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People’s self-management of diabetes key to delivering higher quality and better value NHS, says CQC
The Care Quality Commission (CQC) has today (Tuesday 6 September) published a review that explores the quality of care for people with diabetes in England.
My diabetes, my care highlights that – despite a mostly good picture of care overall – the provision of care and support to help people successfully self-manage their condition is not always flexible and responsive enough to meet individual needs.
CQC talked to people with Type 1 and Type 2 diabetes aged between 18 and 65 about their experiences as well as with commissioners, providers and staff across the country about how community diabetes care is delivered.
The review discovered that people at high risk of developing Type 2 diabetes were not always identified and supported to become healthier. Some people felt they were not receiving enough emotional support – providing this support at diagnosis and beyond can contribute to more effective self-management and increase engagement with services and attendance at structured education programmes.
CQC saw many examples that others can learn from, including local commissioners and providers proactively engaging with individuals and communities, and innovative methods to increase people’s ability to self-manage.
For example, in Slough and South Reading, the Silver Star diabetes charity had been commissioned to run mobile units which travelled around places of work, worship, community events, high streets and retail parks to discuss the risk of diabetes and offer lifestyle advice. Through working with Silver Star, Slough Clinical Commissioning Group (CCG) was able to identify 1,500 people deemed at high risk of diabetes and invite them to join an intervention programme.
The review also highlighted that people who had attended structured education courses felt it improved their ability and confidence to manage their diabetes. But it was evident that the courses were not able to meet everyone’s needs.
CQC found that people from black and minority ethnic (BME) groups were less likely to be aware of education programmes; and that courses were rarely offered to people with a learning disability. It was not always clear how the education needs of those who had not attended were being met.
However, some local services were able to show how they were providing culturally relevant information, support and training to people in their local community. For example, the review saw how City and Hackney CCG trained local people to act as ‘lay educators’ – providing culturally relevant information, support and training to people in their community. This included community awareness sessions and delivery of accredited structured education programmes.
CQC’s Chief Executive, David Behan, said:
“Our review highlights some great examples of community diabetes care. But it also shows that more work is needed to ensure that everyone who lives with diabetes can access the right level of personalised care and support to help them manage their condition.
“We have seen the positive health and financial outcomes that can be achieved when people are empowered to take control and successfully supported to self-manage – and I encourage providers and commissioners to use the findings of this review in order to learn from what is working well.
“With nearly 3.5 million people living with diabetes in England, and predictions that this figure could rise to 4.6 million by 2030, there has never been a more important time for all parts of the health and social care system to address this condition.
“Getting our response right on diabetes is crucial to delivering the vision set out in the Five Year Forward View, which prioritises prevention and public health and transcends traditional boundaries between primary care, community services and hospitals.
“Together, let’s make self-management a real priority for the benefit of people living with diabetes and the future sustainability of the NHS.”
Other key findings from the review include:
- Most people CQC spoke to received the checks recommended by the National Institute for Health and Care Excellence (NICE). Generally, people reported they were able to discuss their care with primary care staff and they felt they received good explanations about their care.
- People showed a lack of awareness and understanding of their test results. Few people had a hand-held care plan that they could take with them as they moved across services and organisations.
- Knowledge of diabetes was often lacking within some staff groups, particularly in adult social care, and in some areas diabetes training for care workers was absent. This could result in insufficient support for people who rely on others to help manage their diabetes.
Andy Broomhead, aged 35 from Sheffield, said: “In 2002, when I was just out of university, I was diagnosed with Type 1 diabetes. I was bombarded with information from the outset. It was overwhelming, and I also had to get used to the idea of having to inject myself – something that caused me a lot of apprehension. I went home with too many pamphlets. I would have been much better to have someone there to walk you through the first few weeks after diagnosis.
“I didn’t feel comfortable to self-manage until a few years later. Almost 10 years after diagnosis, I took a course and it did a lot to help me feel confident in managing my care. The course was hugely beneficial, and I can honestly say that it changed my life. Having diabetes gives you a lot of responsibility, and having education allows you to take ownership of that responsibility.
It’s important for patients to feel confident enough to manage their diabetes care, and that starts with fostering an environment that allows patients to feel engaged by healthcare professionals. They need to treat the person, not the condition. Not everyone will fit into the textbook definition of diabetes and care needs to be personalised to reflect this.”
Chris Askew, Chief Executive of Diabetes UK, said: “As the diabetes crisis continues to escalate we welcome the CQC’s review, which highlights just how crucial it is for people with diabetes to get good support to help them better self-manage this very serious condition.
“This review emphasises the importance of people having much better access to diabetes education, something Diabetes UK believes is vital, and it also makes it clear that emotional support needs to be available for people from the point of diagnosis to give them control of their lives.
“The review also shows the necessity of individuals getting personalised care to ensure they get the best possible health outcomes. We want to see Clinical Commissioning Groups do far more to enable commissioners and healthcare professionals to promote the importance of education for people with the condition and for them to develop more flexible education programmes to help put people with diabetes firmly at the centre of their care. Only then will we see a reduction in costly complications, an end to avoidable suffering and early deaths.
“Finally, the review also highlights lack of support for people to become healthier. A new dimension in NHS diabetes care is the Diabetes Prevention Programme to help people avoid developing Type 2 diabetes. Diabetes UK is working with NHS England and Public Health England to roll out this programme to ever more people across the country.”
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- Last updated:
- 29 May 2017
Notes to editors
1. A full copy of the ‘My diabetes, my care’ review is available here: www.cqc.org.uk/mydiabetesmycare.
2. Tweet about diabetes care using the hashtag #mydiabetesmycare.
3. About the review:
- CQC carried out fieldwork for the review between January and March 2016 in the following areas:
· City and Hackney (London)
· East Lancashire (North)
· Lewisham (London)
· Liverpool (North)
· North East Lincolnshire (North)
· Rushcliffe (Midlands and East)
· Sandwell & West Birmingham (Midlands and East)
· Slough (South)
· South Reading (South)
· South Worcestershire (Midlands and East)
- The review looked at 4 key aspect of care for people with diabetes, including:
· Identification and diagnosis
· Structured education and support for self-management
· Care pathway
· Person-centred care coordination
- The review included interviews with GPs, clinicians and commissioners; multi-professional / multi agency focus groups with staff; focus groups, 1 to 1 interviews, and case tracking of people with diabetes.
- The review used an online web form, limited to the areas covered by the fieldwork, to gather the experiences, opinions and insights of people about their diabetes care. 96 responses were gathered from individuals who told us about the support and education they are given, how in control of their diabetes they felt and how co-ordinated their care was across different services.
- The review looked at existing evidence from CQC’s comprehensive inspections, information provided by Healthwatch, CCGs and other data sources.
- About Type 1 and Type 2 diabetes:
- Type 1 is where the pancreas does not produce any insulin.
- Type 2 is where the pancreas does not produce enough insulin - or the body's cells do not react to insulin
- Type 1 diabetes can develop at any age, but usually appears before the age of 40, particularly in childhood.
- While around 10% of all diabetes is Type 1, it is the most common type of childhood diabetes, and so it is sometimes called juvenile diabetes or early-onset diabetes.
- The risks of developing Type 2 increase with age, being overweight and genetics. Around 90% of adults with diabetes have type 2, and it tends to develop later in life than Type 1.
(Source: NHS Choices)
- The National Institute for Health and Care Excellence (NICE) outlines the care pathway for management of diabetes, which includes a focus on providing individualised care, education and lifestyle advice, and identifying and managing complications of diabetes through an annual review. The annual review is an opportunity to monitor a person’s health, act on any concerns, understand individual needs and plan future care.