Diabetes delivery in Wales: Refreshed

Wales has the highest prevalence of diabetes in the UK, and so it was entirely appropriate that Together for Health – A Diabetes Delivery Plan (Welsh Government, 2012) was published as an action plan to prevent diabetes and to improve diabetes services in Wales. During the last three years of implementation, we have learned lessons about what actions are effective on a national level, what has been less effective and where the barriers to improvement lie. With this in mind, a refreshed Diabetes Delivery Plan in Wales was published in December last year (Welsh Government, 2016).

Based on the experience over the last three years, the refreshed plan is more specific about the actions that need to be taken to improve services and which body is responsible for taking the action. This is combined with a change in function of the Wales Diabetes Implementation Group, such that this group now has a role in monitoring the delivery of the specific actions. It is hoped that this will result in greater cohesion and consistency between national and local plans for the delivery of services.

The revision of the Diabetes Delivery Plan afforded an opportunity to take stock of what was working well and what was not. The improvement of paediatric diabetes services in Wales has been a success; a peer review process has been established that has resulted in tangible benefits in some areas, such as more consultants, more paediatric diabetes nurses and more psychology services. A paediatric structured education programme, SEREN, has been warmly received in Wales and beyond with age-specific resources. The development of a paediatric diabetes network with a lead and a coordinator has been central to these achievements.

Over the last few years there has been a realisation that we must provide education and information for people with diabetes in a much wider range of formats and with greater accessibility. There is a need to find methods that may be up-scaled without a large capital resource. A successful programme has been introduced with a wide range of films that can be prescribed to people with diabetes to watch on smartphones and laptops, covering topics such as lifestyle management, driving rules, preconception care, gestational diabetes and insulin pumps. Early analysis shows beneficial outcomes. In addition, there is an interest in piloting novel methods of delivering structured education. Later this year there will be a pilot of an annual educational update for those on insulin pump therapy using an online module.

Education of healthcare professionals remains central to quality service delivery. There has been investment in online modules particularly aimed at meeting the needs of healthcare professionals in primary care and in care homes (see Box 1). The challenge remains to ensure adequate dissemination of information and engagement. A diabetes quality improvement programme delivered by the Royal College of GPs in primary care is almost complete; the challenge is to sustain and expand similar quality improvement programmes across Wales.

The development of an electronic patient record shared with primary care, secondary care, the person with diabetes, the retinal screening programme and other relevant bodies is expected to have significant benefits to the individuals with diabetes and to organisations developing services for them. This has been a necessarily complex process; however, it is hoped that the final product will benefit all people living with chronic conditions, not just diabetes, and will benefit those with multiple conditions the most.

Future challenges are the positive transformation of transitional services in diabetes and services for young people, provision of a high-quality insulin pump service across Wales, a reduction in amputation rates and improved foot ulcer healing, improving pregnancy outcomes for women with diabetes in pregnancy, improving diabetes services for vulnerable groups and providing services for those with mental health issues and diabetes. Several national appointments have been made to progress these aims: a diabetes network coordinator, an insulin pump coordinator, a transitional care coordinator and a foot care coordinator. Over the next year an education coordinator will also be appointed. Such dedicated focus on a single aspect of the diabetes service is likely to produce the most rapid improvement, and early benefits are already being recognised. 

It is expected that the new Diabetes Delivery Plan, together with the new national structures and initiatives plus the strengthened local diabetes service planning, will have a significant benefit to those living with diabetes in Wales.