Locality Profile England NEW
Selected Area: Great Yarmouth and Waveney
Selected Area Type: new Health Area England

Introduction

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This Locality Profile aims to give you information about the quality of healthcare services available in your area. People with diabetes are entitled to care that meets the standards described within the National service frameworks (NSF). Diabetes UK keeps track of information available to show whether these services are accessible and whether they meet the standards. If you would like to know more about what care to expect, please visit: http://www.diabetes.org.uk/Guide-to-diabetes/What_care_to_expect.

If you are interested you can compare your PCT to . This PCT is comparable on demographics only. For more information go to the locality profile of this PCT.

To measure similarity between PCTS, the Squared Euclidean Distance (SED) was used. This measure takes into consideration the main dimensions in the census data such as demographic structure (this can include ethnic background, age, income, disabilities, mobility, educational attainment, household composition, housing; socioeconomic character, employment and industry sector and employment status). Thus, 42 variables were selected and the choice of variables was selected to adequately represent demographics.

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Healthcare Commission Diabetes Service Review

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The Healthcare Commission reviewed diabetes services to see how primary care trusts are ensuring that they are commissioning services to enable adults (ages 17 and over) with diabetes to care for themselves (self-care).

The overall score for this PCT was Fair.*

Overall results for England: 5% (7) of PCTs scored Excellent, 11% (16) Good, 73% (111) Fair and 12%(18) Weak in commissioning support to help people with diabetes to care for themselves.

Detailed results. The review of diabetes services examined the performance of primary care trusts against the following three criteria. Please see below for the scores given to this PCT for each criteria.

* Interpretation of scores :
Weak – performance that does not meet minimum requirements
Fair – performance that meets minimum requirement
Good – performance that goes beyond minimum requirements
Excellent – performance that goes well beyond minimum requirements

Background to the Review: The Healthcare Commission assessed the services provided for people with diabetes using a range of existing data. The main source of data was the national survey of people with diabetes (adults aged 16+) , as well as data from the Health and Social Care Information Centre’s Quality and Outcomes Framework for 2005/2006 and Hospital Episode Statistics.

To find out more information, please visit the Healthcare Commission website:

link to healthcare commission

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Eye Checks

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Diabetes is the leading cause of blindness in people of working age in the UK and screening for diabetic retinopathy has been specifically described within the national frameworks for diabetes with targets to be met. To see Diabetes UK position statement for retinal screening and national standards visit: http://www.diabetes.org.uk/About_us/Our_Views/Position_statements/Retinal_screening/.

People with diabetes are entitled to annual eye checks, and national guidelines require that from December 2007 these should be offered using a digital camera which takes a photograph of the back of the eye unless there is a medical reason for using a different method.

The Department of Health collect data from retinal screening programmes on the percentage of people with diabetes who have been offered screening and those who have been screened (although not necessarily with a digital camera). The latest quarterly figures are reported below:

The healthcare commission asked people with diabetes if they had an eye test where a photograph of the back of their eyes was taken in the last 12 months: In the PCT progress survey we asked if the PCT has a strategy in place to improve the % of people who have received retinal screening (eg the gap between % offered and % received screening)

PCT comment on strategy in place
NaN

In the PCT progress survey we asked if the PCT commssions services to ensure people who have retinopathy are followed up by eye specialist (ophthalmology) services in a timely manner.

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How many people have diabetes in your local area? (Type 1 and Type 2)

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We know that there are many people with diabetes (Type 2) who do not know they have it, and therefore will not be getting the healthcare and support they need. The sooner they are diagnosed the better, and so we are interested in how well local health areas are doing in finding and registering people with diabetes.

The National Diabetes Audit records Prevalence by Quintiles of deprivation 1 to 5 (5 most deprived)

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Early diagnosis of Type 2 diabetes

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88% of those with diabetes have Type 2 diabetes, which develops over time and may not be diagnosed as promptly as Type 1 which has a more dramatic onset and will be diagnosed more quickly.

Routine testing provided by a systematic screening programme for those at risk of Type 2 is encouraged as the best way to diagnose diabetes at an early stage before complications develop.

Does the PCT have a programme in place for the early identifcation of Type 2 diabetes?

Comment from PCT: The NHS Health checks will identify those at risk of diabetes if aged 40-74yrs

Comment from PCT: No comment

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Emotional and psychological support

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Adults are likely to need emotional support when they are first diagnosed with diabetes and at various times as they adapt to living their lives and managing their diabetes. For some, this is not enough, and where specialist psychological services are needed, they should be available, but unfortunately this is often not the case. Individuals’ emotional and psychological needs to be properly assessed in partnership with the individual, as part of a care planning process.

It is estimated that some 41% of people with diabetes suffer with poor psychological well-being and there is consistent evidence of elevated rates of depression and anxiety disorders. For example, the rate of depression is doubled in people with diabetes compared with controls.
A recent report from Diabetes UK: Minding the Gap - The provision of psychological support and care gives more detailed information about the psychological support in diabetes services in the UK. http://www.diabetes.org.uk/Professionals/Information_resources/Reports/Minding-the-gap---The-provision-of-psychological-support-and-care/pdf

Prioritising emotional well being

Diabetes UK is calling for:
The provision of emotional and psychological support as an integral part of a diabetes care package as a matter of priority. To read more or to download a copy of this position statement please click on link http://www.diabetes.org.uk/Documents/Position%20statements/Emotional_well_being_position_statement.pdf

The Healthcare Commission carried out a survey of people with diabetes in 2006 to find out how many people would like support from a specialist and 3% reported that they needed support.


PCT comments for adult psychological support : No comment
PCT comments for children psychological support : Business case in progress
PCT comments on provision of local support group list: No comment

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Providing education on how to manage diabetes

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Education is vital to support people in managing their diabetes, and ‘structured education’ has emerged as a very valuable way of learning and using the information in a supportive group. This is provided through courses which are provided over several days or weeks. There are significant gaps in the ability of the NHS to provide structured education courses which are accessible to all who want to attend, and there is a current effort to fill the gaps.

The survey also asked those who said 'no' they had not attended a course, if they have ever wanted to attend a course. PCT comments on this question:
No comment

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Care for children with diabetes

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It is vital that children with diabetes get the care they need from specialist healthcare teams. On average, just 15% of under 16s with diabetes in England are achieving recommended blood glucose levels. Poor control can lead to emergency situations requiring hospital admission.

Comments from PCT: No comment

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Providing information about diabetes and healthcare services

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When people have been diagnosed, their health professionals should provide regular and appropriate information and education, for example on food and foot care. They should also provide information about Diabetes UK services and details of local diabetes voluntary group and also information about how to access a member of the diabetes care team for specialist support and advice, in person or by phone.

The Healthcare commission asked people with diabetes if they had been given a phone number of a doctor or a nurse who they could contact for their diabetes after hours (i.e. on weekends and after 6pm on week nights).

The Healthcare commission asked people with diabetes when they received care for their diabetes, did they agree a plan to manage their diabetes over the next 12 months.

The Healthcare commission asked people with diabetes if they know enough about healthy eating to help manage their diabetes.

The Healthcare commission asked people with diabetes if they know enough about the role of physical activity in managing their diabetes.

Comment from PCT:

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Care processes

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Unless people with diabetes are checked for clinical signs which indicate risk of complication, these complications are much more likely. The section below presents information from the Healthcare Commission Patient Survey 2007 and the Quality and Outcomes Framework 2006 to 2007 (QOF). Please note that the 'DM' shown in the QOF tables below refers to Diabetes Mellitus.

The tests which are important are:

Blood glucose test (HbA1c)

Podiatry Care The Quality Outcomes Framework (QOF) identifies the record of the presence or absence of peripheral pulses in the previous 15 months
Dietary Care

Weight Management

Blood Pressure

Cholesterol Test

Neuropathy Test

Micro-Albuminuria
The Healthcare commission asked people with diabetes whether during their most recent stay in hospital overnight, were they visited by someone from the hospital diabetes specialist team (the diabetes specialist nurse, diabetic consultant or dietician).


Smoking

All Care Processes

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Commissioning and Delivery of Diabetes Services

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Delivery of Diabetes Services

User Involvement

Training for Diabetes Healthcare Professionals

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Involving people with diabetes

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People with diabetes are often included in the consultation and decision-making arrangements to ensure diabetes healthcare planning and reporting reflect their views.
‘User Representatives’ are people with diabetes who are involved, and have often received specialised training to prepare them for this role.

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How do we find out about levels of care?

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Wherever possible, we find information about care provided at local levels and make comparisons to the national average.

The Quality Outcomes Framework (QoF) identifies key healthcare activities at local levels across the four nations. These are reported at primary care Diabetes UK surveyed its members in 2005 and 2006 to find out their experiences of accessing healthcare services to help monitor and track progress towards NSF targets.

Primary Care Trusts may have elected to provide information to:
• Your Local Care 2005 (commissioned by Diabetes UK in England and Wales)
• PCT progress survey (Diabetes UK, 2006), a survey of Primary Care Trusts in England
• The National Diabetes Audit in England and Wales

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What is Diabetes UK doing to improve this situation?

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Campaign Profile.

We encourage primary care organisations to share their information freely through participation in the National Audit. We will continue to present information from a range of sources so that people with diabetes can easily assess

Diabetes UK meets regularly with the Minister of Health and the relevant NHS leader for diabetes to advocate on behalf of people with diabetes, and makes submissions on diabetes healthcare issues with the valued assistance of our Advisory Council members.

We have been able to provide valuable information from surveys of our large membership of people with diabetes, which is just as important as the clinical audit data and survey results from the primary care organisations.

We produce Balance, a free monthly magazine for members which keeps people with diabetes informed about important issues related to healthcare as well as providing the Careline phone service.


Early Diagnosis:
We continue to monitor prevalence and compare this to registration of diabetes at local levels (where data is available). Our surveys enable us to compare the rates of diagnosis through routine testing (the method most likely to enable early diagnosis) compared to the rates of diagnosis made because a person has received attention for a different condition, or has noticed symptoms themselves and asked for a test.To know more about shared practice visit http://www.diabetes.org.uk/Professionals/Shared_Practice/


Eye Checks:
We are monitoring progress as demonstrated in the quarterly reports to the Department of Health which shows each PCTs level of service provision and the member’s survey provides an indication of progress. Diabetes UK is advocating for all paediatric audit data to be made public so that the rate of eye screening provided for young people can be demonstrated for local areas. Diabetes UK member's survey 2006 provides an indication of progress towards meeting national targets.


Structured Education:
Diabetes UK has worked with the National Diabetes Support Team (England) to provide a tool which helps PCTs develop structured education courses which meet national guidelines.


Services for Children:
We provide educational and support weekends for children and their families and continue to monitor access to services and standards of care.


Emotional and psychological support
Diabetes UK has initiated a survey of services across all the four nations, to determine the level of access to specialist services, and how support is provided where the specialist services are not available.


Involving people with diabetes
We have provided training and support for people with diabetes who want to play a representative role.

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What can you do?

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‘Have your Say’
Let us know more about your own experience of healthcare services in your region. This provides more evidence to back our calls for action, and will strengthen the impact of our advice to those responsible for delivering the expected level of diabetes care. To have your say visit http://www.diabetes.org.uk/In_Your_Area/Experience_of_Diabetes_Healthcare_Sevices/

‘Get Involved’
To get involved visit: http://www.diabetes.org.uk/Get_involved/

Would you like to become a member of Diabetes UK?

Seven reasons to become a member. You'll get...

(1) A bi-monthly members' magazine, Balance, packed with news and information.
(2) A wide range of publications with the information you need to lead a full and healthy life.
(6) Diabetes UK Services insurance and financial products designed to meet the needs of people with diabetes.
(3) The ability to talk in confidence to Diabetes UK Careline about any issue or aspect of diabetes.
(4) Diabetes UK national and regional offices working to improve diabetes services in your area.
(5) The chance to share experiences with other people with diabetes through our network of voluntary groups (over 400 nationwide).
(6) Diabetes UK Services insurance and financial products designed to meet the needs of people with diabetes.
(7) The chance to help yourself and others with diabetes in the UK.

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