My saving grace is that diabetes is in the NHS
Mandate, NHS Business Plan and Five Year Forward View. Diabetes is high profile for the NHS and
therefore, luckily, there is a plethora of stuff being churned out to provide
rich fodder for me to try and understand and reflect back each week.
However, this week I am focused on what hasn’t been
published rather than what has.
A bit of history.
The CCG Assurance Framework 2015/16 published on the 26th
March 2015 announced that:
“It is our intention
to publish the CCG scorecard which will inform several of these components on MyNHS, through the NHS Choices
website. Our performance and delivery
commitments will be described in relation to five population groups: the
generally well, people with long term conditions, people with mental health
problems or learning disabilities, children and young people, and the frail
elderly, with an additional focus on planning.
The outcome measures in the scorecard will be derived from, and assessed
in line with, the NHS Outcomes Framework.
We will also publish a more detailed operational manual as well as technical
guidance on the metrics used in the scorecard. Key sources of information for assurance will
be thoroughly scrutinised so that everyone has full confidence in the facts.”
The “CCG Scorecard” has now morphed into the “CCG Improvement and Assessment Framework”
which includes six clinical priorities matching those set out in the Five Year
Forward View. One of these clinical
priorities is diabetes.
Considering there are only 2 indicators for each of the six
clinical priorities the wording of the diabetes indicators certainly squeezes a
lot in:
1.
Diabetes patients that have achieved all the
NICE-recommended treatment targets: HbA1c<+58mmol/mol
(7.5%), cholesterol<5mmol/L and blood pressure<+140/80mmHg and for
children: HbA1c<=58mmol/mol (7.5%)
2.
The percentage of people with diabetes diagnosed
for less than one year who have a record of attendance at a structured
education course.
Look at the technical guidance. It
relies on participation in the National Diabetes Audit and also the indicators,
rightly, include adults and children which in some respects have different
needs, funding, services, etc, etc.
Certainly lots to get ones teeth in to.
So, as promised back in March 2015 we now have the Operational Manual and the Technical Guidance and, as of last
Monday the 25th of July we have the performance against the 2 diabetes
indicators on MyNHS. Click on the link. Have a look.
MyNHS: “enables users easily to see how their local health
and care services compares to similar services round the country”.
Putting the information on MyNHS is deliberately to demonstrate transparency to the public although, at the moment, you can tell whether the percentages published for each CCG on each indicator or considered good or not.
So are you wondering what hasn’t been published?
Well, by the end of June, we were meant to have had CCGs
performance ranked by each of the six clinical areas. However, there has been a delay. According to the Health Service Journal (27th of July) there are wrangles
about how the ratings should be described (good, bad, ugly, etc) and also
whether the information being collected on performance for these indicators are
really reflective of a CCG’s performance in these clinical areas.
I can understand it.
Diabetes is complicated. Care
is delivered across so many NHS departments.
Distilling a rating for “better care” just in to 2 indicators must be
tricky if neigh on impossible. The indicators also needed to be an area that needed improvement and therefore, by its nature,
will not look good initially. It will be
in 5 years time when people can really make a judgement. Not now.
I can imagine the public wondering why their CCG is looking
poor for diabetes. You can imagine CCGs
wondering whether those 2 indicators can really provide an assessment of
diabetes care.
Some heads have rolled after the announcement of 26 CCGs
being classed as “Inadequate” further to the publication of the CCG Assurance Annual Assessment 2015/16 last week. Such
tricky stuff. No wonder people are in
knots. No wonder there is a delay.
However, you have to start somewhere. This is all new. Anything new has teething problems. I see it as a huge opportunity to keep diabetes
very much on the NHS radar and I think the 2 indicators selected for diabetes are a really good
starting point and certainly key areas for improvement.
Plus………………………………………………….. it gives me something to write about.
