NHS Diabetes Programme

Transcription

1 NHS Diabetes Programme London Regional Event Vision Through the NHS Diabetes Programme we will aim to slow the future growth in the incidence of diabetes and reduce the rate of complications associated with diabetes in England by 2020/21.

2 National Performance At the end of May there were 55,600 referrals, ahead of target. Contact has been attempted for 91% of referrals as at the end of March. 45% of referrals reaching IA (end May) seen month on month improvements and over target.

3 Referrals by month July August September October November December January February March April May

4 Overall Coverage End of March 2017, referrals have been received from 55% (2,119) of GP practices within Year 1 sites (3,840 practices). Geographical Region Adult (18+) Population Referring CCG adult (18+) population Referring GP adult (18+) population % CCG population coverage % GP population coverage London 7,409,087 5,535,096 3,709, % 50.1%

5 Provider Lag Times Opportunities for improvement with lag times between referral, IA and first session: IA capacity increasing across providers; Call centre capacity increasing significant decrease in unlogged referrals; Variation in referral to IA contact and referral to 1 st session mixture of reasons; Increasing focus of provider management and their improvement.

6 Referral Route Contract Region - London London Source of referral n % Direct referral from GP / NHS Health Check Provider % Contact with provider following letter receipt informing of eligibility % Referral following direct recruitment activity % Self-referral following on-line self-assessment % Total % Contract Region No. referrals to No. of people % of people December '16 attending IA attending IA Confidence Intervals London % 42.3% % Region % 46.4% % Region % 50.5% % Region % 42.3% % Total % 46.3% %

7 Inequalities A higher proportion of females compared to males attended Initial Assessment. However, the percentage of males was higher than expected at 45% Approximately 80% of participants were aged under 75 years. In line with the modelling of prevalence 25% of participants are from Black and Minority Ethnic group (BAME). By comparison, approximately 15% of the population are from BAME populations A higher percentage of participants from the most deprived quintile compared to the least deprived quintile

8 Evaluation NIHR commissioned Manchester University to provide long term evaluation, engagement to follow National Diabetes Audit being expanded to include those at risk of Type 2 diabetes as well as those with established disease Provider MDS provides comprehensive feedback along the patient journey Coding back into Primary Care needs to be supported

9 Year 3 Roll Out Built around STP footprints Commitment to commission nationally services for every area willing to invest energy in identifying and referring NDH patients Need to work towards a steady flow of referrals, align with 500 referrals per 100k population per annum Committed to principle of competition at the end of contracts so that we continue to push providers to improve their offer and price, increasing value

10 London STPs 27. North Central London - Extend current Camden contract to March 19. New referral profiles for Camden contract required by 1 November (Draft 2 October). Period June 18 to March North East London - Re-procure as whole STP for June New whole STP prospectus required by 1 November (Draft 2 October). Period June 18 to June North West London - Re-procure as whole STP for July New whole STP prospectus required by 1 November (Draft 2 October). Period July 18 to July South East London - Re-procure as whole STP for June New whole STP prospectus required by 1 November (Draft 2 October). Period June 18 to June South West London - Re-procure as whole STP for June New whole STP prospectus required by 1 November (Draft 2 October). Period June 18 to June 2020.

11 Transformation Fund: Diabetes Treatment and Care

12 Allocations (1) Q1 allocations made via lead CCGs on 30 June Future allocations will be quarterly in arrears (i.e. end of September, December) Exception in Q4 when year-end procedures may require an earlier date-possibly month 11-to be confirmed

13 Allocations (2) Intention by NHS England Finance is that, by the end of year, the amounts allocated should broadly equal actual expenditure (within the allocation envelope) Will therefore be a need to work with each site quarterly to identify likely spend for that quarter. The following quarter s allocation may be adjusted to reflect actual requirements This will take into account where there will be a significant rise in expenditure for the following quarter (e.g. when staff are coming into post)

14 Allocations(3): Control Totals Conditions in Call to Bid that sites had agreed control totals. Some successful bids contained commissioners or providers without agreed control totals Where a CCG does not have an agreed control total, they should arrange for a partner CCG to receive the funding and commission the improvements on their behalf and confirm in MOU Where no CCG in a bid has an agreed control total, the MOU should include confirmation that the full amount of the funding will be transferred to the relevant providers (normal commissioning arrangements are still needed) Where a provider does not have an agreed control total, then either other providers should receive the funding or they should confirm via the MOU that the funding will be used solely for the purposes of the bid

15 Allocations (4): 2018/19 Sites were invited to include 2018/19 funding requirements in their bids as there is a high likelihood of transformation funding being available in 2018/19, subject to progress being made by individual sites and the overall budgetary position It is recognised that nature of the evidence for the four interventions is that investment is needed over a multi year period for improvements and savings to emerge Need for early clarity is recognised Working closely with NHS Finance to confirm the position as soon as possible

16 Milestones Q1 allocations were conditional upon receipt of draft milestones-all received for A-rated bids. Feedback given, mainly in relation to: Adjusting milestones where delay in funding has meant shift in implementation times Being clear when end point of actions were Ensuring that service commencement dates aligned with recruitment and other milestones Including indication of where service will be by end of 2017/18 in terms of no. of patients seen etc. Q2 allocations partly conditional upon receipt of final milestones. Q3 and Q4 funding conditional upon continued achievement of milestones.

17 MoUs Q2 allocations also conditional upon receipt of final MOUs by 31 July. In response to requests, checklist issued of key issues to include. MOUs cover the mutual commitments of all partners in terms of governance, funding flows, reinvestment of savings, specific control total requirements etc. MOUs do not replace need for usual commissioning arrangements, contract variations etc.

18 Monitoring of progress (1) Final arrangements subject to confirmation, but likely to include: RAG rating of achievement of milestones via regional teams. Amber rating will result in need to agree remedial actions with regional team Red rating will be where there is continued non-achievement of milestones and/or a lack of engagement with agreeing remedial actions. Continued Red rating could lead to suspension of funding, or ultimately ending of funding.

19 Monitoring of progress (2) Diabetes dashboard being developed, covering key metrics to measure whether improvements in outcomes are starting to emerge Recognised that most improvements in outcomes will be over medium term, but will initially detect whether trends are in the right direction. Will seek to use data sources that report more frequently than NDA or NaDIA (e.g. HES)

20 Monitoring of progress (3) Will be drawn from existing data sources as much as possible, but in small no. of cases will be need to ask sites to put local arrangements in place (e.g. structured education attendance reporting to CCGs) Where data indicates trends in wrong direction (e.g. site has DISN team in place but length of stay is increasing), support via clinical networks and other routes to identify possible causes Focussed on bid sites - Considering whether to also include other CCGs where existing national data sources are used, but participation in local data collections by them could only be voluntary

21 NHS Digital Diabetes Prevention Programme Workstream

22 Objectives To support improvements in diabetes outcomes by: Implementing digital behaviour change interventions aimed at preventing Type 2 diabetes in those already identified to be at high risk and evaluate their effectiveness; Improving the provision of information to support self-management and care of people living with Type 1 diabetes; Scaling digital flexible learning resources to support management and self-care for people living with diabetes.

23 Prevention Partnerships with 7 Local Health Economies (LHE s) to take part in pilots established. 30 digital interventions reviewed against the NHS Digital Assessment Framework 14 digital interventions longlisted for consideration for pilots Contract with Delivery and Evaluation Partner to work alongside LHE s in place Mobilisation activities and evaluation design commenced in June Digital intervention provision from November this year (circa 12 month project with 6 month recruitment window) Considering options for future roll out (should they be effective)

24 Self-Management in Type 1 Funding approved to develop the online resource to support selfmanagement in people with Type 1 diabetes. Possible features include: Lifestyle & Life Event Advice personalised content reflecting lifestyle and interests Emotional & Practical Support - Help to access support, including peer support, reminders etc. Data Dashboard: Help to visualise and take action on their numbers A Learning Zone: Easily accessible online education content NHS Digital will take forward the user led design work in August to develop prototypes for the resource. Access to patient networks useful.

25 Digital Education and Self-Management Digital channels offer scalable solutions to deliver content and support, which offer greater flexibility for individuals to decide how and when they wish to interact. Developing approaches which would: Ensure a standardised approach to quality; Stimulate development of the provider market; Take advantage of economies of scale; Ensure comparability between different approaches whilst supporting establishment of the evidence base looking at a wide range of outcomes; Ensure that digital products are not created at the expense of evidence based programmes and provide choice to patients.