Dr Roger Gadsby argues that adequate resources will be crucial to successful implementation of the NSF diabetes standards


   

Part 1 of the NSF for Diabetes, published in December 2001, gives a clear indication of the importance that the Government now attaches to improving diabetes care across the country. There is a clear emphasis on patient empowerment through education and involvement in care. Depression is highlighted as a condition that occurs frequently in patients with diabetes and one that needs to be diagnosed and treated promptly.

The NSF acknowledges that there are significant inequalities in the risk of developing diabetes, in the access to and quality of health services and in health outcomes in type 2 diabetes. The framework gives a clear message that improvements need to be made.

The standards are of the 'broad brush' variety – I do not think anyone could disagree with them. However, more importantly, until Part 2 of the NSF is published in the summer, we will not know exactly how they are to be implemented and what resources and incentives there will be to do the work.

Standard 2 is an illustration of this dilemma. It states that the NHS will develop, implement and monitor strategies to identify people who do not know they have diabetes. However, it is not clear about what sort of screening should be done.

The framework states that there is emerging evidence for the clinical and cost effectiveness of offering screening to those at increased risk of developing diabetes. However, the national screening committee has decided that further research is needed before it can advise the DoH and it will report in 2005! I hope that Part 2 of the framework will clarify exactly what sort of screening general practice should be doing to fulfil this standard.

Part 1 of the NSF for Diabetes is a statement of general principles, aims and standards. Details of implementation, resources and incentives, that I trust will appear in Part 2, will determine how successful the NSF will be in radically improving diabetes care in England over the next 10 years.

Summary of the NSF for Diabetes Standards

1 Prevention of type 2 diabetes:
The NHS will develop, implement and monitor strategies to reduce the risk of developing type 2 diabetes in the population as a whole

2 Identification of people with diabetes:
The NHS will develop, implement and monitor strategies to identify people who do not know they have diabetes

3 Empowering people with diabetes:
All children, young people and adults with diabetes will receive a service which encourages partnership in decision-making, supports them in managing their diabetes and helps them to adopt and maintain a healthy lifestyle

4 Clinical care of adults with diabetes:
All adults with diabetes will receive high-quality care throughout their lifetime, including support to optimise the control of their blood glucose, blood pressure and other risk factors for developing complications of diabetes

5, 6 Clinical care of children and young people with diabetes:
5: All children and young people with diabetes will receive consistently high-quality care and they, with their families and others involved in their day-to-day care, will be supported to optimise the control of their blood glucose and their physical, psychological, intellectual, educational and social development
6: All young people with diabetes will experience a smooth transition of care from paediatric to adult diabetes services, whether hospital or community-based

7 Management of diabetic emergencies:
The NHS will develop, implement and monitor agreed protocols for rapid and effective treatment of diabetic emergencies by appropriately trained healthcare professionals

8 Care of people with diabetes during admission to hospital:
All children, young people and adults with diabetes admitted to hospital, for whatever reason, will receive effective care of their diabetes. Wherever possible, they will continue to be involved in decisions concerning the management of their diabetes

9 Diabetes and pregnancy:
The NHS will develop, implement and monitor policies that seek to empower and support women with pre-existing diabetes and those who develop diabetes during pregnancy to optimise the outcomes of their pregnancy

10, 11, 12 Detection and management of long-term complications:
10: All young people and adults with diabetes will receive regular surveillance for the long-term complications of diabetes 11: The NHS will develop, implement and monitor agreed protocols and systems of care to ensure that all people who develop long-term complications of diabetes receive timely, appropriate and effective investigation and treatment
12: All people with diabetes requiring multi-agency support will receive integrated health and social care

Guidelines in Practice, January 2002, Volume 5(1)
© 2002 MGP Ltd
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