Written evidence from Diabetes UK (CFI
28)
INTRODUCTION
1. Diabetes UK welcomes
the Health Select Committee's further inquiry into the commissioning
structures in light of NHS reform and the opportunity to submit
written evidence.
2. Our submission
focuses on Diabetes UK knowledge and experience in commissioning
specialist services for diabetes.
— Diabetes
services must be commissioned with involvement from a range of
multidisciplinary professionals with expertise in diabetes, including
diabetes specialists.
— Furthermore
people with diabetes and their carers must be involved in shaping
services to meet the needs of the local diabetes population.
— Diabetes
networks, which bring together key stakeholders locally to inform
and support commissioning and service improvement, should be involved
in the commissioning of diabetes services.
— Diabetes
specialist services must be commissioned as part of an integrated
model of diabetes care.
Duties placed on consortia and the NHS Commissioning
Board to involve patients and the public, to seek advice and work
in an integrated manner to deliver integrated services must be
strengthened by legislation.
ABOUT DIABETES
UK
3. Diabetes UK is the largest organisation
in the UK working for over 3.5 million people in the UK with diabetes,
funding research, campaigning and helping people living with the
condition. Our mission is to improve the lives of people with
diabetes and work towards a future without diabetes. We have over
160,000 members. We work for people with diabetes, their carers,
family and friends. It is estimated that within the next 15 years
the number of people in the UK with diabetes will be more than
4 million.1
— Diabetes
is a complex long term condition that touches on almost every
part of the health service. It is and will continue to be the
responsibility of local services, and those working within commissioning
and provider roles, to work together with people with diabetes
to organise, plan and deliver a full range of integrated diabetes
care services.
— In
providing a health service to meet this challenging future, local
commissioners across the UK have a responsibility to provide high-quality,
integrated, person-centred local care, giving people with diabetes
access to the care that they have a right to expect, with the
support and mechanisms that will allow them to effectively self
manage.
Diabetes UK would like to submit the following evidence
in light of Paragraph 96:
"The Committee believes it is essential for
clinical engagement in commissioning to draw from as wide a pool
of practitioners as is possible in order to ensure that it delivers
maximum benefits to patients. GPs have an essential role to play
as the catalyst of this process, and under the terms of the Government's
changes they, through the commissioning consortia, will have the
statutory responsibility for commissioning. They should, however,
be seen as generalists who draw on specialist knowledge when required,
not as the ultimate arbiters of all commissioning decisions. The
Committee therefore intends to review the arrangements proposed
for integrating the full range of clinical expertise into the
commissioning process."
4. Commissioning Diabetes Services through GP
Consortia. Diabetes care is complex and touches upon every
part of the health service and is a condition which calls for
a wide mixture of professional care from a variety of professional
disciplines, including specialists.
— In
order to commission diabetes care effectively, the GP commissioning
consortia must draw clinical expertise from a wide range of diabetes
specialists.
— Diabetes
networks bring together stakeholders with relevant expertise to
inform the commissioning and design of diabetes services within
a locality. These stakeholders include people with diabetes and
their carers, representatives of third sector organisations, multidisciplinary
diabetes specialists, primary care, pharmacy, ambulance services,
public health, social care and education. At a time of structural
upheaval they can be a force for stability and continuity.
— Diabetes
UK is calling for the "duties to seek advice" to be
strengthened to "duties to involve" within the Health
and Social Care Bill. Under these duties we are calling for the
Bill to be amended to include the involvement of:
— multidisciplinary
range of professionals including those with condition specific
expertise; and
— people
with experience of living with the condition and their carers,
patient organisations and groups with condition specific expertise
-relevant networks.
5. We are concerned that new GP Commissioning Consortia
will be responsible for a range of services that cannot be met
within the skill competencies of the general practice team. It
is crucial that the consortia work with specialist teams to provide
direct care for people with diabetes with complex needs. Examples
of the types of services they will need to commission include:
— people
newly diagnosed with Type 1 diabetes;
— people
with Type 1 diabetes (for carbohydrate counting and/or the use
of insulin pumps/or continuous blood glucose monitoring);
— children
with diabetes;
— pregnant
women and those planning a pregnancy;
— patients
with significant and ongoing cardiovascular or peripheral vascular
disease;
— young
patients with diabetes of an undefined nature;
— patients
with active foot ulcers or uncontrolled neuropathic pain;
— patients
with diabetes and renal disease or retinopathy requiring active
management or complex monitoring;
— people
whose risk factors for complications have been unsuccessfully
controlled in primary care;
— patients
with recurrent hypoglycaemia;
— patients
with neuropathy, especially autonomic neuropathy; and
— inpatient
care.
6. Defining a Specialist Service: Diabetes
UK has worked together with a range of partners from the healthcare
sector to produce the guidance document Commissioning Specialist
Diabetes Services for Adults with Diabetes. This document
defines and draws together the various components and roles to
assist managers, commissioners and healthcare professionals responsible
for the delivery of diabetes services. The Guidance outlines how
the right care can be delivered in the right place at the right
time as part of an integrated adult service incorporates the following
principles, which should be viewed as core components for the
delivery of an integrated diabetes care service:2
— A defined
local diabetes network involving clinical teams and people with
diabetes, with high level input from commissioning organisations
and dedicated management support ie a network manager to create
a defined and agreed local model of care.
— The
development of local care pathways with care planning to assess
the individual needs of people with diabetes and agree in partnership
how these needs will be met.
— Commissioning
Plans that have sufficient flexibility to identify and address
individual clinical needs of people with diabetes.
— Integrating
specialist competencies into the commissioning process is key
and can be achieved through ongoing education and training for
healthcare professionals involved in the delivery of diabetes
care, to ensure appropriate competencies are fulfilled.
7. Integrating Services: As commissioning
consortia, local authorities and the NHS Commissioning Board will
all have responsibility for commissioning services; each should
have an explicit duty placed upon them to commission integrated
services for people with conditions, like diabetes and those at
risk of developing it, whose needs will span all three commissioners.
8. Effective commissioning of either whole system
development or of separate component parts of the service must
enable a flexible approach to the specialist services that can
be tailored to local levels of need and priority.
9. A key step to support GP consortia to develop
capacity and capability in commissioning Diabetes would be to
use the NHS Diabetes Commissioning Resource and its associated
information.3 This presents the case for the commissioning
of effective, user involvement led, integrated and patient centred
diabetes services. The resource is already being utilised in a
number of areas by PCTs, with support from NHS Diabetes Regional
Programme Managers.
10. This new commissioning system must be supported
by the diabetes commissioning and development tools previously
described. This reiterates our view that the dismantling of the
current system coupled with the development of the GP consortium
model carries a greater risk than leaving the current system in
place and exploring its potential for effective redevelopment
11. While there are some requirements within the
Bill for integrated and partnership working, and for consortia
and the NHS Commissioning Board to seek appropriate advice from
professionals, Diabetes UK questions the strength of these duties,
and the degree of accountability within the new system to ensure
this occurs.
12. Diabetes UK believes the duties placed on the
NHS Commissioning Board and Health and Wellbeing Boards within
the Health and Social Care Bill, to encourage partnership working
should be strengthened. They can then be held accountable for
discharging this duty. Diabetes UK believes the Bill should also
include a "duty to commission integrated services" as
this would complement the duties on the NHS Commissioning Board
and Health and Wellbeing Boards outlined above, creating further
accountability for achieving this, within the system.
13. In response to Paragraph 118 we would like to
make the following comments.
"The Committee does not find the current
stance on patient and public engagement in commissioning persuasive.
The National Health Service uses taxpayers' resources to deliver
a service in which a high proportion of citizens take a close
interest both as taxpayers and actual or potential patients. While
the Department may be right to point out that there is no special
virtue in uniformity of structure, the Committee regards the principle
that there should be greater accountability by commissioners for
their commissioning decisions as important. We therefore intend
to review the arrangements for local accountability proposed in
the Bill."
14. User Involvement in commissioning Diabetes
UK believes that people living with diabetes should be involved
in decisions about the design, commissioning and provision of
the services they use.
15. Improved systems and processes for partnership
working, including user involvement and partnership working with
local authorities, voluntary sector organisations and individuals
is one of the key ways in which the current system of commissioning
could be improved and enabled to operates.
16. Patient and public involvement should be structured,
systematic, focussed on outcomes and should enable the wide diversity
of people living with diabetes to have a say in how services are
developed. The public involvement duties placed on commissioners
within the Health and Social Care Bill should be strengthened
and reflect involvement in the commissioning cycle from decisions
about priorities and strategy through to monitoring of services.
February 2011
REFERENCES
1 http://www.diabetes.org.uk/Documents/Reports/Diabetes_in_the_UK_2010.pdf
2 Defining a Specialist
Diabetes Service for Adults with Diabetes A Diabetes UK Task and
Finish Group Report (March 2010)
http://www.diabetes.org.uk/Documents/Reports/DefiningSpecialistDiabetesServiceforAdults_Consultation_Final_Mar_2010.pdf
3 http://www.diabetes.nhs.uk/commissioning_resource/
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