Service planning
What are local diabetes planning mechanisms?
The development of local diabetes planning mechanisms
The idea of bringing diverse professionals and lay people together to plan diabetes services is relatively new. In the early 1990s Diabetes UK championed the idea of multi-disciplinary, integrated planning for people with diabetes. This led to the creation of many ‘local diabetes service advisory groups’ (LDSAGs). However, they were not universally adopted and in some places there is little or no experience of this collaborative planning for diabetes.
LDSAGs developed local strategies for diabetes care and prevention, advised on the implementation of these strategies, and monitored progress. The groups were important because they brought together people with many different professional and personal interests to share ideas, expertise and experience. They were an important step towards the development of integrated care for people with diabetes.
The achievements of LDSAGs included the development of local policies, strategies and protocols for diabetes and in some cases the appointment of additional professional staff for diabetes services. They faced many problems, however, including a lack of resources to implement their recommendations and limited power to affect change.
The development of the national service frameworks for diabetes was an opportunity to give greater priority to these collaborative planning mechanisms. Experience in other chronic illnesses, particularly coronary heart disease and cancer, also pointed to the value of wider professional and user networks in improving care and supporting the planning process.
The result is a new emphasis on the development of local diabetes networks that support planning groups with greater power to shape policy and practice.
How are local planning mechanisms constituted?
Every part of the UK has its own history of diabetes planning and the different national frameworks are very new. Consequently, local planning arrangements for diabetes are very varied and many are still provisional.
In its simplest form, the planning mechanism ought to include:
- a core planning group with a membership of diverse local stakeholders, including people with diabetes.
- a wider network of professionals and lay people. This is sometimes called a ‘managed clinical network’ because it is led by clinicians.
- accountability through the local health commissioning body.
These arrangements deliberately cut across organisational boundaries in order to overcome the traditional barriers that prevent organisations and professionals working together. The perspective of people with diabetes, for whom organisational distinctions are irrelevant, is particularly valuable in developing this model of integrated planning.
In principle, the planning group should communicate with the wider network to develop and legitimise all its plans and decision-making. The network itself will have a broader role including professional development and quality improvement in the local area.
The planning group must include managers from the local service organisations who have the power to ensure that planning group decisions can actually be implemented. This includes executive officers from primary care organisations or NHS boards, NHS trusts, local authorities and voluntary sector agencies such as Diabetes UK. The planning group should also include clinical champions, who provide leadership for the clinical professionals in the network, and diabetes champions, who give voice to the interests of people with diabetes.
The involvement of people with diabetes should extend beyond the appointment of a single diabetes champion. Ideally, a variety of interests should be represented, including people from black and minority ethnic groups.
Figure 1, which you can download on the right hand side of page, illustrates the relationships between the core planning group, the wider network and the primary care organisation. In practice, you may find that diabetes planning in your area looks nothing like this.
The following are some possible variations:
- The core planning group may still be called a Local Diabetes Service Advisory Group. Other names include Diabetes Implementation Group, Local Implementation Group, Diabetes Network Board and Diabetes Planning Group.
- In some areas LDSAGs have remained but new groups with executive (i.e. decision-making) powers have also been set up. Similarly, some networks may have a core group that in turn reports to a smaller executive board.
- The planning group and the wider network may not be distinct. Some LDSAGs were very big and may now be seen as the starting point for the new local network without the need for a smaller group. This risks making the planning process overly bureaucratic with too little investment in the decision-making process among the many members.
- There may be no focus for executive decision-making. A purely advisory group may report to the different executive officers or boards of the various local organisations. This approach is unlikely to deliver the full benefits of collaborative, multi-agency planning.
- In many areas, ‘managed clinical networks’ are in their infancy. As they develop, they will gain a higher profile in the overall planning and development process. The core planning group is likely to be seen increasingly as a steering group for these networks.