The NHS in England in August 2013 The National Agenda for Diabetes

1. The NHS in England in August 2013 The National Agenda for Diabetes Jonathan Valabhji National Clinical Director for Obesity and Diabetes

2. Journey so far 2000-2007 Build capacity 2007-2010 Focus on quality 2010-present Deliver better outcomes NHS Plan High Quality Care for All Equity & Excellence Liberating the NHS

3. Build capacity: 2000-2007 • 7000 extra beds • 100 new hospitals • 7,500 more consultants • 20,000 extra nurses • 6,500 extra therapists • GP appts in 48hrs • Long A&E waits ended • Max wait for OP 3mths • Max wait for IP 6mths • Cancer screening ↑ • Waits for heart ops ↓ • 500 new PC centres Focus on improving quality implicit rather than explicit

4. Focus on quality: 2007-2010 Definition for quality Quality Framework

5. Deliver better outcomes: 2010- present “Building on Lord Darzi’s work, the Government will now establish improvement in quality and healthcare outcomes as the primary purpose of all NHS- funded care” Equity & Excellence, Liberating the NHS, July 2010 • Definition of quality now enshrined in legislation- Section 2, H&SC Act • New duties to seek ‘continuous improvements in quality’ placed on the • SofS, NHS England and CCGs • National quality initiatives all retained e.g. NICE Quality Standards, • Quality Accounts, CQUIN, Quality Accounts etc

6. First Mandate for NHS England • First Mandate published on 13th November • 2012 • Sets out what the Government expects in • return for handing over £95bn of tax payers • money to NHS England • The NHS Outcomes Framework sits at the • heart of this Mandate and the Board is • expected to demonstrate progress across the • entire framework • In turn, the NHS Outcomes Framework sits at • the heart of NHS England’s planning • guidance ‘Everyone Counts’, published in • December 2013

7. NHS Outcomes Framework

8. NHS Outcomes Framework ‘At a Glance’

9. New Commissioning Roles • NHS England • Direct commissioning roles for: • Primary Care (£13 billion) • Specialist Services (£12 billion) • Justice Services • CCGs (n = 211) • Directly commission secondary care / non-elective services (£65 billion)

10. NHS Improving Quality • NHS IQ • Improvement body • Supports commissioners to achieve good outcomes • Replaces: • NHS Diabetes • NHS Kidney Care • National Cancer Action Team • National End of Life Care Programme • NHS Improvement • NHS Institute for Innovation and Improvement

11. Opportunities to participate NHS England – CRG membership CCG secondary care / consultant representative Strategic Clinical Network membership Clinical Senate membership

12. Strategic Clinical Networks • Cardiovascular disease (cardiac, stroke, diabetes, renal) • Maternity and children’s services • Mental health, dementia and neurological conditions • Cancer

13. National Clinical Director Role • NHS England, not DoH • Obesity included • Reduced infrastructure support • - no DoH policy team • - no NHS Diabetes • NCDs to work together on broad themes • - multi-morbidity • - transition

14. National Agenda for Diabetes / My Priorities • Prevention / early diagnosis / finding undiagnosed • Managing people well – 9 care processes, 3 targets • Empowering patients – education, care planning • Integrated care – designing financial flows • Transition services – poor engagement / attendance • Inpatient diabetes care – Francis + Keogh Reports • Type 1 diabetes care • Psychology services – “parity of esteem”

15. Opportunism • NHS IQ call for projects to reduce premature mortality in a relatively short time frame • Premature mortality associated with diabetic foot disease • Premature mortality associated with inpatient care of older people with diabetes / admission avoidance