How to gear up an entire country for diabetes care and research was the topic of speaker Prof Andrew Morris at the Inaugural Conference of the National Clinical Programme for Diabetes in Farmleigh, Dublin. As chair of medicine and director of the Institute for Population & Health Informatics and vice-principal of data science at the University of Edinburgh, Prof Morris has seen first-hand how linking up all diabetes services can really benefit patients.

“To sustain a really high-quality diabetes service of a standard our patients deserve, we need three things: first we need leadership, and that has to come from this room [the conference audience]; secondly we need systematic collaboration and the creation of functional networks across primary, secondary and tertiary care; and thirdly we should be measuring everything we do as part of our service,” said Prof Morris.

He said that in Ireland, diabetes is the ideal chronic disease management service to lead the way for establishing a proper national network of services that are linked up across all levels of care. In Scotland, the framework for such a network was set up in 2002 (the Scottish Diabetes Framework) and followed up by an action plan in 2006. 

Prof Morris further mentioned that as Scotland has roughly the same population as Ireland, the system that was set up there should be transferable to Ireland.

Challenges of multimorbidity

Prof Morris looked at the challenge of multimorbidity and said that in order to save money for the State, healthcare professionals need to start challenging the still prevailing single-disease outlook on care. He referred to a recent study in Scotland that sought to answer a very simple question: how many diseases does a 70-year-old person have? The study looked at over two million people, and showed that the majority of 70-year-olds had from two to as many as nine chronic diseases.

“This challenges the single disease focus that still prevails,” said Prof Morris.

So what’s the response to this challenge?

“The key to success and excellence in diabetes care in Ireland is not an excessive amount of resources, rather it’s in this room,” he said, referring to the collaboration between all healthcare professionals present at the conference.

Scottish set-up

He referred to the system in Scotland, which started about 16 years ago when it was decided that all assets available were going to be used to deliver on diabetes care through the power of collaboration. 

GPs, physicians, patients and managers came together to define a plan for diabetes care, and patients were at the heart of that group.

After the group was set up, advertising was initiated to recruit groups across Scotland to focus on various aspects of diabetes care. 

“We were the first group to want to define the standard of care across the journey of care – the patient journey – so these standards apply to general practice, hospitals and the care centres,” said Prof Morris.

“Patients don’t care if they’re in primary or secondary care, they just want a good service,” he added.

The standards were then distributed across Scotland so that all regions would have the same level of care.

The regional networks, referred to as ‘managed clinical networks’, were then established to bring together clinicians, patients and carers to work across the traditional boundaries in planning and delivering diabetes care.

Outcomes in Scotland

To date, the framework and action plan set up in Scotland are still referred to, and the managed clinical networks are still up and running. 

“The Scottish Diabetes Group has survived seven health ministers, it is still going, they haven’t managed to close us down,” said Prof Morris.

He also reiterated the importance of measuring everything that is done in order to review whether the services are meeting the standards. The information technology part of the services is part of Prof Morris’s special interests.

“Data collection and IT systems are extremely important,” said Prof Morris.

“It allows us to link data across general practice, pharmacies, voluntary hospitals, etc in real time.”

“What we’re trying to do is integrate information systems into science and healthcare, cause we have not been good at using computer science in healthcare so far,” he added.

What this has done for Scottish diabetes  care is that it has allowed for easier access to quality data in terms of research, but it has also made management easier by integrating information across the different levels of care so that, for example, a GP opening a patient file can see if the patient recently visited a podiatrist or consultant; the GP can see the files from the retina screen; and the history of prescribed medications, etc. 

The patient file is open to all involved in the care of the patient, so that the information is available across all levels of care, and not only individually to the various healthcare professionals involved.

“This is really at the core of the Scottish system,” said Prof Morris.

“And it should be at the core of any chronic disease care,” he added.

For more information about the Scottish set-up, it is well worthwhile visiting the website: www.diabetesinscotland.org.uk