Scottish Diabetes Framework

Scottish Diabetes Framework

Scottish Diabetes Framework: Executive Summary

Diabetes presents a serious health challenge for Scotland. There are believed to be 150,000 people in Scotland who have been diagnosed with diabetes and there are almost certainly many thousands more who are, as yet, undiagnosed. The number of people developing diabetes is increasing and may double in the next 10-15 years.

Diabetes is a chronic condition with potentially devastating consequences for health. Complications of diabetes include a higher risk of heart disease, stroke, kidney failure, eye disease (diabetic retinopathy) that can lead to blindness, and foot ulceration, which can lead to amputation.

There is robust evidence that good diabetes care (e.g. control of blood pressure, glycaemic control and cholesterol) reduces the risk of complications. The evidence base for diabetes treatment has been collated in a recent SIGN guideline (SIGN 55).

The Scottish Diabetes Framework was developed by a Working Group set up by the Scottish Executive in response to a commitment in Our National Health: A plan for action, a plan for change. A consultation paper was widely circulated during Summer 2001 and the responses to that consultation have shaped this document.

The Framework seeks to draw together existing guidance and best practice. It should be read in conjunction with two key documents; the 'Management of Diabetes' guideline produced by SIGN and the clinical standards for diabetes produced by the Clinical Standards Board for Scotland which were both published in November 2001. The standards and the clinical guideline should be viewed as integral parts of the Framework.

As a planning tool, a model of diabetes care was developed by the Working Group. This consists of 22 building blocks, divided amongst six broad headings: Prevention and early detection; Care, monitoring and treatment; Specific groups; Planning and managing services; Implementation; and Community Issues.

The Framework identifies seven of the building blocks as 'first stage' priorities:

• Patient Information, Education and Empowerment
• Heart Disease
• Eye Care
• Strategy, Leadership and Teamworking
• Education and Training for Professionals
• IM&T and Diabetes Registers
• Implementation and Monitoring

In order to support and monitor the implementation of the Framework a Scottish Diabetes Group has been established as a national steering group.

Throughout the Framework a number of 'milestones' and 'actions points' have been included. A Milestone represents a significant stage on the way towards creating a high quality patient-centred diabetes service. It marks a point for reflection, assessment of progress and confirmation of direction. An Action Point is a specific piece of work that will be undertaken to support this process.

MILESTONES AND ACTION POINTS

Public Education

• Each NHS board should organise in collaboration with other agencies, at least one event to raise public awareness of diabetes during 2002/03. ( paragraph 37)

Patient Information, Education and Empowerment: Seeking the views of people with diabetes

• Partners in Change will publish a report of its work with people with diabetes by June 2002. ( paragraph 43)

Patient Information, Education and Empowerment: Patient education

• A report on patient education programmes in diabetes will be produced by December 2002. ( paragraph 46)

Patient Information, Education and Empowerment: Patient information

• The Scottish Diabetes Group will work with NHS24 to ensure that relevant and up to date information on diabetes care and services is available through NHS24. ( paragraph 47)
• By September 2002 the Scottish Diabetes Group will agree on and put in place a programme of work to help to ensure that relevant high quality patient information on diabetes is available to patients and carers. ( paragraph 49)

Patient Information, Education and Empowerment: Patient involvement

• A project to encourage and support patient and carer involvement in the work of Managed Cinical Networks and Local Diabetes Service Advisory Groups (LDSAGs) will be funded in 2002. ( paragraph 52)
• A guide to encourage the active participation of patients, parents and carers in Local Diabetes Service Advisory Groups (LDSAGs) and other service planning fora will be produced by June 2002. ( paragraph 53)
• A national meeting for lay members and potential lay members of LDSAGs will be held during 2002. ( paragraph 53)

Heart Disease

• Good practice models for screening for cardiovascular risk factors in diabetic patients will be defined and disseminated by December 2002. ( paragraph 58)

Eye Care

• All people with diabetes will have their eye status (retinopathy) recorded on the local diabetes clinical management system by September 2003. ( paragraph 64)

• The Scottish Diabetes Group will produce plans to take forward the implementation of the report of the Health Technology Board for Scotland on the organisation of services for diabetic retinopathy screening by Summer 2002. ( paragraph 65)
• A national co-ordinator to support the implementation of the recommendations of the Health Technology Board for Scotland on the organisation of services for diabetic retinopathy screening will be appointed by September 2002. ( paragraph 65)

Initial and Continuing Care

• Annual measurement of glycated haemoglobin (a measure of the amount of sugar in the blood; HbA1c) will be offered to all people with diabetes by September 2002. The results will be recorded on the local diabetes clinical management system. ( paragraph 69)

Children and Young People

• An educational video for children with diabetes and their families will be funded, produced and made available by autumn 2002. Every new family will be offered a video or DVD. ( paragraph 84)

Ethnic Minority Groups

• By September 2003, the Scottish Diabetes Group will publish a report, in conjunction with the Ethnic Minority Resource Centre of the Public Health Institute for Scotland (PHIS), on the epidemiology of diabetes amongst Scotland's ethnic minorities. ( paragraph 85)

Strategy, Leadership and Teamworking: Leadership

• Clinical leaders should be identified at locality level to champion local integrated diabetes services in all NHS boards by June 2002. ( paragraph 95)
• A dedicated 'diabetes co-ordinator' to improve communications within the local diabetes community and provide administrative support to enhance integrated care across primary and secondary care should be identified in all NHS boards by December 2002. The co-ordinator should be responsible to the LDSAG for strategy and implementation of policy at locality level. ( paragraph 97)

Strategy, Leadership and Teamworking: Local Diabetes Service Advisory Groups

• All NHS boards should establish an effective multi-professional Local Diabetes Service Advisory Group (or equivalent) with service user involvement by June 2002. ( paragraph 98)

Strategy, Leadership and Teamworking: Reporting arrangements

• All NHS boards should publish an Annual Diabetes Report. A report for 2002/03 should be prepared and published by each LDSAG by June 2003. ( paragraph 99)

Strategy, Leadership and Teamworking: Strategy and Implementation plan

• All NHS boards should publish a local diabetes strategy and implementation plan by April 2003. ( paragraph 100)

Strategy, Leadership and Teamworking: Workforce planning

• A workforce survey of diabetes services in hospitals and the community (e.g. specialist nurses, podiatrists, dietitians, community nurses, general practitioners and consultants) will be commissioned by January 2003. ( paragraph 101)

Strategy, Leadership and Teamworking: Diabetes Collaborative Improvement Programme

• A Diabetes Collaborative Improvement Programme will be established by March 2002 to support the sharing of experience and best practice throughout Scotland to improve care and outcomes for people with diabetes. ( paragraph 102)

Strategy, Leadership and Teamworking: Managed Clinical Networks

• Managed Clinical Networks for diabetes will be established in all NHS Boards by September 2004. ( paragraph 103)

Education and Training for Professionals

• A short-life group will be established by the Scottish Diabetes Group to assess the availability and quality of existing diabetes education and training, to ascertain the training needs of staff, especially in primary care, and to make recommendations for meeting these needs. A report of this work will be published by December 2002. ( paragraph 110)

IM&T and Diabetes Registers

• All hospital-based diabetes clinics will be supported by an effective IT system by December 2002. ( paragraph 115)

• A national IT system to support all aspects of diabetes care will be fully implemented throughout Scotland by December 2005. ( paragraph 115)

IM&T and Diabetes Registers: Local Diabetes Registers and the Scottish Diabetes Survey

• All NHS boards should submit data for the 2002 Scottish Diabetes Survey in September 2002. ( paragraph 116)
• A conference for those involved in developing and maintaining local diabetes registers will be held by Summer 2002 to update progress, and foster collaboration between all Scottish regions in the 1.5 million SCI-DC (SCI Diabetes Collaboration) programme. ( paragraph 116)

Implementation and Monitoring

• The CSBS will publish an assessment of the standards of care provided by diabetes services in 2003. ( paragraph 125)

Scottish Diabetes Group

• A website to improve collation and dissemination of information about diabetes in Scotland - www.show.scot.nhs.uk/diabetes - will be established by the Scottish Diabetes Group by September 2002. ( paragraph 132)
• A conference to promote best practice in diabetes care (including service delivery and design, clinical IM&T, research and development, LDSAGs/managed clinical networks, and eye screening) will be hosted in Scotland in November 2002. ( paragraph 132)

• The Scottish Diabetes Group will review and revise the Scottish Diabetes Framework by Spring 2004. ( paragraph 29)