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Five areas NHS integrated care boards can improve diabetes care for people
As integrated care boards (ICBs) are established there is an opportunity to further shift the dial on diabetes prevention, treatment and care, building on improvements over the last two decades.
Preventing type 2 diabetes and supporting the delivery of high-quality care for people living with all forms of diabetes are the priorities of the NHS Diabetes Programme (NDP). The increase in prevalence, long-term risks of complications and budgetary impact of treatment make diabetes one of the most important non-communicable diseases to target.
Our aim is to improve outcomes and equity across socioeconomic deprivation, ethnicity, age, and type of diabetes. We set out five high-impact areas for ICBs to consider:
1. Population health management
Clinical and demographic data can support planning, enabling targeted interventions to prevent ill health, improve care and address variation. Systems like Nottingham and Nottinghamshire ICB have prioritised diabetes as part of their approach. We are working with several ICBs that have built diabetes data into their dashboards and are supporting others to do the same.
We are making access to diabetes data much easier. A new Diabetes data hub on the FutureNHS platform (this platform requires a login) shows information at ICS, PCN and GP practice level. An interactive map shows how systems are performing against diabetes care processes, which are associated with reduced mortality, emergency admissions, amputations and diabetic retinopathy. Through the NHS Long Term Plan (LTP), a share of the annual diabetes implementation fund, worth over £100million across five years, is allocated to each ICB to support this and other LTP commitments.
In some areas, PCN approaches are being successfully adopted to provide new models of diabetes care across a larger footprint, as set out in the Primary Care Diabetes Service (PCDS) ‘at-a-glance’ guide. Risk stratification tools, such as those developed by NHS England, PCDS and the Association of British Clinical Diabetologists, can help care providers ensure those people at greatest risk of complications are called for review.
ICBs should have a clear plan to recover diabetes care process delivery to at least pre-pandemic (2019) levels by the end of 2022/23, to support more people to achieve NICE recommended treatment targets and reduce the risk of diabetes-related complications and deterioration. ICBs should review the available data and use risk stratification tools to inform the areas of focus.
2. Preventing Type 2 diabetes
Weight gain is putting more people at risk of Type 2 diabetes. It is vital that systems prioritise engagement with, and referral into, the National Diabetes Prevention Programme (NDPP). An independent NIHR funded evaluation has shown that the NDPP resulted in a 7% reduction in the number of new diagnoses of Type 2 diabetes in England (2018 – 2019), with programme completers on average 37% less likely to develop Type 2 diabetes, making it a life-changing experience.
The NHS LTP commits that 200,000 people a year will be supported by the NDPP. ICBs should have a clear plan to increase the number of people that are referred to the NDPP in line with their LTP trajectories.
3. Type 1 diabetes treatment and care
Access to specialist care and technology; education; and peer support are key to improving outcomes for people with Type 1 diabetes.
Better integration between primary and secondary care could improve access to specialist care. New Provider Collaboratives, partnering trusts and other providers together, could present opportunities for diabetes care. New national standards for sharing diabetes information across care settings, including self-reported data from digital tools, are also being developed.
Over 80% of people with type 1 diabetes are now using flash continuous glucose monitoring. A recent update to NICE guidance indicates that all adults with Type 1 should be offered this technology. The NHS LTP also committed that all pregnant women with Type 1 are offered continuous glucose monitoring, and we are very close to meeting this target for eligible women being offered it. NICE will soon be consulting on provision of Hybrid Closed Loop systems. ICBs should be aware of these future developments and the need consider demand profiling, workforce development and commissioning strategies to support access.
Diabetes education provision is now bolstered by new, nationally-funded, digital self-management tools like Digibete and My Type 1 diabetes for Type 1 and Healthy Living for Type 2.
ICBs should have clear commissioning policies in place on the provision of diabetes technology, in line with NICE guidance, and ensure that people with diabetes can access structured education to support diabetes management.
4. Diabetic footcare
Lower limb amputation is one of the most feared complications of diabetes, with major impacts on somebody’s quality of life and associated higher morbidity and mortality. Whilst England has some of the lowest rates of amputation internationally, we must continue to improve and address unwarranted variation.
Systems should ensure timely access to multidisciplinary footcare teams. Some ICBs have further to go to meet this commitment and can improve quality by implementing footcare recommendations in the Diabetes GIRFT Programme National Specialty Report.
5. Safety in hospitals
Up to 20% of inpatients have diabetes at any one time. People with diabetes in hospital have higher complication rates, longer lengths of stay and higher re-admission rates. Despite good progress, there is still variation in the quality and availability of inpatient diabetes services and the frequency of hospital-acquired harm.
A key LTP commitment is that all trusts have a diabetes inpatient specialist nurse service. Transformation funding over several years has helped close gaps, but ICBs should be satisfied that all hospitals have this in place.