Diabetes - England

According to a statistical compilation from Diabetes UK, as of 2011, there are 2.9 million people who have been diagnosed with diabetes and about 850,000 more people who have diabetes but have not been diagnosed. In England nearly 2.5 million adults have diabetes - see Diabetes in the UK 2012.

The resources below were last accessed on 18 January 2013. Many of them are in PDF format - see how to access PDF files.

They are arranged under headings.

• National service frameworks  
• National clinical guidelines and standards  
• National diabetes audit  
• Commissioning guidance  
• Other resources.

National service frameworks

Department of Health (2001) National Service Framework for Diabetes
National service frameworks are long term strategies for improving specific areas of care. The National Service Framework for diabetes, published in 2001, sets national standards and identifies key interventions for all aspects of diabetes care and prevention.

Department of Health (2002) National Service Framework for diabetes: Delivery strategy
The delivery strategy sets out the national targets against which local NHS performance on the standards set out in the National Service Framework can be judged.

Department of Health (2003) Diabetes Information Strategy
This information strategy from the Department of Health is an integral part of the National Service Framework delivery strategy. The document sets out the infrastructure for information and information systems and services required to deliver the improvements in services identified by the National Service Framework.

Royal College of Nursing (2003) An RCN guide to the National Service Framework for Diabetes (PDF 132.8KB)
This publication produced by the RCN Diabetes Nursing Forum summarises the standards, offers practical tips on achieving them and outlines the delivery strategy.

Reports are published annually highlighting the progress made with the implementation of the Diabetes National Service Framework since the publication of the National Service Framework delivery strategy. Each report comments on the progress over all the intervening years:

• Department of Health (2010) Six years on: delivering the diabetes national service framework
• Department of Health (2008) Five years on: delivering the diabetes national service framework
• Department of Health (2007) The way ahead: the local challenge - Improving diabetes services: the national service framework four years on
• Department of Health (2006) Turning the corner: improving diabetes care
• Department of Health (2005) Improving diabetes services : the NSF two years on
• Department of Health(2004) National service framework for diabetes one year on.

House of Commons Public Accounts Committee (2012) Seventeenth report: Department of Health: The management of adult diabetes services in the NHS
The report concludes that since the publication of the National Service Framework for Diabetes in 2001 the improvements in diabetes services have not been as great as expected given that the Department of Health set out clear and clinically agreed standards. Variation in the level of progress across the NHS also means that there is an unacceptable "postcode lottery" of care, whereby the quality of diabetes care varies dramatically across the NHS.

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.

NICE - Diabetes

NICE is an independent organisation responsible developing evidence-based clinical guidelines, public health guidance, technology appraisals and pathways. NICE also sets standards for high-quality care (quality standards).

NICE has published clinical guidelines, quality standards and pathways for diabetes. For all diabetes related guidance, public health guidance and technology appraisals, see: NICE Diabetes. This includes:

• CG15: Type 1 diabetes: Diagnosis and management of type 1 diabetes in children, young people and adults.
• CG66: Type 2 diabetes: The management of type 2 diabetes. 
• CG87 Type 2 Diabetes: The management of type 2 diabetes (This is a partial update of CG66)
• Diabetes in adults quality standard (QS6). This quality standard defines clinical best practice in diabetes care in adults excluding children, young people and pregnant women. It provides specific, concise quality statements, measures and audience descriptors to provide patients and the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.
• NICE pathway: Diabetes. This online tool provides quick and easy access to a range of guidance from NICE on diabetes, including quality standards, technology appraisals, clinical and public health guidance and NICE implementation tools.
• NHS Diabetes (2012) Best Practice Tariff for Paediatric Diabetes. In England, NHS Diabetes and the Paediatric Diabetes Networks have worked with the Department of Health to draw up a set of standards that aim to ensure the delivery of high quality paediatric services to every child and young person under 19 with diabetes. These are delivered as out-patient services. The standards are being applied as from April 2012. A paediatric diabetes tariff will offer an enhanced payment to centres that meet the criteria set by these minimum standards of care. A section of the NHS Diabetes website explains the system including FAQs and also information for parents, children and young people.

National diabetes audit 

National Clinic Audit Support Programme (NCASP): Diabetes
NCASP, which is part of the NHS Information Centre for Health and Social Care, delivers the National Diabetes Audit (NDA) in partnership with the Health care Commission. The NDA provides an infrastructure for the collation, analysis, benchmarking and feedback of local clinical data to support effective clinical audit across the NHS. These pages on the information centre website describe the objectives and organisation of the NDA. All reports are available at Diabetes audit reports.

Royal College of Paediatrics and Child Health (2012) National Paediatric Diabetes Audit (NPDA)
The quality of care for infants, children and young people with diabetes is at an eight-year high, according to the results of the largest ever paediatric diabetes audit published by the Royal College of Paediatrics and Child Health. But despite improvements in care processes and outcomes for children with diabetes in England and Wales these remain significantly worse than those for adults - and Hba1c outcomes (a marker of overall diabetes control) still remain poor in comparison to some other European countries.
News: Results of the NPDA released.

Commissioning guidance

NHS Diabetes commissioning resource
This web resource aims to offer practical support, templates, information and case studies for diabetes commissioners and health care professionals to enhance the World Class Commissioning skills and capability to deliver the Diabetes National Service Framework. There are links to commissioning guides for many specific areas of diabetes care and for specific population groups.

NHS Diabetes: Areas of care: Equality in diabetes
This page is aimed at commissioners and providers of diabetes care. It brings together guidance, policy, commissioning guides, links to care pathways and examples of how services can be improved for everyone who lives with diabetes. 'Equality in diabetes runs through every diabetes care area and is evident in every pathway, therefore is pivotal to providing equitable diabetes care for all people who live with diabetes'.

NHS Diabetes and Diabetes UK (2012) Implementing local diabetes networks (PDF 541.2KB)
"There is increasing pressure on the NHS to deliver improved services with limited resources. Effective commissioning and monitoring of services are crucial to driving up quality, improving patient outcomes and delivering the twenty billion pound QIPP". Establishing local diabetes networks can help to achieve this. This report is aimed at commissioners of diabetes services and provides guidance and support needed "to create the local diabetes networks that really can deliver high-quality, cost-effective care through the effective commissioning, delivery and monitoring of services" - see also the NHS Diabetes news item on this report.  

Other resources

Diabetes UK: Reports, statistics and case studies
This area of the Diabetes UK website lists publications produced by Diabetes UK sometimes in partnership with other organisations. This includes overviews and statistics about who is affected and how, for example the State of the Nation reports and the Diabetes prevalence updates.

NHS Diabetes: Reports and guidance
This area of the NHS Diabetes website highlights key reports and guidance relating to diabetes and service improvements which have been published by NHS Diabetes and other organisations.

NHS Diabetes: Factsheets
Factsheets bring together the most important facts and information on a selected topic and can also take the form of a summary of key points from a report.

Health and Social Care Information Centre (HSCIC)(2012) Prescribing for diabetes in England: 2005/6 to 2011/12
Over the period 2005/6 to 2011/12 there was an increase in the number of items for diabetes of 49.9 per cent (13.5 million) and in net ingredient cost of 47.9 per cent (£246.3 million).

You can access information about the other UK countries from National standards and guidance.