Commissioners will soon learn how to apply for a share of NHS England’s £40m Diabetes Transformation Fund (DTF). This follows Simon Stevens' hints in the 2017-19 NHS Operating and Planning Guidance.
Each year Diabetes UK (DUK) publish their State of the Nation Report highlighting current need. The International Diabetes Foundation (IDF) also publish the world Diabetes Atlas annually. Both make sober reading, with global prevalence forecast to rise by 55% by 2040. Closer to home, DUK CEO Chris Askew has stated that “Diabetes is a crisis for the health of the nation”. This is a view echoed by the Public Accounts Committee.
Last week at the Diabetes All Party Parliamentary Group (APPG) reception, Simon Stevens made a big deal of the NHS shifting its focus from treatment to prevention. With 80% of the £10bn that diabetes consumes of the NHS annual budget being spent on avoidable complications, this is a welcome shift. Having lived with Type 1 diabetes for many years and served as a trustee and, more recently, vice president of Diabetes UK and the IDF, it is something I’ve been advocating for over many years.
Speculation over who will be able to bid for DTF is expected to be met with compromise, opening it up to CCGs or collectives, such as STP footprints.
Uptake of structured education is likely to be a key target for the DTF. The National Diabetes Audit tells us that only 3 per cent of people with diabetes attend existing programmes each year. Beyond this, one has to ask how much supported self-management exists. Diabetes UK reckons a patient sees a health professional for 3 hours a year. For the remaining 8,757 we are left to “just about manage”, to coin a phrase.
Changing Health offers the potential to address this gap. We provide access to the first evidence based digital education programme for people with Type 2, based on X-PERT. Critically, we are embedding this into an enhanced service pathway incorporating the first evidence based behaviour change toolkit, including personalised coaching for a year.
In practical terms this means people will get access to behaviour change tools online via mobile, tablet or PC. These are combined with 1-2-1 evidence-based coaching using methodology proven to reduce HbA1c levels and body weight, based on NIHR and MRC funded research at Newcastle University and Newcastle Hospitals NHS Foundation Trust. All our tools have been researched and developed at Newcastle working closely with patients and healthcare professionals throughout.
The APPG, DUK and others have found that many healthcare professionals have lost faith in education service provision. This is because they so often face lengthy waiting lists and low attendance among referred patients. However, it has been shown that web-based programmes can bring a significant boost to uptake. This is because time and location barriers are removed. Referred patients can access material and speak to their coach immediately. In addition, these approaches also reduce regional variation in care provision. Changing Health also deals with the patchy understanding of evidence based behaviour change techniques and their application among healthcare professionals. This is through the provision of online training modules accredited by the Royal College of Physicians (RCP).
Forthcoming NHS England guidance for bidding commissioners will ask important questions. These will include interrogation of the evidence base supporting any bid, and what value the investment is expected to generate. It is expected to include reference to a predefined Value Framework (otherwise known as benefit / cost!). The value element will be defined as improved clinical outcomes and patient experience, with the cost element referring to capital and operating expense as well as staff time.
Our evidence based enhanced service offers a great opportunity to increase access to education. For the first time we are also providing access to supported self management via coaching and digital tools. However, we are not certain that the Transformation Fund will accept bids from digital interventions. If it does, Changing Health already has the business case at its fingertips. It is both theory and evidence based and features a dossier of relevant material to support value generation assertions. This includes publications by our Newcastle University research team along with other referenced material.
In short: Changing Health has been created by leading academic experts in, and advocates for, improving the lives of people with diabetes. Because of this we have a wealth of material which commissioners can use to prepare bids for the Transformation Fund or beyond - however the powers that be decide. If you would like to join our evidence-based drive to prevent the Type 2 diabetes suffering and expense we know are avoidable with the right approach, get in touch. We can tailor our content to meet your needs.
Written by Changing Health
John Grumitt is CEO of Changing Health. He has type 1 diabetes and leads a full and active lifestyle - including completing last year’s mHealth Grand Tour from Brussels to Barcelona. John is Vice President of the International Diabetes Federation and Vice President of Diabetes UK. In 2013 he was appointed to the NHS England Commissioning Board Diabetes Clinical Reference Group. John is managing director of award-winning advisors Metapath (www.metapathsolutions.com), and is a chartered accountant who attended Wharton Business School.