Friday, 6 March 2015

APPG for DSME - OK?!

Well done the All Party Parliamentary Group (APPG) for Diabetes! They have produced a report detailing the parlous situation and implications for people with diabetes of the gross lack of education provided to people when they are diagnosed, and beyond.

The report is concisely written and focuses on recent evidence about barriers to access to education, including the lack of provision of courses in general, and a ‘one size fits all’ approach to provision, in particular. It highlights the gap between services being rewarded for referrals to education through the Quality and Outcomes Framework, a system through which GPs are paid for their activities, and attendance by people at the courses. They conclude that this is often because people are not involved or engaged in the need for them to attend. .

The group gathered evidence from an admirable number of people living with diabetes themselves as well as clinicians, academics and diabetes organisations. This is to be congratulated and will probably give the report even greater credibility as well as those people being sure their voice has been heard. .

It’s a welcome addition, but only an addition, to the body of evidence that provision of opportunities for learning about diabetes are woefully inadequate and that diabetes services and commissioners alike seem to see training and education in the lifelong occupation of caring for diabetes by the person with it themselves, as a bolt-on ‘extra’ to clinical care. It makes recommendations, which are sound, but only an echo of what has already been said. .

The real question is ‘what difference will this report make?’ There are opportunities for clinical commissioning groups to provide courses in sufficient numbers and variety to meet their populations’ needs, but only if they also invest in a system which enables people to be told about them and be encouraged to attend. One of the main barriers to this cited in the report, is the attitude of referrers, who often have no knowledge or experience themselves of what education courses provide, nor their long term benefits. Hence, for many of them, a referral is a ‘take it or leave it’ affair and, in truth, a paper exercise. This must change if attendance at courses is to change and make it worthwhile for all those courses to be provided. .

Like most publications, the report is already in danger of being out of date, despite only being released a day or two ago. Updates to National Institute for Health and Clinical Excellence (NICE) guidance to the NHS for Type 1 diabetes, which are currently in consultation stage, propose to replace one of the documents to which the report refers. This is Technology Appraisal (TA) 60, which details what education programmes should be available. TA 60 was replaced for Type 2 diabetes in the last round of NICE guidance updates. Fortunately the new proposed guidelines for Type 1 diabetes, incorporate much of TA 60’s contents and also place provision of education as a priority for implementation. If adopted, these new updated recommendations should at least help to improve the picture, particularly if their implementation is closely monitored. We will have to ‘watch that space’, but for now at least a tiny further step has been taken to rectify this dire situation. .

All Party Parliamentary Group for Diabetes (2015). Taking Control: Supporting people to self-manage their diabetes. London. Diabetes UK (Sectariat) .

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