National Diabetes Programme 2013 Ronan Canavan National Diabetes Programme NAGP AGM 23 rd Nov 2013

Clinical Care Programmes “ Deliver better care through better use of resources ”. RCPI & HSE appointment Access Quality Cost

National Director Clinical Care Programmes & Strategy Group Managers (Group Leads) Integrated Care Overall Steering Group In Patient Diabetes Management & Diabetes Bundles Diabetes in Pregnancy Subgroup National Multidisciplinary Footcare Package Structured Education Paediatric Diabetes Subgroup Stakeholder Groups & DSIGs Research, Policy Development Retinopathy NCSS/NCCP Gateway Group (Steering Board)) ICT Prototype Team Core Strategic Team Ronan Canavan Marie Tighe Orlaith O’Reilly For IC Deirdre Hall (GP) National Diabetes Working Group

Prevalence and Cost of Diabetes 5.6% of the adult Irish population have diabetes (190,000) Estimated that the number of patients with Type 2 diabetes will increase by 60% over next years WHO states diabetes is the greatest health challenge of the century 10% of the Irish Health Care budget spent on diabetes – €1.35 billion annually 60% of complications (€816 million of this budget is spent on complications)

Men

Women

Diabetes in Ireland, South Dublin/Wicklow Annual estimates Wicklow Catchments St Dublin Catchments Percentage of DM in whole population ? In 2005 the estimated population prevalence of Type 1 and Type 2 diabetes in adults was 5.4% in Northern Ireland and 4.7% in the Republic of Ireland. In 2015 will be 6.3% (84,226 adults) in Northern Ireland and 5.6% (193,944 adults) in the Republic of Ireland. increase 45.1%

National Diabetes Programme National Retinopathy Screening Programme (Implementation NCSS) 2.Foot care screening and treatment service to prevent diabetic foot ulceration and lower limb amputation. 3.Integrated Care Programme for all patients with diabetes with employment of 17 integrated nurse posts 4.ICT development programme & National Diabetes Register. 5.National Model of Care for children and young adults with Type 1 diabetes and the implementation of continuous subcutaneous insulin infusion therapy for children with type 1 diabetes < 5 years (Implementation National Paediatric Programme) 6.Other workstreams – pregnancy/structured education/diabetes bundles

National Diabetic Retinopathy Screening Programme Register compiled 145,000 patients Pilot commenced Q1 – treatment centres with MOU 1,500/wk invitations being issues in initial start areas Q3 Expansion to 2,000 – 3,000/wk in Q4 (all of east cost & areas outside Dublin) Target for 2013 – invitation to 30% of 145,000 Screening & Treatment costs for remaining 70% in 2014 in NSP

National Diabetes Foot Care Programme First part of diabetes programme to role out in 2011 but pause in implementation Nov of 16 WTE in post Reduction of 2061 bed days in 2012 with only partial implementation Practice nurse education on diabetic foot risk assessment Variation in diabetic foot MDT access nationally 8 WTE specialist podiatry posts in NSP 2014

All patients with Type 1 diabetes, complex & genetic will be managed in Secondary Care only (30,000 patients) Uncomplicated Type 2 Diabetes patients will be managed in Primary Care only (100,000 patients) Complicated Type 2 Diabetes patients will be managed by both Primary and Secondary Care (60,000 patients) Integrated Care Diabetes Package

9/2/5/1 of 17 integrated nurse specialists in post with other posts progressing to support implementation of model of care in T2DM 10 shared/structured (not integrated care) schemes nationally Evaluation of how posts are impacting on patients identified in model of care? Integrated Care Diabetes Package

Integrated diabetes nursing activity Structured education –Assessing delivery in terms of quality and access –Addressing issues of access in terms of redirecting programmes if over delivered in certain areas –Directing or delivering where provision is absent Practice involvement –Liaison with practice nurse key –Assessing diabetes register provision & supporting where not developed –Establishing if call and recall systems are effective within practices –Assessing numbers of DM in practice and in network population –Some direct patient involvement is allowed but should be very much directed involvement Supporting injectable treatment initiation Across practices and region –Educational support to practices, localities –Audit of diabetes practice within and across practices –Diabetes facilitator role not envisaged across the whole region –Secondary care patient profile, suitability for integrated care or intermediate care –Diabetes prevention programmes to be encouraged and supported –Good practice in use of resources for diabetes care to be audited e.g. use of and following guidelines, glucose test strip usage, supporting chronic disease initiatives – around diet, exercise, and weight.

Additional Diabetes Work Streams Pregnancy –Updated national diabetes in pregnancy guidelines –National screening guidelines for GDM –LTI scheme & GDM ICT – to support communication Paediatric diabetes Research – HRB/RCQPS

challenges Ongoing funding of the retinopathy screening & treatment programme to cover 100% of register Complete the employment of original 16 WTE & additional 8 WTE diabetes specialist podiatry posts Filling & evaluation of integrated care nursing posts National diabetes audit & research Guidelines for T1DM & tertiary diabetes care