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

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

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

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 13 th 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. 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. 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