NPDA core reports have shown wide variation in the quality of care and outcomes achieved by paediatric diabetes units (PDUs) in England and Wales. The audit was therefore commissioned to conduct two spotlight audits aimed at providing some context to these findings, on topics prioritised by key stakeholders.
The topics chosen were ‘diabetes-related technologies’ and ‘the workforce delivering children and young people’s diabetes care in England and Wales’. The spotlight audits do not, for the most part, measure practice against any particular set of standards but seek instead to highlight variability in the way services differ in their structure and delivery of care. They provide insight into everyday practice and explore how this may be related to outcome.
Diabetes-related technologies 2017-18
Our diabetes-related technologies spotlight audit specifically aimed to:
- determine the prevalence of use of diabetes-related technologies amongst children and young people with Type 1 diabetes across England and Wales
- highlight PDU level and regional differences in access to, and funding of such technologies
- establish the type of support children and young people and their families receive when utilising diabetes-related technology
- enable benchmarking and comparison between nations, regions and PDUs of staff in terms of support for use of diabetes-related technologies for children and young people
- establish relationships between diabetes related technology usage and patient outcomes.
- Use of insulin pumps and continuous glucose monitoring (CGM) devices is associated with better diabetes management outcomes, even after controlling for the characteristics of the children and young people with diabetes using them.
- Huge variation in technology-related diabetes outcomes were observed between different PDUs, meaning that children and young people are benefitting more or less from using diabetes-related technologies to manage their condition depending on the paediatric diabetes service they attend.
- Waiting times for initiation of insulin pump therapy vary by PDU, country and region, with half of PDUs in Wales reporting a typical wait after approval of six months or greater compared to 4.3% of English PDUs.
The workforce in paediatric diabetes units 2017-18
Our workforce spotlight audit specifically aimed to:
- establish the number of PDUs in England receiving Best Practice Tariff and the proportion of Tariff funding being used to support paediatric diabetes services
- enable benchmarking and comparison between PDUs and regions for patient access to support and services
- understand how young people with diabetes transition from PDUs into young adult services in England and Wales
- establish the number of children who are considered as being 'in need', 'looked after' or are currently on the child protection register (Wales) or have a child protection plan (England)
- determine the staffing levels of and training received by healthcare professionals involved in the management and care of children and young people with diabetes
- establish vacancy rates amongst multidisciplinary paediatric diabetes teams
- explore relationships between staffing and glycaemic control.
- Total staffing levels increased in PDUs from 24.4 to 29.2 WTE and 15.5 to 32.6 WTE in England and Wales, respectively, since 2014.
- Overall staffing increases since 2014 have been accompanied by improvements in national average HbA1c; however, at unit level, higher staffing levels were not associated with lower average HbA1c.
- Most PDUs in England were achieving BPT payments, however only 28.1% knew the percentage going directly into diabetes care in their unit (including staff costs, equipment, facilities, network management fees, etc.). Of these, the average percentage being received was 40.0%.
- Just over half of PDUs employed at least one PDSN (Paediatric Diabetes Specialist Nurse) who was a nurse prescriber. There was a statistically significant difference in mean casemix-adjusted HbA1c in services where a nurse prescriber was employed - 67.1 mmol/mol vs 68.5 mmol/mol – indicating overall better outcomes in services where they are employed.
- Over a third of PDUs had at least one vacancy, with the majority of these being unfilled for three months or longer, putting additional strain on an already busy workforce with the risk of workforce fatigue and burnout.
Unit level spotlight audit summaries
We have provided a PDF generator for the 2017-18 unit level summary reports for each spotlight audit.