Health and Social Care Committee
Inquiry into the implementation of the National Service Framework for diabetes in Wales and its future direction
DB 3 – Abertawe Bro Morgannwg UHB
ABMU Health Board is currently working towards meeting the standards set out in the Diabetes NSF and welcomes the opportunity to contribute to the inquiry into its implementation across Wales.
ABMU Health Board has a Diabetes Planning and Delivery Group established and meets on a quarterly basis, as requested by the Health Minister. The group is a multi-disciplinary forum with representation from Diabetes Consultants and Specialist Nurses, service planning leads, primary care clinicians and managers, Diabetes UK and Patient representatives.
In 2011 the DPDG prepared and submitted a Diabetes Delivery Plan to Welsh Government, which cross-referenced required actions within the NSF and those from the All Wales High Impact Changes strategy. Considerable work was carried out to align this plan to the previous LDSAG Action plans that were in place in Swansea, Neath Port Talbot and Bridgend before the re-organisation of Health services in Wales.
Following submission of the above delivery plan, the DPDG held a multi-disciplinary workshop in 2011 in order to identify the priorities for taking forward. As a result, the following initial priorities were agreed:
- Patient Structured Education
- Insulin Pump Therapy
- Diabetic Foot
In order to address these priorities, the following actions were carried out:
Patient Education – A Local Enhanced Service has been implemented across GP Practices in ABMU, where GPs are funded to put in place more regular reviews of Diabetes patients and guide them through a dedicated information booklet produced specifically for this initiative. A comprehensive review of the structured education programmes in place across ABMU has taken place, including analysis of current issues with delivery, financial implications and potential opportunities for re-design.
Insulin Pump Therapy (IPT) – a review of IPT has been carried out across ABMU and recommendations made to the DPDG in 2012. As a result a business case is currently being finalised regarding the resourcing of a specialist initiation team.
Diabetic Foot - The Podiatry team established a multidisciplinary joint foot clinic to enable patients to undergo medical and diabetic reviews at the same time as having their foot problems addressed, therefore reducing the risks of diabetic amputations. By the end of 2011, eight clinics had been held, with 58 appointments, saving 17 patient amputations.
It is recognised that as with most new initiatives, the services identified above need financial investment and considering the financial pressures on health boards, it is very difficult to prioritise the significant funds needed. Nevertheless, the DPDG has begun to explore the opportunity of supplementing any business cases with potential cost savings from other parts of the Diabetes service, where efficiencies can be identified without compromising services to patients.
In addition to the above priorities, the DPDG has also reported other achievements that contribute to the overall implementation of the NSF, including a comprehensive in-patient exercise, where Hypo Boxes were delivered to each ward in ABMU and staff given training on dealing with Diabetic complications. Transition clinics have been established for Children about to enter adulthood in order to support their needs. Also, a unified secondary care IT system , Cellma, has been introduced in Swansea (although the service throughout ABMU- and elsewhere in Wales- continues to struggle in the absence of a national diabetes IT system linking all care providers).
Whilst the above progress contributes to the achievement of some of the main actions within the NSF, ABMU recognises that significant steps are required in order to achieve the NSF by 2013, requiring substantial resource investment at a time when the NHS financial envelope is tightened .