The NHS England GIRFT report presents key recommendations and practical steps on how to provide high-quality care and support, including improving access to technology and transition services.
A new national report for clinical teams looks at how care can be improved for children and young adults aged 0-25 who are living with diabetes in England.
It focuses on key areas we regularly hear about from young people, their families and healthcare professionals, including getting the right wrap-around support, improving access to diabetes technology and making the transition from children to adult services easier. It also provides step-by-step roadmaps to support NHS teams to reduce variation, with examples of best practice.
The review was carried out by Getting It Right First Time (GIRFT), an NHS England programme that helps services improve care and reduce variation around the country. It was developed in partnership with the NHS England Diabetes Programme and led by Dr Dita Aswani, GIRFT clinical advisor for children and young adults with diabetes, and Dr Fulya Mehta, National Specialty Advisor for Diabetes in Children and Young Adults.
The report is informed by a national review which included in-depth conversations with diabetes teams, service leaders, regional networks and people living with diabetes across all local Integrated Care Boards (ICBs) in England.
In England, around 56,000 children and young adults aged 0-25 live with type 1 diabetes, and around 9,000 live with type 2 diabetes. Diabetes is relentless and affects everyday life in many ways. Children and young people and their families need to make many daily decisions about medication, food and activity, so good care and support make a huge difference.
The support young people receive during childhood and early adulthood also shapes their future health. It can help them feel safer, more confident and better able to manage diabetes as they grow older and become more independent.
Priority areas for improvement
The review highlights six areas where there is variation in care to prioritise improvements for children and young people and their families:
Helping young people manage blood sugar levels - making sure children and young people get extra support when they need it, especially if they are at higher risk of poorer health outcomes.
Making sure essential health checks happen - helping services complete and record essential checks, including for emotional and psychological wellbeing.
Reducing avoidable emergency hospital visits - learning from hospital admissions so services can identify where extra support is needed and help prevent repeat emergencies for DKA and severe hypos.
Improving access to hybrid closed loop (HCL) technology - making it easier for young people to access and use technology like HCL to improve diabetes management, and making sure no one is left out because of digital exclusion barriers like not having access to a smartphone.
Supporting young adults in the transition to adult services - designing care around the needs of 19-25-year-olds and helping them build confidence, independence and trusted relationships with their diabetes teams.
Making services easier to understand and more accountable - using clear leadership, better information sharing and collaboration so children and young people receive consistent care wherever they live.
Overarching recommendations for local systems
The report also makes three core recommendations to help ICBs provide high-quality care for children and young adults with diabetes:
Clear leadership: making sure there is clear responsibility for improving diabetes care for children and young adults, to ensure services are working together and problems can be acted on.
Better use of information: bringing information together in one place so services can see where care is working well, where young people may be missing out, and where extra support is needed.
More consistent care: agreeing clear standards for diabetes care so children and young adults receive safe, high-quality support wherever they live.
Dr Dita Aswani, GIRFT clinical advisor for children and young adults with diabetes, who led the national review, said:
"The level of engagement from stakeholders in all 42 system reviews has been admirable. Despite pressures of financial instability and organisational change, colleagues discussed and interrogated the data with interest and played an active role in shaping their own local recommendations.
"What came through was optimism, drive, compassion, and a sincere desire to improve patient care and outcomes.
"I thank everyone for their time and preparation, honesty, engagement, and – now that the findings are shared and the report published - their energy in addressing their local ICB priorities."
Colette Marshall, Chief Executive of Diabetes UK, said:
"Children and young adults with diabetes require support that is adapted to their individual needs and life stage and can meet them where they are.
"The findings in this report show how timely, co-ordinated care is essential to improving health outcomes and quality of life. This is true for all children and young adults with diabetes, and especially so for those who are at higher risk of experiencing poorer outcomes, such as those making the transition between paediatric and adult services and the rising number of young people with type 2 diabetes.
"We look forward to continuing to work with the NHS, partners and communities to support the implementation of these recommendations and to ensure that every child and young adult with diabetes is supported to live well now and in the future."
You can read the full GIRFT national report for Diabetes: Children and Young Adults here.
