The importance of developing effective, co-ordinated services for the care of people with diabetes - described as “Scotland’s epidemic for the 21st century” - is highlighted in a report published today (March 23).
Action needed to improve diabetic care – “Scotland’s epidemic for the 21st century”
The importance of developing effective, co-ordinated services for the care of people with diabetes - described as “Scotland’s epidemic for the 21st century” - is highlighted in a report published today (March 23).
The incidence of diabetes is doubling every decade and treating the condition and its complications already costs #320million a year in Scotland. Although it cannot be cured, diabetes can be treated very successfully. The report from NHS Quality Improvement Scotland (NHS QIS) says that people’s lives could be improved and problems prevented from developing if diabetes was diagnosed earlier and managed more effectively.
Around 150,000 people in Scotland have been diagnosed with diabetes and another 90,000 may already have the condition without knowing it. Although care has improved in the past 10-20 years, services are still too fragmented. This results in patients having to make multiple appointments with different parts of the health service to attend to the various complications posed by the condition.
The first ever national review of the performance of services, carried out by NHS QIS, has found that the care and treatment given is generally of a very high standard. However, it says that services need to be better co-ordinated to help people with diabetes live as normal a life as possible. This needs to be based on early warning systems and risk management, with the patient at the heart of their own care.
People with diabetes have an increased risk of heart disease and stroke, blindness, kidney failure, and nerve damage. They are 15 times more likely to have a limb amputated than people without diabetes. Their care is complex. It requires routine treatment, combined with continual monitoring to make sure any complications are identified early and prevented from developing. It also involves many different professionals whose work needs to be carefully
co-ordinated to ensure patients receive the services they need, when they need them.
The review is based on visits that have taken place across Scotland to assess the performance of local health services against agreed standards for the care of people with diabetes. The standards were drawn up in partnership with the patient group, Diabetes UK. The review teams, which included members of the public, looked in detail at the organisation of services, the information and education offered to patients, and the procedures in place to review the condition of patients and help to prevent complications. The review covered the entire ‘patient journey’ from care provided in general practice, through to specialist hospital-based services.
One key development is the completion of a project known as SCI-DC (Scottish Care Information – Diabetes Collaboration). This is an electronic based record of the care of people with diabetes. It can be accessed by the wide range of professionals involved in diabetic care to give them up-to-date information on the patient. At the moment, the system is operational in only one NHS Board area in Scotland, but is being extended across the country. The report recommends that all NHS Boards put detailed plans in place to implement SCI-DC. NHS QIS is to share the funding of a new post to help with the implementation of this system.
The rise in the number of people with diabetes has put a strain on services and many are struggling to meet the standard of offering a comprehensive annual review to all patients with diabetes. Better organisation of the service would go some way to helping relieve this problem.
The report also says that more needs to be done to involve patients in their own care. There is good evidence that outcomes improve if patients take an active role. The report recommends that information and education for patients should be improved to empower them to become more involved in looking after themselves.
The majority of NHS Boards were found to provide a very high standard of care for people who developed complications of diabetes. Managing these risks is not easy, but the review teams found many well-functioning and committed specialist diabetic services.
The report says the vision for the development of diabetic services in Scotland is to move on from crisis intervention to provide better management of the condition and prevent problems developing. It acknowledges that this will not be easy to achieve across Scotland, but there is already evidence that it can be done.
The review group was chaired by Dr Malcolm Campbell, a GP from Glasgow and Director of Quality Standards at the Royal College of General Practitioners Scotland. He said:
“Diabetic care presents many challenges to health services because of the regular monitoring needed to pick up early signs of problems and the fact that so many different professionals are involved. There is evidence of the development of co-ordinated services and a commitment across the service to drive up the standards of care.
However, ensuring that high quality services are available to everyone with diabetes will require a sustained effort over many years. While there are many examples of very good care in different parts of Scotland, there remains much to do and many issues to resolve.”
The chairman of NHS QIS, Lord Naren Patel said:
“This is an important report which maps the direction diabetes care needs to take in Scotland to help the ever increasing number of people with the condition. Each NHS Board needs to review its services in the light of the recommendations and to take the appropriate action.
“There is also a powerful public health message arising from this review. Being overweight increases the risk of diabetes. The worrying increases being seen in obesity levels in Scotland mean that more and more people are going to develop diabetes. This can be avoided for many people if they follow sensible eating habits. That message has to get through to people in Scotland if we are to avoid an epidemic of diabetes with all the problems that can bring for the individuals involved.”
Ends
NOTES TO EDITORS
Facts about diabetes:
• People with diabetes are five times more likely to develop heart disease
• They are three times more likely to have a stroke
• 20-25% of people entering kidney replacement programmes have diabetes
• The risk of diabetes is higher in older people and people who are overweight
• Diabetes is the leading cause of blindness in the working age population
• Effective screening, diagnosis and treatment could save the sight of 260 people in Scotland a year
• 1,500 children and young people in Scotland have diabetes
The reports and standards are available on the NHS QIS website:
Please see the News section or click on Publications on the left-hand column, and select either ‘National Overview’, ‘Local Reports’, or ‘Standards’ from the drop-down Publications Type menu on the publications page.
The reports cover the following Standards:
STANDARD 1
Organisation: IM&T, Clinical Management Systems, Audit and Monitoring
STANDARD 2
Organisation: Pathway of Care, Teamworking and Integration of Services
STANDARD 3
Patient Focus
STANDARD 4
Clinical Review
STANDARD 5
Clinical Management: Eyes
STANDARD 6
Clinical Management: Cardiovascular Status
STANDARD 7
Clinical Management: Feet
STANDARD 8
Clinical Management: Glycaemia
STANDARD 9
Clinical Management: Renal
STANDARD 10
Clinical Management: Acute Management
NHS QIS Remit:
NHS Quality Improvement Scotland (NHS QIS) has been established to improve the quality of healthcare in Scotland. To do this, it will set standards and monitor performance, and provide NHSScotland with advice, guidance and support on effective clinical practice and service improvements.
The clinical standards it develops, defined in partnership with members of the public and healthcare professionals, follow the ‘patient journey’ as they move through different parts of the NHS. This NHS QIS system of assuring quality is designed to complement the duty that has been laid upon the board of each NHS body by the Health Act 1999 to monitor and improve the quality of healthcare which it provides to individuals (clinical governance).
NHS QIS is independent from government. Although it is accountable to the Scottish Executive for delivering its work programme and for the public money it spends, NHS QIS reaches its own conclusions on the quality of services being provided by the NHS, and publishes its findings.
Background:
Established on 1 January 2003, NHS Quality Improvement Scotland is a Special Health Board, built on the expertise developed within the:
• Clinical Standards Board for Scotland
• Clinical Resource and Audit Group
• Health Technology Board for Scotland
• Nursing and Midwifery Practice Development Unit
• the Scottish Health Advisory Service.
Chaired by Lord Patel, the Board has a broad membership that includes NHS staff and members of the public. Dr David Steel is Chief Executive.
NHS Quality Improvement Scotland Chairman Lord Patel, Chief Executive Dr David Steel, Chairman of the Diabetes Project Group Dr Malcolm Campbell, and Interim Director for Standards and Reviews Jan Warner, are available for interview. To arrange an interview, please contact:
Patrick Maitland-Cullen, Communications Section, NHS Quality Improvement Scotland, Tel: 0131 623 4297 (dl) or 07968 494 164 (mobile – on morning of 23 March).
ENDS