National service frameworks (NSFs)
National service frameworks (NSF’s) have been established to improve services by setting National Standards, their aim is to reduce variations in care and improve the quality of care provided based upon the best available evidence. Each country has its own National Service Framework, although they may vary slightly from country to country what they have in common is that they all aim to detect, treat plan and manage services under one umbrella.
Northern Ireland does not have a National Service Framework it has a Taskforce, which has been charged with developing and providing national guidance. Within each framework the patient is central, this places emphasis on the person and the role that they have to play. To assist with the implementation of the NSF England and Wales have a delivery strategy (DOH 2003), which details how standards that were set out in the NSF could be delivered locally.
England
There are 1.3 million people with diagnosed diabetes in England, 15% of these have type1 diabetes and 85% type 2 diabetes (Department of Health DOH 2001). It is estimated that this figure will increase to 3 million by the year 2010. The reason for this will be due to a combination of an increasing elderly population and rising levels of obesity in the population (Audit Commission 2000).
Diabetes is the biggest cause of kidney failure, the leading cause of blindness in adults of working age, and one of the biggest causes of lower limb amputation. Furthermore it increases the risk of coronary artery disease and stroke. It is estimated to consume up to 10% of hospital resources. England has a National service framework for Diabetes this has a separate delivery strategy.
Northern Ireland
Growing prevalence of diabetes presents a serious threat, Northern Ireland Task Force convened in March 2001, in response to developments in the Republic of Ireland and the Diabetes National Service Frameworks in England, Scotland and Wales. The task force would review the 1996 Clinical resource efficiency support team guidelines (CREST 1996). A guide on the management of pregnancy in primary care has been issued by CREST (CREST 2001). The perinatal mortality in Northern Ireland is 36.7/1000 and congenital malformations 64.7/1000
Estimated that 40,000 people in Northern Ireland have been diagnosed with diabetes, a further 25,000 have the condition and don't know it.
£1 in every £7 spent by the NHS in Northern Ireland goes towards diabetes care, it has been estimated that the cost will be at least £1billion over the next ten years. Delivery of the task force recommendations is not explicit in the report.
Scotland
There are 150,000 people in Scotland with diabetes, and it is estimated that this figure will double in the next 10-15 years. Diabetes is estimated to account for about 5% of the NHS costs in Scotland, this equates to over £320million (Scottish Executive 2002).
The Framework Working Group is working with partner organisations to ensure that one set of recommendations is produced to guide the range of support and services that should be provided for people with diabetes, as there is no delivery strategy.
Wales
Approximately 75,000 people in Wales are currently diagnosed with diabetes, and in addition many thousands may have Type 2 diabetes and not be aware of it (Welsh Assembly Government 2002). The Welsh NSF for diabetes is the same format as the English NSF. The delivery strategy was published in the 2003.