How well do you plan care for people with diabetes?

The end of March 2014 will see the launch of the new, redesigned “Integrated Diabetes Service” for NHS Enfield. Call me cynical but the saying “seen this all before” comes to mind. I am glad to say, however, that I have been involved in this development, unlike some of my colleagues elsewhere in the country that have had service change happen without any consultation. One extreme case is where a whole community diabetes service was de-commissioned without any prior discussion with the providers. Scary or what? Luckily, Enfield Clinical Commissioning Group have also involved people with diabetes in the workshops to redesign the way diabetes care is delivered in Enfield. But who is monitoring whether these new “redesigned” services are fit for purpose? As far as I can see, only the people who are making the changes are going to be doing this.

The main aim of successful diabetes care is making it personal. NICE (2011) recommends that every person with diabetes should receive personalised care planning resulting in an agreed care plan. Recently, I was involved in series of roadshows looking at personalised care in type 2 diabetes. While delivering one of the presentations, I asked the audience whether they were using personalised care plans, as outlined in the Diabetes UK (2014a) guidance shown in Box 1. None of the GPs in attendance used care plans with this detail; the main reasons for not doing so included that they didn’t have the administrative support required to send out blood results to patients prior to their diabetes appointment, nor did they have sufficient time during a consultation to complete this detailed process.

Diabetes UK also found similar results in its recent survey of 1609 people with diabetes; it found that two-thirds do not have a personal care plan in place despite the importance of such care plans in enabling people to manage the condition (Diabetes UK, 2014b). 

Diabetes UK is calling on NHS organisations to ensure everyone with diabetes has a personalised care plan. It is also urging people with the condition to make sure they are aware of the importance of care planning. The charity has launched an animation on their website showing how people can get more involved in their diabetes care (Diabetes UK,  2014b).
Whilst I fully support this idea, I suspect it may not have a major impact on the group of people who really need this information – older people – as many may not regularly use the internet. 

How do we give the person with diabetes the opportunity to work together with their healthcare team to be more informed, more vocal and play a bigger role in their care? It is more than a piece of paper; it’s about a whole paradigm shift from being told what to do by the healthcare professional in the traditional medical model to being a partner in their own diabetes care – and I would argue that not all people with diabetes are ready for this yet!

What is happening in your locality – are you fulfilling all the elements of care planning?