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Regulator says more work needed to provide personalised diabetes care

Diabetes services need to help patients self-manage their condition better.

This is the finding of CQC review that explores the quality of care for people with diabetes in England.

My diabetes, my care’, highlights that – despite a mostly good picture of care overall – the provision of care and support to help people successfully self-manage their condition is not always flexible and responsive enough to meet individual needs.

The review discovered that people at high risk of developing Type 2 diabetes were not always identified and supported to become healthier. Some people felt they were not receiving enough emotional support – providing this support at diagnosis and beyond can contribute to more effective self-management and increase engagement with services and attendance at structured education programmes.

The CQC cites examples that others can learn from, including local commissioners and providers proactively engaging with individuals and communities, and innovative methods to increase people’s ability to self-manage.

For example, in Slough and South Reading, the Silver Star diabetes charity had been commissioned to run mobile units which traveled around places of work, worship, community events, high streets and retail parks to discuss the risk of diabetes and offer lifestyle advice. Through working with Silver Star, Slough Clinical Commissioning Group (CCG) was able to identify 1,500 people deemed at high risk of diabetes and invite them to join an intervention programme.

The review also highlighted that people who had attended structured education courses felt it improved their ability and confidence to manage their diabetes. But it was evident that the courses were not able to meet everyone’s needs.

CQC found that people from black and minority ethnic (BME) groups were less likely to be aware of education programmes; and that courses were rarely offered to people with a learning disability. It was not always clear how the education needs of those who had not attended were being met.

However, some local services were able to show how they were providing culturally relevant information, support and training to people in their local community. For example, the review saw how City and Hackney CCG trained local people to act as ‘lay educators’ – providing culturally relevant information, support and training to people in their community. This included community awareness sessions and delivery of accredited structured education programmes.

CQC’s Chief Executive, David Behan, said: “More work is needed to ensure that everyone who lives with diabetes can access the right level of personalised care and support to help them manage their condition.

“We have seen the positive health and financial outcomes that can be achieved when people are empowered to take control and successfully supported to self-manage – and I encourage providers and commissioners to use the findings of this review in order to learn from what is working well.

“With nearly 3.5 million people living with diabetes in England, and predictions that this figure could rise to 4.6 million by 2030, there has never been a more important time for all parts of the health and social care system to address this condition.

“Getting our response right on diabetes is crucial to delivering the vision set out in the Five Year Forward View, which prioritises prevention and public health and transcends traditional boundaries between primary care, community services and hospitals.”

Other key findings from the review include:

  • Most people CQC spoke to received the checks recommended by the National Institute for Health and Care Excellence (NICE). Generally, people reported they were able to discuss their care with primary care staff and they felt they received good explanations about their care.
  • People showed a lack of awareness and understanding of their test results. Few people had a hand-held care plan that they could take with them as they moved across services and organisations.
  • Knowledge of diabetes was often lacking within some staff groups, particularly in adult social care, and in some areas diabetes training for care workers was absent. This could result in insufficient support for people who rely on others to help manage their diabetes.
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