A National Perspective Diabetes & Prevention. Jonathan Valabhji National Clinical Director for Obesity and Diabetes. 20 th January 2016

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1 A National Perspective Diabetes & Prevention Jonathan Valabhji National Clinical Director for Obesity and Diabetes 20 th January

2 Obesity Prevalence and Diabetes Prevalence Note: diabetes prevalence is modelled, for all types of diagnosed and undiagnosed diabetes

3 Diabetes in England 2.8 million people diagnosed 2,550,000 (91%) Type 2 DM; 250,000 (9%) Type 1 DM Further 500,000 with undiagnosed Type 2 DM (5:1 diagnosed: undiagnosed Type 2 DM) Impact of Ethnicity eg. 1 in 8 of all people with diabetes in the UK are of South Asian origin Cost approx. 10 billion / 10% of NHS budget - 80% spent on the complications

4 5 Year Forward View Getting serious about prevention 5 Year Forward View 2014 The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health 4

5 Five Year Forward View October 2014 Prevention National diabetes prevention programme Employer responsibility for employee health Integrated care Vanguard Programme - Multispecialty Community Providers (MCPs) - Primary and Acute Care Systems (PACS)

6 NHS DIABETES PREVENTION PROGRAMME: Preventing Type 2 Diabetes in England

7 Who we are Public Health England (PHE) is an executive agency of the Department of Health. We protect and improve the nation's health and wellbeing, and reduce health inequalities. NHS England (NHSE) is an executive non-departmental public body of the Department of Health. Our mission is to secure high quality care for all, and to improve the health outcomes for people in England. Diabetes UK is the UK's leading diabetes charity. We care for, connect with and campaign on behalf of all people affected by, and at risk of, diabetes, reaching people with diabetes in local communities across the UK. NHS DIABETES PREVENTION PROGRAMME

8 Impaired Glucose Tolerance + Lifestyle Intervention Pan et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997; 20: Tuomilehto et al. Prevention of Type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. NEJM 2001; 344: Diabetes Prevention Program Research Group. Reduction in the incidence of Type 2 diabetes with lifestyle intervention or metformin. NEJM 2002; 346: Kosaka et al. Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males. Diab Res Clin Pract 2005; 67: Ramachandran et al. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 2006; 49:

9 Demonstrator sites We are currently working with seven local areas, known as demonstrator sites, to learn practical lessons from delivery. These sites were selected to work with us to co-design the service model and support us in developing and implementing the national programme. The demonstrator sites are: Birmingham South and Central CCG Bradford City CCG Durham County Council Herefordshire CCG/LA Medway CCG/LA Salford CCG/LA Southwark Council and CCG NHS DIABETES PREVENTION PROGRAMME

10 An evidence based intervention The NHS DPP behavioural intervention will be underpinned by three core goals: Weight loss Achievement of dietary recommendations Achievement of physical activity recommendations The intervention will be long term, made up of at least 13 sessions, spread across a minimum of 9 months, each lasting between 1 and 2 hours. People will be supported to set and achieve goals and make positive changes to their lifestyle in order to reduce their risk of developing Type 2 diabetes. Sessions will be delivered predominantly in groups and will be face-toface unless there is a strong rationale for an alternative approach. NHS DIABETES PREVENTION PROGRAMME

11 NATIONAL PROCUREMENT A national procurement for the behavioural intervention will allow us to more rapidly roll-out and scale up the NHS DPP, maintaining fidelity to the evidence base A Prior Information Notice (PIN) for the procurement was published in March Invitation to Tender (ITT) was released in early January 2016.

12 FIRST WAVE SITES We have recently issued a call for expressions of interest for CCG and Local Authority partnerships This will involve partnering with our contracted providers The call for first wave sites closed on 18 th September We received high levels of interest from across England We will be communicating further information with all sites in due course

13 TIMELINE FOR NEXT STEPS 2015/16 Identify areas for first wave of national roll-out Implement and evaluate demonstrator plans, feeding learning into national programme National procurement of provider(s) to deliver behaviour intervention 2016/17 Deliver between 10,000 and 30,000 interventions across CCGs identified through expression of interest exercise 2017/18 Aim to deliver long-term contracts providing incremental scaling up of services, with a view to full coverage by 2018/17 (subject to final decisions about the pace of the programme).

14 Evaluation and Research Contract Management National Diabetes Audit Other national evaluation? Maintenance of behaviour change High risk groups BME, SMI Other modes of delivery NHS DIABETES PREVENTION PROGRAMME

15 KEEPING IN TOUCH We re keen to involve range of stakeholders, providers and partners in developing and delivering the programme For more info and to sign up to our regular e-bulletin For any questions

16 Five Year Forward View October 2014 Prevention National diabetes prevention programme Employer responsibility for employee health Integrated care Vanguard Programme - Multispecialty Community Providers (MCPs) - Primary and Acute Care Systems (PACS) 22 Billion Areas with potential for return on investment

17 Implementation of the Five Year Forward View NHSE Prevention, Obesity, Diabetes (POD) work stream DH Childhood Obesity Strategy Diabetes Prevention Programme Diabetes treatment and care

18 Diabetes Prevention Taking Centre Stage Population level interventions to prevent diabetes a focus on childhood obesity Primary prevention of diabetes in those at high risk of developing diabetes Secondary prevention of the complications of diabetes in those that already have diabetes Tertiary prevention of clinical end points in those that already have the complications of diabetes eg. prevent amputations in those that have the complication of peripheral neuropathy