Diabetes care

National Service Framework for Diabetes

The Departments of Health in England, Northern Ireland, Wales and Scotland have all produced a National Service Framework (NSF) for Diabetes, which sets out an ambitious list of standards of care to be met by 2013 (earlier in Scotland). There are some differences between each of the countries but the principles are largely the same.
In England, the 12 standards are as set out in the table on page 130 and a summary leaflet entitled Living with Diabetes: Your future health and well being (number 29335) is available from the Department of Health (see page 146 for the address).
There were two clear milestones in the English NSF:

1 All people with diabetes were to have access to annual eye photography for screening for retinopathy by 2007.
2 All GP surgeries were to have an up-to-date register and systematic programme of care for people with diabetes by 2006.

Whereas universal eye screening is available in most parts of the UK, the second milestone has yet to be universally achieved.

The new contract for GPs specifies certain important targets for all of their patients with diabetes. This means that there are strong incentives to provide comprehensive care at your local surgery.
Contact your health centre or surgery for details of what care is available. It is also proposed to set up locally managed care networks made up of health-care professionals, people with diabetes and their carers, to make sure that there is progress towards meeting all the standards by 2013.
This process is to be supervised by the National Clinical Director for Diabetes. The NSF actively encourages involvement in this process and a local lay champion is to be appointed in every district.
To find out more about how you can get involved you can contact your local primary care trust, NHS Direct (see page 150), Diabetes UK (see page 147) or the Department of Health website (see page 146).

What care should you expect?

Medical and lay members of Diabetes UK have drawn up a charter (see below) of what you should expect from your medical carers.

Newly diagnosed

When you have just been diagnosed, you should have:
• A full medical examination.
• A talk with a registered nurse who has a special interest in diabetes. She or he will explain what diabetes is and talk to you about your individual treatment.
• A talk with a state-registered dietitian, who will want to know what you are used to eating and will give you basic advice on what to eat in the future. A follow-up meeting should be arranged for more detailed advice.
• A discussion of the implications of your diabetes for your job, driving, insurance, prescription charges, etc. and whether you need to inform the DVLA and your insurance company, if you are a driver.
• Information about Diabetes UK’s services and details of your local Diabetes UK group.
• Ongoing education about your diabetes and the beneficial effects of exercise, and assessments of your control.

You should be able to take a close friend or relative with you to educational sessions if you wish.

Insulin treatment.

If you are treated with insulin, you should have:
• Frequent sessions for basic instruction on injection technique, looking after insulin and syringes and pens, blood glucose testing and what the results mean.
• Supplies of relevant equipment.
• Discussion about hypoglycaemia (a hypo) and how to deal with it.

NSF Standards for Diabetes Care

Standard 1: Prevention

The NHS will reduce the overall risk of people developing diabetes.

Standard 2: Identifying/Screening for Diabetes

The NHS will develop programmes for screening for type 2 diabetes.

Standard 3: Patient Empowerment

The NHS will give people with diabetes the information to enable them to take part in decisions about their care. Newly diagnosed people with diabetes will be assigned a named health-care professional who will help them learn how to look after their diabetes.

Standard 4: Clinical Care – Adults

All adults will receive high-quality care including information and support to reduce the risk of developing diabetes complications.

Standards 5 and 6: Clinical Care – Children and Young People

All children and young people will receive equally high-quality care, which will be extended to their carers. Clinical services will be developed to enable a smooth transfer of children from paediatric to adult services.

Standard 7 Clinical Care – Diabetic Emergencies

Diabetes services will have in place evidence-based in England – to be achieved by 2013 protocols for quick and effective treatment of diabetic emergencies including comas.

Standard 8: Clinical Care – Diabetes Patients in Hospital

All people with diabetes who are in hospital will receive informed and effective care of their condition whatever their reason for being an inpatient.

Standard 9: Clinical Care – Pregnancy

All women with diabetes wishing to become pregnant or who are pregnant or develop diabetes during their pregnancy will receive high-quality care to protect their health and to maximise the chance of a normal healthy baby.

Standard 10: Identifying and Treating Complications

All people with diabetes will receive regular checks to identify long-term complications.

Standards 11 and 12: Treating Complications and Providing Support

Long-term complications will be identified and treated at an early stage in order to reduce the risk of permanent disability or early death. The NHS will also work closely with all other relevant organisations in order to provide joint care for people with diabetes.
 

Full details of standards available from the Department of Health website (see ‘Useful addresses’, page 146).

Tablet treatment

If you are treated by tablets, you should have:
• A discussion about the possibility of hypoglycaemia (a hypo) and how to deal with it.
• Instruction on blood or urine testing and what the results mean and supplies of relevant equipment.

Dietary treatment alone

If you are treated by diet alone, you should have instruction on blood or urine testing and what the results mean and supplies of relevant equipment.

Ongoing care

Once your diabetes is reasonably controlled, you should:
• Have access to the diabetes team at regular intervals – annually if necessary. These meetings should give time for discussion as well as assessing diabetes control.
• Be able to contact any member of the health-care team for specialist advice when you need it.
• Have more education sessions as you are ready for them.
• Have a formal medical review once a year by a doctor experienced in diabetes.

At this review:
• Your weight should be recorded.
• Your urine should be tested for protein.
• Your blood should be tested to measure long-term control.
• You should discuss control, including your home monitoring results.
• Your blood pressure should be checked.
• Your vision should be checked and the back of your eyes examined. A photograph may be taken of the back of your eyes. If necessary, you should be referred to an ophthalmologist.
• Your legs and feet should be examined to check your circulation and nerve supply. If necessary, you should be referred to a state-registered chiropodist/podiatrist.
• If you are on insulin, your injection sites should be examined.
• You should have the opportunity to discuss how you are coping at home and at work.

The importance of your involvement

You are an important member of the care team, so it is essential that you understand your own diabetes to enable you to be in control of your own condition.
You should ensure that you receive the described care from your local diabetes clinic, practice or hospital. If these services are not available, you should:
• Contact your GP to discuss the diabetes care available in your area
• Contact your local primary care trust
• Contact Diabetes UK or your local branch (see page 147).