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Higher standards in diabetes care

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Simon O'Neill, BA (Hons), RN, RSCN.

Head of Diabetes Care Developments, Diabetes UK, London


Diabetes UK welcomes the National Service Framework for Diabetes: Standards as the first step towards prioritisation of diabetes and the needs of people with diabetes. At last the Government has acknowledged the importance of diabetes, its prevention and related devastating complications such as blindness, kidney disease and coronary heart disease. The 12 standards are centred on the needs of people with diabetes and we believe that, if implemented appropriately, the care of people with diabetes will improve significantly.

We are, however, disappointed that the standards have been published without the necessary delivery strategy, resources or milestones to support implementation nationwide. It is unacceptable that the needs of people with diabetes have been put on hold and implementation delayed until April 2003.

Local assessments
Despite the delay, the momentum for delivery of diabetes care must be maintained everywhere. The requirement for all primary care trusts to undertake a local assessment of diabetes provides the opportunity to prepare fully for implementation. All those involved in diabetes care, including people with diabetes, must take part. The building blocks to delivering the care that people with diabetes expect should now be put in place. The delay in implementation will mean that their expectations will be higher than ever about what will be delivered in 2003.

Patient-centred care
While the standards document provides the direction of travel for diabetes care in the future, it currently lacks the detail needed to make a radical change to the experiences of people living with diabetes. The next step is to ensure that the delivery of the standards is as patient centred as the standards themselves. Diabetes UK hopes that this will be addressed fully through prioritisation, commitment of resources and the involvement of people with diabetes and health-care professionals, to ensure that the vision of the NSF is achieved.

The 12 standards cover the complete diabetes life cycle - from prevention of diabetes to the management of complications in those diagnosed with diabetes within primary and secondary care. Diabetes UK believes that routine delivery of care which meets these standards will ensure that all people living with diabetes will receive the care they should expect, which is at last focused on the needs of the individual rather than the needs of the NHS. The delivery of high-quality care, early identification of diabetes and services which can support the empowerment of people with diabetes is the only way of tackling the growing burden of this condition and of putting people with diabetes at the centre of their own care. This is one step towards meeting the vision of The NHS Plan (Department of Health, 2000).

High-quality care
Currently lacking in the document is a clear framework of what constitutes 'high-quality care'. Diabetes UK believes that quality care is that which enables the individual with diabetes to achieve a quality of life and life expectancy similar to that of those who do not have diabetes. Quality care can only be achieved if it is the right care, delivered in the right place, at the right time, by the right person.

Despite the welcome given to the overarching standards, the 'devil will be in the detail' worked up within the delivery strategy. The 'how' and the 'who' is just as important as the 'what' and it is vital that people with diabetes are involved nationally and locally. Diabetes UK is pleased to be involved in this process but emphasises the need to have wide consultation with and involvement from people with diabetes and health professionals who are going to be the recipients of and responsible for care delivery.

We hope that the delivery strategy will fully address all of the following issues within its development

- Co-ordination of district diabetes services

- User involvement in local planning and delivery

- The need for improved information technology, especially in terms of population-based registers

- Staffing issues, especially in specialist diabetes care, in both primary and secondary care

- Education of people with diabetes and health professionals

- The needs of special groups who are at a greater risk of developing diabetes, such as those from black and ethnic minority groups and people in institutional care

- The need for structured care organisation

- Monitoring and audit to support quality care.

The NSF for Diabetes: Standards and consultation on service models are available on the DoH website at www.doh. or from: Department of Health, PO Box 777, London SE1 6XH.

Department of Health. (2000) The NHS Plan. London: The Stationery Office.
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