Diabetes and the Health Innovation NetworkCharles Gostling

19 September, 2013

As with the other 14 nationally designated AHSNs, the origins of the South London AHSN were in the Innovation Health and Wealth Report, published by the Department of Health in December 2011. The AHSN has 4 core objectives:

1.Focus on needs of patients and local populations

2.Build a culture of partnership and collaboration

3.Speed up adoption of innovation into practice, to improve clinical outcomes and patient experience

4.Create wealth through co-development, testing, evaluation and early adoption and spread of new products and services

Health Innovation Network is the AHSN for South London

Academic Health Science Network Aims

South London Members

• Strong public health ethos, and integrated mental, physical and social care

• Builds on local academic expertise, with a rigorous approach to evaluation

• Integral involvement of patients, public and third sector

• New industry relationships, supporting wealth generation locally

South London Approach

Organisational Structure

AHSN Board

Joint Membership Council (with HESL)

Industry AdvisoryBoard

Executive Team

Diabetes

Dementia

King’s AHSC

CLARHC

CLRN

Alcohol

MSK

Cancer (LCA)

Research Participation

Patient Experience

London Connect

Evaluation

Informatics

Industry partnership

HESLCLINICAL THEMES Education & training

CROSS-CUTTING THEMES

PATIENT AND PUBLIC INVOLVEMENT

Structuring Each Clinical Theme

Tertiary

Secondary

Primary

Public Health

SRO – CEO level

Clinical Directors

Programme Manager

Innovation Fellow

Commissioner

Patient/3rd Sector/Carer

Expert Panel – multidisciplinary, patient/carer/third sector and industry

Priority Project

Priority Project

Priority Project

Projects aimed to address each tier of long term condition pyramid

Andrew Eyres

Senior Responsible Officer, Diabetes Clinical Theme

Health Innovation Network

Chief Officer

Lambeth CCG

Diabetes Team:

Dr Charles Gostling – Clinical Director

Dr Natasha Patel – Clinical Director

Diabetes Team

Informed by the Joint Strategic Needs Assessments of the 12 South London Boroughs

South London Clinical Themes

Diabetes

Dementia

MSK

Alcohol

Cancer

CLINCAL THEMES

Industry Partnerships

Research Participation

Evaluation

Informatics

London Connect

Patient Experience

Education & Training

CROSS-CUTTING THEMES

Patient & Public Involvement

Why diabetes?

Some key variations in diabetes care

0

10

20

30

40

50

60

Sta

nd

ard

ised

Rat

e p

er 1

00,0

00

Emergency admissions 2010/11: diabetic ketoacidosis

England

London

68% 68%

72%

69%

50%

55%

60%

65%

70%

75%

80%

% of patients with HbA1c <=8mmol/mol, 2011-12

England

London SHA

0

5,000

10,000

15,000

20,000

25,000

30,000

Diabetes detection level, 2011-12Detected prevalence Undetected prevalence

78% 70% 68% 69% 69% 63% 76% 54% 66% 77% 71%Detection ratio

Percentage of people in the National Diabetes Audit with Type 2 diabetes whose most recent HbA1c measurement was 7.5% or less

Percentage of people in the National Diabetes Audit (NDA) with Type 2 diabetes whose most recent HbA1c measurement was 7.5% (58 mmol/mol) or less by PCT (1 January 2009 to 31st March 2010). NHS Atlas of Variation

Diabetes Workstreams

Improving Health Outcomes

Partnership and Collaboration

Adoption and Innovation

Wealth Creation

Supporting Self-Management

Adopting New Technologies

Integrated Care

Communications, Community and Patient Involvement, Workforce Developments and Commissioning

Quality and outcomes framework 2013/14

‘The percentage of patients newly diagnosed with diabetes, on the register, in the preceding 1 April to 31 March who have a record of being referred to a structured education programme within 9 months after entry on to the diabetes register’

Clinical Commissioning Outcomes Indicator Sets 2013/14; Domain 2 ‘Improvement Area’

‘People with diabetes diagnosed less than one year ago referred to structured education’

Self-Management – Structured Education – Drivers for Change

Limited data on how many people with diabetes are actually offered undertake and complete education courses.

Diabetes UK’s 2009 Member Survey reported that only 36% of people had attended a course.

Attendance Rates

•Best Boroughs in England achieve 50%*•Best South London Boroughs achieving 30% *•Lower performing South London Boroughs reporting >10% *

*Health Care Commission national survey of people with diabetes 2007

Self Management – Structured Education – do people attend?

• Better marketing. Locally and more culturally relevant

• Better organisation – designated administrator

• Courses available in variety of formats – group, individual, e-learning, etc

• Use peer educators

• Need for ongoing education

Structured Education – Solutions to Improving Update

• Creating Wealth.

• Implementation NICE guidance – in particular technology appraisals; i.e. use of long acting analogue insulins, use of GLP-1 therapies, patient education

• New innovations to improve existing practices – especially e-health

Adopting New Technologies Drivers

• 6% adults with Type 1 diabetes treated with insulin pumps vs >15% in some European countries and 40% in USA.

• 19% children treated with insulin pumps.

• ? Is funding the obstacle?

• Only 0.69 WTE nursing time available per centre (adult), <1 WTE for children.

• Significant number centres still use pump representatives for training

Pump Therapy

Adopting New Technologies

Integrated care

Integrated Care – Why?

“My mum is 96 years old and lives in Bexley. She was sent to hospital a few weeks ago,

extremely dehydrated. From the moment sending her home was discussed I have been

amazed at how well both her needs, and mine, have been considered. I cried when the

integrated care team asked me how I was coping, and if they could do anything more for me.

My mum was seen often in her own home, without the need to chase after help and I can’t

thank everyone enough for caring so much about us.”

Courtesy Dr Nikki Kanani – GP Bexley

Current models of care are not always integrated

Is this the best way to manage care?

How can we move away from this model? To put the patient at the centre of care

• Integrated information technology HeLP diabetes, Diamond,PAERS, EMIS-web, telehealth – how best to integrate foot-care, Diabetic eye screening, inpatient care (effective discharge planning etc).

• Align Finances and responsibility

• Care planning ‘Year of Care’

• Clinical engagement and partnerships

• United clinical governance

Integrated Care

Where to next?

Invent Adopt

Adapt

• Medicines use and investigation of prescriptions to optimise resources – use long acting analogues vs. isophane – an implementation toolkit

• Pathways for hypoglycaemia across care settings• Improving self management through appropriate use of

technologies – exemplar CSII• Implementation e based structured education programmes• An integrated pathway to ensure better management for

those with diabetic retinopathy

Potential Projects

Small Business Research Innovation Awards for Diabetes

To avoid this……..

Thank you