Diabetes care remains 'patchy and piecemeal'

Patients with diabetes, the major cause of blindness in the UK, continue to suffer a 'patchy and piecemeal' service a new Department of Health report has admitted.
Over two years since a diabetes strategy was put in place - and three and a half since a National Service Framework (NSF) said the Health Service had huge variations in levels of performance for diabetics - the NSF's national clinical director has commented there remained unacceptable differences in care and treatment for patients.
The Diabetes NSF aims to provide eye screening to detect sight-threatening diabetic retinopathy for 80 per cent of those with diabetes by 2006, and for all diabetics by 2007. Local delivery is being supported by the UK National Screening Committee which, as well as setting standards for quality assurance, has agreed a national framework for purchasing digital cameras and related equipment. (See panel and for more details log on www.nscretinopathy.org.uk).
The new DoH document, Improving Diabetes Services - The NSF Two Years On, was written by clinical director Dr Sue Roberts. She reported that although there was no room for complacency 'there is substantial grounds for optimism'.
She singled out a screening scheme based in Exeter as an example of how an effective retinopathy service can work in practice. '[It] started in 1986 with 2,000 patients but by 1993 that figure had risen to 4,000, and now stands at about 12,500, showing that in 14 years the numbers of people with diabetes within their remit has grown more than six fold.'
Roberts reported that the Devon-based programme had successfully treated about 350 people who would otherwise have suffered loss of vision. 'They established, through research, that screening was effective [and by] using digital cameras improved detection rate and using graders specifically trained in DR increased the detection rate significantly further.'
However, she said screening programmes in other areas had 'considerable challenges that may have to be overcome'.

BOXTEXT: Practitioners wanted for pilot
'It is a requirement of the NSF for Diabetes that all personnel involved in the identification of sight-threatening diabetic retinopathy are properly trained and accredited. The National Screening Programme for Diabetic Retinopathy has been working with NHSU to develop an accreditation programme. We are now in a position to call for expressions of interest from existing screening programmes to take part in the pilot phase of this accreditation. If you would like to be considered as part of the pilot phase please send contact details to cynthia.adipue@nhsu.org.uk by 18 April 2005. Interested schemes will then be sent details of course requirements for pilot sites including availability of specific resources, mentors and workplace supervisors/assessors.'