Diabetes care standards for children linked to financial penalties
By Tom Moberly, 03 April 2012
Mandatory standards for the care of children and young people with diabetes, linked to financial rewards and penalties, have been introduced into the NHS.
The 13 standards are included in the best practice tariff for paediatric diabetes under the payment by results system for specialist providers. This means providers missing targets will have funding withdrawn while those meeting these standards will qualify for greater funding.
The initiative to develop the standards and include them in a tariff was led by Dr Tabitha Randell, NHS Diabetes’s paediatric network clinical lead and a consultant in paediatric endocrinology and diabetes.
Dr Randell said: ‘Our paediatric diabetes networks have been working hard with the DH’s payment by results team over the past 18 months to ensure the introduction of our tariff.
She added: ‘Looking to the long term, we hope the changes to the financial levers will lead to an improvement in the care and outcomes for children and young people with diabetes.
‘This should then result in a reduction in costs to the service, in levels of emergency hospital admissions among children with type 1 diabetes, and in the incidence of life-changing, yet often preventable, complications associated with the condition.’
The 13 standards are:
- Every child or young person with diabetes will be cared for by a specialist team of healthcare professionals (consisting of a doctor, a nurse and a dietitian as a minimum) who have specific training in paediatric diabetes.
- The doctor must be a consultant or speciality doctor with training as detailed by the British Society for Paediatric Endocrinology and Diabetes, the nurse must be a paediatric nurse with training in children’s diabetes as detailed by the Royal College of Nursing and the dietitian must be a paediatric dietitian with experience and/or training in diabetes. If the doctor is a specialist registrar who wants to specialise in paediatric diabetes, they must be supervised by the consultant or speciality doctor.
- When a new diagnosis of diabetes is made in a child or young person, this must be discussed with a member of the specialist team within 24 hours of the diagnosis. The child or young person and their family must be seen by a senior member of the specialist team on the next working day.
- The diabetes team should offer a structured education programme at diagnosis and with updates as needed, aimed at the age and understanding of the young person and their family.
- Every child or young person with diabetes must be offered at least four clinic appointments a year with the doctor and specialist team.
- The HbA1C (long term blood glucose measurement) must be checked at every clinic visit and the result available in clinic for the appointment. It is recommended that this is checked at least four times a year.
- Every child or young person with diabetes should be offered an appointment with the dietitian at least once a year.
- At least eight additional contacts per year (phone calls, e-mails, school visits etc) by members of the team are recommended.
- Every child or young person with diabetes must have an annual review, as detailed in the NICE guidelines on managing diabetes in children and young people (blood tests every year, plus BP check and screening for eye and kidney problems from age 12).
- The team should check that the child or young person with diabetes is coping psychologically at least once a year and they should have access to psychology services as needed.
- The team should provide 24-hour access to advice on emergency management of diabetes for the family and other health professionals.
- It is also expected that the team will take part in the National Paediatric Diabetes Audit, attend their local paediatric diabetes network meetings regularly and have a clear policy for transition to adult services.
- Each team must have a clear policy which should cover what they do to try to help children and young people with high HbA1Cs improve their control and what they will do if a child or young person keeps not coming or is not brought to clinic, among other things.
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