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:
2 Identification of people with diabetes:
3 Empowering people with diabetes:
4 Clinical care of adults with diabetes:
5, 6 Clinical care of children and young people with diabetes:
7 Management of diabetic emergencies:
8 Care of people with diabetes during admission to hospital:
9 Diabetes and pregnancy:
10, 11, 12 Detection and management of long-term complications:
- The full document National Service Framework for Diabetes: Standards can be downloaded from the DoH website http://www.doh.gov.uk/nsf/diabetes/