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Diabetes Action Plan 2010: Quality Care for Diabetes in Scotland

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Appendix 2 Table of NHS Board planned investment in Insulin Pump Therapy

NHS Board

2010-11

2011-12

2012-13

NHS Ayrshire and Arran

  • Suitable patients identified by Consultant Physicians in consultation with colleagues
  • 5 children with type 1 diabetes currently on insulin pump therapy (2%)
  • Currently 2 adults on insulin pump therapy and a further 2 adults identified who meet commencement criteria
  • Funding available for additional 8 children
  • Funding available for additional 4 adults
  • Adult a paediatric diabetes services committed to step-wise increase in pump provision
  • Structured education programme available
  • Funding available for additional 12 children
  • Funding available for additional 8 adults
  • Paediatric pump/structured education available
  • Structured Education Programme available
  • Funding available for additional 16 children
  • Funding available for additional 12 adults
  • Paediatric pump/structured education available
  • Structured Education programme available

NHS Borders

  • The Borders Diabetes Service has run its own pump therapy service since 2005. Pumps have been offered to more patients than have taken up pumps. The people who have declined the use of pumps have done so for individual and personal reasons.
  • The pump service will become an integrated service incorporating adult and paediatric pump services.
  • Currently 23 patients (19 adults and 4 children) in total on insulin pump therapy (3.8%)
  • Proposals for future investment will be considered within the standard Local Delivery Planning process The proposed additional investment would support an additional 10 adults and 4 children, bringing the total number of people on pump therapy to 37 (6.1%) in the first year, with year-on-year increase of 1 adult per year.
  • The provision of structured education programmes across the area has been absorbed within the workload of the Diabetes Specialist Nursing ( DSN) team. However, as demand on the DSN service grows, this is becoming increasingly difficult to sustain and any future investment approved through the LDP process will help to address this capacity issue.
  • Previously agreement for additional 6 patients.
  • Outcome of LDP process will inform further expansion of service
  • Previous agreement for 6 additional patients
  • Outcome of LDP process will inform further expansion of service

NHS Dumfries and Galloway

  • No restriction on funding of pumps, which are provided if Consultant Physician considers patient may benefit.
  • 10 adult patients with insulin pumps (1.25%) of the 800 adults with type 1 diabetes.
  • 4 children with pumps out of the 57 children with type 1 diabetes (7.0%).
  • 35 additional pumps being funded through Health Technology Assessment RCT comparing structured education with pumps in promoting glycaemic control. Would take total to 5.72%.
  • Approximately 150 patients per year received DAFNE.
  • Further 30 patients on pump as part of HTA research trial
  • Insulin pumps made available according to clinical need
  • Approximately 150 patients per year received DAFNE.
  • If, in the opinion of the Consultant Physician, the patient may benefit, they are provided with an insulin pump.
  • Approximately 150 patients per year received DAFNE.

NHS Fife

  • 57 adult and 13 paediatric patients (4.4%) on pump therapy.
  • Possible further expansion being considered in setting 2010-11 budget.
  • Patient pathway ensures patient seen by appropriate members of the multi-disciplinary team on 1:1 basis, then followed up at dedicated clinic for pump users. Education programme in place.
  • Possible further expansion will be considered as 2011-12 budgets are set.
  • Possible further expansion will be considered as 2012-13 budgets are set.

NHS Forth Valley

  • 25 adult and 6 paediatric patients on insulin pump therapy as at 2009/ 2010
  • 4 additional children and young people to receive insulin pump service.
  • Further expansion in service provision will be linked to the anticipated efficiencies released from the National Procurement of blood glucose monitors and strips.
  • Final numbers will depend on demand and compliance with local guideline.
  • Current plans dependent upon NHS financial settlements.
  • 4 additional children and young people to receive insulin pump service.
  • Further expansion in service provision will be linked to the anticipated efficiencies released from the National Procurement of blood glucose monitors and strips.
  • Final numbers will depend on demand and compliance with local guideline.
  • Current plans dependent upon NHS financial settlements.
  • 4 additional children and young people to receive insulin pump service.
  • Further expansion in service provision will be linked to the anticipated efficiencies released from the National Procurement of blood glucose monitors and strips.
  • Final numbers will depend on demand and compliance with local guideline.
  • Current plans dependent upon NHS financial settlements.

NHS Grampian

  • Structured education programme in place.
  • Approximately 1.5% of adult patients and 6% of paediatric patients on insulin pumps
  • MCN have reviewed the position of insulin pumps within the existing diabetes priorities for NHS Grampian.
  • Funding secured to maintain the present service
  • Structured education programme in place
  • Funding secured to maintain the present service.
  • Consideration will be given to increasing the number of patients on insulin pumps. Dependent on discussion with CHPs, review of the prioritisation process and budget setting discussions.
  • Structured education programme in place
  • Funding secured to maintain the present service
  • Depending on outcome of 2011/12 discussions - consideration will be given to increasing the number of patients on insulin pumps

NHS Greater Glasgow and Clyde

  • Our immediate priority is paediatric patients and we are committed to use savings of c. £300k from national procurement over the next 2 years to fund an additional 30 paediatric patients.
  • Currently 21 children on an insulin pump
  • We have a detailed plan for expansion but this is constrained by resources and by our interest in seeing the revised SIGN guidance, particularly in relation to the grading of the quality of life evidence, and the emerging evidence from the Health Technology trial on the impact of pumps on wider health costs.
  • An additional 15 children on an insulin pump
  • An additional 15 children on an insulin pump

NHS Highland

  • At 10 March 2010, 20 patients on insulin pump therapy (1.18%).
  • £20,000 made available on a recurring basis for this service.
  • Business case developed. Not possible at this stage to agree funding as laid out in the business case. Recurring funding has been identified to support additional 10 patients, 30 in total (1.78%) through purchase of additional equipment and the appointment of a0.5 wte dietitian
  • No Paediatric service available.
  • Increase the number of adults on pumps to 30 in total
  • Supportive of reinvesting savings from HBGM into CSII.
  • No plans to develop a paediatric pump service.
  • Business case developed to expand service , but no funding identified. This will continue to be reviewed.
  • Supportive of reinvesting savings from HBGM into CSII.
  • No plans to develop a paediatric service.

NHS Lanarkshire

  • DAFNE structured education provision being increased to 12 courses per annum.
  • Currently funding 47 pumps (1.4% of type 1 population).
  • Diabetes MCN has produced business case to allow further work on investment in pump service.
  • Cost to increase to 95 pumps (2.8% of type I population) would be around £344k*. NB Board therefore not committed to investment levels mentioned.
  • DAFNE structured education provision continues with 12 courses (~96 number of patients) per annum.
  • Cost to increase to 143 pumps (4.2% of type 1 population) would be £438k*. NB Board therefore not committed to investment levels mentioned.
  • DAFNE structured education provision continues with 12 courses (~96 number of patients) per annum.
  • Cost to increase to 191 pumps (5.6% of type 1 population) would be £543k*. NB Board therefore not committed to investment levels mentioned

NHS Lothian

  • At March 2010, 153 people were on pumps (3.8% of type 1)
  • 30 additional pumps will be funded in 2010-11, providing pumps to a total of 4.5% of people with type 1 diabetes.
  • Consideration will also be given to reinvestment of savings from national procurement exercise.
  • Structured education, such as DAFNE will be expanded to support people with type 1 diabetes.
  • Similar to the position in 2010/11 if we are successful in identifying funding we will work towards an additional 30 pumps being made available (this would be an increase to around 5.3% of type 1, all ages)
  • Consideration will be given to reinvestment of ongoing savings from national procurement exercise to fund further pumps
  • Continuing delivery of structured education to people with type 1 diabetes.
  • Similar to the position in 2010/11, if we are successful in identifying funding we will work towards an additional 30 pumps being made available (this would be an increase to around 6% of type 1, all ages)
  • Consideration will be given to reinvestment of ongoing savings from national procurement exercise to fund further pumps
  • Continuing delivery of structured education to people with type 1 diabetes.

NHS Orkney

  • 3 current patients out of 158 people with type 1 diabetes (1.9%).
  • 3 additional patients.
  • Board has access to NHS Grampian DAFNE programme and provides type 1 carbohydrate counting and insulin adjustment course on group or 1:1 basis.
  • 3 additional patients. 9 people on an insulin pump.
  • 3 additional patients. 12 people on an insulin pump.

NHS Shetland

  • Currently 2 patients on insulin pump (2%).
  • If patient meets criteria, they will receive a pump.
  • NHS Shetland provides insulin pump service and structured education in conjunction with NHS Grampian.
  • Expected increase to 3%
  • If patient meets criteria, they will receive a pump.
  • NHS Shetland provides insulin pump service and structured education in conjunction with NHS Grampian.
  • No increase in provision.
  • If patient meets criteria, they will receive a pump.
  • NHS Shetland provides insulin pump service and structured education in conjunction with NHS Grampian.

NHS Tayside

  • At 9 November 2009, 83 patients currently on insulin pump therapy (4.7%).
  • Finding available for 20 additional adult and children on CSII, total 103 (5.6%)
  • MCNCSII business case in development.
  • Business case in preparation for 20 additional adult and children, 133 in total. (6.8%)
  • Recurring £102,000 for paediatrics.
  • Business case in preparation for 20 additional adult and children, 153 in total (7.5%)
  • Recurring £102,000 for paediatrics.

NHS Western Isles

  • 179 people with type 1 diabetes. Delivery of CSII programme unsustainable given low numbers of people (7-20) likely to be eligible.
  • Developing CSII strategy, linked to ongoing development of diabetes obligate network with NHS Greater Glasgow and Clyde.
  • CSII strategy linked to ongoing development of diabetes obligate network with NHS Greater Glasgow and Clyde.
  • CSII strategy linked to ongoing development of diabetes obligate network with NHS Greater Glasgow and Clyde.