1. NHS England Diabetes Programme Update
Professor Jonathan Valabhji OBE MD FRCP
National Clinical Director for Diabetes and Obesity
DISN UK Group Conference, 15th October 2019

2. The NHS Long Term Plan
For diabetes, the NHS Long Term Plan sets out a range of improvements for those at risk of Type 2 diabetes and living with Type 1 and Type 2 diabetes; many of which we have already started to implement with our partners across the health system.
For obesity, there are a range of actions outlined, comprising a significant program of work.

3. National Diabetes Programme Treatment and Care Transformation Fund
Inpatient diabetes specialist nurse funding related to the transformation funds and the subsequent long term plan
15 October 2019

4. The NHS Long Term Plan – Diabetes Inpatient Specialist Nursing team (DISN) commitment
The NHS Long Term Plan has committed to continue to funding for new or expanded diabetes inpatient specialist nursing teams to ensure all hospitals provide access to these services, reducing variation and delivering significant benefits for patients.
Targeted funding will be available for systems that have not had access to DISNs by this point, to help improve equality of access and ensure universal coverage

5. Transformation funding 2017-2019
During NHS England has made available £105m to improve services and reduce variation for people living with Type 1 and Type 2 diabetes.
Of this, £13m has been used to establish 31 new or expanded diabetes inpatient specialist nursing teams reducing the lengths of hospital stays for people with diabetes through reducing medication errors and advising on effective treatment.
*as reported at the end of Q1 2019/20
This has supported development and expansion of DISN teams and 94 WTE posts* being put in place.
Allocated to date
17/18 (actual)
18/19 (actual)
19/20 (planned)
£4.4m
£5.7m
£3.1m

6. Future Transformation Funding: 2020/21 – 2023/24
During 2019/20 the programme is preparing to align with wider system change considering implementation through ICS/STP structures as they reach an appropriate level of maturity to take on this responsibility.
The NHS LTP proposes that there will be universal access to these services in future.
There is an expectation that a number of new services will be established to meet this commitment and targeted funding will be made available.
From 2020/21 an equitable shares* approach to ICS/STP funding will be taken to provide all ICS/STPs with funding to support delivery of commitments.
* based on diabetes population

7. Healthier You: NHS Diabetes Prevention Programme

8. NHS Long Term Plan: Type 2 diabetes prevention
Prevention is at the heart of the NHS Long Term Plan
NHS DPP already the largest undertaking of its kind in the world and nearly 250k people have taken up the offer of support since its introduction in 2016.
Key commitment to double, to 200,000 people per year, the scale of the NHS Diabetes Prevention Programme over the next 5 years.
Initial outcomes positive : mean weight change and HbA1c change are highly encouraging
The main observable health inequalities in diabetes relate to who develops diabetes – allocated programme capacity using an equity model and rolling out digital services to boost access and uptake in younger populations

9. NHS England Diabetes
Treatment and Care Programme

10. Diabetes Treatment and Care
Achieving Type 2 Diabetes Remission - Low calorie diets
Some people with type 2 diabetes can achieve remission through adoption of low calorie diets. The DiRECT and DROPLET trials have recently published with promising results and the potential to allow some people to stop taking anti-diabetic drugs and still achieve non-diabetic range glucose levels.
Plans to test an NHS programme supporting low calorie diets for obese people with type 2 diabetes are outlined in the NHS Long Term Plan.
Work underway to gather insight from local areas and providers on the approaches currently being used and are working towards identifying the pilot site locations and to begin the tender process for appointing providers.
The pilots will test for the optimal delivery model for the provision of TDR products for up to 12 weeks alongside either a group, 1:1 or remote / digital behaviour change intervention.

11. Diabetes Treatment and Care
Type 1 Diabetes - specific commitments
Providing patients with type 1 diabetes who meet clinical recommendations access to flash glucose monitors, ending the variation in some parts of England.
In addition, by 2020/21, all pregnant women with type 1 diabetes will be offered continuous glucose monitoring, helping to improve neonatal outcomes.

12. Flash Glucose monitoring (FGM)
NHS LTP commits NHS England to reimburse CCGs for prescribing of FGM to 20% of their Type 1 population in 19/20 and 20/21
Nationally activity levels have increased significantly (to 12%) in the first quarter of 2019/20 compared to previous years.
Significant variation in activity at CCG / STP level with some CCGs exceeding the 20% threshold and others significantly lower

13. Patients receiving FGM
Flash Glucose monitoring (FGM)
NUMBER OF IDENTIFIED PATIENTS WITH PRESCRIPTIONS (based on CCG data) Q1
Total T1 population
Patients receiving FGM %
East
29,635
1,493 5%
London
29,565
3,382
11%
Midlands
46,455
6,109
13%
North East and Yorkshire
40,490
989 2%
North West
30,630
6,084
20%
South East
39,275
6,231
16%
South West
26,875
4,171
England
242,925
28,459
12%

14. Diabetes Treatment and Care – Transformation Fund
As at the end of Q1 2019/20;
181 projects* funded across England
41 new or expanded MDFTs with 162 transformation funded staff
31 new or expanded DISN services with 94 transformation funded staff
57 new or expanded structured education services with 99 transformation funded staff
52 treatment target projects with 126 transformation funded staff
180 projects are currently operational. 1 project in the South is still to become operational and progress is being closely monitored by the regional team.
181 projects are now operational
Following the end of Q1 review meetings two projects have merged (DTCN17 SE has now merged with DTCN20 SE) due to small size and level of funding – this will now count as one project
There is 1 project which is ‘on hold’ at this stage, DTCS13 TT, as this project was on hold at the end of 2018/19 the site has accrued £100k into 2019/20 and this funding will be used to develop a Type 1 service for the patients of Berkshire West. Only an additional £10k will be distributed to the site in 19/20 if this service work comes into development.

15. Diabetes Treatment and Care
Mental Health and Diabetes
The IAPT Pathway for people with long-term physical health conditions
Diabulimia pilots:
Kings College Hospital, London
Royal Bournemouth Hospital, Wessex

16. NHS England Diabetes
Digital Programme

17. Diabetes Digital Work Stream
The Diabetes team has been harnessing the power of digital across its workstreams for a number of years. The Long Term Plan outlines strategies to continue this work including:
Digital access within the NHS Diabetes Prevention Programme for those who decline or drop out of face-to-face interventions – particularly relevant for those of working age.
Rolling out HeLP Diabetes nationally – Healthy Living for Type 2 Diabetes: an online self-management tool for those with type 2 diabetes
Test Bed Programme - £2m invested for a specific challenge around self-management and support for people with Type 2. Three Test Beds:
Greater Manchester
South West London
North East Hampshire and Farnham