nhs diabetes prevention programme: the journey so far€¦ · programme: the journey so far...

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NHS Diabetes Prevention

Programme: The Journey so Far

Professor Jonathan Valabhji

National Clinical Director for Obesity and Diabetes, NHS England

Consultant Diabetologist, Imperial College Healthcare NHS Trust

Adjunct Professor, Imperial College London

www.england.nhs.uk/expo | @ExpoNHS | #Expo18NHS 2

5 Year Forward View 2014

“The future health of millions of children,

the sustainability of the NHS, and the

economic prosperity of Britain all now

depend on a radical upgrade in

prevention and public health”

5 Year Forward View - Prevention


• Available for those individuals who have non diabetic hyperglycaemia (at high risk of Type 2 diabetes)

• Programme over 9 months to support long term changes in lifestyle to lower risk, including:

• Achieving a healthy weight

• Improving nutrition

• Increasing physical activity

• Significant evidence that Type 2 diabetes can be prevented through these changes

The NHS Diabetes Prevention Programme


• Current Framework achieved 100% programme coverage of England earlier this year.

• To date over 230k have been referred, around 104k initial assessments and over 50k have attended a first intervention session.

• In 2017/18 the programme exceeded its Mandate and FYFV targets and the programme is ahead of profile to achieve its 2020 Mandate target of 100k on programme per year.

Progress to date


• First wave of national roll-out

• 27 local health economies – 50% coverage of England

• 43,000 referrals, 59% conversion to attendance

Evolution - 2016/2017


• Second wave of national roll-out

• 13 larger geographies - 75% coverage of England

• 182,000 referrals, 78,000 attended initial assessment

Evolution - 2017/2018


Characteristics of participants

44%

55%

45%

55%

0%

10%

20%

30%

40%

50%

60%

Male Female

Pe

rce

nta

ge

Sex

2016/17 2017/18

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

18-24 30-34 40-44 50-54 60-64 70-74 80-84

Pe

rce

nta

ge

Age

2016/17 2017/18

19%20% 20% 20% 21%20%

21%

23%

19%17%

0%

5%

10%

15%

20%

25%

IMD 1(Most

deprived)

IMD 2 IMD 3 IMD 4 IMD 5(Least

deprived)

Pe

rce

nta

ge

Deprivation quintile

2016/17 2017/18

26%

67%

7%

19%

69%

13%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Asian, black, mixed,other

White Unknown

Pe

rce

nta

ge

Ethnicity

2016/17 2017/18


Initial analysis of completers to March 2018

• 52% of participants attended 8 sessions or more (out of 13 sessions)

• Mean weight change for completers -3.2kg (-3.1 to -3.4kg)

• Mean weight change for all (intention-to-treat, last observation carried

forward) -2.3kg (-2.2 to -2.4kg)

• Percentage mean weight change of -3.8% (-3.6 to -4.0%)

• Mean weight change for all (intention-to-treat, last observation carried

forward) -2.7% (-2.5 to -2.8%)


Evolving the Healthier You NHS Diabetes Prevention ProgrammeOpportunities for Digital Health Interventions


Evaluating the NHS Diabetes Prevention Programme (NHS DPP): the

DIPLOMA research programme

Diabetes Prevention – Long term Multimethod Assessment



Programme: A user perspective

Bridget Hopwood – Diabetes UK


• Public consultation hosted by Diabetes UK

• 215 completed on-line survey responses

• Also gained some more in-depth feedback from attending provider

events and DPP sessions around the country.

• 43 respondents

• 2 x focus groups and 1:1 interviews

• Range of backgrounds / demographics

Context


Referral

Initial

Assessment Intervention

Sessions

Delivery:

Remote vs

f2f

Completion

Journey through the NHS DPP


“GPs should attend too”

“They didn’t know much about it. It was

quite frightening, I knew something was

wrong but they just gave me a phone

number to ring”

Referral


“People need to know more. It

was too vague why the course is 9 months.”

“Tell them why it is important – it is about continual support; emphasise the lifestyle element – about making a lifestyle change . Then there is a perception from day 1 about how it is for your life

longer term. Focus your mind.”

Referral


“Use ‘scare tactics’ …like

on cigarette boxes”

“I got a separate letter, so I could do

what I wanted – go, or not go. The

seriousness of it was not conveyed

by the GP”

Referral


Programme delivery: Face to face

“I know it'll be hard but being with

other people will influence me and - I

hope - add to my resolve to make a

change in my life.”

“…turning up is part of the

commitment”


“The consequences and complications

section…was very emotional and shocking.

Here you have people around you to

support you and help you…”

“Wouldn't enjoy it as much not in a

group. Coming out of the house is

important, I have nowhere to go, not

many friends”

Programme delivery: Face to face


Programme delivery – Remote support

“A very good idea that will help

the housebound & disabled public”

“As a shift worker I would find it difficult to get to

a location at the same time every week due to

work commitments.”


“Doing it in your own time and pace

makes it easier to complete with other

commitments”

“I would not be comfortable in a

group and more likely to drop out of

the programme. I would be more

likely to complete the programme if

it was delivered remotely.”

Programme delivery – Remote support


End of programme

“Wonderful. Everything about it was

wonderful – portion control, exercise. I feel

‘born again’, fresh and new”

“It has opened my eyes. I learnt how to

make changes, I've made changes to

my diet. I have learnt a lot of

information I didn't know.”


“After 9 months it stops completely. Need

something else afterwards to maintain that

lifestyle, on-going”

“Hope I can be on track once I've finished. Need

to keep 'checking in', need incentives to carry

on”

“Linking in with other things would stop the void

after programme finishes.”

End of programme


Summary• Referral process: referrer needs to be knowledgeable about the

programme, T2 Diabetes and the seriousness of it.

• Pre-course communication is vital – needs to be regular to maintain

momentum, manage expectations and reduce anxiety.

• Group learning likely to be more effective but remote provides a

flexible alternative and increases reach

• Programme itself needs to be flexible, tailored to local communities

and provide opportunities for 1:1 support where possible

• Support at end of programme needed – regular check-ins or links with

existing community services etc.



Programme: Next Steps

Tom Newbound – National Implementation Lead

NHS England


• Current Framework expires March 2019

• Opportunities for improvement:

• Currently up to half of people referred decline the service and a further percentage don’t progress to group sessions;

• For a range of individuals there are barriers to committing to and attending a face to face intervention;

• Remote can support attendance and retention on face to face services;

• Digital diabetes prevention services provide an opportunity to extend access to those who decline or do not progress onto the face-to-face service.

The Provider Framework


• We have undertaken analysis of the characteristics of those who decline or do not progress through the current face to face service.

• In order of importance characteristics of those declining are that they are of working age, deprived and from a BAME demographic.

• If we can show that digital delivery routes boost uptake for these demographics we can raise overall performance and target health inequalities.

Who could benefit from digital?


• Evidence base for digital approaches not yet as well developed

• Important that patients are offered a high quality service with a robust evidence base

• Taking a novel approach to the inclusion of digital, where patients are offered digital at the point where it is clear that face to face is not a suitable route of access for them

• Programme therefore continues to offer a single point of access to patients and primary care for support preventing their diabetes

Incorporating Digital


• The main observable health inequalities in diabetes relate to who

develops diabetes, with South Asian populations up to 6 times more

likely to develop diabetes than white populations and black populations

3 times more likely;

• Future allocation of programme capacity from 2019/20 will be linked to

both social deprivation and BAME prevalence;

• Outcome based payment for providers focused on both social

deprivation and BAME;

• Digital services likely to be of greater benefit proportionally to BAME

people as they are on average younger.

Inequalities


Next Steps

• Invitation To Tender closes 15 Oct

• Framework Provider approvals Dec 2018

• Implementation begins from Jan 2019

• 40% of England will take up these new services from July 2019

• First time that we will offer a digital service at this scale so implementation challenges to overcome


• NHS England will continue to commission and fund the NHS DPP nationally

for at least a further 3 years from 19/20.

• Digital included to widen access, but only in addition to face to face, does not,

and will not replace.

• Clear focus on widening access and supporting our working age cohorts.

• New providers and framework, and therefore will be an implementation phase.

• Programme working, with weight loss in line with the RCT evidence base that

we have drawn from.

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nhs diabetes prevention programme: the journey so far€¦ · programme: the journey so far...

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