Four years ago we saw the publication of the National Service Framework for Diabetes: Delivery Strategy (DoH, 2003). Dr Sue Roberts recently published the fourth report (DoH, 2007) on the progress we are making in achieving the targets set in the previous Standards document (DoH, 2001).
The annual report is quite long this year; the 64 pages reflect the amount of work and research which has been done and that which continues to be carried out.
In the third chapter of the report, which addresses the prevention of diabetes, the rising prevalence of the condition is one topic discussed. There are maps showing the estimated number of people with diabetes in 2001 and the forecast for 2010. The latter are sobering, especially for those of us who live in coastal areas who are likely to see the largest increase due to the high density of older people in these localities.
The fourth chapter addresses empowerment of people with diabetes. The increase in provision of structured education courses, care planning and psychological care are the topics raised here.
Chapters five and six discuss the clinical care of adults, young people and children. One example of an area particularly pertinent to nurses is that of recent research into the level of understanding adults with diabetes have in regards to their medicines and timing of administration. Rectifying this lack of knowledge would obviously contribute to a reduction in long-term complications of diabetes and is an example of something that all nurses and other healthcare professionals working in diabetes care need to address urgently.
The next chapter deals with diabetes-related emergencies. Ambulance call-outs for hypoglycaemia and inpatient care of people with diabetes are just two of the issues discussed. From a nursing perspective these chapters deal with the issues we perhaps have greatest impact upon, and, although they have been the focus of much recent work, there is obviously still much to be done.
Chapter eight discusses the care of pregnant women with diabetes; the achievements to date are outlined and the need for further improvements discussed. One issue that needs to be addressed is the rise in the numbers of women of childbearing age with type 2 diabetes who become pregnant and the concomitant need for services for them.
The last three of the 12 standards in the NSF are dealt with in chapter nine of the report. Charts illustrating amputation rates or prevalence of myocardial infarction in people with diabetes are just two instances of information provided in the report that enables healthcare professionals and commissioners to compare their performance with others. These figures are based on old Strategic Health Authority boundaries and the information derives from data supplied to the National Diabetes Audit.
The last chapter provides a context for the future: new boundaries for PCTs, altered commissioning processes and the rise in information gathering tools are all described, albeit briefly, as are new technologies. All of these changes and innovations will need to be incorporated into effective service planning to improve diabetes care.
The appendices provide information about the National Diabetes Support Team publications in 2006 and the case studies that could not be included within the report itself.
One of the components of this report that makes it worthwhile reading for all nurses working in diabetes care is the number of case studies. There are several in each chapter, each describing ways in which elements of the topics under discussion have been implemented. Contact details are provided for those who wish to follow these up. It is encouraging to see that one does not need to re-invent the wheel and that good ideas are being shared!