Diabetes and the Health Innovation Network Charles 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 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

Structuring Each Clinical Theme Tertiary Secondary Primary Public Health SRO – CEO level Clinical Directors Programme Manager Innovation Fellow Commissioner Patient/3 rd Sector/Carer Expert Panel – multidisciplinary, patient/carer/third sector and industry 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

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 31 st 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.” “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