Diabetes Services need to improve care offered

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Published: 20 July 2007

Diabetes Services need to improve care offered

Healthcare Commission (HC) says that most primary care trusts are commissioning services that deliver the basic needs for people with diabetes. However, PCTs need to improve the help they offer people with diabetes to manage their condition.

The Healthcare Commission has found that 73% of PCTs (those rated ‘fair’) were meeting basic diabetes health requirements, in a national review of diabetes released this week. The people with diabetes in those trusts are being given yearly check-ups & relevant tests, such as for their long-term blood sugar levels and blood pressure.

People with diabetes in the ‘fair’ trusts also reported they knew enough about when to take their medication and how much medication to take.

The review also found that:

· 5% of trusts were ‘excellent’

· 11% were ‘good’, and

· 12% were ‘weak’

The 12% of trusts that were rated weak fall into two categories. Either the HC found their services were ‘weak’, or the HC could not make an assessment because they had too little information from them about the views of the people with diabetes in their area.

The Commission found that trusts that were rated ‘fair’ (and ’weak’) (85%) were not commissioning services that offered enough support to people with diabetes to manage their condition.

Managing their own condition, and being given the support to do so, can have significant benefits for a person with diabetes.

By being helped to manage their own condition through agreeing plans with their healthcare professional, for example on weight management and exercise plans, or attending education courses that help people with diabetes to understand how to eat well or stop smoking, they can prevent the onset of diabetic complications such as heart problems, blindness, kidney failure and limb amputation.

These complications not only have physical effects for people with diabetes, but there is also a large & growing financial impact on the NHS. In 2002, £1.3 billion, or around 5% of total NHS expenditure, was used to care for people with diabetes.

Estimates from 2006 suggest that total diabetes expenditure could be as high as 10% of NHS expenditure, which is planned to be around £92 billion in 2007/2008.

This means that about £9 billion is estimated to be spent on care for people with diabetes, which is over £25 million every day.

Diabetes is a growing problem in England . In 2006, figures showed nearly 1.9 million people were diagnosed and registered with diabetes.

The number of diagnosed & undiagnosed people with diabetes is forecast to rise by 15% between 2001 and 2010. 9% of this rise is due to increasing numbers of obese people and 6% is due to an ageing population.

The review assessed how well PCTs commissioned primary and secondary care services to help people with diabetes to look after their condition, looking at both the commissioning and provision of services.

Making support available to people with long-term conditions to care for themselves is claimed to be central to the Government’s policy for diabetes.

The issue of supported self-care is highlighted in the 2001 Diabetes National Service Framework as a priority area for healthcare professionals. Services were given a delivery strategy for this framework in 2003.

The Commission benchmarked PCTs against one another on three areas:

· are adults with diabetes looking after their condition?

· are adults with diabetes supported to self-care through planning, information & education?, and

· are adults with diabetes having key tests and measurements carried out?

The 16% of primary care trusts (PCTs) that were found to be ‘excellent’ or ‘good’ were going beyond meeting minimum requirements and offering enough help to people with diabetes to manage their condition.

These PCTs are more likely to have people with diabetes meeting their clinical targets, reporting they have jointly agreed care plans with their healthcare professional, are meeting their weight & physical activity lifestyle targets, and are improving their knowledge on how they care for their diabetes through attending education courses.

All services need to look to these trusts and follow their example of care.

Of concern is the 12% of PCTs that the Commission found were commissioning ‘weak’ diabetes care.

These PCTs are not meeting the basic health needs of people with diabetes or supporting them to manage their own condition, or we could not assess them because no data was available on their services from the national survey of people with diabetes.

The Commission and strategic health authorities will be working with these PCTs to create improvement plans and will be monitored closely on their progress.

Healthcare Commission Chief Executive Anna Walker says:

"Diabetes services that are providing ‘good’ and ‘excellent’ care to people with diabetes deserve to be praised.

They are doing more than meeting the basic needs of people with diabetes by taking that care one step further and offering the right support to people with diabetes to help them manage their condition.

This is essential to the well being of people with diabetes. By managing their condition, people with diabetes can prevent serious health complications such as blindness, kidney failure and even extend their life expectancy.

These services that are helping people to manage their own condition, are positively affecting the health and quality of life of people with diabetes.

All services that provide care to people with diabetes need to look to these services and follow their example of care."

Key improvements for all commissioners and providers of diabetes services, highlighted in the report:

· Improve care planning between people with diabetes and their healthcare professional

By creating a care plan with their healthcare professional a person with diabetes can set out how they will meet their lifestyle targets, such as weight management, increasing physical activity and what they will do in the event of developing emergency complications

People with diabetes reported that key aspects of care planning were not happening, particularly those with Type 2 diabetes and those from black and minority ethnic groups

The number of people who had agreed a care plan going forward with their health professional ranged from 34% at the trust with the lowest numbers to 61% at the trust with the highest numbers

· Increase the number of people attending education courses and improving their knowledge

By becoming more knowledgeable about diabetes through education courses, people with diabetes can make informed choices about how to manage their condition

The number of people with diabetes in PCTs who have not attended an education course on diabetes care, and would like to, ranged from 16% at the trust with the lowest attendance rate to 41% at the trust with the highest rate

Approximately half of trusts (55%) had 10% of people or fewer reported attending a course on diabetes care.

Overall, between 1% at the trust with the lowest attendance rate and 53% of adults at the trust with the highest rate, had attended a course

People with Type 2 diabetes, more than people with Type 1, and people from black and minority groups more than white people, report not attending an education course but wanting to

· All organisations providing and commissioning diabetes services need to work more closely together to reduce emergency admission rates

Emergency admission rates can indicate how well services that provide care to people with diabetes are working together

If the healthcare professionals involved in diabetes care from the acute hospital to the ambulance services and general practices, worked together in a multi-disciplinary network, their PCTs could have significantly lower emergency admissions relating to diabetic complications

The Commission found in 95% of PCTs, there is scope to reduce the number of emergency admissions to hospital for diabetes-related complications

From 2003 to 2006 Emergency admission rates for patients with diabetes related complications were lower than expected in only eight trusts

The Commission believes all PCTs should aim to have rates lower than expected

By services working together in a multi-disciplinary team, there could potentially be 1000 less emergency admissions relating to diabetic complications in England a year

· Increase the number of people with diabetes having blood glucose levels of 7.4 or less

For a person with diabetes, high blood glucose levels can lead to micro-vascular conditions such as blindness, kidney failure and nerve damage

National diabetes guidelines recommend people with diabetes should all have blood glucose levels of 7.4 or less, to prevent these complications

In PCTs the number of people achieving blood glucose levels of 7.4 or less ranged from 52% at the trust with the lowest numbers and 65% at the trust with the highest numbers

· Variations in outcomes, and processes, of key measurements need to reduce in general practices

The Commission found variations in the achievement of general practices within PCTs, meaning some people with diabetes were getting better care than others

The variations of the recording and outcomes of blood glucose levels from general practices at the PCT that had the widest variations, was 12 times wider than the PCT that had the least variations from general practices in these recordings and outcomes

Recommendations to healthcare professionals, PCTs & SHAs in the report include:

· Healthcare professionals providing frontline care to people with diabetes need to offer individual support to people with diabetes encouraging them to look after their diabetes

The patient’s experience must be considered as important as the healthcare professionals view when creating a care plan for a person with diabetes

· PCTs should implement the National Institute for Health and Clinical Effectiveness (NICE) guidelines on structured education for patients, which says people with diabetes should be offered education courses

PCTs also need to improve the way they commission diabetes services by reviewing data submitted by services caring for people with diabetes, and support implementation for care planning between people with diabetes and their healthcare professional

· Strategic health authorities should monitor the implementation of all recommendations from this review and the improvement plans of PCTs scoring ‘weak’ overall

The Commission will continue to encourage improvement in diabetes care by monitoring trusts on how well people with diabetes are looking after their condition

This includes monitoring trusts on a small number of diabetes indicators, for example assessing the percentage of people within trusts that have blood glucose levels at 7.4 or below

Further information

Service review of diabetes

2001 Diabetes National Service Framework

DH - Diabetes

Diabetes UK

National Diabetes Support Team

Education for patients

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