The Scottish Government

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2. PROGRESS IN SCOTLAND

Implementing the Action Plan

2.1. The Diabetes Action Plan, published in June 2006, set out an ambitious agenda for the period up to 2009. Its priorities were developed in response to the progress made on implementation of the Scottish Diabetes Framework (2002). (See Appendix I).

2.2. The Scottish Government's action plan, Better Health, Better Care, set out its approach to helping people to sustain and improve their health, especially in disadvantaged communities, through better, local and faster access to health care. The Diabetes Action Plan is being revised to align it with the mutual NHS described in Better Health, Better Care, where people are regarded as leading partners in their own care.

2.3. The Scottish Diabetes Group ( SDG), chaired by Dr Donald Pearson, the Scottish Government's Lead Clinician for Diabetes, was established to oversee diabetes care across Scotland. It has representation from people with diabetes, voluntary sector organisations, researchers, a broad range of health care professionals and suppliers, and those involved in planning health care services at local, regional and national level. The diabetes Managed Clinical Networks in each NHS Board provide the SDG with regular reports on progress against each of the actions in the 2006 Plan.

2.4. The SDG is supported in the implementation of the Diabetes Action Plan by a number of subgroups:

• Diabetes Care Focus Group
• Ethnic Minorities
• Foot Care
• Psychology
• Type 1 Diabetes
• SCI-DC
• Education
• Retinopathy Screening

2.5. The SDG also works closely with a number of partners and stakeholders from all parts of the diabetes community on delivering the diabetes Action Plan. These include: Diabetes UK Scotland, the diabetes Managed Clinical Network in each NHS Board, the Scottish Study Group for the Care of Diabetes in the Young, the Scottish Public Health Network, the Scottish Diabetes Research Network, the Scottish Diabetes Education Network, Juvenile Diabetes Research Foundation, National Services Division, Diabnet and the Scottish Diabetes Industry Alliance.

2.6. The 2006 Action Plan set out nine aims to be addressed by 2009. This was described in the Action Plan as 9 by 9. Regular reports from the diabetes MCNs have allowed an assessment of progress on the 9 by 9. A detailed summary of progress can be found in Appendix II. An illustration of progress can be found in Table 1 below:

Table 1.

2.7. Improved NHS performance

2.7.1. In March 2008, NHS Quality Improvement Scotland (NHS QIS) and Diabetes UK Scotland produced a report on performance in 2007 against the NHS QIS diabetes standards published in 2002. They found significant changes and improvements since the first review against standards in 2004, and they also found that patients were increasingly involved in planning and developing these services.

2.7.2. Key findings from the report were:

• There is good evidence that NHS Boards continue to provide a very high standard of clinical care;
• Scottish Care Information - Diabetes Collaboration ( SCI-DC) had been rolled out across Scotland but further work was required to ensure the transfer of information from SCI-DC to GP practices. They also found a lack of data interfaces that would allow one data entry to populate both primary and secondary care systems; and
• Generally education is provided at the time of diagnosis and on an ongoing basis. However the information is provided in a variety of settings and patients have reported that this information is not always consistent.

2.7.3. Most NHS Boards now meet all the clinical management standards. This has been supported through the introduction of the Quality and Outcomes Framework ( QOF) in the General Medical Services contract, particularly in supporting the routine collection of data.

2.7.4. NHS QIS identified particular concerns with:

• Lack of psychological support;
• Foot care; and
• Access to dietetics advice.

2.7.5. A summary of findings from Diabetes UK Scotland patient focus groups was also included in the NHS QIS report. Key issues highlighted in the focus groups were: lack of access to support for self-management; provision of information; lack of provision of psychological and emotional support. However it also highlighted the role played by the diabetes specialist nurse in positive care experiences.

2.8. Building on success

2.8.1. Progress has been made towards each element of the Action Plan in nearly every NHS Board. This is particularly the case with the roll-out of the Diabetic Retinopathy Screening programme across Scotland and the work towards reducing the incidence of emergencies in Type 1 diabetes. SCI-DC continues to develop as an integral part of diabetes care in Scotland.

2.8.2. Some Action Plan aims proved more challenging to achieve. Most diabetes MCN have yet to undertake a needs analysis or review of services for minority ethnic communities. Only three NHS Boards currently offer structured education for those with Type 2 diabetes within 3 months of diagnosis, though a further nine are developing such programmes. Progress on access to psychological and emotional support for people with diabetes has also been a particular challenge. Additional funding over 2009/10 is targeted on making significant improvements in this area.

2.8.3. This section has set the scene with a brief overview of the main developments over the last 3 years, and the lessons which these hold for the way in which future developments should take place. The rest of the consultation document looks at how we can build on the work to date.

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