Report of Dr Manisha Kumar, Clinical Director, Manchester Health and Care Commissioning

This report provides the Committee with an update on the activities to reduce inequalities in diabetes care and outcomes for the people of Manchester.

The Committee considered a report of the Clinical Director, Manchester Health and Care Commissioning (MHCC) that provided an update on the diabetes work programme that had been designed to reduce inequalities in diabetes care and outcomes for the people of Manchester. The main aim was to improve the health outcomes and quality of life for all those at risk of, or living with diabetes in Manchester, through supported self-management, personalisation and early optimal interventions.

The Clinical Director MHCC referred to the main points of the report which were: -

·                Providing a description of the different types of diabetes and the implications of this condition;

·                Describing the prevalence of diabetes in Manchester, providing comparisons against Greater Manchester and England figures;

·                Projected figures for the number of cases of diabetes, noting that Manchester’s expected diabetes prevalence rates were set to increase;

·                Information on The National Diabetes Prevention Programme, an ongoing national programme which began in 2016 and was rolled out in Manchester in August 2017;

·                Data on the diagnosis of diabetes, with particular reference to NHS Health Checks that helped to identify people with diabetes, particularly as the service was able to provide outreach in hard to engage with populations;

·                The role of Primary Care in the prevention of diabetes, including adoption of the Manchester Standards with its eight processes of care to standardise care for patients;

·                Data on how the Manchester Standards had reduced the number of emergency hospital admissions;

·                Information on the Community Diabetes Service, the Community Diabetes Education and Support Team, Secondary Care Services, Inpatient Support Services and transition to Adult Services;

·                The work undertaken to deliver Health Care Professional Education;

·                Activities to educate people living with diabetes; and

·                The work to reduce the number of lower limb amputations.

Members sought clarification on the information that had been provided in the graphs and tables throughout the report and an explanation was provided as to the various data sets and recording periods.

In response to concerns expressed by Members regarding the numbers of reported medical errors Prof Ball described what constituted a medical error, and provided examples of what would be categorised as severe to minor errors. He stated that all errors had a negative impact on patients and their experience of care. He said that all incidents are recorded and reported and practitioners are held to account.

Prof Ball explained that the report presented to the Committee reported processes rather than clinical outcomes. He said that this was the beginning of a new approach to the management of diabetes and clinical benefits were understood, however the clinical outcomes would be reported in future years.

Dr Rutter responded to questions from Members regarding flash glucose monitoring to improve self-care for patients.He said that this would be provided for those patients with the highest clinical need and funding had been awarded for this.

Members commented that the impact of austerity, wage freezes and welfare reform had a significant detrimental impact on people’s health and their ability to make healthy lifestyle choices.  Members further commented that diabetes was a serious illness with serious outcomes for patients if not managed correctly and more needed to be done to raise people’s awareness of this condition.

Members also discussed the importance of improving the experience for patients when transitioning from young people’s services to adult services. Prof Ball agreed with the view of the Committee, commenting that it would be beneficial to establish age appropriate and lifelong care pathways and work was underway with commissioners to consider this approach, further stating that often barriers are self-engineered by systems. The Chair noted that consideration needed to be given as to how topics that cross the remit of more than one Scrutiny Committee were reported appropriately. 

Ms Milne responded to a comment from a Member who suggested that the Care Processes described were in fact diagnostic tests by advising that these prompted Health Professionals to engage in conversations with patients to identify the correct care pathways so as to manage their condition appropriately. Dr Rutter stated that the correct management of diabetes had reduced the number of admissions to hospital. Prof Ball said appropriate conversations were needed between health professional and patients to establish a relationship and motivate people to take self-care of their condition.

Dr Rutter explained that Manchester, in recognition of the diverse makeup of the population had attracted funding to pioneer this new approach to diabetes management. He said that appropriate education programmes would be devised and delivered to reach all members of the community, using appropriate language and materials, in addition Community Champions would be identified to support this activity. Funding had also been secured to deliver an online resource that patients could access to obtain information and advice on their health care and people would be supported to access this resource.   

Dr Kumar stressed the importance of education in relation to diabetes awareness and informed the Committee that activities were focused on preventative measures that promoted healthy living as a system wide message. Ms Milne commented that NHS Health Checks were also being promoted amongst the general population that included screening for diabetes. In response to a question regarding routing retina screening the Committee were informed that this service was administered nationally.

Decision

The Committee;

1. Note the report;

2. Recommends that a progress report is submitted for consideration at an appropriate time; and

3. Recommends that the Chair considers how topics that cross the remit of more than one Scrutiny Committee are reported.