National service frameworks: Northern Ireland

In 2006 it was estimated there were 74,000 people living with diabetes in Northern Ireland - 49,000 diagnosed and 25,000 undiagnosed (Ireland and Northern Ireland's Population Health Observatory 2006).

The Northern Ireland Diabetes Task Force submitted a framework for diabetes care to the Clinical Resource Efficiency Support Team (CREST) which was published in 2003 as ‘A blueprint for diabetes care’. The framework was made up of 18‘key building blocks that were grouped into five main areas.

CREST has since joined with other groups to form the Guidelines and Audit Implementation Network (GAIN). Prior to this framework CREST had already published guidelines for management of diabetes in pregnancy with the aim of addressing unacceptably high perinatal mortality and malformation rates in babies born to diabetic mothers.

In 2009 diabetes was included as part of the Service Framework for cardiovascular health and wellbeing. This is one of a number of frameworks being developed which set out the type of services that patients and users in Northern Ireland should expect specifying the standards and supporting actions required.

The Framework for cardiovascular health and wellbeing sets out three overarching standards for diabetes:

accurate diagnosis of diabetes
the provision of access to structured education programmes and emotional and psychological support for all patients with diabetes
access to, at a minimum, an annual review to a defined standard by an appropriately trained multidisciplinary team.

Diabetes UK Northern Ireland have expressed concern that these standards are insufficient to adequately address issues around diabetes prevention, diagnosis and treatment in Northern Ireland.

Details of the framework documents referred to can be found below.

Key documents

Many of the documents below are in PDF format. See how to access PDF files.

National framework

CREST (2003) A Blueprint for Diabetes Care in Northern Ireland in the 21st Century
The framework and associated documents are made available on the Guidelines and Audit Implementation Network (GAIN) website in Northern Ireland.

Department of Health, Social Services and Public Safety (2009) Service frameworks: Cardiovascular health and wellbeing
This is one of a range of service frameworks which set out explicit standards for health and social care in Northern Ireland. The standards have been informed by expert advice and by national standard setting bodies such as the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE). Standards for diabetes have been included as part of this framework.

Department of Health, Social Services and Public Safety (2009) Service framework for cardiovascular health and wellbeing: Diabetes (PDF 40KB)
These standards for diabetes care in Northern Ireland are included in the service framework for cardiovascular health and wellbeing. There are three standards which focus on diagnosis, the delivery of annual reviews and ensuring access to structured education programmes and emotional and psychological support.

Diabetes UK: Health care policy in Northern Ireland
Diabetes UK Northern Ireland continue to lobby and campaign for a dedicated service framework for diabetes.

National clinical guidelines and standards

Further guidelines and guidance and standards for specific aspects of diabetes and diabetes care are also included within the specific resource lists.

CREST (2006) Safe and effective use of insulin in secondary care: recommendations for treating hyperglycaemia in adults (PDF 415KB)
Recommendations are presented in four sections: education and training; protocols and administration; medical incidents and discharge planning; and audit. They are made available on the GAIN website.

CREST (2001) Management of diabetes in pregnancy (PDF 207KB)
The guidelines aim to provide a standard of joint diabetic and obstetric specialist care across Northern Ireland in the management of diabetes in pregnancy. They are made available on the GAIN website.

Guidelines and Audit Implementation Network (2010) Guidelines and clinical standards of care for people with diabetes in care homes (PDF 225.70KB)
These guidelines set out four minimum standards of care which will be subject to audit. These are in line with the national recommendations and standards of care for diabetes. The guidelines aim to optimise the quality of life of people with diabetes living in care homes and provide guidance to reduce the risks of developing complications.