DAFNE Strategic Plan 2012-2017 DAFNE PU09.001, Version 1 September 2012 Page 1 of 7
Current Position Since 2000 the DAFNE Collaborative has been committed to providing access to high quality structured education for intensive insulin therapy for people with Type 1 diabetes. The DAFNE programme has been instrumental in changing the face of diabetes care and the relationship between healthcare professional and patient in the UK, Ireland and beyond. The evidence base and high quality of the DAFNE programme achieved through audit, the DAFNE research programme, healthcare professional training and quality assurance has resulted in DAFNE being regarded as the gold standard in structured education for people with Type 1 diabetes both nationally and internationally. The DAFNE programme is currently being delivered in 75 diabetes services in the UK and the Republic of Ireland. There are 593 DAFNE Educators, 374 DAFNE Drs and 57 Level-1 DAFNE Advisors in the UK and the Republic of Ireland. As of the 28 September 2012, there have been a total of 3,600 DAFNE courses delivered providing structured education to 25,282 adults with Type 1 diabetes. Additionally we have shared our expertise with teams from Australia, Kuwait, South Africa, Spain and Nigeria. DAFNE has been delivered in Australia as Oz DAFNE since 2005 and were joined by New Zealand in 2008 and Singapore in 2011; there are currently 24 active centres in the Oz DAFNE programme. DAFNE was adopted as the preferred Type 1 programme in Kuwait in 2010. In 2012, we rolled out two new delivery models for the DAFNE Programme, DAFNE 5-week and Pump DAFNE, commenced. DAFNE Mission Statement Our mission is to improve outcomes for people with Type 1 diabetes through high quality structured education which is embedded in the Health Service. We will use the DAFNE programme, including the DAFNE Educator Programme (DEP), DAFNE Doctor Programme (DDP), DAFNE Advisor Programme (DAP), Peer Review, Quality Assurance (QA) and audit as a framework in which to develop this patient centred model of care. We will improve and develop the DAFNE programme through and Development (R&D) and collaboration with other groups, to understand the determinants of success. Values The DAFNE programme is based upon the values and beliefs made explicit in the DAFNE Philosophy. This is coupled with the belief that as a form of treatment for diabetes, therapeutic patient education programmes must be developed and delivered with the same rigour and governance required of pharmaceutical treatments, in terms of having an appropriate evidence base and content, with delivery subjected to rigorous quality assurance and audit to guarantee and maintain quality. DAFNE PU09.001, Version 1 September 2012 Page 2 of 7
Key Strategic Objectives (Goals / Themes) Our long term strategic objectives can be summarised as: 1. To achieve centralised funding for the DAFNE Programme embedded in the NHS. 2. To continue to evolve the DAFNE Programme through research. 3. To understand better how to initiate / sustain behaviour change. 4. To use learning from research to enable more people to self-manage their diabetes to treatment targets. 5. To have developed a wider portfolio of programmes so one size does not have to fit all. 6. The DAFNE Programme will be part of an on-going educational programme (to include programmes for paediatrics and adolescents) as part of the routine care pathway for the life of a person with Type 1 diabetes. 7. The DAFNE principles (carbohydrate counting and a basal bolus multiple injection therapy) will be available to all people with Type 1 diabetes from diagnosis, if clinically and socially appropriate. 8. All diabetes HCPs, through appropriate undergraduate and professional training, will understand the DAFNE principles of structured flexible intensive insulin therapy so that they can support and treat people with Type 1 diabetes. Key strategies In keeping with our mission statement we will pursue the following key strategic aims and objectives. 1. The DAFNE programme will have evolved through research and will enable more people to self manage to treatment targets. 2. The principles of flexible intensive insulin therapy, as demonstrated by the DAFNE programme, will be introduced to people with Type 1 diabetes from diagnosis. These principles will remain fundamental components of the routine Type 1 diabetes care pathway with all diabetes healthcare professionals trained to support the person with Type 1 diabetes. 3. We will understand better how to initiate and sustain behaviour change and will evolve a wider range of programmes so that one size does not fit all. 4. The DAFNE programme will be embedded in the NHS with central funding and clarity over political responsibility. DAFNE PU09.001, Version 1 September 2012 Page 3 of 7
Major Goals The following key targets will be achieved within the key strategic areas within the next 5 years Theme 1: DAFNE will have evolved through research and will enable more people to self manage to treatment targets 1.1 Conclude reporting on current 5 year NIHR research 31 Aug 2013 programme by publishing a further 5 papers by Summer 2013 1.2 Submit expression of interest to NIHR for next 5 year research plan (including behaviour change / psychosocial interventions & technology. If successful submit full plan March 2013 Oct 2013 1.3 Adapt DAFNE to what research tells us adaptable to other longterm conditions * Harness technology to support HCP * Exploring different models of DAFNE for sustaining benefits professional support / coaching Educator 2013 2019 Executive 1.4 Succession planning for Chair of the DAFNE August 2017 Whilst waiting for the outcomes of the current and future research programmes 1.5 Analysis of data from DAFNE Database with respect Mark Evans 31 May 2013 to outcomes by centre and by post code 1.6 Reinforce targets with existing educators via networks & new Spring 2013 educators via emphasis in DEP 1.7 Focus attention on centre outcome data send all centres report detailing centre change in HbA1c (compared to national DAFNE average) establish as a regular annual event inform centres in next newsletter about focus on targets and that data being sent and purpose / rationale, why are we doing DAFNE tick box or to improve self management and remind them about metabolic control League table of all centres outcome data as posters at Collaborative 2013 to become a regular annual event Workshop at Collaborative 2013 potential involvement of top performing centres 1.8 Obtain feedback from DAFNE Graduates how can we raise and manage the issue of targets why they think HbA1cs are not better feed in outcomes from follow-up survey from Graduates and HCPs Educator via Networks & DEP Susan Moore Editor DAFNE News Database January 2013 31 Oct 2012 1 May 2013 Executive 14 June 2013 DUAG 31 Aug 2013 DAFNE PU09.001, Version 1 September 2012 Page 4 of 7
Theme 2: Principles of flexible intensive insulin therapy from diagnosis for life, with all diabetes HCPs trained to enable support (i) HCP training 2.1 Contact Deaneries / Colleges etc re diabetes training- curricula to cover where possible 2.2 DH to ask Stephanie Amiel re progress of previous contact on this matter 2.3 RCP curricula for SpRs to include DAFNE competencies advertise DAFNE week observation for all SpRs not necessarily DDP 2.4 Standard letter to be provided for lead educator to issue to doctor who has completed an observation week, to be keptkeep in doctor s appraisal folder 2.5 Get competencies to include DAFNE principles e.g. CHO counting and dose adjustment for dietitians and DSN as core competencies (TREND, DMEG etc) 2.6 Investigate online education for HCPs (in line with safe use of insulin, with pharma / NHS Diabetes funding a. Talk to Anna Morton on how / who did safer use of insulin b. Talk to Angus Forbes (involved with Nurse. competencies and online packages for HCPs) c. Talk to Diabetes Bible.com re. resource; if we develop online training would they include a link to the training? 2.7 Investigate getting something into YDF training/course rather than DDP to observe a course talk to Jyothis George (ii) Pathway development 2.8 Leicester foundation programme talk with them (Sarah Phillips) re how this can be rolled out to signpost newly diagnosed people towards DAFNE. Pilot in Glasgow just starting up led by Lynn Doran with HH not necessarily restricted to DAFNE sites 2.9 How do we get patients started on mealtime insulin from diagnosis? Can we investigate who is already doing this, what are the issues, how well is it working? 2.10 Need to establish research agenda / development to give evidence for creating pathways eg for particular patient groups 5 wk etc, appropriate follow-up etc HH Scotland DH England 31 Dec 2012; completion 2015/17 DH 1 Dec 2012 HH Scotland DH England GT/SW 2013 DAFNE Educator 31 Dec 2012; completion 2015/17 2013 to 2017 31 Dec 2012 - information GJ gathering; 2013/15 DH resource development LR SO N 31 Dec 2012 HH Educator to explore via Regional Networks / questionnaire Simon Heller to explore with Database group if someone could look at data SH and DH via group 31 Dec 2012; Pilot 2012/13 Network Meetings Spring 2013 Database meeting 2 Nov 2012 meeting 18 Oct 2012 DAFNE PU09.001, Version 1 September 2012 Page 5 of 7
Theme 3: We will understand better how to initiate and sustain behaviour change and will evolve a wider range of programmes so one size doesn t have to fit all (i) Initiate and Sustain behaviour change 3.1 Incorporate into next programme grant enhancing skills within programme (behaviour change expertise): Refer to theme A evolving through research SH via (ii) Evolve wider range of programmes so one size does not have to fit all 3.2 Develop processes and infrastructure to roll out 5 week and pump Educator and Central DAFNE 3.3 Explore by gathering information and data about support kick start new programmes Professional support for people DAFNE Graduates Flexibility s, 1:1 and timing Use audit more actively Help centres to use their audit outcome data and information to their benefit Educator via Network Meetings Database via Theme 1.7 Oct 2012 - Oct 2013 Oct 2012 Spring 2013 Jan 2013 Theme 4: Embed DAFNE in NHS with central funding and clarity over political responsibility 4.1 Contact NHS Outcome Framework 5 Domain leads HH 31 Dec 2012 4.2 Talk to Islet Transplant Programme as to how their consortium was HH 31 Dec 2012 established 4.3 Investigate how User voices can push for structured education being provided equitably (online petition - 100,000 signatures required) develop e-petition for launch World Diabetes Day 2012 writing to MPs etc, stop the post code lottery for education lobby Diabetes UK to take this on PR and IM via DUAG and dafneonline SO N (need to work together coordinate 14 Nov 2012 5 Oct 2012 4.4 EDM (Early Day Motion)/Question by MP Helen to try to get question in Scotland. Link to public awareness work at DUK re APPG / Adrian Saunders to raise question 4.5 NICE Type 1 Guideline group need to lobby Formal DAFNE consultation response once the draft is published. Revised guidelines due for publication July 2014 4.6 Commissioning Guidance get the document completed and decide how DAFNE can promote it approach) HH SO N Executive HH to get back to Anna Morton Oct 2012 Sept 2013 Oct 2012 Oct 2012 July 2014 31 Oct 2012; completion 2013/14 Strategic action programmes will be developed and implemented to cover requirements of each of the four themes. The Executive Board will be responsible for the monitoring of progress against the action programmes. DAFNE PU09.001, Version 1 September 2012 Page 6 of 7
Our Priorities 2012-2017 Purpose To improve outcomes for people with Type 1 diabetes through high quality structured education which is embedded in the Health Service Themes Evolve via research enabling more people to self manage to target Activities Report on current NIHR programme - publishing a further 5 papers by Summer 2013 Develop research plan for next 5 years to include: - Behaviour change / psychosocial interventions - Technology - support for self management skills - Learning generic to other LTC Adapt DAFNE to what research tells us Succession planning within Self management to target Await research Focus attention on outcome data: - Analysis of outcomes by centre / post code - Reinforce targets with existing DAFNE HCPs - all centres to receive annual report detailing centre HbA1c change compared to all DAFNE centres - League table poster of HbA1c outcome data at Collaborative meeting - learn from top performing centres and share best practice Obtain feedback from DAFNE Graduates - How can HCPs raise & manage the issue of targets From diagnosis for life and all HCPs able to support HCP Training Pathway development Contact Deaneries / Colleges - Aim to get diabetes training in to curricula where possible - DSN, Dietitian and RCP curricula for SpRs to include DAFNE competencies Investigate & develop online education for HCPs Promote observation of a full DAFNE course - in addition to DDP fellowships with YDF - work in partnership with YDF to promote Leicester Foundation Course - explore with Leicester team how this can be rolled out to support DAFNE. Investigate how we get patients started on mealtime insulin from diagnosis? - explore which DAFNE services currently do this - establish the issues - Use the DAFNE database to establish how well this is working Include in research agenda to provide evidence for creating pathways including appropriate follow-up Understanding of behaviour change; evolve wider range of programmes Initiate & sustain behaviour change Incorporate into next programme grant Enhance skills within programme - identifying and working with behaviour change experts - incorporating learning from research into the DAFNE Programme, developing models and processes as required Wider range of programmes Continue to roll out 5-day, 5 week and pump amending infrastructure to incorporate all models - develop appropriate organisational IT systems to support Gather information from centres on: - HCP support provided for DAFNE Graduates - Flexibility s, 1:1 and timing Provide information to centres on how to actively use audit data - use data for their own benefit - kick start new programmes Embed DAFNE in NHS with central funding Embedding in the NHS & Central funding Contact 5 Domain leads for NHS Outcome Framework how Islet Transplant consortium was established Harness User voices to push for equitable services - online petition - Letters to Health Minister, MPs and stakeholders to stop the post code lottery - lobby Diabetes UK to take on this campaign Raising awareness in government - Early Day Motions - Questions in parliament - Engage with APPG for Diabetes Commissioning Guidance - Engage with NHS Diabetes regarding both the Economic Case & Commissioning Toolkit - Complete documents & decide how to promote Engage with NICE Type 1 Guideline review group - ensure a response is made to the draft guidance - Why they think HbA1cs are not better DAFNE PU09.001, Version 1 September 2012 Page 7 of 7