Outputs from the project

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Outputs from the project
Advised by User group Expert
group Commissioning group Stakeholder events
The model of care 2
Commissioning guide 3
The case for change 1
Blimey, weve got a problem
Now get on and do it
Heres what we need to do
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What does this mean for those with diabetes?
Users said The lack of consistency patients
experience . leaves them feeling that the
quality of service they receive is too
variable
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Summary of performance data by SHA
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Summary of performance data by PCT
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Overweight and obese Year 6 children - 06/07
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Education / training (1)
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Education / training (2)
Source Healthcare Commission, 2007 Q. 42
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An average London PCT
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Principles underlying the model of care

• Early detection
• case finding in healthcare settings
• screening in hard-to-reach populations
• Patient at the centre of care
• All should contribute to a collaborative care
  plan discussed and agreed between professional
  and patient
• Patient supported in self-management by a trained
  healthcare team
• Model should support patients and healthcare
  professionals
• Providing care
• Majority care primary care
• Fully integrated specialist services
• All care should be integrated to avoid
  duplication and conflicting advice and messages,
  which undermines self-management
• Quality assurance, evaluation and monitoring

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Settings for care
Diabetes care
Hospital-based Tier 4

Primary/community care
Community-based specialist care Tier 3
Tier 2 Enhanced services
Tier 1 Core services
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Institutional Care / Housebound
Care planning
Structured education
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Podiatry
Diabetes specialist nurses/nurse consultant
Diabetes specialist dietitians
Learning from users facilitation / Peer
review research and development
GP Lead
Diabetes consultant
Psychological support / mental health
Pharmacists
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Aim to Deliver

• Identify
• Consistency
• Personal who you see / competency
• Approach
• Confidence / Trust
• Realistic Understanding of their condition
• Understand their position better

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The implications for the maternity community

• Changes to where, how and who delivers care
• intermediate care centres
• polyclinics
• better access to multidisciplinary teams
• More midwives working in the community - training
  /support specialist skills training/cost
  implications
• More midwives with enhanced skills such as
  Diabetes specialist podiatrists and dieticians.
• Workforce development HCP training, specialist
  qualifications

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Implications for Podiatry and Dietetics

• Podiatry shift of focus to seamless care across
  different tiers of Diabetes care.
• Workforce demands to support Intermediate care
  initiatives.
• Responsibility for training of Nurses, HCAs and
  patients in Footcare screening and prevention of
  complications
• Dietetics increased demand to support different
  tiers of Diabetes care
• Increased emphasis on prevention of Diabetes and
  tackling the Obesity epidemic

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Implications for the maternity community

• Physiotherapy increased emphasis on fitness
  exercise tackling the Obesity epidemic.
  Rehabilitation programmes for Diabetic co
  morbidities e.g. Cardiac, Stroke, Amputees
• Occupational Therapy increased demand for
  seamless care from hospital to home.
• Opthamology workforce implications to meet the
  continued increase in Diabetes and need for
  Digital Retinal Screening
• Orthotists closer working with Diabetic Foot
  team to ensure appropriate and timely
  orthotic/footwear provision.
• Radiology shift to polyclinics and increased
  demand for diagnostic scans and digital x-rays

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Leadership and the way ahead

• Diabetes care can be better
• Opportunities for the maternity community to help
  plan future care and services
• Develop new skills and experiences
• Work together to really make a difference and
  improve care for everyone who has diabetes in
  London, now and in the future

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Useful references

• http//www.diabetes.nhs.uk/ (Diabetes NSF 5 years
  on)
• http//healthguides.mapofmedicine.com/choices/map/
  diabetes5.html (evidenced based clinical
  pathways)
• www.footindiabetes.org (Framework and education
  updates)
• www.diabetes.org.uk/ (Diabetes charity and
  campaign site with HCP section)

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Foresight. Tomorrow belongs to the people who
prepare for it today
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The diabetes model of care

• What do you think the maternity communitys
  priorities should be to ensure the diabetes
  project is implemented successfully?

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