Health and Social Care Committee

Inquiry into the implementation of the National Service Framework for diabetes in Wales and its future direction

DB 21 Cwm Taf Health Board

 

INQUIRY INTO IMPLEMENTATION OF DIABETES NSF

 

CWM TAF HEALTH BOARD RESPONSE

 

STANDARD

 

PROGRESS

STATUS

Standard 1

The NHS will develop, implement and monitor strategies to reduce the risk of developing Type 2 diabetes in the population as a whole and to reduce the inequalities in the risk of developing Type 2 diabetes.

Within Cwm Taf the following progress has been made in relation to lifestyle management strategies which assist in reducing the risk of developing Type 2 Diabetes amongst and other chronic conditions.

 

SMOKING:

·         A variety of community based Stop Smoking groups available via Stop Smoking Wales.

·         Packs of Credit card sized contact detail cards available for distribution to patients if required.

·         29 pharmacies in Cwm Taf offering Stop Smoking services – info leaflets available.

·         Brief intervention training for staff available as part of Stop Smoking Wales Training calendar (also Alcohol Brief Intervention available).

·         On line e-training programme available to NHS staff via Stop Smoking Wales.

·         Making every contact count is a priority for all staff.  Our aim is to ensure that all staff are able to provide the appropriate advice on local services to all patients, and refer where appropriate to the Stop Smoking Wales Community based sessions, community Pharmacies and via the in house Health Board service.

 

EXERCISE:

·         Well controlled diabetics can access NERS for 16 week programme.

·         Merthyr NERS currently linking with a GP Practice to pilot a system of providing info and considering referral for every diabetic patient undergoing their annual check.

 

WEIGHT MANAGEMENT:

·         Community based weight management classes currently being set up in a number of Communities First areas.

·         Funding being sought to develop a comprehensive weight management programme pilot from Oct to March 2013 looking at nutrition, cookery skills and exercise delivered by a new team of staff across a variety of community settings linking to the NERS programme.  This will  initially be for orthopaedic patients but if successful would hope to look for a way to  open out to a wide range of conditions.

·         Local Obesity Strategy currently out to consultation.

·         The public health team has been working in partnership with a number of Community First areas to provide their staff with the training and resources to set up a number of informal, community based weight management groups.  There are also a number of activities such as walking groups attached to their areas. 

  • Also a recent evidence review conducted by Public Health Wales highlighted that although the long term effectiveness of commercial weight loss programmes is currently unclear two commercial weight loss programmes (Weight Watchers and Slimming World) comply with current NICE guidelines.  Both are diet based programmes led by the individual and promote physical activity.  They offer participants with the opportunity to weigh weekly and both charge membership fees.  
  • Potential forthcoming projects include the opportunity to use the exercise referral scheme to undertake weight management programmes using a programme developed by a working group of dieticians lead by WG together with the existing exercise component. 

 

Standard 2

The NHS will develop, implement and monitor strategies to identify people who do not know they have diabetes

RAISING AWARENESS:

  • Annual Diabetes in primary care course; Formal medical lectures; core training hospital junior medical staff; dedicated Diabetes inpatient teams which also deliver “Think glucose” education package for ward staff.
  • The Health Board support Diabetes UK in their annual campaigns which seek to raise awareness of Diabetes and the risk factors.  The 2012 and 2011 campaigns were particularly successful.

 

SCREENING:

Cwm Taf LHB has developed a comprehensive diabetes strategy that includes identifying patients in high risk groups and then screening for diabetes. Work is ongoing to include screening for diabetes as a component of the ‘over-50 health check’. Patients with cardiovascular disease and hypertension are tested annually for diabetes in most practices.

 

Standard 3

All children, young people and adults with diabetes will receive a service which encourages partnership in decision-making, supports them in managing their diabetes and helps them to adopt and maintain a healthy lifestyle. This will be reflected in an agreed and shared care plan in an appropriate format and language. Where appropriate, parents and carers should be fully engaged in this process.

CHILDREN & YOUNG PEOPLE:

The Health Board has made good progress in relation to this standard for example:

 

  • As part of All Wales programme all families encouraged to be involved in care and treatment.
  • All paediatric patients encouraged to become involved in the management of their condition.
  • Information provided to patients and families with regard to healthy lifestyles.
  • Shared care plans in place for all Paediatric patients.

 

ADULTS:

Programmes to strengthen and support self care management:

Structured Diabetes Education (SDE):

 

  • DAFNE Type 1 SDE program available in both PCH and RGH. Available to 6% Type 1 Diabetic population per annum.
  • XPERT Type 2 SDE. Limited availability in Cwm Taf. Available to 1% Diabetic population per annum.

 

Partnership and active involvement:

  • Patient Reference groups established.
  • RCT CBG monitoring diaries which includes ability to record other results (e.g. BP, lipids etc) and current treatment issued throughout Cwm Taf.
  • No single shared care plan at present.

 

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Standard 4

All adults with diabetes will receive high-quality care throughout their lifetime, including support to optimise the control of their blood glucose, blood pressure and other risk factors for developing the complications of diabetes.

The Health Board has made steady progress against this standard.  The increasing prevalence of Diabetes however will present issues in relation to capacity and resources available to support the Diabetic population in Cwm Taf.

 

o    Training and Education (students, health/social care staff and patients)

o    Facilitation and Supervision (for example, sitting alongside a Practice Nurse to provide shared care until such a time that the Practice Nurse has developed the required clinical competencies)

o    Direct Clinical support and professional advice to the District Nursing service, GP Practices, Care Home staff and Community Hospital staff regarding the clinical management of a patient presenting with Diabetes

    The Health Board would like to develop this role further.

 

Standard 5

All children and young people with diabetes will receive consistently high-quality care and they, with their families and others involved in their day-to-day care, will be supported to optimise the control of their blood glucose and their physical, psychological, intellectual, educational and social development.

Steady progress has been made against this standard however gaps remain.

 

 

Standard 6

All young people with diabetes will experience a smooth transition of care from paediatric diabetes services to adult diabetes services, whether hospital or community-based, either directly or via a young people’s clinic. The transition will be organised in partnership with each individual and at an age appropriate to and agreed with them.

Steady progress has been made against this standard however gaps remain.

 

Standard 7

The NHS will develop, implement and monitor agreed protocols for rapid and effective treatment of diabetic emergencies by appropriately trained health care professionals. Protocols will include the management of acute complications and procedures to minimise the risk of recurrence.

The Health Board has made good progress in this area.  Of note:

 

Recognition:

 

 

Management:

 

Standard 8

All children, young people and adults with diabetes admitted to hospital, for whatever reason, will receive effective care of their diabetes. Wherever possible, they will continue to be involved in decisions concerning the management of their diabetes.

Steady progress has been made against this standard however gaps remain.  Of note:

 

 

Recognition:

Taught as part of Undergraduate training in nursing and medical schools

Think Glucose project in both Hospitals.

 

Management:

Diabetes inpatient team pilot demonstrated significant reduction in average length of stay for inpatients with Diabetes.

 

Foot screening of PWD on admission to hospital not established.

 

Updated glucose monitoring and insulin prescribing charts including the management of hypoglycaemia implemented. Hypoglycaemia management boxes (hypoglycaemia treatment & management algorithm) introduced all clinical areas Hospital.

 

Standard 9

The NHS will develop, implement and monitor policies that seek to empower and support women with pre-existing diabetes and those who develop diabetes during pregnancy to optimise the outcomes of their pregnancy.

Good progress has been made against this standard.  Of note:

 

 

Standard 10

All young people and adults with diabetes will receive regular surveillance for the long-term complications of diabetes.

Steady progress made against this standard, for example:

 

Standard 11

The NHS will develop, implement and monitor agreed protocols and systems of care to ensure that all people who develop long-term complications of diabetes receive timely, appropriate and effective investigation and treatment to reduce their risk of disability and premature death.

Steady progress has been made in this area.  Of note:

 

 

·         Referral guidelines established

·         Discharge guidelines established

·         Diabetic (medical) e mail advice project planned

·         All Wales Consensus guidelines established (available online)

 

Standard 12

All people with diabetes requiring multi-agency support will receive integrated health and social care.

The Health Board has very good working relationships with its Local Authority partners.  However we acknowledge that further progress could be made and a considerable amount of work is underway at present particularly in relation to a more integrated approach to discharge planning, access to Reablement services and multi-disciplinary / multi- agency community teams for frail elderly patients.  A number of this patient group will have Diabetes.

 

Specifically within the area of Diabetes, the Diabetes Nurse Facilitator provides direct clinical support and professional advice to Care Homes to support the management of patients with Diabetes.  The Health Board also has a Local Enhanced Service for Care Homes which supports regular monitoring of Care Home patients.