A National Service Framework for People with Diabetes Adrian Sieff December 2001.

A National Service A National Service Framework for People with Framework for People with

DiabetesDiabetes

Adrian SieffDecember 2001

The Quality FrameworkThe Quality Framework

MONITOREDSTANDARDS

Prof self regulation

LifelongLearning

• National Performance Framework• Commission for Health Improvement

• National Patient and User Survey

• NationalService Frameworks• National Institute for

Clinical Excellence

Clinical Governance

Patient &Public

Involvement

CLEAR STANDARD

S OF SERVICE

DEPENDABLELOCAL

DELIVERY

Purpose of NSFsPurpose of NSFs

Drive up qualityReduce variationsHelp deliver The new NHS, Modernising

Social Services and Saving Lives: Our Healthier Nation.

National Service FrameworksNational Service Frameworks

Interventions

National Standards

Service Models

Milestones

Performance indicators

UNDERPINNING PROGRAMMESresearch & development; clinical decision support systems;

information; human resources; revenue and capital

NSF ProgrammeNSF Programme

PublishedMental Health, CHD, Older People and

Cancer PlanOlder People

Coming soonDiabetesRenal and children’sNeurological conditions

Why an NSF in Diabetes:Why an NSF in Diabetes:CostsCosts

Individual costsNHS costsSociety costs

Complications Increase NHS Costs by Complications Increase NHS Costs by Increasing In Patient Costs -TIncreasing In Patient Costs -T22ARDIS ARDIS

surveysurvey

0

1

2

3

4

5

6

None (n=904) Micro (n=382) Macro (n=184) Both (n=108)

Cos

t im

pact

fact

or

Primary Care Drugs Out patient In patient

2.5x2.7x

5.6 x

Why an NSF in Diabetes:Why an NSF in Diabetes:VariationsVariations

The National ServiceThe National ServiceFramework for DiabetesFramework for Diabetes

AimsDecrease the incidence of type 2 diabetesImprove health outcomes of people with diabetes

By:Improving the overall quality of diabetes servicesReducing unacceptable variations in the quality of these services

NSF: StandardsNSF: Standards

AimStandardRationale Interventions Implications for service planningSupporting evidenceService modelsPerformance indicators

NSF: Delivery StrategyNSF: Delivery Strategy

Underpinning programmesActions and milestonesService modelsPerformance management

By 2013By 2013

Fewer people develop diabetesEarlier identification of diabetesPeople with diabetes have greater controlFewer complicationsEarly treatment of complicationsEffective in-patient careHealthy pregnancies

What will the NSF become?What will the NSF become?

Pathways in DiabetesPathways in Diabetes

Diagnosis InitialManagement

ContinuingCare

PREVENTION

Pregnancy

EVENTSEVENTS

Non diabetes Related Hospital

Admissions

New

Protenuria

New

CHD

New stroke

New Erectile

Dysfunction

Institutional Care

At Risk

Foot

New Eye Complications

DKA

HONK

Severe Hypoglycaemia

Major Life Events

Major Treatment

Change e.g. Starting Insulin

Other new

complications

A Different A Different PerspectivePerspective

www.doh.gov.uk/nsf/diabeteswww.doh.gov.uk/nsf/diabetes

diabetes.nsf@doh.gsi.gov.ukdiabetes.nsf@doh.gsi.gov.uk

Bulletin BoardBulletin Board

Involving practitioners Involving practitioners andand

people with diabetespeople with diabetes

ERG, topic work and cross-cutting areas Review of existing literature on user views Further analysis of existing data on user views:

Audit Commission, Bradford HAZ Focus groups and in-depth interviews Nottingham event Seeking good practice

Delivering the NSF for Delivering the NSF for DiabetesDiabetes

ambitious but realistic programmes which “pull all the levers simultaneously’

recognition that change requires time if it is to be sustainable

determined and effective approach to reshaping clinical and social work practice

a commitment to leadership - within and between agencies, local communities, patients, service users and their carers