.

The National Diabetes Inpatient Audits (NADIA) in 2009 and 2010 also revealed that between 3.2 and 2.2% of inpatients with diabetes developed a new foot lesion whilst in hospital. The Scottish Inpatient Diabetic Foot Audit in November 2013 revealed that: 2.4% of inpatients with diabetes developed a new foot lesion whilst in hospital, 57% of inpatients had not had their feet checked and 60% who were discovered to be at risk of developing a foot ulcer did not have any pressure relief in place. In response to this the Scottish Diabetes Foot Action Group (SDFAG) has developed and launched a Check, Protect and Refer (CPR) for diabetic feet campaign to raise awareness of this problem and introduce appropriate pressure relief to prevent avoidable foot ulcers.

Feedback from patient surveys undertaken by Diabetes Scotland has provided valuable insight into aspects of care which can be investigated and improved whilst receiving inpatient care. Quality improvement methodologies such as small tests of change provide a helpful way to begin the process of improving the patient experience. The main areas for improvement identified by the surveys were:

• Food - suitability, carbohydrate counting, timing and access, gluten free, vegetarian.
• Insulin - being locked away or administered incorrectly.
• Equipment - access to pens, meters etc.
• Understanding of diabetes in general.

Actions:

1. Improve glycaemic control of people admitted to hospital

• The Scottish Diabetes Group will work with NHS Boards and support them in the introduction and spread of key aspects of the 'think, check, act' (Diabetes in Scottish Hospitals) initiative.

2. Improve foot care outcomes

• Improve the awareness of foot care to reduce the number of people developing avoidable ulcers including distribution of 'Check Protect Refer' (CPR) for feet posters; developing a LearnPro module and training manual on CPR to inform ward staff.

3. Improve the experience of people with diabetes admitted to hospital

• Improve admission procedures for planned admissions to include planning for insulin management, food and other specific needs of people with diabetes.

Priority 7. Improving Information

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

Overview

Delivering the improvements in care set out in this plan, and ensuring consistent care delivered on a day to day basis wherever people live in Scotland, requires data and information on diabetes to be comprehensive and accurate and for the systems that manage the data to be effective, reliable and responsive.

There needs to be clarity around the differences between (a) the use of data in a consultation between a patient and their healthcare professional, (b) what is needed at a local team or MCN level to identify where improvements can be made and health outcomes targets monitored and achieved, (c) the health informatics required to drive service improvements, model changes to care and to understand what is happening in diabetes care and health outcomes; and (d) the data required for formal; reporting at national and NHS Board level. A key issue is how to maintain the current system whilst improving upon it in order to deliver 'Data Driven Diabetes Care'.

Actions:

1. Improve access to appropriate and accurate information

• Review and enhance the clinical system holding clinical data to ensure that it meets the needs of frontline healthcare professionals and that: patient data is available and more accessible for use during each consultation; design of the interface is driven by the service user; and enhancing mechanisms to prioritise system improvements.

2. Better reporting and use of data at both national and local levels

• The Scottish Diabetes Group will strengthen mechanisms to ensure that data is available and used to inform national discussions on improving care through accessible and relevant reporting.
• The Scottish Diabetes Group will work with stakeholders to review and improve the Scottish Diabetes Survey.

3. Improve patient access to their data to support self management

• The Scottish Diabetes Group will work with the third sector to develop and enhance the MyDiabetesMyWay website to ensure that it is accessible and supports mobile technology and assess options for a public awareness campaign building on the previous Chat Click Call campaign.

Priority 8. Innovation

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

Overview

The increasing numbers of people developing diabetes is placing ever greater pressures on diabetes services. Managing this pressure, combined with the challenge of improving the quality, effectiveness, efficiency and person-centredness of diabetes care will require the diabetes community - in consort with others - to strengthen its capacity and willingness to innovate. It is hard to see how diabetes services - and the NHS as a whole - can remain sustainable without introducing radical change.

Medicines innovation and use of medicines for patients with diabetes, has increased considerably over the last 6 years, leading to more treatment options for patients. The pace of growth in the availability of new SMC approved medicines can create challenges for health care professionals in optimising medicines for the individual patient. The Diabetes Prescribing Strategy 2014-2016 provides guidance to support clinicians in finding the correct medicine for the patient ensuring this decision is based on clinical-evidence, safety profile and cost-effectiveness.

A number of innovative tools and ideas developed for and/or could be utilised by diabetes services (e.g. insulin pumps, continuous glucose monitors and emerging sensor based technology) have, for a variety of reasons, been slow to be adopted. The challenge is to find effective ways to overcome barriers to implementation.

The Scottish Government has highlighted innovation as one of its key priorities and in health is taking forward a range of measures including publishing 'Health and Wealth in Scotland: A Statement of Intent for Innovation in Health', establishing the Innovation Partnership Board (IPB), setting up new Innovation Centres (such as the Digital Health Institute), and giving a commitment to define National Priorities for Innovation and to develop Managed Innovation Plans.

Diabetes in Scotland already has a number of advantages for building partnerships and opportunities for innovation. These include: existing strong networks - both national and international - involving those with clinical, IT, research, third sector, pharmaceutical and other expertise; rich sources of data; and a track record of collaboration and implementation of innovative approaches. From this starting point, the goals for diabetes should be to:

• Speed up the diffusion and implementation of proven clinical and cost effective innovative solutions in Scottish diabetes services which will demonstrably improve outcomes, quality of life of people living with diabetes and efficiency in diabetes care.
• Encourage and support innovators in diabetes to develop and pilot innovative solutions.
• Develop and support networking to increase opportunities for fruitful collaboration and innovation - both within the diabetes community and by the diabetes community engaging more effectively with Government, other public bodies, global and national firms, Small and medium enterprises, the third sector and academia.
• Support the development of high quality diabetes research and the mechanisms to translate the outputs of this work into improvements in care.
• Improve the communication and promotion - nationally and internationally - of the opportunities and successes of Scotland's contribution to innovation and research.
• Increase access to training in technology approaches for healthcare professionals and patients.

Actions:

1. Promote networking and mechanisms to support innovation

• The Scottish Diabetes Group will produce by spring 2015, a robust plan to enable the diabetes community to ensure that it is well placed to develop and deliver innovative solutions which offer improved care to people living with diabetes.

2. Increase the pace of adoption of proven innovations

• The Scottish Diabetes Group will work with the Innovation Partnership Board and other stakeholders to develop robust approaches to identify innovative ideas and solutions and put in place appropriate agreements and mechanisms to ensure the effective implementation of these innovations.