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Hywel Dda University Health

Board Diabetes DeliveryPlan

Refresh 2015-2016

June 2015

Version 5

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Contents

1. Background and context Page 3

2. Hywel Dda UHB delivery plan Page 4

3. The vision Page 6

4. The drivers Page 6

5. Organisation profile Page 10

6. Development of local delivery plan for Diabetes

Page 11

7. Priorities for the coming year Page 12

8. Action Plan 15/16 Page 15

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1. Background and context “Together for Health – a Diabetes Delivery Plan” was published in 2013 and provides a framework for action by Local Health Boards and NHS Trusts working together with their partners. It sets out the Welsh Government’s expectations of the NHS in Wales in delivering high quality diabetes services. It therefore focuses on maximising efficiency and effectiveness, tackling variation in access and reducing inequalities in service provision across 7 themes. For each theme it sets out:

• Delivery expectations to ensure the right patient, in the right care and the right time

• Specific priorities for 2013 – 2016

• Responsibility to develop and deliver actions

• Assurance measures that will be used to ensure that this plan is delivered and effective outcomes achieved.

What do we want to achieve? The Delivery Plan sets out action to improve outcomes in the following key areas between now and 2016:

• Children and young people

• Preventing diabetes

• Detecting diabetes quickly

• Delivering fast, effective treatment and care

• Supporting living with diabetes

• Improving Information

• Targeting research The NHS Wales Planning Framework 2015/16 1 diabetes delivery plan priorities are:

• Focus on improving outcomes in paediatric care for children with Type 1

• Prevention of Diabetes – evidence review and supporting General Practice

• Improving Structured Education and self management

• Introduce Patient Management Information System

• Focus on foot care for inpatients

• Focus on inpatient insulin management

1 Welsh Government (2014) NHS Wales Planning Framework 2015/16 Appendix F

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The Framework2 also states: Domain In Partnership with the

NHS People Can Expect How We Will Measure Improvement/the NHS

STAYING HEALTHY People in Wales are well informed and supported to manage their own health

I have a healthy and active long life

Number of emergency admissions and readmissions within a year Attainment of the national influenza vaccination targets

My children have a good healthy start in life

% of reception class children (aged 4/5) classified as overweight or obese

I can access the support and information I need and when I need it, in the way that I want it

% of people with long term conditions reporting being well informed and supported through their care plan

SAFE CARE People in Wales are protected from harm and protect themselves from known harm

I receive a high quality safe service whist in the care of the NHS

Serious incident and never event rate in all care settings

EFFECTIVE CARE People in Wales receive the right care and support as locally as possible and are enabled to contribute to making that care successful

I receive the right care and support to either improve or manage my own health and wellbeing

Diabetes mortality rate under 75 years

2. Hywel Dda University Health Board’s Delivery Plan Hywel Dda University Health Board produced its first delivery plan in 2014. In our delivery plan we set the following priorities for 2014: 2.1 Paediatrics

• The development of a formal paediatric diabetes managed network

• Mandatory participation in a quality assurance programme

• Development of a structured education programme with trained educators and resources; structured education for Children and Young People and families from diagnosis, tailored to their learning needs,

2 Welsh Government (2014) NHS Wales Planning Framework 2015/16 Appendix G & H

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with updates and refreshers as they grow older and move into transition. Education programmes for staff within schools particularly primary school age group

2.2 Preventing Diabetes

• Preventing diabetes in our population is crucial and the best ways to achieve this is by working in partnership with the Hywel Dda Public Health team. We need to recognise that with the support of the Hywel Dda Public Health Team we need to interface with our local population to embed healthy lifestyle into everyday living to support the prevention of diabetes.

2.3 Making our Services As Effective as Possible

• SCI Diabetes – it has been agreed that SCI Diabetes will be provided free under licence from Scotland, and NWIS will oversee implementation across Wales

• Foot Care – the whole patient journey for foot care will be considered, utilising existing tools e.g. Putting Feet First, ThinkGlucose and ensuring education for both patients and healthcare professionals.

Considerable progress has been made against these priorities as highlighted below: Paediatrics

• Established a Hywel Dda Paediatric Team

• Undertaken peer review

• Representation at All Wales group for education programme development

• Developed a information booklet for ward staff Preventing Diabetes

• Nationally recognised diabetes and CVD screening programme

• Obesity programmes Making our services as effective as possible

• Developed a single point of referral for al Type 2 Diabetes Education programmes through existing EPP service

• Developed e-digital films for primary care for the introduction to self management for people with diabetes

• Implemented ThinkGlucose in our hospitals

• Annual diabetes care update for primary care

• Developing patient stories and learning from their journey

• Undertaking local audits in line with Think Glucose

• Undertaking the NADIA audit

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In delivering our services for patients with diabetes, there are a number of service improvements that we have implemented locally that have had a real impact on patient care. Examples of this include:

• Established the Hywel Dda Paediatric Diabetes Team.

• Established a single point of referral for all Adult Type 2 Diabetes education programmes across the Hywel Dda UHB.

• Established equitable service for Adult Type 2 Diabetes structured education programmes across all three counties of Hywel Dda UHB.

• Commenced European wide Diabetes Type 2 telehealth project ‘Effect of telehealth on community delivered diabetes care’.

• ThinkGlucose programme has standardised referrals to specialist adult diabetes services in secondary care, standardised pathway for hypoglycaemia and monitoring of blood glucose levels pathway across Hywel Dda UHB.

• Re-established the Ceredigion Diabetes Patient Reference Group with an identified Chair and strong administrative support through the chronic conditions team.

• Development of film-based diabetes education package.

3. The vision:

For our population we want:

• People of all ages to have a minimised risk of developing diabetes.

• Where diabetes does occur, an excellent chance of living a long and healthy life, wherever they live in Wales.

4. The drivers:

Spending in Welsh hospitals in 2012-13 on diabetes was almost £90m3, this is an increase of 4% when compared to 2011-12. However NHS expenditure on diabetes related care is almost £500m a year4. In 2013-14; 177,212 people over the age of 17 were registered with their GP as diabetic. This is 3,9135 more people than in 2012-13. In Hywel Dda in 2014 there are 22877 people registered with their GP with a diagnosis of diabetes (5.8%) There were 1,469 children and young people with diabetes, under the

3 NHS Expenditure Programme Budgets – Wales 2012 -13

4 Together for Health – a Diabetes Delivery Plan

5 Stats Wales

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age of 25 in Wales. Almost all have type 1 diabetes. Gestational diabetes is a type of diabetes that some women get during pregnancy. Between 2 and 10% of expectant mothers develop this condition, making it one of the most common health problems of pregnancy. It is widely accepted that Wales is facing a huge increase in the number of people with diabetes. The numbers of adults aged 17 and above registered at a GP practice with diabetes has increased by just over 24,000 people in the last 5 years. Much of the increase is type 2 diabetes due to the aging population and the increases in the numbers of overweight people. There is evidence to show that:

• the onset of type 2 diabetes can be delayed, or even prevented;

• effective management of the condition increases life expectancy and reduces the risk of complications; and

• supported self-management is the essential element of effective diabetes care.

People with diabetes have a substantially higher risk of serious illness, hospitalisation and premature death compared to the non-diabetic population. We have developed a number of outcome and assurance measures, which together, will demonstrate how diabetes services are improving in Wales. Some progress against these measures has been made giving us the reassurance that diabetes care in Wales is developing in line with our vision:

• Deaths from diabetes is not a common cause of death in Wales. In 2013, 300 people died from diabetes. This has fallen from 420 deaths in 2009. Mortality in HDUHB is the same as the national average for both Type 1 and Type 2 Diabetes

• Half of all deaths from diabetes result from cardiovascular disease including heart attacks and strokes. In 2001, in Wales, almost 14,000 people died from cardiovascular disease, by 2011 this had fallen to just over 9,000 deaths. HDUHB stroke deaths are the same as the national average. HDUHB has a lower than national average death rates from myocardial infarctions and heart failure

• In Wales in 2012-13, 98.9% of patients under the age of 25 years had their HbA1c measured and 97.6% in England. This is considerably improved from 2011-12, where 89.3% of patients in England and Wales had their HbA1c measured.

• In 2011-12 there has been a decline in the diabetic ketoacidosis (DKA) incidence rates for children and young people from 9,662 in 2010-11 to 5,683.

• 84% of inpatients stated that they were satisfied or very satisfied with the overall care of their diabetes while in hospital.

• In 2013-14, 93% of patients on the diabetes register had a record of retinal screening, and 91% of patients on the register had a record of a

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foot examination, in the preceding 15 months. HDUHB’s foot screening is 81.9% compared to the national average of 85.1% .

• Emergency admissions for diabetics have dropped by over 230 patients from 2,815 to 2,584 between 2010 and 2013. Emergency admissions across Hywel Dda remain unchanged over the past year 13/14 averaging at approximately 313 emergency admissions per month.

We need to continue to improve in these areas as well as ensuring that progress is made where performance has not been as good as anticipated:

• Type 2 diabetes is more prevalent among less affluent populations. Those in the most deprived one-fifth of the population are one-and-a-half times more likely than average to have diabetes at any given age6. 9% of those people living in the most deprived areas of Wales report being treated for diabetes compared to 6% of those living in the least deprived - showing the pronounced impact of poverty and the socio-economic determinants of health.

• A child with HbA1c levels above 9.5%, according to the National Institute for Clinical Excellence, would be at risk of medical complications in the future. In Wales, 27.1% had poor glycaemic control (HbA1c over 9.5%); with 59.5% having moderate control (HbA1c between 7.5 and 9.5%). Hywel Dda UHB participated in the National Paediatrics Diabetes Audit (NPDA) The Health Board results showed the mean value of HbA1c at Withybush Hospital was 76 mmol/mol, Glangwili Hospital was 69.1mmol/mol, Bronglais Hospital was 68.9 mmol/mol compared to the All Wales value of 74 mmol/mol. The median HbA1c at Withybush Hospital was 72 mmol/mol, Glangwili Hospital was 67.2 mmol/mol and Bronglais Hospital was 68.3mmol/mol compared with the All Wales value of 70 mmol/mol.

• Obesity is the top risk factor for type 2 diabetes at all ages. 58% of all adults in Hywel Dda and Wales in 2014 are overweight or obese (Ref number 6 at bottom on page – can’t get a little number to appear!!). The prevalence of those overweight or obese children aged 4-5 years in Hywel Dda 28.3% was significantly higher than that for England (23%)7.

• It is estimated that there are around 66,000 people with undiagnosed type 2 diabetes in Wales.

• High blood pressure is an important risk factor for diabetes, and while 20%8 of adults are being treated for high blood pressure, it has been

6 National Diabetes Audit

7 Child measurement Programme for Wales Report 2013/2014 Public Health Wales NHS Trust

Published 2015 8 Welsh Health Survey 2014, Welsh Government Statistics released June 2015

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estimated that across the UK around half of people with high blood pressure are not receiving treatment9.

• Less than 8% of newly diagnosed patients in Wales received structured education in 2012-13.

• 60% of adults with type 1 diabetes and 33% of adults with type 2 diabetes are not having the annual tests and investigations associated with the national standards. Of those having the annual tests, 86% of type 1 diabetic patients and 65% of adults with type 2 diabetes do not meet the agreed treatment targets. In Hywel Dda UHB 84.2% of GP practices took part in the National Diabetes Audit 2013-13. This audit identified:

o Prevalence of all Diabetes in Hywel Dda 5.82%(Wales 4.87%) with Type 1, 0.48% (Wales 0.40%) and Type 2, 5.26% (Wales 4.38%)

o The age group with the highest prevalence of Type 1 Diabetes is 20-59 years more males overall than females.

o The age group with the highest prevalence of Type 2 diabetes is 70-89 years more males overall than females.

Table 1: Percentage of patients in Hywel Dda LHB and England and Wales receiving NICE recommended care processes (excluding eye screening) by care process, diabetes type and audit year

Type 1 Type 2

Under 40 40 to 64 64 to 79 80 and over

Under 40 40 to 64 65 to 79 80 and over

HbA1c

Hywel Dda UHB

61.9% 82.95% 91.6% 93.5% 78.1% 90.7% 95.2% 92.7%

England and Wales

68.9% 88.0% 93.5% 92.4% 85.7% 92.7% 95.6% 93.6%

Blood Pressure

Hywel Dda UHB

76.3% 90.0% 96.1% 93.5% 83.4% 92.0% 96.1% 95.3%

England and Wales

81.3% 93.0% 96.9% 95.8% 89.3% 95% 97.5% 96.8%

Cholesterol Hywel Dda UHB

52.8% 81.7% 92.7% 93.5% 75.4% 89.3% 93.7% 90.1%

England and Wales

64.0% 86.1% 92.6% 89.5% 82.5% 91.6% 94.6% 91.7%

Serum Creatinine

Hywel Dda UHB

60.8% 86.6% 95.5% 96.8% 79.3% 91.8% 96.0% 95.3%

England and Wales

68.5% 88.1% 94.0% 93.2% 84.8% 92.3% 95.6% 94.6%

Urine Albumin Hywel Dda UHB

39.8% 60.7% 74.7% 83.9% 54.1% 75.1% 85.7% 81.4%

England and Wales

43.7% 63.0% 76.4% 75.0% 59.2% 72.0% 79.6% 77.0%

Foot surveillance

Hywel Dda UHB

49.1% 75.7% 81.5% 87.1% 61.2% 80.4% 88.2% 81.1%

England and Wales

59.3% 79.4% 87.6% 83.8% 73.8% 84.8% 90.1% 85.5%

BMI Hywel Dda UHB

71.4% 85.2% 92.1% 96.8% 79.9% 88.7% 92.3% 84.4%

England and Wales

77.6% 87.9% 91.9% 85.5% 86.4% 91.5% 93.6% 87.4%

Smoking Hywel Dda UHB

69.1% 72.1% 77.5% 74.2% 78.1% 82.0% 85.4% 76.0%

9 Scarborough P, Bhatnagar P, Wickramasinghe K, Smolina K, Mitchell C, Rayner M (2010).

Coronary heart disease statistics 2010 edition. British Heart Foundation: London

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England and Wales

75.8% 82.1% 84.8% 79.4% 84.1% 86.8% 88.3% 83.3%

All eight processes

Hywel Dda UHB

24.6% 42.5% 53.9% 64.5% 41.4% 61.1% 71.4% 60.0%

England and Wales

29.1% 47.7% 59.9% 54.4% 46.3% 59.2% 66.7% 59.8%

Red identifies Hywel Dda UHB below national average Yellow identifies Hywel Dda UHB just below national average Green identifies Hywel Dda UHB above national average

5. ORGANISATIONAL PROFILE

Organisational Overview Hywel Dda University Health Board has the following within the Diabetes teams across the three counties Secondary Care 3.2 FTE Consultant Diabetologists Diabetes Dieticians Ceredigion 0.91 FTE ADULTS providing clinical leadership across the three counties Carmarthenshire 0.9 FTE Pembrokeshire 0.48 FTE plus additional 0.2 funded to end of August Podiatrists in Diabetes Carmarthenshire 1.7 FTE in specialist care (About 25% of all treatments in the community are on diabetes patients ) Ceredigion 1.2 FTE in specialist care (About 25% of all treatments in the community are on diabetes patients ) Pembrokeshire 1.6 FTE in specialist care (About 25% of all treatments in the community are on diabetes patients ) Diabetes Specialist Nurses Ceredigion 2.6 FTE of whom 1.6 FTE are secondary care based and 1.0 FTE is community based. Currently no Paediatric DSN

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Carmarthenshire 9.7 FTE of whom 5.7 FTE are secondary care based and 3.0 FTE are community based . 1.0 FTE is a Paediatric DSN Pembrokeshire 2.0 FTE of whom 1.2 FTE are secondary care based; no community based and 0.8 FTE is a Paediatric DSN Total DSN workforce for the HB is 14.3 FTE of which 8.5 FTE is hospital based; 4.0 FTE is community based; and 1.8 FTE is Paediatric Overview of Local Health Need and Challenges for Diabetes Services Hywel Dda UHB challenges include:

• Providing psychological support for both CYP and adults

• Providing a 24 hour on call advice system for paediatrics

• Providing structured education for people Type 1 diabetes from child hood through to adulthood

• Improving access and availability to structured education for people with Type 2 diabetes

• Ensuring the MDT has adequate funding for all members including administrative support, dieticians, specialist nurses and consultant support.

• Implementing recommendation from the Paediatric peer review

6. Development of (Hywel Dda University Health Board) local delivery plan for diabetes

In response to the “Together for Health – A Diabetes Delivery Plan” (2013), health boards are required, together with their partners, to produce and publish a detailed local service delivery plan to identify, monitor and evaluate action needed within timescales. The health board executive leads for diabetes will need to report progress formally to their Boards against milestones in these delivery plans and publish these reports on their websites at least annually. Following our assessment of progress against priorities we have reviewed how service provision may need to change, we have drawn up actions to be undertaken during the period of the national delivery plan and in particular actions and outcomes we want to see happen this year). In addition to this the lead clinicians have been tasked with assessing what we are currently doing, to look at what we can do differently or collectively and to set priorities for 2015-16 within this plan).

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7. Priorities for the coming year The Together for Health Diabetes Delivery Plan sets out action to improve outcomes in key areas between now and 2016. For 2015/16 the following national priorities have been agreed:

• Improving care for children with diabetes � Establishing a paediatric diabetic network � Participating in peer review � Developing services for children in transition to adulthood

• Preventing diabetes in our population � Aligning prevention priorities � Working together to prevent childhood obesity � Identifying people at risk of developing diabetes in primary care

• Making our services as effective as possible � Implementing a Single Diabetes ICT system � Undertake an audit of foot care across all LHBs � Improving in-patient care

• Helping people manage their care � Improving patient and carer engagement � Implementing a consistent approach to structured diabetes

education � Developing peer support

In addition to these national priorities Hywel Dda University Health Board highlights the following priorities for 2015/16 which reflect the needs of the local population.

Children and Young People(CYP) The priorities for 2015/16 are:

• Review of dietetic support across all three sites to support the extensive responsibilities highlighted in the operational policy for CYP.

• Implement mandatory training for all ward staff and junior doctors in paediatric diabetes care.

• Review the current provision of psychological support for CYP

• Review the absence of a 24 hour on call advice system for CYP

• Review current staffing levels to support a paediatric diabetes team across the Health Board

Preventing Diabetes The priorities for 2015/16 are:

• To continue to work closely with the Hywel Dda Public Health Team to deliver the messages of health and well being to reduce smoking, obesity and alcohol consumption. This includes all services that support people, with diabetes. Also includes the population as a whole and utilising the prudent health care messages, shared decision making, person centres outcomes and supported self care.

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• To work with the North Ceredigion GP cluster to implement and review pre diabetes screening and lifestyle interventions.

Detecting Diabetes Quickly The priorities for 2015/16 are:

• Continue primary care annual diabetes update day

• Reduce variation in practice in primary care supported by the Diabetes LES.

• Support Diabetes UK with local events promoting the importance of educating our community on the signs of diabetes and the importance of life style change to support diagnosis.

Delivering Fast, Effective Care The priorities for 2015/16 are:

• Look at a clinical change management programme for primary care and understand if it will support local needs for improved diabetes care

• Continue Diabetes LES in primary care Supporting Living with Diabetes The priorities for 2015/16 are:

• Improve access to Type I Diabetes education programmes

• Expand access to Type 2 Diabetes education

• Continue to conduct research that will benefit local patients i.e. telehealth and diabetes education projects

• Implement e-digital films across the health board to support early implementation of self management skill.

Improving Research The priorities for 2015/16 are:

• Complete current research projects

• Develop further research projects which will benefit local patients Improving information The priorities for 2015/16 are:

• Continue through the Think Glucose project to improve the quality of documentation across all four hospital sites

• Continue to use the Insulin Passports where appropriate

• Encourage all health professionals to ensure every person with a diagnosis of diabetes has a care plan in place.

• Support Diabetes UK with local information campaigns

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• PERFORMANCE MEASURES/MANAGEMENT The Welsh Government’s Together for Health – a Diabetes Delivery Plan (2013) contained an outline description of the national metrics that health boards and other organisations will publish:

• Outcome indicators which will demonstrate success in delivering positive changes in outcome for the population of Wales.

• NHS assurance measures which will quantify an organisation’s progress with implementing key areas of the delivery plan.

Progress with these outcome indicators will form the basis of Hywel Dda UHB’s annual report on diabetes. The first of these annual reports was published on XXXX and the next one will be published in September 2015. Hywel Dda UHB also reports progress against the local delivery plan milestones to the Board annually and via our website.

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8. ACTION PLAN 2015 – 2016

Children and Young People Priority Actions required Lead Due Date Progress

Establishing a paediatric diabetic network

None Dr Simon Fountain-Polley

Completed

• All Wales Brecon group meets regularly.

• Paediatrics part of the Hywel Dda UHB Diabetes Planning and Delivery Group

Participated in peer review- implementing response to peer review within the appropriate timescales

• Review of dietetic support across all three sites to support the extensive responsibilities highlighted in the operational policy.

• Implement mandatory training for all ward staff and junior doctors in paediatric diabetes care.

• Review the current provision of psychological support

• Review the absence of a 24 hour on call advice system

• Review current staffing levels to support a paediatric diabetes team across the Health Board

Dr Simon Fountain-Polley

• Hywel Dda Diabetes Paediatric team signed up to the Quality Assurance Programme and this was undertaken in November 2014.

Bronglais Hospital Peer Review Report Paeds.pdf

Glangwili General Hospital Peer Review Report Paeds.pdf

Withybush Hospital Peer Review Report Paeds.pdf

Developing services for

• Implement the check list to guide young people through

Dr Simon Fountain-Polley/

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children in transition to adulthood

transition.

• Develop transition clinics to run on a regular basis

• Improve links with adult diabetes team to provide seamless transition

Dr Sam Rice

Preventing Diabetes Priority Actions required Lead Due Date Progress

Aligning prevention priorities

Raise awareness of those lifestyle behaviours that promote healthy lifestyles, prevent diabetes (primary prevention) and support those with diabetes (secondary prevention): e.g. - To access local Smoking Cessation Services -Foodwise -NERS -Alcohol Brief Advice -Five Ways to Wellbeing -Seasonal Influenza vaccination

Beth Cossins/Helen Jones

Working together to prevent childhood obesity

The Public Health team will work in partnership to: - Develop a comprehensive

Beth Cossins/Helen Jones

Q3 update HDUHB Obesity Pathway 2014-2015 (OPIG L1-L3).docx

Hywel Dda Obesity Pathway Implementatio

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early years /childhood obesity pathway: -Facilitate midwives to access 'Eating for 1- Healthy for 2' training

The Women and Children Population Health Group has focused on reconfiguration Training package for Midwives to promote healthy and safe weight in pregnancy developed.

Identifying people at risk of developing diabetes in primary care

The Public Health Team and Dietetics will support weight management and promoting healthy lifestyles by delivering the Lifestyles Advocate Project in Primary Care Cluster Areas Working in partnership to support the N. Ceredigion Cluster to develop and deliver the Pre-diabetes project

Geinor Jones Michelle Dunning

Detecting Diabetes Quickly Priority Actions required Lead Due Date Progress

Improve access to education and training for all professionals involved in the care of people with Diabetes

• Individuals working in diabetes care ensure learning needs are identified at their yearly PDR

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• Continue annual update diabetes day for primary care

• Continue to deliver the Swansea Diabetes MSc module locally

Delivering fast, effective treatment and care Priority Actions required Lead Due Date Progress

Implementing a Single Diabetes ICT system

SCI Diabetes is an All Wales Project Carmarthenshire have Diabeta 3- Consider the need to implement Diabeta 3 across all 3 counties as Carmarthenshire are able to produce an annual report where as the other counties are unable to do so

? Dr Sam Rice

?

Carms Annual Report 2014 1.pdf

• Undertake an audit of foot care across all LHBs

Continue Diabetic assessment of primary and secondary care staff training supported by ‘putting feet

Ensure all four hospitals sites have registered to take part in the national audit. Ongoing education

Joanne Morris Joanne Morris

First deadline 31st July 2015 Ongoing

All four hospital sites are participating in audit. Launch date was 14th July 2014 As pat of wound healing modules, Swansea masters modules in diabetes

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first’ programme and FRAME web based education tool

• Open access clinics on three hospital sites Glangwili, Bronglais, Llanelli, for diabetes foot emergencies

• Improve in-patient diabetes foot care

Ensure setting up of open access clinic for Pembrokeshire Launch project ‘CPR for Diabetic feet’ on all wards for prompt referral to diabetes foot clinic

Joanne Morris Joanne Morris

End of 2015 End of 2015

and Thinkglucose campaign As part of ThinkGlucose programme

Improving in-patient care

• Continue ward based learning programme across all four sites

• Continue quarterly steering group meetings

• Continue spot checks

Chris Cottrell Implementing the ThinkGlucose programme

Supporting living with diabetes Priority Actions required Lead Due Date Progress

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Improving patient and carer engagement

• Health Board continue support of Patient Reference Groups

• Continue patient membership on DPDG

• Review outcomes of European Telehealth Project and work with the Health Board to establish telehealth for people with diabetes

Sarah Hicks/ Claire Hurlin

• Established Patient Reference Groups in Ceredigion and Carmarthenshire

Implementing a consistent approach to structured diabetes education

• Consider how to deliver education to people with Type 1 Diabetes

• Review single point of access for all education or people with Type 2 Diabetes and assess if increased access to programmes across the health board

• Ensure licensing agreement is adhered to

• Work to establish consistent funding

Claire Hurlin/ Zoe Paul Gough/ Caroline Davies

Single point of access has increased referrals to self management education programmes, numbers of programmes has also increased and number completing are improving. Working with relevant programmes to improve data capture of all relevant issues to support licensing agreements

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available across all thee counties in particular for dietetic input into X-pret programmes

• Improve Q&A assessments and recording.

• Promote the uptake of seasonal influenza vaccination at every opportunity

Rhys Sinnett/Liz Newbury-Davies

Working with X-pert to improve assessments monitoring and Q&A procedures

Developing peer support

Improving information Priority Actions required Lead Due Date Progress

Think Glucose documentation and training for new charts to be completed

• New charts to be printed

• Training in use of new charts to be completed by 80% staff prior to roll out

Chris Cottrell

Laminated posters to be completed and printed

Posters to be put in relevant areas on wards to inform patients, visitors and hospital

Chris Cottrell

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staff of the importance of diabetes care whilst an inpatient

Targeting research Priority Actions required Lead Due Date Progress

Completion of the evaluation of the e-digital self management films in primary care and next steps

Review of evaluation Dr Sam Rice Pilot phase will run over next 6 months

Ongoing. Pilot areas in surgeries in ABMU and HDUHB. Updated film produced on diet based on patient feedback.

Completion of the evaluation of the lay led Diabetes Self Management Programme and next steps

• Complete post evaluation of DSMP

• Review evaluation

Dr Sam Rice/ Claire Hurlin

Data collection due to end in the autumn

• Feasibility study in progress

• Post course evaluation sessions in progress

• Recently accepted as NISCHR portfolio study.