Agenda item

Lesley Wyman introduced her presentation to the Board on tackling type two diabetes in West Berkshire. Joint working was taking place between the Local Authority and the Clinical Commissioning Groups however, areas of work were needed to promote this. Lesley Wyman proposed that type two diabetes was an area where the Board could positively demonstrate joint working and was aligned to the Health and Wellbeing Strategy. A piece of work was required which established how large an issue type two diabetes was in West Berkshire.

The priority within the Health and Wellbeing Board Strategy which gave focus to type two diabetes was:

Supporting those over 40 years old to address lifestyle choices detrimental to health

In order to help prevent diabetes and assist early identification of the disease there were a number of areas that could be focused on such as increasing health checks to help identify early cases of diabetes; promoting healthy eating to reduce obesity, one of the largest risk factors in developing diabetes; promoting and supporting work places supported healthy lifestyles and ensuring services were accessible to those living in rural locations as people with diabetes as well as the elderly were at risk of becoming isolated.

Lesley Wyman referred to a slide which illustrated the estimated total (diagnosed and undiagnosed) diabetes prevalence in adults in WB (PHE). Much work had been carried out with the Public Health Observatories and Public Health England in studying the prevalence of diabetes in different areas. Figures showed that in 2012 the estimated prevalence of diabetes in West Berkshire was 6.5%. Lesley Wyman highlighted that these were just estimates and therefore were adjusted by age, sex, ethnic group and deprivation pattern of the local population

Although figures in West Berkshire were lower that the England average, they were still predicted to rise and could be as high as 7.5% by 2025.

Lesley Wyman continued to the next slide which looked at the Quality Outcomes Framework figures (QOF) for 2011/12. She reported that the number of patients on the diabetes register had risen to just below 5000 from 4829 (2011/12) across the 14 GP practices. Prevalence ranged from 3.1% to 4.9% with an average of 4.1%. It was suspected that there were also many people who had developed type two diabetes, but not yet been diagnosed.

Lesley Wyman briefly talked about the complications of diabetes. Those over 45 with type two diabetes were more likely to be admitted to hospital as it was associated with a whole host of other health problems.

It was vital that the JSNA was used to assess what services needed commissioning. Then once commissioned they needed to be monitored and evaluated. In essence three steps needed to be followed:

·         Step 1 – understand the health needs of the population with diabetes.

·         Step 2 – understand what needed to be commissioned as an integrated service.

·         Step 3 – implementation of key services across the care pathway from prevention and early identification through to treatment and supporting those living with diabetes.

Lesley highlighted the different components which were required for commissioning across the diabetes care pathway. Regarding seeking out those at risk, there was already positive work taking place within communities. There was a Silver Star Bus (screening bus) which visited Mosques and temples. Its key objective was to raise awareness within communities and encourage people to go for a screening, especially men who were more at risk of developing diabetes.

It was important that both the Voluntary and Community Sector were included when shaping services for diabetes, as well as people living with the condition, particularly when it came to decision making.

There was no shortage of NICE guidance to support commissioning across the diabetes care pathway. It was important that emotional, psychological and mental wellbeing were considered.

IAPT (Increasing Access to Psychological Therapies) were piloting a new course targeting people living with long term conditions like diabetes, as these people often became isolated and depressed.

Lesley Wyman felt that more positive press was needed within local media, particularly in relation to what was being done to tackle diabetes. This would help to raise the awareness of diabetes in West Berkshire. Awareness raising activities could also be held in places within the community such as leisure centres, schools, pubs, libraries etc. It was noted by the Board that there was a lot of work taking place around diabetes however, more could be done.

Dr Catherine Kelly informed the Board about the Diabetic service in Newbury and North and West Reading CCGs.

A National Diabetes Audit had taken place and shown that diabetic services provided by Newbury and District, North and West Reading and Wokingham were expensive however were not achieving good outcomes for patients. This had led to a redesign of services across all four CCGs. A working group has been set up to tackle the situation and stakeholders across the pathways had worked together including patients, GPs, practice nurses, consultants, pharmacists and community services. 

The key to tackling diabetes was diet and exercise. There were two groups of people with diabetes. Type two was often caused by an unhealthily diet and lack of exercise and type one was caused through insulin resistance.

Education Programs for patients and professionals had been set up to help education practice nurses and GPs to ensure better care was given to those with diabetes.

There had been improved integration within the service between hospitals and community services including four new Specialist Diabetic Nurses, a specialist consultant and an improved diabetic eye screening service. The aim of this was to reduce the amount of times people with diabetes had to go into hospital. There was also a new talking therapy programme, which people were referred to through their Health Professional.

Dr Kelly stated that it was about a new way of working which took the care planning approach and involved working with patients to look at what they wanted to do about their results.

There was a new diabetic website for patients, which could be used by both patients and professionals and a new IT program which enabled patients to access and monitor their results. Virtual Clinics were being introduced as another way to decrease the amount of trips taken to hospital.

Dr Kelly stated that this was a great opportunity for the Health and Wellbeing Board. If the Board decided to support the diabetes agenda, Dr Kelly reported that Richard Croft who chaired the Diabetic working group would be happy to come and speak in more detail about what was happening locally.

Dr Anderson reported that the Falkland Surgery was carrying out a pilot scheme to help identify people who were in the pre-diabetic stages by introducing lifestyle management steps.

Rachael Wardell questioned whether the redesign of diabetic services was being carried out with existing resource or required investment. Dr Kelly confirmed that the specialist nurses and consultant were new investments. The eye screening service would be supported through existing resources.

Rachael Wardell stressed that an impact evaluation was required to assist with the redesign of services, this would help determine how best to invest new time and money.

It was proposed that the Health and Wellbeing Board set up a sub-group or focused workshops to look at what the gaps were regarding diabetic services and how it could assist with improving the situation. Adrian Barker stressed that if there was a working group then diabetic patients needed to be on the group.

Andy Day reported that there was already a diabetic working group in existence, so rather than create a new one this should be used. Lesley Wyman was concerned that this group already had a very large agenda and therefore did not see it as a suitable option.

RESOLVED that: a meeting be set up to take the work forward and to discuss the need for a diabetes working group.