Monday, 13 January 2014

Action on 'Action for Diabetes'?

It’s great news that a document full of vision for diabetes has been published at the start of the new year, a time brimming with motivation and good intention. ‘Action for Diabetes’ is NHS England’s manifesto for making inroads into the challenges and complexities of this massively important condition. What does it say and will it be effective? are the questions on everyone’s lips – or should be!

The document is an easy read, well-formatted and simply presented. It talks about the importance of diabetes in the modern world. Its huge and growing prevalence, its disastrous consequences and need for ongoing, lifelong, quality care. So much we know – that has all been said before. Often in these documents it’s just the numbers that change and usually upwards. So what is new (or at least new-ish?) A commitment to developing personalised care planning – with systems and processes and tools to document it all specified. That’s good, much needed. There’s a commitment to produce another service specification – for young people transitioning from children’s to adult services. Also good, also much needed, having foxed the life out of many practitioners over many years. Maybe this time? Mention is made also of enabling people with diabetes to access structured education within 9 months of diagnosis. Extremely good. Making this a quality indicator (ie must do) would really show commitment and it looks like this iteration of diabetes policy might, just might, do that.

Action on diabetes also tells us what’s recently been put in place to support action. A toolkit for clinical commissioning groups to ‘transform participation in health and care’. That is excellent. But for those with a condition like diabetes, participation isn’t just a ‘no-brainer’, it’s mandatory. They already participate by virtue of having the condition and it doesn’t go away, just because someone isn’t paying it any attention. So I’d say, remember that the idea of participation is more that health and care services also participate with people with diabetes, rather than just the other way round. For example, that their view comes first in a consultation, their personal priorities are respected and that they are treated holistically rather than 'an HbA1c on legs'. That isn’t mentioned and should be, perhaps?

There’s a model behind the vision – the model is of a house, whose walls and roof will not stand up unless all the elements are in place, including firm foundations of good commissioning. This house model has been used over recent years to illustrate the importance of all elements working together, for example in Year of Care work on diabetes. It’s great that an old model is being used in new ways, showing how national, local and individual priorities can be represented in it. And we can all relate to a house, so in this way it makes the words even more accessible.

Will the contents of the document come to pass? I hope so – action is a great word to use, and even greater when it jumps off the page into our clinics and services. NHS England, you’ve made a great start. Keep up the good work, we are watching…

Action for Diabetes
Transforming participation in Health and Care