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.