diabetes and the health innovation network charles gostling 19 september, 2013
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Diabetes and the Health Innovation NetworkCharles Gostling
19 September, 2013
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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
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South London Members
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• 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
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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
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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
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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
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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
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Why diabetes?
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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
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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
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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
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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
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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?
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• 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
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• 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
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• 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
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Integrated care
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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
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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
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• 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
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Where to next?
Invent Adopt
Adapt
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• 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
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Small Business Research Innovation Awards for Diabetes
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To avoid this……..
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Thank you