Diabetes services in Northern Ireland – speak up now!

It’s finally happened! After many years (and a few health ministers), the draft of the Diabetes Strategic Framework for Northern Ireland was presented by Simon Hamilton MLA, the current Northern Ireland Health Minister, in March this year. It was encouraging to hear the announcement of £1.7 million of funding for diabetes in Northern Ireland; however, at the time of writing, the exact details have not been released. The consultation period ends on 31^st May 2016 and your views are needed. Now is the chance to have your input on how diabetes care in good ol’ “Norn Iron” can be improved.

It’s just another document I hear you cry! Well yes it is, but it is an extremely important document with an implementation plan developed as an integral part of the framework. So where did it come from, and why is it worth the read (all 73 pages, including appendices)?

In March 2015, there were 84 836 adults in Northern Ireland with type 1 or type 2 diabetes, 1207 children with type 1 diabetes and there had been a 12-fold increase in gestational diabetes  cases (1251 women in 2013–2014 totalling 5.2% of all pregnancies; Department of Health, Social Services and Public Safety [DHSSPS], 2016). We are struggling with the numbers and we are all aware of the impact across our Health and Social Care system. The quoted economic cost of diabetes is 10% of the Health and Social Care budget, spent on the treatment of diabetes and its complications (NIdirect, 2016). In the context of Northern Ireland, this is equivalent to approximately £1 million daily. The economic case for change can easily be demonstrated; however, at the personal and individual level, the cost for people affected by diabetes and its complications is incalculable.

In 2012, faced with the increasing challenge of diabetes and the drive to ensure high-quality, patient-centred services, the then Health Minister, Edwin Poots MLA, commissioned a review of diabetes care in Northern Ireland. A Diabetes Review Steering Group was set up chaired by the Chief Medical Officer, Dr Michael McBride, and a report was published in June 2014. The report included 11 recommendations, one of which was to develop a regional strategic framework for diabetes (DHSSPS, 2013). The principle of a partnership approach was recognised in the report and the recommendation was made to  develop an appropriate mechanism to enable healthcare professionals, patient representatives and people with diabetes to be engaged in decisions about developing services. A regional workshop was held in April 2015 to discuss the strategic way forward and the proceedings from the workshop were used to refresh and update the recommendations made by the Diabetes Review Steering Group. The work over recent years is reflected in the content of the draft Diabetes Strategic Framework, which is now under consultation.

Draft Diabetes Strategic Framework
There are seven key themes in the framework and governance arrangements are in place to support implementation (Box 1). For each theme, actions and lead responsibility are included with associated time scales, and an implementation plan is also included for the first 3-year phase (with agreement to revise and update annually). It sounds like they mean business this time, doesn’t it? And the question also remains – are we ready for business?

Partnership approach
One of the key themes is a partnership approach to service transformation. The vision (or is it a dream?) is for clinicians and people with diabetes to be actively involved in decision-making about service development. A diabetes network for Northern Ireland is planned and primary care teams are to be an essential part of the network. Northern Ireland is not best known for agreeing, but could it be possible for diabetes care? Could we have a regionally agreed model of care?

Recent and ongoing work of Diabetes Integrated Care Partnerships in Northern Ireland could perhaps be the basis for the way forward. Understanding what will improve the partnership between primary and specialist care across the five trusts, and what we can do to assist this, is key to improving diabetes care in Northern Ireland. Currently, there are regional specialist groups (i.e. diabetes specialist nurses, dietitians, podiatrists, psychologists, pharmacists, consultants and trust-wide diabetes groups). Are we all working towards the same goal? We need to ensure that we are not unnecessarily duplicating work and that we are all on the right path, heading in the same direction.

Next steps
There is an absolute need to ensure that the resources we have (scarce though they may be) are used to their best. The draft strategy gives us the chance to pause and reflect on the diabetes service in Northern Ireland and consider what we can do differently, what we can do better and what the person with diabetes wants from the service. In my opinion, the draft framework does not provide all the answers to the current headaches within the diabetes service in Northern Ireland, but it is a starting point…and we have to start, don’t we?

The draft of the Diabetes Strategic Framework can be accessed at www.dhsspsni.gov.uk/consultations/diabetes-strategic-framework-consultation. The Department of Health, Social Services and Public Safety is seeking the views of the public and stakeholders until 5 pm on Monday 31^st May 2016.