“Is integrated care achievable?”

1. Diabetes in Scotland “Is integrated care achievable?” Lewis Ritchie Andrew Morris 14th March , 2001

2. Priority Clinical Issues : NHSiS • Increasing Patient Involvement • Health Priorities : heart disease, cancer, mental health, (diabetes) • Professional Isolation • Integration of Care • Enhance Professional Education • Reconfiguration of Services: Managed Clinical Networks

3. Clinical Governance • Setting standards • External peer review • Reporting findings

4. Pressures on the System • Limited resource • Limited time • Fragmentation/inefficiencies • Conflict between service delivery & training • Increased demands/expectations • Increased number of clinical priorities • Aging population • Low morale

5. Teamwork How do we meet the diabetes challenge?

6. Clinical IM&T: Underpins the solution • Patient care • Teamwork • Clinical networks • Audit • Governance • Research Communication!

7. GP Lab Data Screening Nursing HospitalCare Investigations PAMS Social Services Pharmacy The Health Care Family

8. Nursing Lab Data PAMS GP Pharmacy Hospital Care Social Services Screening Investigations Working togetherVital for Seamless Care

9. Community Health Number 07 10 64 02 50 Date of Birth Sex Check

11. Characteristics of Tayside • Population 400,000 • Dundee United 2 Rangers 0 • Rural and inner city • Static population • Unique patient identifier

12. Community Health Number 07 10 64 02 50 Date of Birth Sex Check

13. Data Sources • Encashed prescriptions • Diabetic Clinics • Discharge Diagnoses • Regional biochemistry • Diabetic Eye Van • Primary care

14. Diabetes in Tayside9003 patients in 1997; prevalence 2.26% Morris et al, BMJ, 1997

15. DARTS and general practices • Automated returns for chronic disease management • Identification of high risk patients • Anonymised audit of monitoring targets • “Seamless” diabetes care

16. St Vincent Endpoints -Eyes Percent patients B’ground Prolif Laser Blind

17. St Vincent Cardiovascular Percent patients Hypertension IHD MI CABG/PTCA

18. DARTS aggregate summary report

20. The Core Structure

21. Regional Diabetes Managed Clinical Network TDAG Specialist Nurses Training and education Network Development/IT Clinical Governance & guidelines Acute Trust Register SIGN 25 DARTS/MEMO Steering Group LHCC’s/Trusts THB Facilitator Clinical Network Co-ordinator

22. What Are We Achieving? • annual audit • agreed regional protocols • multi-speciality collaboration • patient involvement • professional education & training • quality research programme

23. Key aspects of development • Guidelines/governance (Perth and Kinross LHCC) • Clinical effectiveness (Angus/Dundee LHCCs) • Pilot IT system (Arbroath LHCC) • Educational package - Warwick • Electronic Communication

24. DARTS 2000 Communications General Practice Hospitals / Clinics

25. www.diabetes-healthnet.ac.uk

26. The DARTS / MEMO Collaboration

27. The DARTS / MEMO Collaboration

28. Each practice / clinic has it’s own secure home page

36. The DARTS / MEMO Collaboration

37. The DARTS / MEMO Collaboration

38. Improved Clinical Outcomes? • On-going evaluation a priority • Locality evidence growing

39. Clinical Networks Network Co-ordination Clinical IM&T Multi-specialty teamwork Health Board/Trust/LHCC support

40. Clinical Network Development in Tayside Risk Areas • Competition vs Collaboration • Personal fiefdoms! • Technology and change is a “painful disorder” • Underestimating the Commitment! • “Not invented here”should not be the excuse to avoid change Let’s remember - Scotland is a small place!

41. Summary • Levers in the system • We need to work as a team • Managed clinical networks work • If we can’t do it for diabetes, who can? • Will 2001 be the year of delivery?

42. Thank you for listening! Comments Please

43. Thank you for listening!