The promotion of self-management of diabetes by the person with the condition themselves is not new. As far back as the 1940s, when insulin was relatively new in town and medications for Type 2 diabetes were hardly thought of, a young doctor called Robin Lawrence wrote in his book ‘The Diabetic Life’ – ‘the patient must be at once his own doctor, dietitian and lab technician’. This urge and acceptance that diabetes is absolutely a self-managed condition somehow got lost over proceeding decades, when health professionals tended to take charge of both medications and expectations
More recently there’s been a massive upsurge in ‘people power’ in society generally. The expectation and indeed, often, political will, is that people will do things for themselves. We are our own cashiers in the supermarket, our own bankers and even our own hotel receptionists. This upsurge has been replicated in medicine, not least because most illnesses these days are the long term variety, such as diabetes, that people have to manage themselves each day. This is well recognised, being mentioned in health policy documents as well as official guidelines and enacted in practical situations such as GP’s clinics and hospital wards. Indeed, our own work here at SD is all about promoting success in living with diabetes
Given this situation, the news this week that a major international meeting of the great and the good of diabetes care and education, held here in the UK, had formed an alliance which resolved to make diabetes care more person centred and promote self management, would seem rather unnecessary. Surely things are going in the right direction already? Do we need another layer of ‘initiative’ in this direction?
The truth is, as we’ve no doubt said before, that there is a lot of TALK about promoting self-management and being person-centred, but often the ‘old ways’ – a rather paternalistic approach, people being ‘told off’ for not achieving text book results, scant regard for the emotional turmoil which many people experience their diabetes, etc etc – persist, even supported by protestations that ‘the patients need me to tell them what to do, otherwise they wouldn’t know’
Hence a new, eye-catching way of promoting this way of being in relation to helping people really run their own condition has got to be good. The words might not be new, but the actions could reflect new times to come. We await this Alliance’s progress with our full support
Talking of old and new, SD is changing its ways this week, too. 30th September 2015 sees the last issue of our monthly newsletter, which has been running since 2008. Our refreshed communication plan is to make much more use of the instant means available to us, to update much more often using the 21st century tools of social media, Facebook, Twitter and the like – and add more frequent, but shorter, comment on the blog here. The need to communicate is as old as the hills, but the ways of doing it can be ever newly minted!
References
The Diabetes Times: Alliance formed to promote diabetes self management
Showing posts with label education. Show all posts
Showing posts with label education. Show all posts
Tuesday, 29 September 2015
Tuesday, 30 September 2014
Is this the best use of £140 million?
Up and down the country of England, GP practices have been scrambling towards a deadline of today and are completely distracted by it.
This is the date by which many practices have to compile a register of a minimum of 2% of adults on their books who are at risk of an unplanned hospital admission by virtue of their previous history of emergency admissions, long term condition, age or frailty. The practices concerned are those who have signed up to a particular ‘enhanced service’ or ES – basically extra payments for particular activities, offered by NHS England, the body in control of delivering health policy in England.
The idea of the register is to identify and put in place a care plan, agreed with the person and any other relevant people involved in their care, for example, family carers or professionals such a social workers or mental health workers. The care plan aims to identify and share with everyone concerned, how a potential emergency admission to hospital could be avoided and then activate it when necessary.
For the register and associated actions specified in the ES, practices will be paid around £3 per head of their practice population, resulting in a typical total payment of around £20,000. This money is much needed, say the GPs who have signed up to the ES (it is not obligatory), whatever they need to do to receive it. And there are a lot of activities associated with receiving payment for this ES. If you want to read more, all the details are in the published specification. The total funding for this ES across England is £140 million. It was announced in the Spring and was initially to last for one year. However, it has been announced today that it will continue for a further year.
You may be wondering why we are discussing such an initiative, which might not at first glance have anything to do with SD’s speciality – helping people live and work with diabetes successfully. However, there is a link and it is the following:
The majority of people with diabetes and other long term conditions are not among the 2% of adults in a practice covered by this ES. They can easily take steps now to avoid becoming vulnerable to unplanned admissions in later years, as long as they are given the ‘tools to do the job’.
These tools are: knowledge and confidence to take appropriate actions, along with the opportunity to constantly participate and collaborate in decisions about their condition. Many of these skills are developed and reinforced in structured education programmes for diabetes – for example X-PERT, DESMOND and The Diabetes Manual Programme for Type 2 diabetes and BERTIE and DAFNE for Type 1 diabetes, to mention just a few nationally available programmes. The same body who has announced the ES, NHS England, has recommended that everyone with diabetes receives an education programme to actively help them learn to live with it.
The problem is that these education programmes are not available to all people diagnosed with diabetes, and even where they are technically available, the numbers of people being offered, or taking up the offer of a place, are vanishingly small. We have covered this, at worst completely iniquitous, and at best rather ridiculous, situation in previous blog postings.
Successive annual reports have shown that less than 15% of people with diabetes overall, are either offered or take up a place. Even among the areas with the best uptake, the highest number of people being referred for or uptaking education is just under 60%.
We believe that whilst it remains to be seen whether the avoiding unplanned admissions ES discussed above will really make a difference to numbers of admissions, diabetes structured education has been shown over and over again to provide people with the confidence and skills to look after their own condition and take avoiding actions themselves, without recourse even to their health professionals. And yet the money can be found for the former, but not the latter.
So the question arises in our mind: ‘why is a sum such as £140 million not also being offered to General Practices to incentivise them to provide proper, formalised diabetes education?’ The programmes are there, they are not expensive (compared in particular to a single hospital admission), they have been shown to work, and yet they are not being used.
In our view, it’s time there was an Enhanced Service for Diabetes Education – or whatever title suits – that is, a system which specifically rewards GPs for providing diabetes education. While the present situation exists, millions of people are being failed every day by the NHS which has vowed to look after them as much as the 2% of people in each practice covered by the unplanned admissions ES.
Successful Diabetes completely supports the provision of Structured Diabetes education in the NHS for all people with diabetes as recommended. We will continue to call for it ourselves, as we have in previous posts here and in many other activities. We will also continue to support other organisations’ efforts, as well as encouraging people with diabetes to lobby their local health providers to invest in their future health by commissioning education programmes.
However, while we wait – and wait – for money to be put where guidelines are, we will soon be offering something practical in addition.
From November 14th this year (World Diabetes Day), we will be launching the Diabetes Manual Programme as ‘Diabetes Manual Complete’, a one to one, supported education programme, which is available directly to people with Type 2 diabetes who wish to purchase a programme for themselves (much as they might any other form of healthcare such as a private operation or GP consultation or prescription).
‘Diabetes Manual Complete’ fulfills all the current recommendations for a structured education programme in the NHS and is provided by diabetes and education specialists. More information about it is available now by request from SD, and will be published publicly from the launch date. People will be able to help themselves to quality, specialist education, with no referral, no waiting times and no extra appointments.
We are excited to spearhead this unique development in diabetes education, but sad that it is necessary. The Diabetes Manual Programme is available now for the NHS to commission for local people with Type 2 diabetes, and has been for many years. To date, not one local organisation has seen fit to comprehensively commission this cost-effective programme to people with Type 2 diabetes. As we have said, other programmes, such as group-based education, are also not purchased in enough quantities to meet the need.
By making ‘Diabetes Manual Complete’ available, we can help people to help themselves to the quality and expert education that they deserve and are entitled to, but are not likely to get anytime soon, partly because the NHS is ‘looking the other way’ with short- term measures like the unplanned admissions ES, and partly because commissioners and managers have not yet grasped the vital importance and long term impact of 100% coverage of diabetes structured education. As the saying goes ‘desperate situations require desperate measures’. This may be desperate but it will be effective, and in a good way, too.
References
NHS England Proactive Care Programme for Unplanned Admissions
Structured Education for People with Diabetes – A Box Waiting to be Ticked?
Contact us about Diabetes Manual Complete
This is the date by which many practices have to compile a register of a minimum of 2% of adults on their books who are at risk of an unplanned hospital admission by virtue of their previous history of emergency admissions, long term condition, age or frailty. The practices concerned are those who have signed up to a particular ‘enhanced service’ or ES – basically extra payments for particular activities, offered by NHS England, the body in control of delivering health policy in England.
The idea of the register is to identify and put in place a care plan, agreed with the person and any other relevant people involved in their care, for example, family carers or professionals such a social workers or mental health workers. The care plan aims to identify and share with everyone concerned, how a potential emergency admission to hospital could be avoided and then activate it when necessary.
For the register and associated actions specified in the ES, practices will be paid around £3 per head of their practice population, resulting in a typical total payment of around £20,000. This money is much needed, say the GPs who have signed up to the ES (it is not obligatory), whatever they need to do to receive it. And there are a lot of activities associated with receiving payment for this ES. If you want to read more, all the details are in the published specification. The total funding for this ES across England is £140 million. It was announced in the Spring and was initially to last for one year. However, it has been announced today that it will continue for a further year.
You may be wondering why we are discussing such an initiative, which might not at first glance have anything to do with SD’s speciality – helping people live and work with diabetes successfully. However, there is a link and it is the following:
The majority of people with diabetes and other long term conditions are not among the 2% of adults in a practice covered by this ES. They can easily take steps now to avoid becoming vulnerable to unplanned admissions in later years, as long as they are given the ‘tools to do the job’.
These tools are: knowledge and confidence to take appropriate actions, along with the opportunity to constantly participate and collaborate in decisions about their condition. Many of these skills are developed and reinforced in structured education programmes for diabetes – for example X-PERT, DESMOND and The Diabetes Manual Programme for Type 2 diabetes and BERTIE and DAFNE for Type 1 diabetes, to mention just a few nationally available programmes. The same body who has announced the ES, NHS England, has recommended that everyone with diabetes receives an education programme to actively help them learn to live with it.
The problem is that these education programmes are not available to all people diagnosed with diabetes, and even where they are technically available, the numbers of people being offered, or taking up the offer of a place, are vanishingly small. We have covered this, at worst completely iniquitous, and at best rather ridiculous, situation in previous blog postings.
Successive annual reports have shown that less than 15% of people with diabetes overall, are either offered or take up a place. Even among the areas with the best uptake, the highest number of people being referred for or uptaking education is just under 60%.
We believe that whilst it remains to be seen whether the avoiding unplanned admissions ES discussed above will really make a difference to numbers of admissions, diabetes structured education has been shown over and over again to provide people with the confidence and skills to look after their own condition and take avoiding actions themselves, without recourse even to their health professionals. And yet the money can be found for the former, but not the latter.
So the question arises in our mind: ‘why is a sum such as £140 million not also being offered to General Practices to incentivise them to provide proper, formalised diabetes education?’ The programmes are there, they are not expensive (compared in particular to a single hospital admission), they have been shown to work, and yet they are not being used.
In our view, it’s time there was an Enhanced Service for Diabetes Education – or whatever title suits – that is, a system which specifically rewards GPs for providing diabetes education. While the present situation exists, millions of people are being failed every day by the NHS which has vowed to look after them as much as the 2% of people in each practice covered by the unplanned admissions ES.
Successful Diabetes completely supports the provision of Structured Diabetes education in the NHS for all people with diabetes as recommended. We will continue to call for it ourselves, as we have in previous posts here and in many other activities. We will also continue to support other organisations’ efforts, as well as encouraging people with diabetes to lobby their local health providers to invest in their future health by commissioning education programmes.
However, while we wait – and wait – for money to be put where guidelines are, we will soon be offering something practical in addition.
From November 14th this year (World Diabetes Day), we will be launching the Diabetes Manual Programme as ‘Diabetes Manual Complete’, a one to one, supported education programme, which is available directly to people with Type 2 diabetes who wish to purchase a programme for themselves (much as they might any other form of healthcare such as a private operation or GP consultation or prescription).
‘Diabetes Manual Complete’ fulfills all the current recommendations for a structured education programme in the NHS and is provided by diabetes and education specialists. More information about it is available now by request from SD, and will be published publicly from the launch date. People will be able to help themselves to quality, specialist education, with no referral, no waiting times and no extra appointments.
We are excited to spearhead this unique development in diabetes education, but sad that it is necessary. The Diabetes Manual Programme is available now for the NHS to commission for local people with Type 2 diabetes, and has been for many years. To date, not one local organisation has seen fit to comprehensively commission this cost-effective programme to people with Type 2 diabetes. As we have said, other programmes, such as group-based education, are also not purchased in enough quantities to meet the need.
By making ‘Diabetes Manual Complete’ available, we can help people to help themselves to the quality and expert education that they deserve and are entitled to, but are not likely to get anytime soon, partly because the NHS is ‘looking the other way’ with short- term measures like the unplanned admissions ES, and partly because commissioners and managers have not yet grasped the vital importance and long term impact of 100% coverage of diabetes structured education. As the saying goes ‘desperate situations require desperate measures’. This may be desperate but it will be effective, and in a good way, too.
References
NHS England Proactive Care Programme for Unplanned Admissions
Structured Education for People with Diabetes – A Box Waiting to be Ticked?
Contact us about Diabetes Manual Complete
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