A. WHY DIABETIC RETINOPATHY?
1 Our National Health
The Health White Paper Our National Health: A plan for action, a plan for change (December 2000) highlighted the importance of diabetes and included a commitment to publish a Scottish Diabetes Framework.
“In 2001, we will launch a Scottish Diabetes Framework to draw together existing guidance and best practice in order to raise the standard of diabetes care. The Framework will include plans to establish a national strategy for diabetic retinopathy”.1
The key milestones of the Framework were published in November 2001, with the full Framework document following in April 2002.
2. Scottish Diabetes Framework
The Scottish Diabetes Framework identifies a model of diabetes care consisting of 22 building blocks, divided amongst six broad headings:
- Prevention and early detection
- Care, monitoring and treatment
- Specific groups
- Planning and managing services
- Implementation
- Community issues
This is a pragmatic model. It is acknowledged that there is some overlap between the 22 building blocks and that sub-dividing the care and treatment of diabetes in this way brings with it the risk of losing the concept of holistic care. Nevertheless, the model is an attempt to make the complex and multi-professional nature of diabetes services more manageable.
All of the 22 building blocks of diabetes are important. However, the Working Group concluded that significant progress towards securing real improvements in services for people with diabetes would only be achieved by focusing on a limited number of issues at a time, rather than by overloading the system with too many objectives. Seven issues for early action were identified by the Working Group and highlighted in the consultation paper:
- Patient Information, Education and Empowerment
- Heart Disease
- Eye Care
- Stategy, Leadership and Teamworking
- Education and Training for Professionals
- IM&T and Diabetes Registers
- Implementation and Monitoring
In order to support and monitor the implementation of the Framework a Scottish Diabetes Group has been established as a national steering group.
MILESTONES
Throughout the Framework a number of ‘milestones’ and ‘actions points’ have been included. A Milestone represents a significant stage on the way towards creating a high quality patient-centred diabetes service. It marks a point for reflection, assessment of progress and confirmation of direction. An Action Point is a specific piece of work that will be undertaken to support this process.
Eye Care
Milestones
“All people with diabetes will have their eye status (retinopathy) recorded on the local diabetes clinical management system by September 2003.”
“The Scottish Diabetes Group will produce plans to take forward the implementation of the report of the Health Technology Board for Scotland on the organisation of services for diabetic retinopathy screening by Summer 2002.”
Action Point
“A national co-ordinator to support the implementation of the recommendations of the Health Technology Board for Scotland on the organisation of services for diabetic retinopathy screening will be appointed by September 2002.”