Saturday, 19 January 2013

Legacy or Let Down? A Decade of the Diabetes National Service Framework

With great promise and excitement, the ambitious 10 year delivery strategy of the diabetes national service framework (NSF) was launched in January 2003. For the first time, a government was taking a long view of long term conditions care with these 10 year programmes, enacted from ‘the NHS Plan’ of 1997. Diabetes was just the third NSF to be published, showing what we thought was a brilliant commitment to this important and growing condition

At the time, 10 years seemed an age away with plenty of time to do everything the standards demanded. Yet here we are in 2013 with a whole new health policy world and with the next huge NHS reform upon us. So did the NSF achieve anything and will its legacy live on in the current incarnation of diabetes care - or were we let down on its promises?

As is our wont here at SD Comments, we’ll start by looking at some of the success stories that seem to be here to stay and have undoubtedly changed the face of diabetes care:

LEGACY: Eye screening for retinopathy is universally available and pretty much everyone with diabetes is invited to have their eyes photographed annually. As a result, blindness rates due to diabetes in the working population are getting lower every year, thanks to the early intervention on problems detected through retinal photography

LEGACY: Local diabetes networks bringing together people working within hospital, community and general practice services for diabetes have grown and persisted. Communication between health professionals working together has improved and faster referrals and decisions about acute situations such as foot ulcers can be made as a result. The latest recommendations about communication between services have just been published by NHS Diabetes, quite rightly highlighting their continuing importance in the ‘new’ NHS

LEGACY: Specific mention of children and young people as well as adults with diabetes. The NSF was very clear about the needs of children and young people as a specialty, a distinction that hadn’t always been so clearly made. Every one of the 12 NSF standards mentioned each age group and today, the focus on children and young people with diabetes is intense, with Diabetes UK’s most recent awareness campaign highlighting the need for prompt and early recognition of symptoms of Type 1 diabetes in children

Unfortunately, there are also some let downs when looking back at the NSF and these have to be examined too – so these important aspects don’t continue to be forgotten

LET DOWN: Diabetes structured education. Despite the NSF heralding the importance of supported self management and the provision of high quality information and education, there is still a massive lack of access to structured education and enormous variation throughout the country. Even more worrying (as detailed in this blog before) is the very low invitation to and uptake of diabetes education courses. In addition, education courses are often the first to be cut when economies in services have to be made, as in recent years in the NHS. This leads to people being unable to manage their condition for lack of the ‘tools to do the job’.

LET DOWN: Personalised care planning and participation in decision making. Despite a whole standard to do with empowering people to manage their condition themselves and being helped to make decisions based on their own goals and aspirations, there is still very little results sharing prior to consultations and consultations still often follow the traditional medical model of ‘health professional knows best’, despite the day to day management of diabetes actually being in the hands of the person living with it.

Happily, the current health policy is still promoting a personalised approach with the ideal of ‘no decision about me, without me’ and there is a strong focus on this for people with long term conditions in the Government’s recent instructions to the NHS, so maybe there is a glimmer of hope that this let down will become a legacy in the end

LET DOWN: User involvement in how services are planned and delivered. This aspect of the NSF started with great promise, with a number of initiatives and organisations, guidelines and recommendations dedicated to developing this approach. However, enthusiasm for it seems to have waned over the years, even among campaigning organisations. Proper, proactive involvement of people who use services is now extremely patchy. Apparantly, the new NHS will have a much stronger ‘patient’ voice, but this may be more to do with complaints and accountability than involvement and consultation in how services are actually run

So that’s our take on what is and what might have been. Ever optimistic, however, we will continue to bang the drum for person centred approaches, access to diabetes education and user involvement, and do all we can to ensure that the ‘brave new NHS’ will take note of these let downs as well as the legacies


Department of Health (2003). Diabetes National Service Framework: delivery strategy

Department of Health (2012). The Mandate. A mandate from the Government to the NHS Commissioning Board: April 2013 to March 2015

NHS Diabetes (2013). Implementing Local Diabetes Networks

Do you agree with what we’ve said? If so – and if not – your views and comments are welcome below!

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