Diabetes Managers – We Need You

I get this type of phone call from a manager every week:

“Hello, my colleague suggested I call you.  I’m on a short term contract and have been asked to cover diabetes.  I haven’t been given much of a hand over”.

I’m thinking:  “Crikey.  The last manager didn’t last long”.

“I’ve never done diabetes before.  I need to know how many Type 1 diabetes cases will be avoided by the diabetes prevention programme for the business plan I am writing”.

I’m thinking: “Oh dear!!”

“I cover Long Term Conditions and Cancer.”

I’m thinking: “Well no wonder you don’t know the difference between Type 1 and Type 2 diabetes when you covering so many conditions”.

Diabetes affects people from head (retinopathy) to toe (neuropathy).  People with diabetes account for at least 17% of all hospital beds.  Diabetes cuts across and impacts every patient pathway and care is commissioned from social care; to public health; to primary care; to community care to hospital care.  It is a complicated condition.  It is complicated to commission.

In England there are 209 CCGs (too many in some areas, if you ask me, but I’m hoping STPs will sort this out).  Each CCG has a manager who supports a CCG GP Lead for diabetes.  The turnover of CCG GP and Manager Diabetes Leads seems excessive and sometimes a change of person leads to planning, rather than getting on with implementation, starting all over again.

CCGs hold a third of the £76bn of the NHS budget and we know that at least 10% is spent on diabetes.

Yet many managers are being asked to squeeze diabetes in on top of a myriad of other conditions that they have to provide management support for.

Managers like everyone in the NHS are extremely busy.  They go from a meeting about cancer straight into a meeting about diabetes.  It doesn’t matter how much support, simplification, tools that are provided - there are only so many hours in a day. 

We now have a “Diabetes Aide Memoire” to support the Sustainability and Transformation Planning process.  For a document that is only 2 pages long there is a lot to achieve.  We need management capacity to support the team/network/STP approach to getting it right.

Given the lack of management capacity to support diabetes care.  I am constantly in awe of how much managers, as part of a team, achieve.  But more management support, particularly to support “the doing” rather than just the planning, are needed to make the seismic shift in preventing diabetes and preventing the complications of diabetes.

The Right Honourable Stephen Dorrell, in his opening address last week at the NHS Confederation Conference said:

 “It is important to begin this conference by restating yet again the vital role played in by the management community.  Managers are not a cost born by the healthcare team, they are part of the team an indispensable part of the team and part of its success “.

Managers are needed.  More management support for team/network approaches to diabetes improvement is needed.  Managers working in diabetes are amazing.

A Broken Record

Anyone who knows me will probably be rolling their eyes at this blog.  Not this again!   Honestly can she not have a conversation without asking how things are going in planning and supporting this year’s participation in the National Diabetes Audit.  She’s like a broken record!

I hope they are saying this.  I hope it is with an indulgent smile.

So this year’s audit upload period has arrived.  From the 20th of June to the 12th of August CCGs will be working hard to support their practices to upload information to the National Diabetes Audit.

There is lots of easy to read information on what practices have to do on the NDA website.

From what practices tell me, it takes about 10 – 20 minutes to participate and this year the process has been made much easier for practices using Vision.

I get questions from CCGs and Practices about “consent”.   A letter that went out to all practices in May makes the position very clear – “The NDA has approval from the Health Research Authority Confidentiality Advisory Group, to collect patient identifiable data under Section 251."; “This means there are no legal obstacles to services participating in the NDA”.  Therefore patients do not have to be individually consented but posters should be placed in surgeries and these can be downloaded from the NDA website.

Anyone can see which practices uploaded data for last year’s audit by looking at the CVD Primary Intelligence Packs produced by the National Cardiovascular Intelligence Network.
The NDA provides an essential overview of diabetes care in England and enables high quality commissioning.  if we didn't have it we'd all end up trying to invent it.  Diabetes is one of the six priority clinical areas of the CCG Improvement and Assessment Framework (CCG IAF) and CCGs with less than 25% GP practice participation will be categorised as ‘greatest need for improvement’ due to an inability to make a reliable assessment.

I was talking to a CCG who has had 100% participation for the last 2 years.  They were excitedly telling me how impactful and helpful having robust data was to their local diabetes improvement plans but until then had not realised the value. 

I am really looking forward to having this conversation with more CCGs and Health Care Professionals.  This audit and all the tools are funded. It is so valuable. So go for it. 

Diabetes Networks – I shouldn’t have given up

I am realising that writing a blog is an opportunity for self-reflection.

In Diabetes UK’s publication: “Improving the Delivery of Adult Diabetes Care Through Integration” it says, “The need to join up health services to centre around patients rather than the needs of the system is increasingly recognised in national policy.” 

The key enabler for supporting an “integrated” approach to diabetes care is through robust Diabetes Networks.  A clinically led diabetes network, involving people with diabetes, provides the means to integrate care, improve clinical outcomes, cost-effective services, improved patient experience, and equity of service provision.

I absolutely fundamentally believe this.  And there is a plethora of documents, evidence, policies, and guides, to support this belief.

In 2004, one of my tasks as South East Regional Manager for the National Diabetes Support Team (later to become NHS Diabetes and disbanded in April 2013) was to support the development of Diabetes Networks.

The “The National Diabetes Service Framework Delivery Strategy” (2003) definition of: “An effective network should cover ‘a natural population’ – usually determined by the population served by a specialist diabetes service based within an NHS trust".  I’d like to see a map of how many diabetes networks there are in the UK that meet that definition and with the name of the managerial and clinical lead.  Very, very few I suspect.

I believe in the necessity and the power of Diabetes Networks to support integrated diabetes care and yet why have I stopped trying to support, cajole, thump the table to encourage more Diabetes Networks being developed?  Why did I give up?

Some of the reasons, off the top of my head:

·       No one else seems bothered.  No one seems that interested in talking about diabetes networks.  I speak to a lot of Trusts and CCGs each week, not a single one has initiated a conversation about starting a Diabetes Network to support integrated care.  Some have CCG based groups – not the same I’m afraid.

·        Who pays for the Network support?  As there is often more than 1 CCG, a hospital trust, may be a community trust and other organisations that are all part of the network then it is in the interest of everyone to support a network but can you imagine how many board papers have to be written to get agreements through all these different NHS/PH organisations for them to toss it in few quid each to make it happen.  I know a “few quid” is easy for me to say.  Getting any funding for anything is extremely difficult but it is a “few quid” in comparison to 10% of the NHS budget spent on diabetes.

·        Diabetes networks are difficult to pin down.  I’ve had the most ridiculous conversations about what office and computer a Diabetes Network Manager would sit at, if they aren’t really “owned” by any one organisation. 

·        Shouldn’t it be a local CVD Network? – maybe, in a utopian world but going to a CVD Network meeting can be extremely long and I found that those interested in Renal walked out when the diabetes stuff was discussed and then those interested in cardiology walked in only when their agenda items were on.  Unless it is a network built around mutual interest it just won’t work.   However, that is not to say, that a Diabetes Network should not strongly interlink with other pathways and networks.

·       Diabetes Networks are not like Cardiac, Stroke and Cancer Networks.  No they are not. There should be more of them because; barring Vascular hubs (non arterial centres) Diabetes Networks should be centred on the local patient pathway.  For example the county of Kent should have 4 diabetes networks by the NSF definition.

·       Diabetes Networks also stumble across the same issues as all changes to models of care, namely, money flows, PBR, contracting, mandate, IT integration.

Whatever the reason, I sniff change in the wind.  There may be a new opportunity to get back to Diabetes Networks as the conduit for radical and robust transformation of integrated diabetes care – Sustainability and Transformation Plans (STPs) or 5 Year Forward View Plans (5YFV plans).

Now I might be wrong but when I am reading information about the STPs it says things like:  “health and care organisations within these geographic footprints are working together to develop STPs” and “footprints should be locally defined, based on natural communities, existing working relationships, patient flows” and “STPs footprints are not statutory bodies, but collective discussion forums which aim to bring health and care leaders to support the delivery of improved health and care based on the needs of the local populations.  They do not replace existing local bodies or change local accountabilities”.  Well you could be reading the very good guide from Diabetes UK on “How to: Delivery a successful local network”.  If we are developing an environment that supports STP principles, which are so akin to the principles of Diabetes Networks then surely there is a much bigger hope for Diabetes Networks to be understood and supported?

I shouldn’t have given up.   My Diabetes Week resolution is to capitalise on the opportunity that the “footprint” or “Network” approach to STPs has presented to bang the drum for establishing a networked, integrated approach to robust and safe transformation of diabetes care.

Finger on the Pulse

I am often asked how I keep updated.  Unfortunately, I don’t think they mean my fashion sense!  I’m pretty sure that they are referring to how to keep on top of the latest information on diabetes for managers.

I am in a very privileged position.  I almost, exclusively work in diabetes which is a luxury that few managers have.  We have Diabetologist and Specialist Diabetes Nurses and I often wonder whether there is a place for the Specialist Diabetes Manager.  I suppose we do have a few Diabetes Network Managers across the country but they are few and far between.

Lots of reading is the answer, which is tricky because I am dyslexic.  Yes – expect my blogs to be littered with spelling mistakes.  So I am discerning about my reading sources.   But knowing how very busy managers working in diabetes are, I’ll try and give you my list of top sources short.

So here’s my essential list:

1)      I subscribe to NHS Networks daily news stories as it is really easy to flick through the list

2)      I subscribe to the fortnightly newsletter and regularly browse The Diabetes Times website

3)      Diabetes UK have just launched a Diabetes Commissioners Network monthly newsletter

4)      I get "Practical Diabetes" delivered to my home – for free

If I can, I also go to 2 conferences:

Diabetes UK Professional Conference which is in Manchester next year and
Diabetes Professional Care Conference at Olympia, London in November and is FREE.  I  am also happen to be helping with a workshop this year so do pop in and say hello.

And of course you could always subscribe to this blog by putting your email address into the box on the right hand of my blog page.  Happy Reading.