The Welsh Diabetes Delivery Plan

Introduced 10 years ago, the National Service Framework for Diabetes (NSF) set 12 challenging core standards to inform diabetes care delivery, and therefore it is not surprising that some have not yet been achieved. Lack of resources, compounded by the increasing prevalence of diabetes and the emphasis on tighter control to reduce mortality and morbidity, have resulted in some key aspects of the NSF remaining undelivered.

Diabetes remains a key priority for NHS Wales as around 175 000 people are currently being treated for diabetes (around 7% of the population), including 16% of those over 65 years of age. Diabetes represents 10% of the NHS budget, which translates into a £500 million spend in Wales (2009–10). Progress has been made, with 9% fewer admissions for diabetes, length of stay down 0.8 days and emergency readmissions down 21% over the last year (Welsh Government, 2013).

In order to build on the NSF and address the challenges posed by diabetes within the Principality, the Welsh Government has published a Diabetes Delivery Plan to provide a framework for action by all those involved in influencing and delivering diabetes care. Although the timescale for the plan spans 2013–16, the expectation is that several key objectives must be achieved by early 2014.

The aim is for Wales to have diabetes incidence and health outcomes in line with the rest of Europe. This will be measured by using several population outcome indicators: incidence of type 2 diabetes, per 100 000 population; circulatory disease mortality rate in those aged under 75 years, per 100 000 people; age group-specific diabetes mortality rates, per 100 000 people; and variation in the incidence of diabetes complications by geography and deprivation.

The Diabetes Delivery Plan: key points

• The Plan has been developed following due consultation with the National Service Advisory Group, Public Health Wales and primary and secondary care representation.
• The Plan has high-level outcomes that will need to be delivered by the local health boards (LHBs). The actions required have been identified by reviewing key unmet areas of the NSF and setting new initiatives believed to be vital in the management of diabetes within Wales. There are seven key areas that have been highlighted as a priority (see Box 1).
• The Plan sets out guidelines regarding management policies and the need for adequate monitoring. In order to ensure that it is employed, a Diabetes Development Implementation Group has been set up. The group’s purpose is not only to help LHBs achieve success but also to ensure that progress will be made.
• The Plan sets out how performance and progress will be monitored. It is planned that an initial indicator framework will be available in early 2014 (not yet available at the time of writing).
• LHBs will be expected to achieve full compliance with the NSF and the Plan. LHBs will also be expected to support their local diabetes planning and development groups and to report progress to the Assembly every 6 months.

What will be needed next?
The Diabetes Delivery Plan will ensure that diabetes will be considered a priority within NHS Wales. However, for its implementation and achievement of targets, there will need to be an overview of current baseline delivery of diabetes care. Investment will need to take place in improved community support, evidence-based intensive lifestyle intervention programmes for diabetes prevention, as well as training of healthcare professionals in delivering brief lifestyle interventions, greatly increased availability of structured education, employment of more specialist nurses and a review of integrated care models. These will require significant new financial and people investments.

The Plan is now in place; let’s see what it can achieve.