Networks The networks have agreed nationally a set of initial outcomes and are working toward a memorandum of understanding across the networks to ensure that they deliver against these outcomes
Other Groups –Learning Difficulties –Children in care –Language barriers –Young offenders Schools training and support Education accreditation New Technologies – CGMS, Text IT Systems NDA2 Submission Register DiabetesE What Makes a Good Service
Pumps and consumables Transition Specification Inpatient care Admissions and contractual guarantees What Makes a Good Service
The service has to ensure basic care required by all CYP & Families – and to be in touch if there are problems day to day Basic care covers the entire MDT and also Psychological support Quality Pathways and Specifications
Yorkshire and the Humber have an established network with commissioning support, they are developing with the cancer networks Peer Review and are adopting an accreditation process In South Central there is a programme of training volunteers to work in schools with150 Children but this requires training, supervision and refresher training – DSN’s deliver this A care pathway is in development and is ready for peer review from Harrogate one is coming from South Central Other networks are working on these items too When put together we have all the components required
Quality Pathways and Specifications The guidelines and specifications required to deliver a quality service have been in place and continually updated since 2007 when the ‘Making Every Young Person with Diabetes Matter’ document was published and the DoH Implementation Group formed The NHS Diabetes Commissioning Guides and Implementation Map along with the Emotional and Psychological Support and Care in Diabetes Report both published in 2010 provide the latest standards required
NHS Diabetes Education Task and Finish Group Membership is representative from all MDT’s, colleges and professional bodies delivering Paediatric Diabetes care nationally and DEN, Diabetes UK and JDRF Development of Core Curriculum - training of HCP’s –This continues to be developed. Based on Knowledge, skills and competency levels using Skills for Health as a framework –Academic units that presently supply training have agreed to a core curriculum –Development of learning workbooks for aspects of paediatric care –Ensuring the link with current RCT’s for education programmes Development of training standards and components for patients
Funding Mechanisms October 2010 From April this year a non-mandatory tariff was put in place for paediatric diabetes. Work has continued to develop a pricing structure reflecting the resources actually required to deliver the service and start to put this in place for April 2011. However, this staged approach to change will only be fully realised if we have the full commitment of regional networks, the commissioners and the Department of Health.
Funding Mechanisms The Decision The Department of Health will ensure a mandatory tariff for paediatric diabetes is in place for April 2011 and the minister has stated this in a parliamentary debate. As part of this process, representations have been made to the department to uplift the current non-mandatory tariff price particularly for follow up. The level of uplift would ideally reflect the issues identified within the services costed specifically for this purpose or at the very least to be in excess of general paediatrics and paediatric endocrinology, to make it worthwhile for trusts to move activity.
Funding Mechanisms and Tariff Basic Yearly Tariff plus complexity payment per child for the following in year - April to April; –Newly diagnosed in year –Education required in year –Pump required in year –Pump user –Child protection –Over 12 years old –Transition year over 19
Funding Mechanisms and Best Practice Tariff Future Development This is toward a more appropriate funding mechanism is supported and PbR governance groups at the department are keen that our work goes forward and proposals moving towards a ‘Best Practice – Clinical Pathway Tariff’ will be supported but are not guaranteed. This work needs to be completed and submitted by March 2011 so that it can be assessed and tested to see if it is viable and deliverable. Over the coming months NHS Diabetes will be working with many of you and the networks to develop all the aspects of this approach and will need the support of the networks to help communicate this to all stakeholders.
Funding Mechanisms and Best Practice Tariff Best Practice Tariffs The objective of the best practice tariff policy is to reduce unexplained variation in clinical quality and to universalise best practice Issues to consider: References to relevant clinical guidelines. Are there significant variations in practice? Information, which would, as a minimum, allow for an assessment to be made of the gap between current and best practice. Information on the impact on outcomes of the gap between current and best practice. Is the area being looked at a high volume service area? Information, which would, as a minimum, allow for an assessment to be made the volume of activity being carried out. Information on the relevant HRGs/TFCs to be affected. Estimate of potential gain - expressed qualitatively or quantitatively or, Estimate of potential gain - expressed on a monetary basis, or on a benefits to patients basis.
Funding Mechanisms The Decision At this point we are awaiting a final decision and confirmation that all aspects will be in place to be contracted against for April 2011.
What Makes a Good Service Staffing and MDT capacity –Consultant –DSN –Dietitian –Psychology –Social Worker –Other? Shared care – Social, Parents and Schools Telephone Contacts Networked OOH
Pump Therapy Pumps are not a new technology they are merely now a method of delivering an intensive insulin regime so lets stop treating them as a special case and make them part of the norm Payment for pumps varies NICE Guidance needs to be reviewed New Technology needs to be addressed – CGMS, Patch Pumps, Text Messaging
Networks Data and Audit NDA2 –Submission to the National Diabetes Audit to be part of the PbR Guidance Notes –The National Diabetes Audit is the largest clinical audit in the world and analysis tools are inbuilt to allow networks to performance manage and benchmark Registers –Local registers to ensure that units know there own population –Regional registers for networks to understand the region and use within peer reviews –National registers to ensure that the total number of children is known and the demographics monitored DiabetesE is a self assessment tool which can be completed by commissioners and providers of services to show –Good Practice –Gaps in provision, documentation, guidance and policy –Can be used for contract monitoring and peer review
Networks Data and Audit Deaths from diabetes in children/YP From a study  of deaths related to diabetes in children/YP - of 116 deaths notified, 83 were caused by diabetes. The standardised mortality ratio was 2.3 (95% confidence interval (CI), 1.9 to 2.9), being highest in the age group 1-4 years, at 9.2 (95% CI, 5.4 to 14.7). Of the 83 diabetic deaths, hyperglycaemia/diabetic ketoacidosis (DKA) was implicated in 69 and hypoglycaemia in 7.  Cerebral oedema was the most common cause of death in young children (25 of 36 diabetes related deaths in children under 12 years of age). 34 young people (10-19 years; 24 male) were either found dead at home (n = 26) or moribund on arrival at hospital (n = 8). In 24 of these, it appeared that DKA was the cause of death, in four hypoglycaemia was likely. Nine of these were found "dead in bed". Children with IDDM (insulin dependent diabetes) have a higher mortality than the general population. Cerebral oedema accounts for most hospital deaths in young children. There are a large number of young men dying at home from neglected IDDM. Early diagnosis of IDDM in children and closer supervision of young people might prevent some of these deaths. Deaths by cause, sex and age, 2007, United Kingdom Sources: ONS (2008), GRO Scotland (2008) and GRO Northern Ireland (2008) All ages Under 35 yrs Diabete s* Men2,99136 (E10- E14) Wome n3,36248 Total6,35384 *Nb: the number of deaths attributed to diabetes in national mortality statistics is likely to represent an underestimate of the actual number of deaths caused by diabetes. This is because other diseases caused by diabetes - such as CVD - are normally given as the cause of death in the death certificates of people with diabetes.   Causes of death in children with insulin dependent diabetes 1990-96 J. Edge, M. Ford-Adams, and D. Dunger
QIPP Evidence DMIT has evidence of emergency admissions in paediatrics and potential for savings across PCT areas for example; If all services could reduce the variation in rates of ‘emergency’ admissions to average rates this would release nationally somewhere between £1M & £5M per 100,000 population and at least some of this is associated with inappropriate coding of ward attendees and day cases.
NHS Diabetes Network Patient Experience NHS Diabetes and the NHS Information Centre have produced a standardised and validated set of questions for CYP and for parents which can be used by units to satisfy the requirement to seek the views of service users and feed the outcomes back to the NDA. This DPEP work will be completed in 2010 with questionnaires, costings and analysis methodology also available at no cost –Cost to units will be for printing, postage and data logging and analysis
Where Now For Paediatric Diabetes Networks And Tariff Is It Up To You?