for Diabetes, believes it also presents new opportunities. for diabetes communities. January by Health Secretary John Reid, replicate those in the Diabetes …
Draft 2
The new model of care for supporting people with long term conditions takes
its cue from good practice in diabetes services Sue Roberts, National
Clinical Director for Diabetes, believes it also presents new opportunities
for diabetes communities
When it comes to delivering improved care under the new NHS and Social Care
model Supporting People with Long Term Conditions, diabetes services are
ahead of the game
Many of the principles behind the modernisation blueprint, launched in
January by Health Secretary John Reid, replicate those in the Diabetes
National Service Framework published in 2003Indeed, most of the national
and international research that this model is based upon has actually come
from examples of good practice in diabetes care in the UK, Europe and more
recently the US and it cites a number of current examples
The model highlights opportunities for diabetes teams to build on this
good work empowering individuals with the tools, knowledge and confidence
they need to manage their condition themselves
In addition, it reinforces the need for primary and specialist
professionals, working with people with diabetes, to ensure structured,
systematic and
organised services for more than 13 million people who have
diabetes in England today
The model emphasises the links between the social and healthcare needs of
people with long term conditions The delivery plan itself broadly divides
patients into three groups requiring different levels of support
It distinguishes those at level one - around 70 to 80 per cent of all
patients with long term conditions who manage their care themselves with
appropriate information and knowledge, from those at level two who are at
greater risk and require greater service input
In diabetes care these two categories are merged Everyone needs the three
Rs registration, recall and review the systematic care outlined in the
Diabetes NSF and in which supporting self management is a central part
The challenge is to match care to need for each individual in a diabetes
population increasing by 15 per cent each year The care planning process
outlined in the Diabetes NSF provides the means to do this
The publication of this review provides the lever for PCTs to increase
their support for conditions such as diabetes By being better organised,
diabetes networks can also take advantage of this
Level three of
the new model of care, referring to patients with multiple
conditions and highly complex needs, is the current focus of government
policy
People in this group, who are often admitted to hospital unnecessarily,
have
previously been a relatively neglected group Each patient will now have a
case manager who will act as both the provider and procurer of their care,
taking responsibility for ensuring all health and social care needs are met
so that the patients condition stays as stable as possible and his or her
well-being is increased The aim is to provide on-going care that will
prevent crisis points at which patients are unnecessarily admitted to
hospital The principal target is to reduce emergency bed days by five per
cent
What does this mean for diabetes? As routine care has become more
systematic
and education improved, fewer patients with diabetes are admitted to
hospital as an emergency than previously However, there is still much to
be done and patients who have diabetes and are admitted to hospital for
other reasons stay in disproportionally longer Ensuring that length of
stay is reduced as well as unnecessary admissions avoided is good for
people with diabetes and will
help PCTs meet their targets
Diabetes networks can capitalise on this by developing well thought out
projects, backed up by local numbers that will provide more and better
services for people with diabetes and address some of the NSF Standards not
included in national priorities
There are three such areas, which most networks will identify although
local teams, using local data, may identify others
The two groups of patients admitted as emergencies unnecessarily are those
with metabolic derangement or ketoacidiosis, and infected and ischemic
feet
These problems can be prevented by developing education programmes
and preventative foot services respectively for the whole diabetes
population Those with recurrent hospital admissions may benefit from
individual input by specialist nurses or podiatrists acting as case
managers
The third area where more input will reap benefits addresses increased
length of stay There are increasing examples of specialist teams based in
hospital which have taken on the job of restructuring their work to speed
up discharge for people with diabetes admitted with other conditions This
may involve
working with individual patients themselves, but more
often success depends
on providing support to other teams via training, protocols or simply
regular reassurance and contact This document provides opportunities to
further support this type of work
It is imperative that the NHS strives to better manage long term conditions
to reduce unnecessary hospital admissions and improve the quality of life
of
patients
When you consider that five per cent of the population may have diabetes,
diabetes services have a vital role to play and should take full advantage
of the opportunities for increased support and service development that the
new model of care presents
ends
Source:cgsupport.nhs.uk
