APPG for Diabetes 07.09.16


Improving Standards in Diabetes Care: Putting Learning into Practice

Wednesday, 7th September 2016

17:00 – 18:00

Committee Room 18, House of Commons

This was the fourth and final expert options meeting in the year-long investigation into diabetes care conducted by the APPG for Diabetes. The Group heard from a range of professionals involved in CCG delivery of diabetes care. Challenges include a lack of staff, a lack of training, and a high degree of complexity in CCG commissioning.

Read the full minutes.

This meeting finalises the APPG’s investigation into how to improve standards and reduce variation in diabetes care. On November 23rd the report for the full investigation will be launched looking, in depth, at what practical solutions there are to reduce variations and making clear recommendations forexpert option app change.



Diabetes in Parliament:16th – 24rd September

House of Commons Questions

Diabetes: Nurses – DH – Keith Vaz

Mon, 19 September 2016 | House of Commons – Written Answer

  1. Asked by Keith Vaz (Leicester East) To ask the Secretary of State for Health, how many diabetes specialist nurses are employed by the NHS.
  1. Asked by Keith Vaz (Leicester East) To ask the Secretary of State for Health, what steps the Government is taking to recruit more diabetes specialist nurses

Answered by: (Grouped answer)
Mr Philip Dunne
Answered on: 19 September 2016

NHS Digital provides information on the number of nursing, midwifery and health visiting staff employed in the National Health Service in England but it does not separately identify diabetes specialist nurses.

It is for local NHS organisations with their knowledge of the healthcare needs of their local population to invest in training for specialist skills such as diabetes nursing and to deploy specialist nurses.

Diabetes: Health Services – DH – Keith Vaz

Fri, 16 September 2016 | House of Commons – Written Answer

  1. Asked by Keith Vaz (Leicester East) To ask the Secretary expert option demo of State for Health, what progress has been made on reducing required variations in the care provided to people with diabetes.
  1. Asked by Keith Vaz (Leicester East) To ask the Secretary of State for Health, what steps his Department is taking to ensure access to structured education for people with type 1 and type 2 diabetes.
  1. Asked by Keith Vaz (Leicester East) To ask the Secretary of State for Health, what plans his Department has to make continuous glucose monitoring and insulin pump technology available to diabetics on the NHS.

Answered by: (Grouped answer)
Nicola Blackwood
Answered on: 16 September 2016

This Government is working hard to improve outcomes and quality of life for those already living with diabetes and those who will develop it in the coming years. One of our key goals in the mandate to the National Health Service is a measurable reduction in variation in the management and care of people with the condition within the lifetime of this Parliament. Funding has been secured through the spending review to help achieve this and NHS England is developing a programme to ensure that those clinical commissioning groups (CCGs) which need extra investment in this area, accompanied by sound plans for delivery, receive it.

In addition, the Clinical Commissioning Group Improvement and Assessment Framework will play a key role in delivering this as it contains two recognised evidence based measures of whether patients with diabetes are being supported to successfully manage their condition (achievement of the National Institute for Health and Care Excellence treatment targets and participation in structured education programmes).

Using data from the NHS Atlas of Variation, NHS Right Care is also working with CCGs and other local partners to make improvements in diabetes care and reduce variation by providing hands on practical support.

Since 2009/10, there has been an almost 70% increase in the proportion of people newly diagnosed with diabetes recorded as being referred to structured education courses, designed to help them manage their condition in the long term. However, whilst we know that the data on take up needs improving, there is still much further to go in enabling people with diabetes to access these programmes.

The Department, NHS England and Diabetes UK are working on ways to improve the take up of structured education including exploring how more diversity of provision might be delivered through digital and web based approaches. The Department recently held a seminar with key stakeholders to identify actions that would facilitate improved access.

CCGs are primarily responsible for commissioning diabetes services to meet the requirements of their population. In doing so, CCGs need to ensure that the services they provide are fit for purpose, reflect the needs of the local population, are based on the available evidence, taking into account national guidelines. This should include consideration of access to continuous glucose monitoring for people with Type 1 diabetes who might benefit from it.

Obesity: Children – DH – Dr Lisa Cameron

Fri, 16 September 2016 | House of Commons – Written Answer

Asked by Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) To ask the Secretary of State for Health, with reference to the Government’s recently-published childhood obesity action plan, how he plans to work with the public health community to ensure that approaches to reduce child obesity are evidence-based.

Answered by:
Nicola Blackwood
Answered on: 16 September 2016

The policies in the plan are informed by the latest research and evidence, including from the Scientific Advisory Committee on Nutrition report Carbohydrates and Health, Public Health England’s evidence package Sugar reduction: the evidence for action, other government departments, debates in this House and various reports from key stakeholders including the Health Select Committee.

In delivering the plan, we will continue to work with the public health community and other partners to ensure implementation is aligned to our proposals.

Copies of Carbohydrates and Health and Sugar reduction: the evidence for action are attached and are available at:

SACN Carbohydrates and Health(PDF Document, 2.39 MB) PHE Sugar reduction The evidence for action(PDF Document, 1.16 MB)

Points of Order

House of Lords

Schools: Health Education – DfE – Lord Roberts of Llandudno

Mon, 19 September 2016 | House of Lords – Written Answer

Asked by Lord Roberts of Llandudno Asked by Lord Roberts of Llandudno Asked on: 06 September 2016 Department for Education Schools: Health Education Lords HL1628 To ask Her Majesty’s Government what assessment they have made of the case for patients who have certain medical conditions, such as diabetes, mental health problems or other illnesses, to go into schools to talk to children about those conditions, to give them a better understanding of the nature of those illnesses.

Lord Nash Answered on: 19 September 2016

The national ‎curriculum sets the expectation that pupils study personal, social, health and economic (PSHE) education in maintained schools and academies are encouraged to teach it as part of a broad and balanced curriculum.

Schools and teachers should decide what to teach based on their pupils’ needs, and taking account of pupil and parent views, when planning health education as part of PSHE.

We believe that schools are best placed to decide whether they draw on the support of patients or resources using patients’ perspectives when delivering PSHE.


Removing barriers for diabetes care: putting learning into practice

The APPG on Diabetes has launched at the beginning of the year its investigation in Diabetes Care to improve standards and reduce variation. On September 7th it has held its fourth and last meeting on Improving Standards in Diabetes Care: Putting Learning into Practice.

The previous meetings showcased the challenges faced by those living with both Type 1 and Type 2 diabetes and healthcare professionals (HCP) in dealing with and addressing the variation in knowledge, processes, technology access and consequently care across the country.

The final meeting focused on how local areas have successfully applied knowledge and learning to improve the standards and reduce variation in care in practice. The speakers included consultants and specialists in the field of diabetes with expertise in influencing improvements in care and treatment outcomes, who have designed and implemented new ways of removing the barriers and delivering better diabetes care.


The first speakers were Dr David Lipscomb, Consultant in Diabetes and Endocrinology East Sussex Healthcare NHS Trust, and Abigail Kitt, Independent Consultant in the Healthcare Sector and Diabetes Support for South East Coast Strategic Clinical Network. Together they spoke about the role of Clinical Networks, a non-statutory body that supports commissioners and providers to implement improved care for diabetes. They identified three key challenges: CCG management capacity, capability and engagement.

According to the speakers, there is a rapid turnover of CCG diabetes commissioners in England, which leads to a varying capability and engagement, as diabetes is not necessarily a priority to everyone, and a slowness of change. Furthermore, there is an overall lack of capacity in commissioning and providers to have space to develop and engage with the Clinical Networks.

To address this, they spoke about the importance of using education to champion improvement. One of the strategies is to provide clinical leadership and Healthcare Professionals training face-to-face and via webinars, enabling a wide participation. Moreover, they conduct gap analysis every year in order to have locally specific data that can support business planning.

They also highlighted the importance of relationships, developing a consultants’ forum that meets twice a year to share problems and brainstorm solutions.

“We became leaders in diabetes prevention because of the relationships we built”, said Dr. Lipscomb.

Dr David Lipscomb and Abigail Kitt presentation.

Dr Kate Fayers, lead consultant for the new West Hampshire Community Diabetes Service (WHCDS), spoke next about the need to design 21st century diabetes service. According to Dr. Fayers, people with diabetes and the NHS have changed across the years, but the models haven’t, leading to stagnation and complication. She identified the three “As” that constitute her vision for improved diabetes care: access to excellent skills and knowledge, achieve individual goals where possible and activate self-care where possible.

To address this, she stated the importance of integration, improving patient care through improved communication with ambulance crews and community teams and working together with other practices. “I need to work collaboratively to work more”, said Dr. Fayers.

Furthermore, she spoke about the need for innovation across the system, explaining the staff are too busy to change practice and there is a limited access to research opportunities. To address this, Dr. Fayers advocated for a new triage pathway, which improves patient care with swifter consultant advice, and the development of a research unit, which improves patient care with equitable access to research for community patients.

In order to achieve her vision, Dr. Fayers created a successful evidence-based intervention, which focused on patient engagement and on integration with different groups and providers. She developed an intermediate community service, which has moved Type 1 and Type 2 diabetes care into the community, supported by a portfolio of education for patients and healthcare professionals. The results showed that contact goes down as engagement goes up.


Dr Kate Fayers presentation.

Carol Metcalfe, Lead Paediatric Diabetes Specialist Nurse at Macclesfield District General Hospital, spoke about paediatric diabetes. She explained that while the issues and problems with diabetes care are still the same, national paediatric diabetes outcomes are improving steadily since 2011, due to a number of interventions such as Best Practice Tariff (BPT), National Paediatric Audit (NPDA), peer reviews and regional and national networks. However, there are still variances across the country and the need for a strategy to eliminate it.

She also stated the importance of education, advocating for a consistent and continuous message for children across the country. She explained that as children develop, there is a need for regular contact. There are also specific issues about the level of care during the transition from paediatric to adult diabetes care.

Furthermore, Carol Metcalf spoke about the need for this education to be more accessible to parents and healthcare professionals. She said all healthcare professionals working in paediatric diabetes should be trained to teach all ages, from toddlers to adolescents, and should have access to accredited courses recognized and supported by their managers.

“We need to continue with the ongoing work and ensure diabetes staff receive high class education to deliver excellent diabetes education to children and families”, said Carol Metcalfe.

David Hiles, Consultant for the Diabetes UK Service Redesign and Improvement Consultancy, explained how health care professionals and practices that are achieving better results in diabetes primary care often don’t realize what it is that make them different. To address this, he works with a system for improvement called Best Practice Modelling, which focuses on taking the learning from these practices and spreading it throughout all practices across the CCG.

After identifying the top performing CCGs using the Diabetes Primary Care Profiling Tool (DPCPT), David Hiles conducts structured interviews with key players in each practice to identify the reasons for this success. He asks them to walk him through the detailed process of different patient journeys, revealing that the secret is on what and how very specific pieces of information are given to patients at key moments. He identified three simple answers for success: use of resources, continuity of care and point of diagnosis.

With this information, local best practice pathways are created for each parameter and a short education programme is delivered to help embed the new pathways and produce enduring change. “The answer to better care is a local answer”, said David Hiles, explaining that as solutions are locally owned, those are simple, cost effective and easily replicable ways to deliver local improvement.

As a consequence, practices successfully encourage patients to attend for essential diabetes reviews and to gain better control of their condition, lowering the incidence of diabetes complications and therefore helping generate savings.

David Hiles presentation.

MP George Howarth chaired the meeting and highlighted the need for a collaborative and inclusive work; the need to reinforce the message to children; and advocated that a care model should be part of ideas put forward.

Following the panel speakers there was a chance for questions and comments from the audience. Discussions were centred on a variety of areas including: the possibility of an international model of care; how can parliament help improve diabetes care in CCGs; the challenges of providing consistent education in varied regions and to a varied public; and the need for more qualitative data.

This meeting finalises the APPG’s investigation into how to improve standards and reduce variation in diabetes care. On November 23rd the report for the full investigation will be launched looking, in depth, at what practical solutions there are to reduce variations and making clear recommendations for change.

The APPG is still accepting until midnight, 16th of September, case studies from commissioners and providers from across the UK who have implemented new ways of working to improve standards and tackle variations in diabetes care. If you would like to submit your story, please use this guidance form.


AGM 06.09.16

Minutes: APPG for Diabetes AGM

6.9.16 5-6pm, PCH Room Q


Members in attendance:

  • Rt Hon Keith Vaz MP
  • Jill Furniss MP
  • Nick Dakin MP
  • Christina Rees MP
  • Fabian Hamilton MP
  • Pat Glass MP
  • Jenny Chapman MP
  • Valerie Vaz MP


Item 1:

Chair, Rt Hon Keith Vaz MP, welcomed members to the AGM.

Notified attendees that the purpose of meeting was to re-elect the officers of the Group.

Chair read out the current roles held by members of the group.


Item 2:

Fabian Hamilton MP moved to re-elect all officers to their previous roles.

No objections.

Roles appointed as follows:


Rt Hon Keith Vaz MP – Chair

Jim Shannon MP – Vice Chair

Victoria Atkins MP – Vice Chair

Liz McInnes MP – Co-Secretary

John McNally MP – Co-Secretary

Baroness Ludford – Treasurer


Item 3:

Any other business – none.


Next APPG Meeting -Improving Standards in Diabetes Care: Putting Learning into Practice

This year the APPG for Diabetes launched an investigation under the theme: Diabetes Care: improving standards and reducing variation, which is ongoing.

Our next meeting will take place on Wednesday, 7 September 2016 from 5.30-6.30pm with the theme: Improving standards in diabetes care: putting learning into practice.

This will be the fourth and final meeting of this investigation. The focus of this meeting will be on how existing knowledge and learning has been applied to improve care and will present case studies of how Clinical Commissioning Groups (CCGs) have reduced the variation in care in practice.

CCGs are responsible for implementing the commissioning roles as set out in the Health and Social Care Act 2012. This includes working with providers and stakeholders to develop services that support the needs of their patient population. People with diabetes rely on a range of services due to the complexity of the condition and how it is managed. The Group will hear from speakers who have policy and practical expertise in driving improvements in care and improving treatment outcomes.

If you would like to attend, please RSVP by emailing Due to limits on room capacity, please note that admittance will be on a first come, first served and one organisation, one person basis.

Minutes from the last meeting:

The APPG’s last meeting took place on 20 July 2016 under the theme: The role of healthcare professionals in diabetes care. Minutes from the meeting can be found here.


Diabetes in Parliament: 22nd – 29th July

House of Commons Questions

Diabetes: Depressive Illnesses – DH – Jim Shannon

Mon, 25 July 2016 | House of Commons – Written Answer

Asked by Jim Shannon (Strangford) To ask the Secretary of State for Health, what research his Department has undertaken or assessed on links between depression and diabetes.

Answered by:
Nicola Blackwood
Answered on: 25 July 2016

NHS England is undertaking work aimed at supporting people with diabetes who need psychological support: for example, psychological support for children with diabetes is being incentivised through the paediatric diabetes best practice tariff.

More generally, work has recently been undertaken on treating common mental health disorders for people with long term physical conditions, including diabetes. Based on the findings from this and other published evidence, Implementing the Five Year Forward View for Mental Health outlines NHS England’s ambition that two thirds of the expansion of psychological therapies services for common mental health problems, such as depression, will be integrated within physical health pathways, including diabetes.

Diabetes: Medical Equipment – DH – Jim Shannon

Mon, 25 July 2016 | House of Commons – Written Answer

Asked by Jim Shannon (Strangford) To ask the Secretary of State for Health, what plans his Department has to make personal devices for instant monitoring of insulin levels available to people with diabetes on the NHS.

Answered by:
Nicola Blackwood
Answered on: 25 July 2016

We are not aware of any clinical utility associated with the instant monitoring of insulin levels. However, continuous glucose monitoring devices can measure glucose levels 24 hours a day and it is for National Health Service commissioners to decide whether to make these available to their local populations.

In August 2015, National Institute for Health and Care Excellence (NICE) published guidelines which recommend that such devices should not be made routinely available to people with Type 1 diabetes unless they are willing to commit to using them at least 70% of the time and to calibrate them as needed (as well as meeting certain other criteria).

NICE has found that, for some people, continuous glucose monitoring can have clinical benefit but generally it is not more effective than current methods of self-monitoring. Continue Reading


A view of how healthcare professionals work to improve diabetes care

The APPG for Diabetes investigation into diabetes care, with the aim of improving standards and reducing variation held its third meeting on 20th July. The Group heard from a range of healthcare professionals (HCP) involved in the care of people with diabetes. HCPs face a number of pressures when caring for those with a complex condition such as diabetes: limited time, varying knowledge and different processes depending on the environment they work in.

Liz McInnes 2

Liz McInnes MP co-charing the meeting with the healthcare professioanl speakers

The HCPs speaking included a consultant in diabetes and endocrinology, a diabetes specialist nurse, a pharmacist, a dietician and a podiatrist with each focusing on challenges they face and potential solutions to these challenges.

Continue Reading