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Introduction

This third report on the implementation of the Diabetes National Service Framework (NSF) standards shows some real progress in a number of areas. Apart from the examples of what is working well, I am particularly pleased by the developments that enable us to properly understand the nature of the challenge we face on a national scale. A more accurate prevalence model combined with the National Diabetes Audit, DiabetesE and the Quality and Outcomes Framework (QOF) outcomes are providing baseline data that will support effective measurement of improvement in diagnosis and care. We now know what the challenges are and it is up to us all to respond to them.

I welcome the continuing development of diabetes networks as essential components of a system of integrated diabetes care. This is accompanied by the increasing realisation by frontline staff that networks can drive through real improvements in care.

This has all taken place against a background of significant change for both how health services are organised and how care is commissioned and delivered. The impact of Delivering a Patient Led NHS, Payment by Results (PbR) and Practice Based Commissioning (PBC), all elements of what is collectively known as System Reform, on diabetes services still require full clarification. As an example PbR was originally calculated on the basis of elective surgery in the acute sector and we have worked to ensure that specialist diabetes services understand the challenge of PbR whilst at the same time that PbR reflects the needs of long term conditions. The recent White paper acknowledges that there is more thinking to be done on how long term conditions are properly catered for within system reform and our aim is to ensure diabetes is directly involved in that debate.

However events will not stand still and the year ahead sees further developments that will impact on diabetes services. Criteria for identifying what constitutes a quality service will be developed. Work on how effective models of integrated care can be commissioned, especially the concept of commissioning for health rather than illness will have great relevance for diabetes services. Putting quality at the centre of commissioning services rather than a singular emphasis on quantity will also support much of what diabetes teams are already doing.

Taken together all of these elements of system reform provide extra challenges for people delivering services and it is to their credit that they have kept their eye on the ball so accurately.

These new challenges are also new opportunities and services should be using them to support working towards all the NSF standards. Commissioning high quality services that are properly patient focused, are integrated, multi-disciplinary and delivering care at the time and place people want is essential. These need to be supported by commissioning high quality services aimed at preventing diabetes rather than treating it. This will entail links with local authorities and independent sector providers in terms of healthy eating and fitness programmes.

In many ways this is a very exciting time to be working in diabetes. Many of the ways of working promoted by the NSF and its delivery strategy are central to recent policy initiatives. Recent White Papers with a focus on prevention, self care and patient centred services have enormous relevance to diabetes. The growing challenge of diabetes provides a stimulus to service providers to tackle the existing prevalence and examine how to stop people getting it. Prevention programmes will get a further boost from the decision of the Austrian president of the EU to have reducing the growth of Type 2 diabetes as one of the central themes of his presidency.

There are still a considerable number of challenges though. The need to deliver patient education that meets the National Institute for Health and Clinical Excellence (NICE) guidelines, the diabetic retinopathy screening target, effective care planning and the maintenance of diabetes networks through the restructuring of PCTs and introduction of an increasing number of Foundation Trusts will all require careful planning.

I am confident that many of the building blocks of moving diabetes services towards the NSF standards are in place. It is now up to the diabetes community to seize the opportunities currently provided and run with them to deliver the world class services users demand. I will conclude with one very sobering fact; the current generation is predicted to be the first to have a shorter life expectancy than its parents, with diabetes and its complications being a major contributor to that. It is up to us to avoid that dismal forecast and from my knowledge of the skills, energy and commitment of the diabetes community I know we will give it our very best.

Sue Roberts
National Clinical Director for Diabetes

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