Maximising the value of our investment in health services in Scotland
4.1 Ensuring quality care
Where we want to be:
We want to ensure that people with diabetes have access to evidence-based clinical services from an NHS which also acknowledges the importance of people's experience as a measure of the quality of care, as well as the vital contribution service users can make to the design of services.
Why we want to be there:
For the diabetes community, working towards a 'mutual NHS' means ensuring that people living with diabetes are at the centre of the care process with the support of healthcare professionals who are themselves properly supported and valued.
Implementation of SIGN Guideline 116 will help to drive forward best clinical practice, but equal weight needs to be given to learning from people's experience of services through programmes such as 'Better Together' to underpin improved outcomes for people with diabetes across Scotland. The results of the survey of people with diabetes undertaken by Diabetes UK Scotland as part of the consultation on revising the 2006 Diabetes Action Plan will be a helpful contribution to that approach.
The work of the Diabetes Care Focus Group ( DCFG), a sub group of the Scottish Diabetes Group, is integral to this work. The DCFG, along with Diabetes UK Scotland, will ensure that patient experience and engagement are continuous drivers of improvement.
Actions we will take:
1. Implementation of research-based high quality clinical practice will be supported by:
- NHS Boards, through their diabetes Managed Clinical Networks, will update their local clinical guidelines in the context of the SIGN Guideline 116.
- The diabetes Managed Clinical Networks will actively promote and report the number of patients registered on the SDRN research register as part of the annual Scottish Diabetes Survey to support the SDRN target of increasing recruitment to trials by 12.5% each year.
- NHS Quality Improvement Scotland will implement a diabetes improvement programme based on SIGN Guideline 116, using the diabetes Managed Clinical Networks as the mechanism.
- Diabetes UK Scotland, in consultation with the Diabetes Care Focus Group, will ask the 'Better Together' Team to ensure appropriate representation of people with diabetes in taking forward its long term conditions module.
- The Chief Scientist Office, through its Experimental and Translational Medicine Research Committee, will continue to support diabetes research. An example of a recently funded project is the creation of a Scottish diabetes research network type 1 diabetes bioresource.
2. Ensure that the SDG and linked organisations such as the SDRN, as well as diabetes Managed Clinical Networks are able to communicate effectively through the development of a communications strategy (responsibility: SDG)
- The DiS (Diabetesinscotland.org.uk) website will communicate progress of the implementation of the Diabetes Action Plan through an annual report from the Scottish Diabetes Group.
- Each diabetes Managed Clinical Network should host an event for people living with diabetes to raise awareness of local services and research. This could be done in partnership with the local voluntary sector.
- SDG and the diabetes Managed Clinical Networks will consider how existing diabetes care information/resources can be effectively disseminated amongst other agencies/third party organisations. These resources will be developed and evaluated through effective patient engagement.
Healthcare Quality Dimensions: all six.
4.2 Professional development
Where we want to be:
We want to ensure that the delivery of all aspects of patient care is underpinned by high quality and appropriate professional education and training which is patient focused.
Why we want to be there:
A world-class diabetes service requires highly motivated, experienced teams of professionals communicating effectively, sharing experience and developing other members of the team to the highest standards of clinical practice.
The diabetes community shares expertise and experience. Healthcare professionals deliver care to, and learn about diabetes from, people living with the condition. This interdependence characterises the 'mutual NHS' which is at the heart of the Scottish Government's ambitions for the health service. We would expect to see patient and professional education aligning more closely over the lifetime of the Action Plan, leading to improved self management and better outcomes.
The Diabetes Education Advisory Group ( DEAG) has been working on the development of a Scotland-wide strategy for professional education. Co-ordination of this with the patient education strategy is critical and means that close liaison with Diabetes Education Network Scotland ( DENS) needs to be built in from the outset. The DEAG has also contributed to training of junior doctors and will be an important contributor to the planned Inpatient Management Group. Formal links will be established between DEAG and DENS to ensure that the national strategy for professional education is linked with patient education.
DIABETES EDUCATION ADVISORY GROUP ( DEAG)
DEAGis a sub group of the Scottish Diabetes Group comprising multidisciplinary representation of healthcare professionals from around Scotland involved in delivering diabetes care and with an interest in diabetes education.
DIABETES EDUCATION NETWORK SCOTLAND ( DENS)
DENSis a Regional Network of the Diabetes Education Network, previously known as the Type 1 Education Network. It aims to support the diabetes teams to integrate structured education for children and adults with diabetes into their service by:
- Providing a structure for sharing educational strategies, ideas and approaches.
- Supporting the work of the Scottish Diabetes Group ( SDG) and its sub groups to further develop its framework for patient education to meet NICE criteria including curriculum development, educator training, quality assurance and audit.
- Organising meetings and events in Scotland with a focus on local issues and structures while utilising the experience and support of the established UK network.
The diabetes Managed Clinical Networks are responsible for co-ordinating educational and training initiatives for staff to ensure professionals are equipped to deliver the range of clinical services across the Network both in the community and in specialist practice. This can range from the delivery of highly specialist services such as treatment with continuous subcutaneous insulin infusion ( CSII) to the management of diabetes by non-specialist staff in care homes. The diabetes Managed Clinical Networks need to strengthen local infrastructure and co-ordination to ensure that opportunities for professionals are optimised and match patient need. This should include training in working cross-culturally.
As partners in the care of people with diabetes, clinicians will have the active listening skills and abilities needed to ensure that care and the implementation of guidance such as SIGN Guideline 116 are designed to support the person living with diabetes. The Consultation and Relational Empathy ( CARE) measure which is being developed as an integral part of the Quality Strategy assesses how empathetic and person-centred a clinician's consultation has been, by asking people to answer ten simple questions. It uses people's own words to highlight areas where improvement is needed to drive up the quality of communication in healthcare. When people understand each other, care becomes safer and more effective.
Actions we will take:
1. Each diabetes Managed Clinical Network will identify an individual with responsibility for coordinating diabetes education. They will:
- Review the specific diabetes learning needs of staff.
- Promote educational initiatives to suit all staff across primary and secondary care.
- Compile a database of staff training, linking to the long term conditions education database maintained by NES.
- Ensure training programmes recognise the differences between different cultural and social groups.
2. The SDG and the diabetes MCNs will consider how to share best practice, such as the CARE measure, in delivering person-centred consultations. This should link to the wider long term conditions environment to consider the spread and sustainability of best practice.
3. The SDG through the Diabetes Education Advisory Group will ensure that healthcare professionals have access to the training and support required to deliver high quality patient-centred care.
Healthcare Quality Dimension: safe; effective