Paediatric DiabetesNetworks and Tariff

Trudi AkroydNHS Diabetes

www.diabetes.nhs.uk 

Networks

• The networks have agreed nationally a set of initial outcomes and are working toward a memorandum of understanding across the networks to ensure that they deliver against these outcomes

• Other Groups– Learning Difficulties– Children in care– Language barriers– Young offenders

• Schools training and support• Education accreditation• New Technologies – CGMS, Text• IT Systems• NDA2 Submission• Register• DiabetesE

What Makes a Good Service

• Pumps and consumables

• Transition Specification

• Inpatient care

• Admissions and contractual guarantees

What Makes a Good Service

• The service has to ensure basic care required by all CYP & Families – and to be in touch if there are problems day to day

• Basic care covers the entire MDT and also Psychological support

Quality Pathwaysand Specifications

Quality Pathwaysand Specifications

• The guidelines and specifications required to deliver a quality service have been in place and continually updated since 2007 when the ‘Making Every Young Person with Diabetes Matter’ document was published and the DoH Implementation Group formed

• The NHS Diabetes Commissioning Guides and Implementation Map along with the Emotional and Psychological Support and Care in Diabetes Report both published in 2010 provide the latest standards required

NHS Diabetes Education Task and Finish Group

• Membership is representative from all MDT’s, colleges and professional bodies delivering Paediatric Diabetes care nationally and DEN, Diabetes UK and JDRF

• Development of Core Curriculum - training of HCP’s – This continues to be developed. Based on Knowledge, skills and

competency levels using Skills for Health as a framework– Academic units that presently supply training have agreed to a

core curriculum – Development of learning workbooks for aspects of paediatric

care– Ensuring the link with current RCT’s for education programmes

• Development of training standards and components for patients

Funding Mechanisms

October 2010

From April this year a non-mandatory tariff was put in place for paediatric diabetes. Work has continued to develop a pricing structure reflecting the resources actually required to deliver the service and start to put this in place for April 2011. However, this staged approach to change will only be fully realised if we have the full commitment of regional networks, the commissioners and the Department of Health.

 

Funding Mechanisms

The Decision

The Department of Health will ensure a mandatory tariff for paediatric diabetes is in place for April 2011 and the minister has stated this in a parliamentary debate. As part of this process, representations have been made to the department to uplift the current non-mandatory tariff price particularly for follow up.

The level of uplift would ideally reflect the issues identified within the services costed specifically for this purpose or at the very least to be in excess of general paediatrics and paediatric endocrinology, to make it worthwhile for trusts to move activity.

 

Funding Mechanisms and Tariff

• Basic Yearly Tariff plus complexity payment per child for the following in year - April to April;

– Newly diagnosed in year– Education required in year– Pump required in year– Pump user – Child protection– Over 12 years old– Transition year over 19

 

Funding Mechanisms and Best Practice Tariff

Future Development This is toward a more appropriate funding mechanism is supported and PbR governance groups at the department are keen that our work goes forward and proposals moving towards a ‘Best Practice – Clinical Pathway Tariff’ will be supported but are not guaranteed.

This work needs to be completed and submitted by March 2011 so that it can be assessed and tested to see if it is viable and deliverable. Over the coming months NHS Diabetes will be working with many of you and the networks to develop all the aspects of this approach and will need the support of the networks to help communicate this to all stakeholders.

 

Funding Mechanisms and Best Practice Tariff

Best Practice Tariffs

The objective of the best practice tariff policy is to reduce unexplained variation in

clinical quality and to universalise best practice

Issues to consider:

• References to relevant clinical guidelines.

• Are there significant variations in practice?

• Information, which would, as a minimum, allow for an assessment to be made of the gap between current and best practice.

• Information on the impact on outcomes of the gap between current and best practice.

• Is the area being looked at a high volume service area?

• Information, which would, as a minimum, allow for an assessment to be made the volume of activity being carried out.

• Information on the relevant HRGs/TFCs to be affected.

• Estimate of potential gain - expressed qualitatively or quantitatively or,

• Estimate of potential gain - expressed on a monetary basis, or on a benefits to patients basis.

 

Funding Mechanisms

The Decision

At this point we are awaiting a final decision and confirmation that all aspects will be in place to be

contracted against for April 2011.

 

CYP & Families

Service DefinitionsQuality and Standards

User surveysDiabetes NSF

Making Every Young Person with Diabetes Matter

Diabetes UK Childrens Charter

Self Care

User Support Groups

New Diagnosis

Year of Care

Over the age of 12 Structured Education

Child Protection

Transition when Over 19

Pump Initiation

Pump user

Standards

Self Care

At Diagnosis Education

Peer Support

Pump EducationAge Appropriate

Education

RCPCH Competencies

MDT/HCP Competencies

Curriculum

Education Task and Finish Group

DPEP User Survey

Designation to claim tariff

levels

Benchmarking and Peer Review

Regional Networks

NDA2Local Register

DiabetesE

Regional Register

National Register

NDA2Hosted by RCPCH

Paediatric Service

Tariff FundingQuality and Standards

NHS Diabetes Commissioning Guides

Diabetes NSF

Making Every Young Person with Diabetes Matter

Diabetes UK Childrens Charter

Growing up with Diabetes: children and young people with diabetes in EnglandNetworks

Newly Diagnosed Year

Basis Yearly Tariff

Over the age of 12 Structured Education

Child Protection Case

Transition Year Over 19

Pump Initiation Year

Pump user

Supported by network coordinator and memorandum of

understanding between network and units

Education for CYP and Families

NICE

NICE

Accredited Education Programmes

Paediatric Diabetes Service Delivery, Quality and

Governance in England

Draft Overview – Mark Hannigan Aug 2010

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Where Now For Paediatric Diabetes

Networks And TariffIs It Up To You?