Reviews and reports

First ever mandatory care standards to improve the level of care of children and young people with diabetes

Announced in early April 2012, every child and young person with diabetes in England can expect an improvement in their level of care as a landmark funding agreement for paediatric diabetes services comes in to force.

The ‘Best Practice Tariff for Paediatric Diabetes’ sets out 13 mandatory care standardsfor paediatric diabetes service teams to meet. Providers who can prove they meet these levels of care will qualify for greater funding. Local services unable to achieve these standards will be supported to improve but face having their funding withdrawn if unable to reach the required level by April 2013.

The long-term aim is that these changes will lead to improvements in care and outcomes for children and young people with diabetes. In turn this should lead to a reduction in costs, a reduction in emergency admissions to hospital and in a reduction in the long-term preventable complications.

Anna Morton, Director of NHS Diabetes, said: “Outcomes for children with diabetes in this country compare poorly to the rest of Europe. We will show that with a proper funding mechanism and access to expert support, providers can improve, and unacceptable variations in care can be addressed.
“We are encouraging all paediatric providers, particularly those in poor performing areas, to engage with us to ensure our standards are met, and that every child, no matter where they live, receives the care and support they deserve.”

NHS Diabetes is calling on all healthcare professionals involved in the support and care of children and young people with diabetes to join their paediatric diabetes network to ensure sharing of good practice, up-to-date guidance and education tools.

What are the 13 care standards?

1. Every child or young person with diabetes will be cared for by a specialist team of health care professionals (consisting of a doctor, a nurse and a dietician as a minimum) who have specific training in paediatric diabetes.
2. 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 dietician must be a paediatric dietician 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.
3. 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.
4. 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.
5. Every child or young person with diabetes must be offered at least four clinic appointments a year with the doctor and specialist team.
6. 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.
7. Every child or young person with diabetes should be offered an appointment with the dietitian at least once a year.
8. At least eight additional contacts per year (phone calls, e-mails, school visits etc) by members of the team are recommended.
9. 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 blood pressure check and screening for eye and kidney problems from age 12).
10. 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.
11. The team should provide 24 access to advice on emergency management of diabetes for the family and other health professionals.
12. 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.
13. 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.