1. A National Service Framework for People with Diabetes Adrian Sieff December 2001

2. The Quality Framework MONITORED STANDARDS Prof self regulation Lifelong Learning National Performance Framework Commission for Health Improvement National Patient and User Survey NationalService Frameworks National Institute for Clinical Excellence Clinical Governance Patient & Public Involvement CLEAR STANDARDS OF SERVICE DEPENDABLE LOCAL DELIVERY

3. Purpose of NSFs zDrive up quality zReduce variations zHelp deliver The new NHS, Modernising Social Services and Saving Lives: Our Healthier Nation.

4. National Service Frameworks Interventions National Standards Service Models Milestones Performance indicators UNDERPINNING PROGRAMMES research & development; clinical decision support systems; information; human resources; revenue and capital

5. NSF Programme Published zMental Health, CHD, Older People and Cancer Plan zOlder People Coming soon zDiabetes zRenal and childrens zNeurological conditions

6. Why an NSF in Diabetes: Costs zIndividual costs zNHS costs zSociety costs

7. Complications Increase NHS Costs by Increasing In Patient Costs -T 2 ARDIS survey 0 1 2 3 4 5 6 None (n=904)Micro (n=382)Macro (n=184)Both (n=108) Cost impact factor Primary CareDrugsOut patientIn patient 2.5x 2.7x 5.6 x

8. Why an NSF in Diabetes: Variations

9. The National Service Framework for Diabetes Aims zDecrease the incidence of type 2 diabetes zImprove health outcomes of people with diabetes By: zImproving the overall quality of diabetes services zReducing unacceptable variations in the quality of these services

10. NSF: Standards zAim zStandard zRationale zInterventions zImplications for service planning zSupporting evidence zService models zPerformance indicators

11. NSF: Delivery Strategy zUnderpinning programmes zActions and milestones zService models zPerformance management

12. By 2013 zFewer people develop diabetes zEarlier identification of diabetes zPeople with diabetes have greater control zFewer complications zEarly treatment of complications zEffective in-patient care zHealthy pregnancies

13. What will the NSF become?

14. Pathways in Diabetes Pathways in Diabetes Diagnosis Initial Management Continuing Care PREVENTIONPREVENTION Pregnancy EVENTS Non diabetes Related Hospital Admissions New Protenuria New CHD New stroke New Erectile Dysfunction Institution al Care At Risk Foot New Eye Complications DKA HONK Severe Hypoglycaemia Major Life Events Major Treatment Change e.g. Starting Insulin Other new complic ations

15. A Different Perspective

16. www.doh.gov.uk/nsf/diabetesdiabetes.nsf@doh.gsi.gov.uk Bulletin Board

17. Involving practitioners and people with diabetes ERG, topic work and cross-cutting areas Review of existing literature on user views Further analysis of existing data on user views: Audit Commission, Bradford HAZ Focus groups and in-depth interviews Nottingham event Seeking good practice

18. Delivering the NSF for Diabetes zambitious but realistic programmes which pull all the levers simultaneously zrecognition that change requires time if it is to be sustainable zdetermined and effective approach to reshaping clinical and social work practice za commitment to leadership - within and between agencies, local communities, patients, service users and their carers