Diabetes and the Health
Innovation Network
Charles Gostling
19 September, 2013
Academic Health Science Network Aims
As with the other 14 nationally designated AHSNs, the
origins of the South London AHSN were in the Innovation
Health and Wealth Report, published by the Department of
Health in December 2011. The AHSN has 4 core
objectives:
1.Focus on needs of patients and local populations
2.Build a culture of partnership and collaboration
3.Speed up adoption of innovation into practice, to improve clinical
outcomes and patient experience
4.Create wealth through co-development, testing, evaluation and early
adoption and spread of new products and services
Health Innovation Network is the AHSN for
South London
South London Members
South London Approach
• Strong public health ethos, and integrated mental, physical
and social care
• Builds on local academic expertise, with a rigorous
approach to evaluation
• Integral involvement of patients, public and third sector
• New industry relationships, supporting wealth generation
locally
Organisational Structure
Joint Membership Council (with HESL)
King’s
AHSC
Industry Advisory
Board
AHSN Board
Industry partnership
Diabetes
Dementia
Executive
Team
CLRN
Research Participation
Evaluation
Alcohol
Informatics
MSK
London Connect
Cancer (LCA)
Patient Experience
CLINICAL THEMES
CLARHC
CROSS-CUTTING
THEMES
Education & training
PATIENT AND PUBLIC INVOLVEMENT
HESL
Structuring Each Clinical Theme
SRO – CEO level
Tertiary
Clinical Directors
Secondary
Programme Manager
Primary
Innovation Fellow
Public Health
Commissioner
Patient/3rd Sector/Carer
Projects aimed to address
each tier of long term condition
pyramid
Expert Panel – multidisciplinary, patient/carer/third sector and industry
Priority
Project
Priority
Project
Priority
Project
Diabetes Team
Andrew Eyres
Senior Responsible Officer, Diabetes Clinical Theme
Health Innovation Network
Chief Officer
Lambeth CCG
Diabetes Team:
Dr Charles Gostling – Clinical Director
Dr Natasha Patel – Clinical Director
South London Clinical Themes
Informed by the Joint Strategic Needs Assessments of the 12 South
London Boroughs
CLINCAL
THEMES
CROSS-CUTTING
THEMES
Diabetes
Industry Partnerships
Research Participation
Dementia
MSK
Alcohol
Evaluation
Informatics
London Connect
Patient Experience
Cancer
Education & Training
Patient & Public Involvement
Why diabetes?
Some key variations in diabetes care
Percentage of people in the National Diabetes Audit with Type 2 diabetes
whose most recent HbA1c measurement was 7.5% or less
Percentage of people in the National Diabetes Audit (NDA) with Type 2 diabetes whose most recent HbA1c measurement was 7.5%
(58 mmol/mol) or less by PCT (1 January 2009 to 31st March 2010). NHS Atlas of Variation
Diabetes Workstreams
Improving Health
Outcomes
Partnership and
Collaboration
Supporting SelfManagement
Adoption and
Innovation
Adopting New
Technologies
Wealth
Creation
Integrated
Care
Communications, Community and Patient Involvement, Workforce
Developments and Commissioning
Self-Management – Structured Education
– Drivers for Change
Quality and outcomes framework 2013/14
‘The percentage of patients newly diagnosed with diabetes, on the
register, in the preceding 1 April to 31 March who have a record of being
referred to a structured education programme within 9 months after entry
on to the diabetes register’
Clinical Commissioning Outcomes Indicator Sets 2013/14; Domain 2
‘Improvement Area’
‘People with diabetes diagnosed less than one year ago referred to
structured education’
Self Management – Structured Education
– do people attend?
Limited data on how many people with diabetes are actually offered
undertake and complete education courses.
Diabetes UK’s 2009 Member Survey reported that only 36% of people
had attended a course.
Attendance Rates
•Best Boroughs in England achieve 50%*
•Best South London Boroughs achieving 30% *
•Lower performing South London Boroughs reporting >10% *
*Health Care Commission national survey of people with diabetes 2007
Structured Education – Solutions to
Improving Update
• Better marketing. Locally and more culturally relevant
• Better organisation – designated administrator
• Courses available in variety of formats – group, individual,
e-learning, etc
• Use peer educators
• Need for ongoing education
Adopting New Technologies Drivers
• Creating Wealth.
• Implementation NICE guidance – in particular technology
appraisals; i.e. use of long acting analogue insulins, use of
GLP-1 therapies, patient education
• New innovations to improve existing practices – especially
e-health
Adopting New Technologies
Pump Therapy
• 6% adults with Type 1 diabetes treated with insulin pumps
vs >15% in some European countries and 40% in USA.
• 19% children treated with insulin pumps.
• ? Is funding the obstacle?
• Only 0.69 WTE nursing time available per centre (adult),
<1 WTE for children.
• Significant number centres still use pump representatives
for training
Integrated care
Integrated Care – Why?
“My mum is 96 years old and lives in Bexley. She was
sent to hospital a few weeks ago,
extremely dehydrated. From the moment sending her
home was discussed I have been
amazed at how well both her needs, and mine, have
been considered. I cried when the
integrated care team asked me how I was coping,
and if they could do anything more for me.
My mum was seen often in her own home, without
the need to chase after help and I can’t
thank everyone enough for caring so much about us.”
Courtesy Dr Nikki Kanani – GP Bexley
Current models of care are not always
integrated
Is this the best
way to manage
care?
How can we move away from this
model?
To put the patient
at the centre of
care
Integrated Care
• Integrated information technology HeLP diabetes,
Diamond,PAERS, EMIS-web, telehealth – how best to
integrate foot-care, Diabetic eye screening, inpatient care
(effective discharge planning etc).
• Align Finances and responsibility
• Care planning ‘Year of Care’
• Clinical engagement and partnerships
• United clinical governance
Where to next?
Invent
Adopt
Adapt
Potential Projects
• Medicines use and investigation of prescriptions to
optimise resources – use long acting analogues vs.
isophane – an implementation toolkit
• Pathways for hypoglycaemia across care settings
• Improving self management through appropriate use of
technologies – exemplar CSII
• Implementation e based structured education programmes
• An integrated pathway to ensure better management for
those with diabetic retinopathy
Small Business Research Innovation
Awards for Diabetes
To avoid this……..
Thank you