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No change one year on from NSF, says diabetes charity

Published on 26/04/04 at 04:09pm

One year on from the launch of the National Service Framework (NSF) for Diabetes, the planning of care has improved but patients have yet to see the benefits, according to charity Diabetes UK.

The NSF aims to improve care for the 1.3 million people in the UK who have diabetes as well as identifying the estimated one million others with undiagnosed diabetes.

Bridget Turner, head of policy at Diabetes UK acknowledged that diabetes had risen up the NHS list of priorities but said: "Things haven't been put in on the ground in the majority of places to enable people with diabetes to see much of a difference yet." She said the optional nature of the NSF, which contains very few concrete targets means the buy-in at a local level is reduced as other targets which carry greater weight and are monitored by Whitehall win resources of time and money.

"More targets, clearer targets and ring-fenced resources to actually do it would have been a lot more help to move things quickly," she said.

Pharmaceutical companies involved in the area  have also noted little direct action promised to improve frontline care and eradicate the image of diabetes care as an under-resourced 'Cinderella service' despite progress made at the strategic level.

Paul Hackworth, marketing manager for the Diabetes Business Unit at Aventis welcomed the progress the NSF had made, but said funding for diabetes care remained an issue.

"The diabetes NSF is a good thing, but the question for pharmaceutical companies and healthcare practitioners alike is about the availability of funding for its implementation," he said.

He added that the NSF would be complemented by the new GP contract, which includes incentives for GPs to manage patients with diabetes more carefully, but he said that was only a start.

Like other companies in the field, Aventis provides primary care clinicians with training and education in managing patients.

"There's a long way to go and more central funding from government for drugs, for people, for more consultants and diabetic specialist nurses is needed to meet the targets in the NSF," he said.

The remarks follow the publication in April of the Department of Health's (DH) own review of the strategy, a document called One Year On, despite the fact that the delivery strategy was launched 15 months ago and the NSF standards first published in December 2001.

The report also contains tacit admissions that the NSF is running behind schedule on all of its aims for its first year in operation. First among these was the setting up of a local diabetes network. This complex process is to include involving local leaders, appointing and resourcing network managers, clinical champions and one or more people with diabetes to champion the views of local people.

The report admits the development of this networks is "at an early stage for most health communities", adding: "Some networks set out to appoint network managers but where diabetes is not seen as a priority by PCTs, this is less successful." Rather than containing milestones for the first year - as in the CHD NSF - the Diabetes NSF instead identified optional steps that PCTs "may wish" to follow in its first year.

In the January 2003 document the DH said it would assume PCTs will wish to spend money on the building capacity to treat diabetes.

The NSF set out medium-term targets to be achieved within three to four years. These included practice-based registers and systematic treatment regimens to cover the majority of patients at high risk of coronary heart disease by 2006, and eye-screening services to be provided by every PCT for all diabetics at risk of retinopathy by 2007.

Effective registers are critical to enable primary care clinicians to manage the condition of diabetes patients, as well as identifying high-risk or undiagnosed patients.

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