commissioning guide diabetes and cardiovascular care june 2011 · commissioning diabetes and...
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CommissioningDiabetes and
Cardiovascular Care
Supporting, Improving, Caring
June 2011
NHS Diabetes Information Reader Box
Review Date 2013
Commissioning Diabetes and Cardiovascular Care
NHS Diabetes would like to thank the following for their advice and contribution to the development ofthis commissioning guide:
Roger Boyle National Clinical Director for Heart Disease and Stroke
Julie Harris Director, NHS Improvement
Mel Varvel National Improvement Lead, NHS Improvement
Felix Burden Community Consultant in Diabetes, Heart of Birmingham Teaching PCT
Mark Dancy Consultant in Cardiology, North West London Hospitals NHS Trust
And to Thoreya Swage who wrote this publication.
3
Page
Commissioning for Diabetes and Cardiovasular Care 5
Features of Diabetes and Cardiovasular Care 6
Diabetes and Cardiovasular Care Intervention Map 8
Contracting Framework for Diabetes and Cardiovasular Care 12
Standard Service Specification Template for emergency care for 25cardiovascular events to be provided by Ambulance Services
Standard Service Specification Template for Diabetes and Cardiovascular Care 29
Contents
5
Commissioning Diabetes andCardiovascular Care The NHS Diabetes commissioning approach helps to deliver high quality integrated care through a three-stepprocess that ensures key elements needed to build an excellent diabetes service are in place. The approach issupported by a wide range of proven tools, resources and examples of shared learning.
Step 1 – involves understanding the local diabetespopulation health needs by developing a local HealthNeeds Assessment and setting up a steering groupwith key stakeholder involvement including a leadclinician, lead commissioner, lead diabetes nurse andlead service user
Step 2 – involves the development of a servicespecification to describe the model of care to becommissioned. This becomes the document onwhich tenders may be issued.
Step 3 – involves monitoring the delivery of theservice specification by the provider and evaluatingthe performance of the service. Input from thesteering group with service user representation willbe an important mechanism for monitoring theservice as well as patient surveys.
This commissioning guide has been developed byNHS Diabetes with key stakeholders including clinicaland social services professionals and patient groupsrepresented by Diabetes UK.
It is not designed to replace the Standard NHSContracts as many of the legal and contractualrequirements have already been identified in this setof documents. Rather, it is intended to form the basisof a discussion or development of diabetes andcardiovascular services between commissioners andproviders from which a contract for services can thenbe agreed.
This commissioning guide consists of:
• A description of the key features of high qualitydiabetes and cardiovascular care
• A high level intervention map. This interventionmap describes the key high level actions orinterventions (both clinical and administrative)diabetes and cardiovascular services shouldundertake in order to provide the most efficientand effective care, from admission to discharge (ordeath) from the service.
It is not intended to be a care pathway or clinicalprotocol, rather it describes how a true ‘diabeteswithout walls’1 service should operate going acrossthe current sectors of health care.
The intervention map may describe current servicemodels or it may describe what should ideally beprovided by diabetes and cardiovascular services.
• A diabetes and cardiovascular services contractingframework that brings together all the keystandards of quality and policy relating to diabetesand cardiovascular care
• A template service specification for diabetes andcardiovascular services that forms part of schedule2 or section 1 (module B) of the Standard NHSContract covering the key headings required of aspecification. It is recommended that thecommissioner checks which mandatory headingsare required for each type of care as specified bythe Standard NHS Contracts.
For further detail on how to approach thecommissioning of diabetes services please seehttp://www.diabetes.nhs.uk/commissioning_resource
Step 2
Step 3
• Understanding your diabetes population health needs
• Implementing improved services and evaluation
• Understanding what you need to commission for an integrated service
Step 1
1 Commissioning Diabetes Without Walls, 2011, http://www.diabetes.nhs.uk/commissioning_resource/
6
High quality diabetes and cardiovascular servicesshould:
• provide an assessment of people who are at riskof cardiovascular conditions, e.g. smokingstatus, lifestyle factors, hypertension, high bloodcholesterol levels and diabetes
• have mechanisms in place to provide immediateassessment and treatment of people whoexperience cardiovascular events, e.g.stroke/transient ischaemic attacks/ myocardialinfarction in the community together withimmediate transfer to appropriate specialistcentres, e.g. stroke units and PercutaneousCoronary Intervention Centres, where necessary
• have mechanisms in place to identify peoplewho present with acute cardiovascularconditions, e.g. myocardial infarction, stroke/TIAetc to screen for possible diabetes
• ensure that people in hospital (including strokeunits and Percutaneous Coronary InterventionCentres) with cardiovascular conditions anddiabetes to have access to appropriate diabetesand cardiovascular specialist expertise both foremergency and planned care
• ensure that all patients with cardiovascularconditions and diabetes who have emergencyand planned in patient care have admission anddischarge care plans
• ensure that all patients with diabetes receivecardiac rehabilitation when needed
• have monitored protocols in place to ensure thatpatients can continue to manage their diabetesthemselves while in hospital (food andmedication)
• be delivered through an integrated care planincorporating both cardiovascular and diabetescare needs
In addition the services should:
• be developed in a co-ordinated way, taking fullaccount of the responsibilities of other agenciesin providing comprehensive care and placingusers at the centre of decisions about their careand support - "no decision about me withoutme" (Equity and Excellence: Liberating theNHSi).
• be commissioned jointly by health and socialcare based on a joint health needs assessmentwhich meets the specific needs of the localpopulation, using a holistic approach asdescribed by the generic model for themanagement of long term conditionsii
• provide effective and safe care to people withdiabetes in a range of settings including thepatient’s home, in accordance with the NICEQuality Standards for Diabetesiii
• deliver the outcomes for diabetes as determinedby the NHS Outcomes Frameworkiv
• take into account the emotional, psychologicaland mental wellbeing of the patientv
• take into account race and inequalities withrespect to access to care
• ensure that services are responsive andaccessible to people with Learning Disabilitiesvi
• have effective clinical networks with clear clinicalleadership across the boundaries of care whichclearly identify the role and responsibilities ofeach member of the diabetes healthcare team
Features of Diabetes andCardiovascular Care
i Available on the DH website athttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353
ii Available on the DH website at http://www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_120915
iii Quality Standards: Diabetes in adults, http://www.nice.org.uk/guidance/qualitystandards/qualitystandards.jsp
iv Available on the DH website athttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122944
v Emotional and Psychological Support and Care in Diabetes, Joint Diabetes UK and NHS Diabetes Emotional and PsychologicalSupport Working Group, February 2010, http://www.diabetes.nhs.uk/our_work_areas/emotional_and_psychological/
vi http://www.diabetes.nhs.uk/commissioning_resource/
7
• ensure that there are a wide range of optionsavailable to people with diabetes to support selfmanagement and individual preferences
• take into account services provided by socialcare and the voluntary sector
• provide patient/carer/family education ondiabetes not only at diagnosis but also duringcontinuing management at every stage of care
• provide education on diabetes management toother staff and organisations that supportpeople with diabetes
• have a capable and effective workforce that hasthe appropriate training, updating, skills andcompetencies in the management of peoplewith diabetes
• provide multidisciplinary care that manages thetransition between adult and older peoples’services
• have integrated information systems that recordindividual needs including emotional, social,educational, economic and biomedicalinformation which permit multidisciplinary careacross service boundaries and support careplanningvii
• produce information on the outcomes ofdiabetes care including contributing to nationaldata collections and audits
• have adequate governance arrangements, e.g.local mortality and morbidity meetings ondiabetes care to learn from errors and improvepatient safety
• take account of patient experience, includingPatient Reported Outcomes Measures, in thedevelopment and monitoring of servicedeliveryviii
• actively monitor the uptake of services,responding to non-attenders and monitoringcomplaints and untoward incidents
vii http://www.diabetes.nhs.uk/year_of_care/it/
viii http://www.ic.nhs.uk/proms
8
NH
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etes
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HS
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ialis
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men
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qu
ired
?
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Ap
po
intm
ent
for
nex
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view
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list
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ible
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ide
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iew
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po
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to
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itia
l th
erap
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Yes No
Upd
ate
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ca
re p
lan
-ac
cord
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to
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prot
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s
Ref
erra
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rmat
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-lia
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abet
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iag
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and
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nti
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car
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d o
lder
p
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om
mis
sio
nin
gg
uid
es Upd
ate
diab
etes
ca
re p
lan
Ch
eck
for
card
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scu
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sym
pto
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st p
ain
Ref
erra
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ca
rdio
log
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rvic
es if
sy
mp
tom
atic
Go
to
p
ages
10
and
11
Diabetes and Cardiovascular CareIntervention Map
9
NH
S D
iab
etes
Dia
bet
es a
nd
car
dio
vasc
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esEm
erg
ency
car
e –
com
mu
nit
y/am
bu
lan
ce
Pati
ent
has
su
spec
ted
ca
rdio
vasc
ula
r ev
ent
E.g.
Che
st
pain
, str
oke/
TIA
999
call
Cal
l tri
aged
at
amb
ula
nce
call
cen
tre
E.g.
-FA
ST
prot
ocol
for
st
roke
s
-ca
tego
ry A
re
spon
se
Am
bu
lan
ce
and
cre
w
dis
pat
ched
Am
bu
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ce
arri
ves
at t
he
scen
e
-m
axim
um
resp
onse
tim
e is
8 m
inut
es
Ass
essm
ent
by
amb
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nce
st
aff
-cl
inic
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asse
ssm
ent
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rdin
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ag
reed
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ols
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, EC
G a
s ap
prop
riate
Ass
essm
ent
outc
ome
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vasc
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t ot
her
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genc
y
Tran
sfer
to
near
est
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cord
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cal
agre
ed p
roto
cols
Ass
essm
ent
ou
tco
me
No
t ca
rdio
vasc
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d N
ot
an
emer
gen
cy
Patie
nt re
mai
ns a
t ho
me/
com
mun
ityRe
ferr
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ap
prop
riate
ag
enci
es
acco
rdin
g to
loca
l ag
reed
pro
toco
ls
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essm
ent
ou
tco
me
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scu
lar
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gen
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. Str
oke
/M
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farc
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aler
t ca
ll to
str
oke
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ntr
e o
r p
ercu
tan
eou
s co
ron
ary
inte
rven
tio
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cen
tre,
as
app
rop
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e lig
ht
amb
ula
nce
Tran
sfer
dir
ectl
y to
str
oke
cent
re
or p
ercu
tane
ous
coro
nary
in
terv
enti
once
ntre
, as
appr
opri
ate
Go
to
p
age
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tinue
tr
eatm
ent
of
card
iova
scul
ar
emer
genc
y
10
NH
S D
iab
etes
Dia
bet
es a
nd
car
dio
vasc
ula
r se
rvic
esSp
ecia
list
care
–Em
erg
ency
car
e
Imm
edia
teas
sess
men
tan
d t
reat
men
t o
fca
rdio
vasc
ula
r em
erg
ency
co
nd
itio
n
A&
E /s
trok
e un
it/pe
rcut
aneo
us
coro
nary
in
terv
entio
nce
ntre
Dia
bet
es f
oo
t em
erg
enci
es
see
dia
bet
es
foo
t ca
re
com
mis
sio
nin
g
gu
ide-re
susc
itate
- st
abili
se
-in
itiat
e tr
eatm
ent
acco
rdin
g to
ag
reed
pr
otoc
ols
-ch
eck
for
di
abet
es
adm
issi
on
-co
ntin
ue
man
agem
ent
of
the
card
iova
scul
ar
emer
genc
y, a
s ap
prop
riate
-id
entif
y pe
ople
w
ith p
revi
ousl
y un
know
n di
abet
es
acco
rdin
g to
ag
reed
pro
toco
ls
-co
ntin
ue
man
agem
ent
of
diab
etes
if
know
n to
hav
e di
abet
es
(adm
issi
on c
are
plan
)
Co
nti
nu
ed
man
agem
ent
of
card
iova
scu
lar
con
dit
ion
acco
rdin
g t
o
agre
ed p
roto
cols
E.g.
-Pr
imar
y an
giop
last
y
-th
rom
boly
sis
-st
roke
/TIA
m
anag
emen
t et
c
-D
iabe
tes
team
to
advi
se/
man
age
No
Rev
iew
car
e p
lan
nin
g
incl
ud
ing
dis
char
ge
pla
n
-lia
ise
with
car
e co
-or
dina
tor
-in
itiat
e di
scha
rge
plan
-nu
triti
onal
as
sess
men
t (f
or o
lder
pe
ople
)-
prom
ote
self
care
of
diab
etes
Yes
Dis
cuss
d
iag
no
sis
wit
h
pat
ien
t
Init
iate
car
e pl
anni
ng in
clud
ing
iden
tifi
cati
on o
f ca
re c
o-or
dina
tor
and
asse
ss c
arer
’s
need
s
-in
itiat
e di
scha
rge
plan
-pr
omot
e se
lf ca
re o
f di
abet
es
Pati
ent
stab
le
- C
ardi
ovas
cula
r co
nditi
ontr
eate
d,
acco
rdin
g to
ag
reed
pro
toco
ls
-go
od g
lyca
emic
co
ntro
l
Dis
char
ge
care
pla
nD
isch
arg
e
-in
form
GP
-ca
rdia
c re
habi
litat
ion
and
inte
grat
ed c
are
plan
s
-in
form
car
e co
-or
dina
tor/
dia
bete
s te
am in
com
mun
ity
for
follo
w u
p
- se
e di
agno
sis
and
cont
inui
ng c
are
com
mis
sion
ing
guid
e
-di
scha
rge
med
icat
ion
New
ly
dia
gn
ose
d
dia
bet
es?
Pres
enta
tion
w
ith
card
iova
scul
ar
emer
genc
y (e
.g. M
I/st
roke
et
c)
Fro
mp
age
9
11
NH
S D
iab
etes
Dia
bet
es a
nd
car
dio
vasc
ula
r se
rvic
es
Spec
ialis
t ca
re –
pla
nn
ed c
are
Hea
lth
Nee
ds
Ass
essm
ent
Ass
essm
ent
of
gly
caem
icco
ntr
ol
Ass
essm
ent
at
card
iolo
gy/
card
iova
scu
lar
serv
ices
fo
r ca
rdio
vasc
ula
r co
nd
itio
n
- di
abet
es t
eam
to
man
age
patie
nt
Ad
mis
sio
nre
qu
ired
fo
r ca
rdio
vasc
ula
r co
nd
itio
n?
-st
abili
se
card
iova
scul
ar
cond
ition
or
cons
ider
card
iova
scul
ar
proc
edur
e
No
Yes
Trea
tmen
t ac
cord
ing
to
ag
reed
p
roto
cols
Ad
mis
sio
n
Follo
w u
p b
y ca
rdio
log
y/ca
rdio
vasc
ula
r se
rvic
es a
cco
rdin
g t
o
agre
ed p
roto
cols
Info
rmat
ion
to
d
iab
etes
tea
m
loo
kin
g a
fter
p
atie
nt
-lia
ison
with
car
e co
-or
dina
tor
- up
date
dia
bete
s ca
re
plan
Man
agem
ent
of
card
iova
scu
lar
con
dit
ion
Aim
to
ach
ieve
g
oo
d g
lyca
emic
co
ntr
ol d
uri
ng
ad
mis
sio
n
-se
e em
erge
ncy
and
inpa
tient
com
mis
sion
ing
gu
ide
Pati
ent
read
y fo
r d
isch
arg
e
-go
od g
lyca
emic
co
ntro
l
-go
od p
ost
-op
erat
ive/
pr
oced
ure
reco
very
-lia
ison
with
car
e co
-or
dina
tor
Dis
char
ge
care
pla
nD
isch
arg
e
-in
form
GP
-ca
rdia
c re
habi
litat
ion
and
inte
grat
ed c
are
plan
s
-in
form
car
e co
-or
dina
tor/
diab
etes
te
am in
com
mun
ity f
or
follo
w u
p
- se
e di
agno
sis
and
cont
inui
ng c
are
com
mis
sion
ing
gui
de
-di
scha
rge
med
icat
ion
-up
date
dia
bete
s ca
re
plan
Follo
w u
p b
y ca
rdio
log
y/ca
rdio
vasc
ula
r se
rvic
es a
cco
rdin
g
to a
gre
ed
pro
toco
ls
12
Contracting Framework for Diabetes andCardiovascular Services
IntroductionThis contracting framework sets what is requiredof clinically safe and effective services that areproviding care for people with diabetes who havecardiovascular complications. The framework isdesigned to be read in conjunction with the highlevel patient intervention map, which describes theinterventions and actions required along thepatient pathway as well as entry and exit points,and the standard service specification template fordiabetes and cardiovascular services.
The framework brings together the key qualityareas and standards that have been identified byNHS Diabetes, Diabetes UK, the Royal Colleges andother related organisations.
The principles that establish a safepathway for patient care Establishing the principles that underpin thesystems and processes of pathways for patient careleads to more efficient patient throughput and canreduce risk of fragmentation of care and seriousuntoward incidents. The principles operate at fourlayers within a patient pathway:
• Commissioning
• Clinical Case Direction or the overall Care Plan(i.e. the management of an individual patient)
• Provision of the clinical service or process
• Organisational platform on which the clinicalservice or process sits (the provider organisation)
A straightforward or simple pathway is one inwhich the overall management including bothClinical Case Direction and the delivery of theclinical processes conventionally sits within oneorganisation. However, with a more complexpathway, there is a danger that fracturing theoverall management pathway into componentscarried out by different clinical teams andorganisations will require duplication of effortleading to inefficiency and increased risk athandover points.This can be managed byestablishing clear governance arrangements for allthe layers in the pathway.
In addition, Commissioning Bodies must balancethe benefits of fracturing the pathway againstincreased complexity and ensure that the increasedrisks are mitigated.
The governance arrangements required for allthree layers and the commissioner responsibilitiesare shown below:
13
In essence, at each level, there are governancearrangements to ensure sound and safe systems ofdelivery of patient care with clear lines ofaccountability between each level.
Cardiovascular services for peoplewith diabetes The key principles of good diabetes andcardiovascular services are to provide high qualitycare that is reliable in terms of delivery and timelyaccess for patients requiring that care.
Care of people with diabetes who havecardiovascular complications is provided by anumber of different teams in the primary,community and acute settings. It is essential thatthere is co-ordination of care of patients throughthe care planning process and that thecardiologist/diabetes physician retain jointresponsibility for overall patient care across thewhole pathway and retain overall responsibility forthe management of side effects and furthercomplications.
The initial management and continuing care ofindividuals with diabetes should include anassessment of their emotional and psychologicalwell-being, together with timely access toappropriate psychological and biological/psychiatricinterventions. Mental health disorders can posesignificant barriers to diabetes care and thereforemental health stability is vital for good self care1.
The services themselves will also have clinicaloversight and accountability for governancepurposes.
This contracting framework focuses on peoplewith diabetes who require care for thecardiovascular complications of diabetes.Management of foot complications of diabetes,including peripheral vascular disease, can be foundin the diabetes foot care commissioning guide2.This contracting framework should also be read inconjunction with the diabetes commissioningguides for children and young people , diagnosisand continuing care , older people and follow theprinciples for the effective commissioning ofservices for people with Learning Disabilities2.
Ensuring qualityCommissioning Bodies should ensure that thecardiovascular services for people with diabetescommissioned are of the highest quality. Theremay, in addition, be some organisations that wishto offer their services, but do not have a history ofproviding such care.
i) For provider organisations already involved inthe delivery of cardiovascular services for peoplewith diabetes, there should be retrospectiveevidence of systems being in place,implemented and working.
ii) For organisations new to the arena, thecommissioner should reassure itself that theprovider has the organisational attributes,governance arrangements, systems andprocesses set up to provide the platform forsafe and effective delivery of cardiovascularservices for people with diabetes to beprovided.
This framework describes what theCommissioning Body needs to ensure ispresent or addressed in its discussions withthe provider organisation.
Under the ‘elements’ column there are crossreferences to the Standard NHS Contract for AcuteServices– bilateral (main clauses and schedules)3. This is to assist commissioners and providers inhaving an overview of how the elements link to theStandard NHS Contracts. Some of the areas areopen to interpretation and consequently thereferences are not exhaustive.
14
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Gov
erna
nce
Lead
ersh
ip
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:11
,16,
19,3
3,48
,49,
51,5
3, 6
0
Sche
dule
s: 1
0
Cla
rity
of t
he o
rgan
isat
ion’
spu
rpos
e w
ith e
xplic
itco
mm
itmen
t to
pro
vidi
ng h
igh
qual
ity s
ervi
ces
A c
ultu
re t
hat
dem
onst
rate
s an
open
lear
ning
eth
os
An
orga
nisa
tion
that
is le
gal a
ndet
hica
l in
all i
ts a
ctiv
ities
Prov
ider
mus
t ha
ve o
rgan
isat
iona
l str
uctu
reth
at p
rovi
des
lead
ersh
ip f
or a
ll pr
ofes
sion
san
d di
scip
lines
In p
artic
ular
, the
re m
ust
be a
cor
pora
tecl
inic
al d
irect
or w
ith t
he r
espo
nsib
ility
and
acco
unta
bilit
y fo
r th
e cl
inic
al s
ervi
ce
Ther
e m
ust
be a
lear
ning
fra
mew
ork
in t
heor
gani
satio
n
Ther
e sh
ould
be
a de
sign
ated
clin
ical
dire
ctor
with
resp
onsi
bilit
y an
d ac
coun
tabi
lity
for
the
diab
etes
and
card
iova
scul
ar s
ervi
ces
Gov
erna
nce
Inte
grat
ed G
over
nanc
e
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:11
,19,
27,4
8,49
,51,
53,5
4,56
, 60
Sche
dule
s:
10
An
orga
nisa
tion
that
is g
uide
d by
the
prin
cipl
es o
f go
odgo
vern
ance
:
- cl
arity
of
purp
ose
- pa
rtic
ipat
ion
and
enga
gem
ent
- ru
le o
f la
w-
tran
spar
ency
- re
spon
sive
ness
- eq
uity
and
incl
usiv
enes
s-
effe
ctiv
enes
s an
d ef
ficie
ncy
- ac
coun
tabi
lity
An
orga
nisa
tion
that
acc
epts
resp
onsi
bilit
y an
d ac
coun
tabi
lity
for
all i
ts a
ctio
ns
Cle
ar o
rgan
isat
iona
l and
int
egra
ted
gove
rnan
ce s
yste
ms
and
stru
ctur
es in
pla
cew
ith c
lear
line
s of
acc
ount
abili
ty a
ndre
spon
sibi
litie
s fo
r al
l fun
ctio
ns. T
his
incl
udes
inte
rfac
es a
nd t
rans
ition
s be
twee
nse
rvic
es
Qua
lity
Gov
erna
nce
in t
he N
HS.
A g
uide
for
pro
vide
r bo
ards
4
Gov
erna
nce
Clin
ical
Gov
erna
nce
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:4,
4A,6
,9,1
0,12
,14,
15,1
6,17
,19,
21,
27,2
9,31
,32,
33,
48,4
9,51
,53,
54
Sche
dule
s:
3 (p
arts
1,2,
4,4A
,4B,
4C,5
,6),
7,10
,12,
18,2
0
Expl
icit
com
mitm
ent
to q
ualit
yan
d pa
tient
saf
ety
Patie
nt f
ocus
ed w
ith r
espe
ct f
orth
e pe
rson
al w
ishe
s of
pat
ient
s in
all a
spec
ts o
f th
eir
care
A c
omm
itmen
t to
inno
vatio
n an
dco
ntin
uous
impr
ovem
ent
Clin
ical
Gov
erna
nce
syst
ems
and
polic
ies
shou
ld b
e in
pla
ce a
nd in
tegr
ated
into
orga
nisa
tiona
l gov
erna
nce
with
cle
ar li
nes
of a
ccou
ntab
ility
and
res
pons
ibili
ty f
or a
llcl
inic
al g
over
nanc
e fu
nctio
ns
e.g.
• C
linic
al A
udit
• C
linic
al R
isk
Man
agem
ent
• U
ntow
ard
Inci
dent
Rep
ortin
g•
Infe
ctio
n C
ontr
ol•
Med
icin
es M
anag
emen
t•
Info
rmed
Con
sent
• Ra
isin
g C
once
rns
• St
aff
Dev
elop
men
t
All
sub-
cont
ract
ors
mus
t m
eet
gove
rnan
ce a
nd le
ader
ship
arra
ngem
ents
of
the
mai
n pr
ovid
er o
rgan
isat
ion
Com
mis
sion
er, p
rovi
der
and
NH
S Li
tigat
ion
Aut
horit
y m
ust
revi
ew t
he C
linic
al N
eglig
ence
Sch
eme
for
Trus
tsar
rang
emen
ts /o
r ot
her
orga
nisa
tiona
l / p
rofe
ssio
nal i
ndem
nity
arra
ngem
ents
The
serv
ice
shou
ld h
ave
in p
lace
writ
ten
prot
ocol
s an
dpr
oced
ures
def
inin
g cl
ear
lines
of
acco
unta
bilit
y an
dre
spon
sibi
lity.
The
serv
ice
is r
equi
red
to c
ompl
y w
ith g
uide
lines
, pub
lic h
ealth
guid
ance
and
app
rais
als
publ
ishe
d by
the
Nat
iona
l Ins
titut
e fo
rH
ealth
and
Clin
ical
Exc
elle
nce
that
are
rel
evan
t to
the
car
epr
ovid
ed b
y th
e se
rvic
e 5,
6
15
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Gov
erna
nce
Clin
ical
Gov
erna
nce
• C
ompl
aint
s M
anag
emen
t•
Patie
nt a
nd P
ublic
Invo
lvem
ent
• Pa
tient
dig
nity
and
res
pect
•
Equa
lity
and
dive
rsity
• In
trod
ucin
g ne
w t
echn
olog
ies
and
trea
tmen
ts•
An
exte
rnal
ly a
ccre
dite
d Q
ualit
yA
ssur
ance
sys
tem
and
inte
rnal
err
orre
port
ing
invo
lvin
g al
l sta
ff g
roup
s.
CG
sys
tem
s sh
ould
hav
e cl
ear
and
dem
onst
rabl
e lin
ks t
o ot
her
NH
S sy
stem
sw
ith c
olla
bora
tive
CG
act
iviti
es a
nd s
harin
gof
exp
erie
nce
and
lear
ning
Prov
ider
sho
uld
prod
uce
annu
al C
linic
alG
over
nanc
e re
port
s as
par
t of
NH
S C
Gre
port
ing
syst
em
Prov
ider
s ar
e re
quire
d to
agr
eeC
omm
issi
onin
g fo
r Q
ualit
y an
d In
nova
tion
sche
mes
(CQ
UIN
) for
dia
bete
s ca
re, e
.g.
mod
el C
QU
IN s
chem
e pr
opos
ed b
y th
e N
HS
Inst
itute
for
Inno
vatio
n an
d Im
prov
emen
t 10
In a
dditi
on, t
he s
ervi
ce is
req
uire
d to
com
ply
with
the
follo
win
g:
i. G
uida
nce
publ
ishe
d by
NIC
E
• M
edic
ines
adh
eren
ce: i
nvol
ving
pat
ient
s in
dec
isio
ns a
bout
pres
crib
ed m
edic
ines
and
sup
port
ing
adhe
renc
e 7
ii. D
H g
uida
nce
on t
reat
men
t of
hea
rt a
ttac
k 8
iii. C
linic
al g
uide
lines
for
Typ
e 2
Dia
bete
s M
ellit
us p
rodu
ced
byth
e Eu
rope
an D
iabe
tes
Wor
king
Par
ty f
or O
lder
Peo
ple
9
Clin
ical
qua
lity
Qua
lity
assu
ranc
e
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:4,
4A,1
2,16
,17,
18,
19,2
0,21
, 31,
32,
33, 5
4
Sche
dule
s:
2,3
(par
ts 4
, 4A
,4B,
4C,5
,6)
7, 1
0,12
, 18,
20
Und
erst
andi
ng t
he c
once
pt o
fcl
inic
al q
ualit
y
Has
con
cern
for
qua
lity
whi
lew
orki
ng e
ffic
ient
ly
An
unde
rsta
ndin
g of
the
use
of
audi
t, p
atie
nt a
nd s
taff
fee
dbac
kto
impr
ove
qual
ity
An
orga
nisa
tion
that
pro
vide
scl
arity
of
obje
ctiv
es a
ndpr
omot
es r
efle
ctiv
e pr
actic
e to
impr
ove
qual
ity o
f pa
tient
car
e
Qua
lity
assu
ranc
e sy
stem
s m
ust b
e in
pla
cean
d ap
prov
ed b
y co
mm
issio
ning
bod
y w
ithre
gula
r rep
ortin
g of
out
com
es
Prov
ider
s ar
e re
quire
d to
pub
lish
qual
ityac
coun
ts fo
r the
pub
lic re
port
ing
of q
ualit
yin
clud
ing
safe
ty, e
xper
ienc
e an
d ou
tcom
es
Prov
ider
s sh
ould
par
ticip
ate
in n
atio
nal a
udit
prog
ram
mes
Car
diov
ascu
lar
serv
ices
for
peo
ple
with
dia
bete
s se
rvic
es m
ust
com
ply
with
the
per
form
ance
mea
sure
s re
quire
d of
NH
Sse
rvic
es, i
.e m
eetin
g: 11
• Re
ferr
al t
o Tr
eatm
ent
wai
ts (9
5th
perc
entil
e m
easu
res)
•
A&
E Q
ualit
y In
dica
tors
• A
mbu
lanc
e re
spon
se t
imes
The
serv
ices
are
req
uire
d to
par
ticip
ate
in t
he f
ollo
win
gac
tiviti
es/p
rogr
amm
es:
• N
atio
nal D
iabe
tes
Aud
it 12
• N
atio
nal D
iabe
tes
Inpa
tient
Aud
it of
Acu
te T
rust
s 13
(NB
Prov
ider
s m
ay w
ish
to c
ondu
ct a
dditi
onal
aud
its in
the
are
asid
entif
ied
in t
his
docu
men
t)•
Patie
nt E
xper
ienc
e Su
rvey
s 14
• D
iabe
tes
E 15
• Pa
tient
Rep
orte
d O
utco
mes
Mea
sure
s 16
16
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Clin
ical
qua
lity
Wor
kfor
ce/ s
taff
Clin
ical
sta
ff a
ttrib
utes
criti
cal t
o sa
fety
and
qual
ity o
f int
erve
ntio
ns
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:11
,16,
26,3
3, 4
8 ,5
6
The
prov
ider
org
anis
atio
n ha
ssy
stem
s an
d pr
oced
ures
in p
lace
to a
ssur
e th
e co
mm
issi
oner
tha
tth
eir
clin
ical
tea
m h
as t
hene
cess
ary
qual
ifica
tions
, ski
lls,
know
ledg
e an
d ex
perie
nce
tode
liver
the
ser
vice
Staf
f are
com
pete
nt a
nd fi
t for
pur
pose
Prov
ider
to s
atisf
y co
mm
issio
ner t
hat a
ll st
aff
have
cur
rent
app
raisa
l, cl
eara
nces
and
regi
stra
tion
chec
ks a
nd h
ave
dem
onst
rate
dco
mpe
tenc
e in
all
proc
edur
es re
leva
nt to
path
way
.
Prov
ider
to
satis
fy c
omm
issi
oner
tha
t th
ey c
an r
ecru
it (o
rpr
ocur
e) a
nd r
etai
n a
com
pete
nt c
linic
al t
eam
to
deliv
er t
hese
rvic
e
Spec
ific
qual
ifica
tions
req
uire
d of
hea
lth p
rofe
ssio
nals
prov
idin
g th
e se
rvic
e ar
e:
• Fo
r m
edic
al p
ract
ition
ers:
o
Dia
bete
s: r
egis
trat
ion
with
the
GM
C a
nd e
vide
nce
of f
urth
er q
ualif
icat
ion
in d
iabe
tes
care
or
expe
rienc
e w
ithin
dia
bete
s cl
inic
o C
ardi
olog
y: r
egis
trat
ion
with
the
GM
C a
ndev
iden
ce o
f fu
rthe
r qu
alifi
catio
n in
car
diol
ogy
o St
roke
: reg
istr
atio
n w
ith t
he G
MC
and
evi
denc
e of
furt
her
qual
ifica
tion
in t
he m
anag
emen
t of
stro
kes/
TIA
• N
urse
s: o
Dia
bete
s : r
egis
trat
ion
with
the
NM
C a
nd f
urth
erev
iden
ce o
f qu
alifi
catio
n in
dia
bete
s ca
re o
rex
perie
nce
with
in d
iabe
tes
clin
ic 17
o C
ardi
olog
y: r
egis
trat
ion
with
the
NM
C a
nd f
urth
erev
iden
ce o
f qu
alifi
catio
n in
car
diol
ogy
orex
perie
nce
with
in c
ardi
olog
y cl
inic
o St
roke
: reg
istr
atio
n w
ith t
he N
MC
and
fur
ther
evid
ence
of
qual
ifica
tion
in m
anag
emen
t of
stro
ke/T
IA o
r ex
perie
nce
with
in a
str
oke
unit
Hea
lthca
re p
rofe
ssio
nals
invo
lved
in d
eliv
erin
g ca
re f
or p
eopl
ew
ith d
iabe
tes
who
hav
e ca
rdio
vasc
ular
com
plic
atio
ns a
rere
quire
d to
hav
e th
e re
leva
nt c
ompe
tenc
ies
in t
hem
anag
emen
t of
18:
• di
abet
es
• ca
rdio
vasc
ular
dis
ease
•
coro
nary
hea
rt d
isea
se
• st
roke
17
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Clin
ical
qua
lity
Wor
kfor
ce/ s
taff
Clin
ical
sta
ffco
mpe
tenc
ies
in u
se o
feq
uipm
ent
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:11
, 16,
17,
21,
26,
33
The
prov
ider
org
anis
atio
n ha
ssy
stem
s in
pla
ce t
o as
sure
the
com
mis
sion
er t
hat
thei
r cl
inic
alte
am a
re c
ompe
tent
to
use
all
equi
pmen
t ne
eded
to
deliv
er t
hese
rvic
e
Prov
ider
to s
atisf
y th
e co
mm
issio
ner t
hat a
llst
aff h
ave
had
docu
men
ted
com
pete
nce
asse
ssm
ent r
elat
ive
to a
ll eq
uipm
ent u
sed
inco
ntra
ct.
All
heal
thca
re p
rofe
ssio
nals
invo
lved
in d
eliv
erin
g ca
re fo
r peo
ple
with
dia
bete
s w
ho h
ave
card
iova
scul
ar c
ompl
icat
ions
are
requ
ired
to h
ave
the
rele
vant
com
pete
ncie
s in
usin
g ap
prop
riate
equi
pmen
t e.g
. blo
od g
luco
se a
nd k
eton
e m
onito
rs, i
nsul
inde
liver
y de
vice
s in
clud
ing
insu
lin p
umps
, EC
Gs,
taki
ng b
lood
pres
sure
mea
sure
men
ts e
tc
Clin
ical
qua
lity
Wor
kfor
ce /
staf
f
Dev
elop
men
t
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:11
,16,
19,3
048
The
prov
ider
org
anis
atio
n ha
ssy
stem
s in
pla
ce t
o as
sure
the
com
mis
sion
er t
hat
thei
r cl
inic
alte
am is
for
mal
ly in
duct
ed a
ndre
ceiv
es o
ngoi
ng a
ssis
tanc
e to
deve
lop
thei
r sk
ills,
kno
wle
dge
and
expe
rienc
e t
o en
sure
tha
tth
ey a
re a
lway
s fu
lly u
pdat
ed
Prov
ider
to s
atisf
y co
mm
issio
ner o
f the
irco
mm
itmen
t to
indu
ctio
n an
d C
PD re
leva
ntto
role
s
Prov
ider
to s
atisf
y th
e co
mm
issio
ner o
f the
irco
mm
itmen
t to
trai
n st
aff t
o m
eet f
utur
ese
rvic
e ne
eds
All
Hea
lth C
are
prof
essio
nals
shou
ld h
ave
suff
icie
nt s
tudy
leav
eal
loca
tion
(tim
e an
d fin
ance
) to
enab
le th
em to
dev
elop
ski
llsap
prop
riate
ly
Clin
ical
qua
lity
Regi
stra
tion
and
licen
sing
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:4,
4A,5
,9,1
0,11
,12,
14,1
5,16
17,1
8,19
,21,
26,
27,2
9,33
,34,
35,
3643
,48,
49,5
253
,54,
56,6
0
Sche
dule
s:
2,3,
4,5,
6,8,
10,
12,1
3,15
,17,
19
, 20
The
Prov
ider
is r
equi
red
to b
ere
gist
ered
with
the
Car
e Q
ualit
yC
omm
issi
on t
o de
mon
stra
te t
hat
is m
eets
the
ess
entia
l sta
ndar
dsof
qua
lity
and
safe
ty f
or t
here
gula
ted
activ
ities
del
iver
ed.
The
Prov
ider
is r
equi
red
to b
elic
ense
d w
ith t
he N
HS
Econ
omic
Regu
lato
r (M
onito
r) in
ord
er t
opr
ovid
e N
HS
care
.
Com
plia
nce
with
the
Car
e Q
ualit
yC
omm
issio
n an
d M
onito
r req
uire
men
tsC
ompl
ianc
e w
ith th
e fo
llow
ing
Nat
iona
l Ser
vice
Fra
mew
orks
,w
here
app
licab
le:
• O
lder
Peo
ple’
s N
SF 19
• C
oron
ary
Hea
rt D
iseas
e N
SF 20
• Th
e M
enta
l Hea
lth S
trat
egy21
• Lo
ng T
erm
Con
ditio
ns N
SF 22
Com
plia
nce
with
:
• En
d of
Life
car
e St
rate
gy 23
Com
plia
nce
with
Car
e Q
ualit
y C
omm
issio
n Re
view
s
18
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Clin
ical
qua
lity
Out
com
es
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:4,
4A,1
0,14
,15,
16,2
1
Sche
dule
s:3
(par
t 5),
5 (p
arts
1,2
,3),
12
Com
preh
ensi
ve u
nder
stan
ding
and
com
mitm
ent
to d
eliv
erin
gan
d im
prov
ing
outc
omes
of
care
Com
plia
nce
with
the
NH
S O
utco
mes
Fram
ewor
k24C
ompl
ianc
e w
ith t
he Q
ualit
y St
anda
rds
for
Dia
bete
s,sp
ecifi
cally
25
Qua
lity
Stat
emen
t 11
Peop
le w
ith d
iabe
tes
adm
itted
to
hosp
ital a
re c
ared
for b
yap
prop
riate
ly tr
aine
d st
aff,
prov
ided
with
acc
ess
to a
spe
cial
istdi
abet
es te
am, a
nd g
iven
the
choi
ce o
f sel
f-m
onito
ring
and
man
agin
g th
eir o
wn
insu
lin
Qua
lity
Stat
emen
t 13
Peop
le w
ith d
iabe
tes
who
hav
e ex
perie
nced
hyp
ogly
caem
iare
quiri
ng m
edic
al a
tten
tion
are
refe
rred
to a
spe
cial
ist d
iabe
tes
team
Clin
ical
qua
lity
Patie
nt p
athw
ay
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:4,
4A,9
,10,
12,
14,1
5,16
,17,
18,1
9,20
,21,
27,2
9,32
,33,
34,
35,3
6,54
Sche
dule
s:3
(par
ts 1
and
2)
Resp
onsi
vene
ss a
nd p
artic
ipat
ive
appr
oach
to
incl
udin
g pa
tient
s’vi
ews
abou
t th
eir
care
in t
hede
sign
of
care
pat
hway
s
Col
labo
ratio
n w
ith o
ther
orga
nisa
tions
invo
lved
in t
hepa
tient
pat
hway
to
prov
ide
ase
amle
ss p
athw
ay o
f ca
re
All
poss
ible
ent
ry a
nd e
xit
poin
ts m
ust
bede
fined
with
com
preh
ensi
ve p
atie
ntpa
thw
ays
that
fac
ilita
te s
moo
th p
assa
gean
d ef
fect
ive,
eff
icie
nt c
are
for
patie
nts
All
inte
rfac
es in
the
pat
hway
mus
t be
defin
ed s
o th
at c
ontin
uity
of
clin
ical
car
e is
ensu
red
with
no
frac
turin
g of
the
pat
hway
Ther
e m
ust
be s
peci
ficat
ion
of c
lear
timel
ines
and
ale
rt m
echa
nism
s fo
rpo
tent
ial b
reac
hes
Ther
e sh
ould
be
audi
t of
pat
hway
to
ensu
reth
at s
tand
ards
are
met
Ther
e m
ust
be e
xplic
it sp
ecifi
catio
n of
prov
ider
and
com
mis
sion
er r
espo
nsib
ilitie
sfo
r th
e w
hole
pat
ient
epi
sode
fro
mre
gist
ratio
n to
fin
al d
isch
arge
Acc
ount
abili
ties
shou
ld b
e ag
reed
and
docu
men
ted
by a
ll st
akeh
olde
rs
Ther
e ar
e a
num
ber
of s
ervi
ces
supp
ortin
gpa
tient
s w
ith d
iabe
tes
and
ther
e m
ust
becl
ear
sub
cont
ract
s st
atin
g th
e re
ferr
alcr
iteria
and
acc
ess
to t
hese
sup
port
ing
serv
ices
.
The
path
way
sho
uld
follo
w th
e pr
inci
ples
set
out
by
the
Gen
eric
Long
Ter
m C
ondi
tions
mod
el 26
. Thi
s in
clud
es:
• St
ratif
ying
the
leve
ls of
nee
d an
d ris
k •
Cas
e m
anag
emen
t•
Pers
onal
ised
care
pla
nnin
g•
Supp
ortin
g pe
ople
to s
elf c
are
• A
ssist
ive
tech
nolo
gy
The
key
elem
ents
that
car
diov
ascu
lar s
ervi
ces
for p
eopl
e w
ithdi
abet
es s
houl
d pr
ovid
e in
clud
e:
1. R
isk a
sses
smen
t and
initi
al m
anag
emen
t
2. E
mer
genc
y ca
re in
the
com
mun
ity
3. S
peci
alist
car
e fo
r car
diov
ascu
lar c
ompl
icat
ions
, inc
ludi
ngem
erge
ncy
and
plan
ned
care
, e.g
. str
oke/
TIA
/ MI/
acut
eco
rona
ry s
yndr
omes
etc
4. R
ehab
ilita
tion
(pos
t myo
card
ial i
nfar
ctio
n an
d st
roke
)
1. R
isk a
sses
smen
t and
initi
al m
anag
emen
t •
Ther
e sh
ould
be
agre
ed p
roto
cols
for a
sses
sing
the
risk
of :
o di
abet
eso
the
effe
cts
of s
mok
ing
o ca
rdio
vasc
ular
dise
ase
o hy
pert
ensio
no
hype
rcho
lest
erol
aem
ia(e
.g. N
HS
Hea
lth C
heck
s 27
).
19
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Clin
ical
qua
lity
Patie
nt p
athw
ayA
t en
try
to p
athw
ay:
The
Com
mis
sion
er s
houl
d as
sure
them
selv
es t
hat
the
prov
ider
has
sys
tem
san
d pr
oces
ses
in p
lace
to
i) re
gist
er p
atie
nts
ii) c
olle
ct r
elev
ant
clin
ical
and
adm
inis
trat
ive
data
iii) m
anag
e th
e ap
poin
tmen
t pr
oces
s,(r
eapp
oint
men
t an
d D
NA
pro
cess
, if
appr
opria
te)
iv) p
rovi
de in
form
atio
n to
pat
ient
sv)
und
erta
ke in
itial
ass
essm
ent
in t
heap
prop
riate
loca
tion
At
poin
t of
inte
rven
tion:
The
Com
mis
sion
er s
houl
d as
sure
them
selv
es t
hat
the
prov
ider
has
sys
tem
san
d pr
oces
ses
in p
lace
to
ensu
re t
hat:
i) th
e in
terv
entio
n is
con
duct
ed s
afel
yan
d in
acc
orda
nce
with
acc
epte
dqu
ality
sta
ndar
ds a
nd g
ood
clin
ical
prac
tice.
ii) t
he p
atie
nt r
ecei
ves
appr
opria
te c
are
durin
g th
e in
terv
entio
n(s)
, inc
ludi
ng o
ntr
eatm
ent
revi
ew a
nd s
uppo
rt, i
nac
cord
ance
with
bes
t cl
inic
al p
ract
ice
iii) w
here
clin
ical
em
erge
ncie
s or
com
plic
atio
ns d
o oc
cur
they
are
man
aged
in a
ccor
danc
e w
ith b
est
clin
ical
pra
ctic
eiv
) the
inte
rven
tion
is c
arrie
d ou
t in
afa
cilit
y w
hich
pro
vide
s a
safe
envi
ronm
ent
of c
are
and
min
imis
esris
k to
pat
ient
s, s
taff
and
vis
itors
v) t
he in
terv
entio
n is
und
erta
ken
by s
taff
with
the
nec
essa
ry q
ualif
icat
ions
, ski
lls,
expe
rienc
e an
d co
mpe
tenc
e vi
) The
re a
re a
rran
gem
ents
for
the
man
agem
ent
of o
ut o
f ho
urs
care
acco
rdin
g to
bes
t cl
inic
al p
ract
ice
• Fo
r peo
ple
with
kno
wn
and
new
ly d
iagn
osed
dia
bete
s, in
addi
tion
to th
e ab
ove,
ther
e sh
ould
be
agre
ed p
roto
cols
for:
o pe
riphe
ral v
ascu
lar d
iseas
e (s
ee a
lso d
iabe
tes
foot
care
com
miss
ioni
ng g
uide
) 2
o ch
ecki
ng fo
r act
ual c
ardi
ovas
cula
r sym
ptom
s, e
.g.
ches
t pai
n
2. E
mer
genc
y ca
re in
the
com
mun
ity
• Th
ere
shou
ld b
e pr
otoc
ols
in p
lace
to m
anag
e pe
ople
who
expe
rienc
e ca
rdio
vasc
ular
em
erge
ncie
s in
the
com
mun
ity, e
.g.
UK
Am
bula
nce
Serv
ices
Clin
ical
Pra
ctic
e G
uide
lines
28,2
9
3. S
peci
alist
car
e
i. Em
erge
ncy
trea
tmen
t in
A&
E
• th
ere
shou
ld b
e cl
ear p
roto
cols
for t
he a
sses
smen
t of p
eopl
e (in
clud
ing
olde
r peo
ple)
who
are
adm
itted
to h
ospi
tal w
ith a
nac
ute
card
iova
scul
ar c
ondi
tion,
e.g
. str
oke/
TIA
30, m
yoca
rdia
lin
farc
tion
20an
d ca
rdia
c fa
ilure
• th
ere
shou
ld b
e cl
ear p
roto
cols
for t
he a
sses
smen
t of p
eopl
e(in
clud
ing
olde
r peo
ple)
who
are
adm
itted
to h
ospi
tal w
ith a
nac
ute
card
iova
scul
ar c
ondi
tions
to b
e sc
reen
ed fo
r pos
sible
diab
etes
(Thi
nkG
luco
se)31
• ex
pert
adv
ice
and/
or c
are
from
the
mul
tidisc
iplin
ary
diab
etes
team
mus
t be
avai
labl
e fo
r the
man
agem
ent o
f peo
ple
who
pres
ent w
ith a
cute
car
diov
ascu
lar c
ondi
tions
who
hav
edi
abet
es o
r are
new
ly d
iagn
osed
with
dia
bete
s 24
hou
rs a
day
and
also
for c
ontin
uing
inpa
tient
car
e 2
ii. In
pat
ient
car
e
• th
ere
shou
ld b
e cl
ear p
roto
cols
for t
he c
ontin
ued
man
agem
ent
of p
eopl
e (in
clud
ing
olde
r peo
ple)
who
are
in h
ospi
tal w
ith a
nac
ute
card
iova
scul
ar c
ondi
tion,
e.g
. str
oke/
TIA
30, m
yoca
rdia
lin
farc
tion
20an
d ca
rdia
c fa
ilure
• th
e m
anag
emen
t of
a pe
rson
with
dia
bete
s w
ho is
adm
itted
for c
ardi
ovas
cula
r con
ditio
ns s
houl
d fo
llow
the
prin
cipl
es s
etou
t in
the
emer
genc
y an
d in
patie
nt c
omm
issio
ning
gui
de, i
.e.2
o ha
ve a
cces
s to
the
mul
tidisc
iplin
ary
diab
etes
team
o ha
ve a
dmiss
ion
and
disc
harg
e ca
re p
lans
o ha
ve a
n in
tegr
ated
car
e pl
ano
have
clo
se li
aiso
n w
ith th
eir c
are
co-o
rdin
ator
20
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Clin
ical
qua
lity
Patie
nt p
athw
ayA
t ex
it fr
om p
athw
ay:
The
Com
mis
sion
er s
houl
d as
sure
them
selv
es t
hat
prov
ider
has
sys
tem
s an
dpr
oces
ses,
whi
ch a
re a
gree
d w
ith a
ll pa
rtie
san
d ne
twor
ks, i
n pl
ace
to:
i) un
dert
ake
tele
phon
e tr
iage
ii) m
ake
urge
nt o
nwar
d re
ferr
als
whe
relif
e-th
reat
enin
g co
nditi
ons
or s
erio
usun
expe
cted
pat
holo
gies
are
dis
cove
red
durin
g an
inte
rven
tion/
asse
ssm
ent
iii) e
nsur
e th
at p
atie
nts
rece
ive
disc
harg
ein
form
atio
n re
leva
nt t
o th
eir
inte
rven
tion
incl
udin
g ar
rang
emen
tsfo
r co
ntac
ting
the
prov
ider
and
fol
low
up if
req
uire
div
) pro
vide
tim
ely
feed
back
to
the
refe
rrer
re in
terv
entio
n, c
ompl
icat
ions
and
prop
osed
fol
low
up
v) e
nsur
e th
at t
he p
atie
nt r
ecei
ves
requ
ired
drug
s/dr
essi
ngs/
aids
vi) e
nsur
e th
at s
uppo
rt is
in p
lace
with
othe
r ca
re a
genc
ies
as a
ppro
pria
te
o th
ere
shou
ld b
e pr
otoc
ols
in p
lace
to a
llow
pat
ient
s,w
ho a
re a
ble
to d
o so
, to
self
man
age
thei
r dia
bete
sm
edic
atio
n.o
the
first
pha
se o
f reh
abili
tatio
n an
d th
e ne
ed fo
rdi
abet
es m
anag
emen
t sho
uld
be e
xpla
ined
to th
epa
tient
o ar
rang
emen
ts fo
r reh
abili
tatio
n sh
ould
hav
e be
enm
ade
prio
r to
disc
harg
e an
d th
e re
habi
litat
ion
serv
ice
notif
ied
4. R
ehab
ilita
tion
• se
rvic
es s
houl
d be
dev
elop
ed to
pro
vide
reha
bilit
atio
n an
dot
her s
uppo
rt fo
r pat
ient
s po
st m
yoca
rdia
l inf
arct
ion
and
stro
ke 30
,32
Prov
ider
s sh
ould
ens
ure
acce
ss to
tran
spor
t fac
ilitie
s to
ena
ble
atte
ndan
ce fo
r spe
cial
ist tr
eatm
ent,
as re
quire
d
Prov
ider
s ar
e re
quire
d to
take
not
e of
the
resu
lts o
f the
Nat
iona
lSu
rvey
of P
eopl
e w
ith D
iabe
tes
33
Clin
ical
qua
lity
Clin
ical
em
erge
ncy
situa
tions
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:6,
11,1
2,14
,15,
16,1
8,32
,33,
42, 5
4
Sche
dule
s:
2,12
,20
Abi
lity
to n
egot
iate
and
agr
eear
rang
emen
ts w
ith a
ppro
pria
tepe
rson
nel a
nd o
rgan
isat
ions
to
prov
ide
effe
ctiv
ely
for
emer
genc
ysi
tuat
ions
The
Com
mis
sion
ers
shou
ld s
atis
fyth
emse
lves
tha
t pr
ovid
er h
as s
yste
ms,
proc
esse
s an
d co
mpe
tent
per
sonn
el a
re in
plac
e an
d im
plem
ente
d to
ens
ure
that
all
clin
ical
em
erge
ncie
s an
d co
mpl
icat
ions
are
hand
led
in a
ccor
danc
e w
ith b
est
prac
tice
Ther
e sh
ould
be
prot
ocol
s in
pla
ce to
ens
ure
the
avai
labi
lity
ofad
vice
and
/or s
uppo
rt o
f spe
cial
ist d
iabe
tes
clin
ical
sta
ff to
man
age
diab
etes
clin
ical
em
erge
ncy
situa
tions
, e.g
. dur
ing
asu
rgic
al p
roce
dure
or o
ther
clin
ical
inte
rven
tion
for t
he d
iagn
osis
and
man
agem
ent o
f the
car
diov
ascu
lar c
ondi
tion
21
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Clin
ical
qua
lity
Kno
wle
dge
and
unde
rsta
ndin
g of
hea
lthan
d sa
fety
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:5,
11, 1
9, 5
4, 5
6, 6
0
Und
erst
andi
ng o
f cl
inic
alac
coun
tabi
litie
s of
hea
lth a
ndsa
fety
pol
icie
s
H&
S st
rate
gy a
nd p
olic
ies
in p
lace
and
impl
emen
ted
with
aw
aren
ess
thro
ugho
ut th
eor
gani
satio
n
Acc
essib
ility
to e
xecu
tive
resp
onsib
le fo
r H&
Sfo
r qui
cker
, firs
t con
tact
ser
vice
s
Hea
lth a
nd s
afet
y po
licie
s as
per
pro
vide
r agr
eem
ent w
ithco
mm
issio
ners
Dat
a an
din
form
atio
nm
anag
emen
t
Stra
tegy
and
pol
icie
s
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:8,
9,17
,19,
21,2
3,24
,27,
29,3
2,33
,54
Sche
dule
s: 5
,7,1
5,16
,18
Stra
tegy
and
pol
icy
deve
lopm
ent
skill
s
The
abili
ty t
o an
alys
e da
ta a
ndha
ve a
cces
s to
info
rmat
ion
that
can
pred
ict
tren
ds a
nd t
hat
coul
did
entif
y pr
oble
ms
The
abili
ty t
o ca
ptur
e ev
iden
ceba
sed
prac
tice
from
R&
D N
atio
nal
Serv
ice
Fram
ewor
ks, N
ICE
guid
ance
The
abili
ty t
o us
e da
ta a
ndin
form
atio
n ap
prop
riate
ly t
oim
prov
e pa
tient
car
e
Tran
spar
ency
and
obj
ectiv
ity
The
Prov
ider
sho
uld
have
an
expl
icit
data
and
info
rmat
ion
stra
tegy
in p
lace
that
cov
ers
• Ty
pes
of d
ata
• Q
ualit
y of
dat
a•
Dat
a pr
otec
tion
and
conf
iden
tialit
y•
Acc
essi
bilit
y•
Tran
spar
ency
• A
naly
sis o
f dat
a an
d in
form
atio
n•
Use
of d
ata
and
info
rmat
ion
• D
issem
inat
ion
of d
ata
and
info
rmat
ion
• Ri
sks
• Sh
arin
g of
dat
a an
d co
mpa
tibili
ty o
f IT
acro
ss d
iffer
ent p
rovi
ders
with
resp
ect t
oca
re o
f pat
ient
s ac
ross
a p
athw
ay
This
info
rmat
ion
shou
ld b
e in
clud
ed in
the
Dat
a Q
ualit
y Im
prov
emen
t Pla
n
The
Prov
ider
is re
quire
d to
hav
e in
form
atio
n sy
stem
s th
at re
cord
indi
vidu
al n
eeds
incl
udin
g em
otio
nal,
soci
al, e
duca
tiona
l,ec
onom
ic a
nd b
iom
edic
al in
form
atio
n w
hich
per
mit
mul
tidisc
iplin
ary
care
acr
oss
serv
ice
boun
darie
s an
d su
ppor
t car
epl
anni
ng 34
The
Prov
ider
is re
quire
d to
use
the
follo
win
g fo
r the
col
lect
ion
and
prod
uctio
n of
dat
a, w
here
app
ropr
iate
:
• N
HS
Out
com
es F
ram
ewor
k24
• N
atio
nal D
iabe
tes
Info
rmat
ion
Serv
ice
35
• N
atio
nal D
iabe
tes
Aud
it 12
• D
iabe
tes
E 15
• Q
ualit
y an
d O
utco
mes
Fra
mew
ork36
• M
yoca
rdia
l Isc
haem
ia A
udit
Proj
ect37
• H
ospi
tal E
piso
de S
tatis
tics38
• Pa
tient
Exp
erie
nce
14,3
3
• Pa
tient
Sat
isfac
tion
33
• Pa
tient
Rep
orte
d O
utco
mes
Mea
sure
s 16
• N
atio
nal D
iabe
tes
Con
tinui
ng C
are
Dat
aset
39
Clin
ical
qua
lity
Esta
tes
and
equi
pmen
t
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:5,
29, 3
3, 5
6
Sche
dule
s: 3
,10,
19
Und
erst
andi
ng o
f bu
ildin
gre
gula
tions
Acc
ess
to a
dvic
e on
“fit
-for
-pu
rpos
e” e
quip
men
t an
d fa
cilit
ies
Com
mis
sion
ers
mus
t as
sure
the
mse
lves
tha
tpa
tient
car
e is
del
iver
ed in
app
ropr
iate
lybu
ilt a
nd e
quip
ped
faci
litie
s w
hich
mee
tre
leva
nt H
TMs
and
Build
ing
Not
es, a
nd,
whe
re a
ppro
pria
te, a
re r
egis
tere
d an
d ar
esa
fe a
nd c
lean
.
Equi
pmen
t m
ust
be f
it fo
r pu
rpos
e
Com
mitm
ent
to e
ffic
ient
use
and
satis
fact
ory
mai
nten
ance
of
equi
pmen
t
22
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Dat
a an
din
form
atio
nm
anag
emen
t
Stra
tegy
and
pol
icie
sTh
ere
shou
ld b
e po
licie
s in
pla
ce th
at in
clud
e:
• C
onfid
entia
lity
Cod
e of
Pra
ctic
e•
Dat
a Pr
otec
tion
• Fr
eedo
m o
f Inf
orm
atio
n•
Hea
lth R
ecor
ds•
Info
rmat
ion
Gov
erna
nce
Man
agem
ent
• In
form
atio
n Q
ualit
y A
ssur
ance
• In
form
atio
n Se
curit
y
Ther
e m
ust b
e a
nam
ed in
divi
dual
who
is th
eC
aldi
cott
Gua
rdia
n
23
Source documentsCommissioners and providers should takeresponsibility for making reference to the latestversion of the various documents and guidance.
1. NHS Diabetes and Diabetes UK, Emotional andPsychological Support and Care in Diabetes, JointDiabetes UK and NHS Diabetes Emotional andPsychological Support, 2010http://www.diabetes.nhs.uk
2. The NHS Diabetes Commissioning Guides areavailable on the NHS Diabetes website athttp://www.diabetes.nhs.uk/commissioning_resource/
3. Department of Health, Standard NHS Contractshttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124324
4. National Quality Board, Quality Governance in theNHS, 2011 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_125239.pdf
5. NICE Diabetes guidance,http://guidance.nice.org.uk/Topic/EndocrineNutritionalMetabolic/Diabetes
6. NICE, Cardiovascular guidancehttp://guidance.nice.org.uk/Topic/Cardiovascular
7. NICE, Medicines adherence: involving patients indecisions about prescribed medicines andsupporting adherence, Jan 2009,http://guidance.nice.org.uk/CG76
8. Department of Health, Treatment of heart attacknational guidance: final report of the NationalInfarct Angioplasty Project (NIAP), 2008http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089455
9. European Diabetes Working Party for OlderPeople. Clinical Guidelines for Type 2 DiabetesMellitus, www.instituteofdiabetes.org
10. NHS Institute for Innovation and Improvement,model CQUIN scheme: inpatient care for peoplewith diabetes, 2009
11. Department of Health, The Operating Frameworkfor the NHS in England 2011/12, 2010,http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122738
12. National Diabetes Audit.www.ic.nhs.uk/services/national-clinical-audit-support-programme-ncasp/diabetes
13. National Diabetes Inpatient Audit,http://www.diabetes.nhs.uk/our_work_areas/inpatient_care/inpatient_audit_2010/
14. The King’s Fund, The point of care. Measures ofpatients’ experience in hospital: purpose,methods and uses. July 2009
15. DiabetesE - https://www.diabetese.net
16. Patient Reported Outcomes Measures,http://www.ic.nhs.uk/proms
17. Training, Research and Education for Nurses inDiabetes – UK, An Integrated Career &Competency Framework for Diabetes Nursing(Second Edition), 2010
18. Skills for Health, Diabetes CompetencyFramework, https://tools.skillsforhealth.org.uk/
19. Department of Health, National ServiceFramework for Older People, May 2001,http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4003066
20. Department of Health, National ServiceFramework for Coronary Heart Disease – modernstandards and service modelshttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4094275
21. Department of Health, No health without mentalhealth: a cross-government mental healthoutcomes strategy for people of all ages,February 2011,http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123766
24
22. Department of Health, The National ServiceFramework for Long Term Conditions, March2005 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4105361
23. Department of Health, End of Life Care Strategy– promoting high quality care for all adults at theend of life, July 2008,http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086277
24. Department of Health, The NHS OutcomesFramework 2011/12, December 2010http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122944
25. NICE, Quality Standards: Diabetes in adults,March 2011,http://www.nice.org.uk/guidance/qualitystandards/qualitystandards.jsp
26. Generic Long-term conditions modelhttp://www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_120915
27. Putting Prevention First, NHS Health Check,Vascular risk assessment and management , Bestpractice guidance, 2009,www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_097489
28. Joint Royal Colleges Ambulance LiaisonCommittee, UK Ambulance Service ClinicalPractice Guidelines 2006, Acute coronarysyndrome http://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/prehospitalcare/jrcalcstakeholderwebsite/guidelines/acute_coronary_syndrome_2006.pdf
29. Joint Royal Colleges Ambulance LiaisonCommittee, UK Ambulance Service ClinicalPractice Guidelines 2006, Stroke/TransientIschaemic Attackhttp://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/prehospitalcare/jrcalcstakeholderwebsite/guidelines/stroke-transient_ischaemic_attack_tia_2006.pdf
30. NICE, Quality Standards:Stroke, June 2010,http://www.nice.org.uk/guidance/qualitystandards/stroke/strokequalitystandard.jsp
31. NHS Institution for Innovation and Improvement,ThinkGlucose Toolkit,http://www.institute.nhs.uk/quality_and_value/think_glucose/welcome_to_the_website_for_thinkglucose.html
32. NICE, Commissioning a cardiac rehabilitationservice,http://www.nice.org.uk/usingguidance/commissioningguides/cardiacrehabilitationservice/CommissioningCardiacRehabilitationService.jsp
33. Healthcare Commission, National Survey ofPeople with Diabetes, 2006,www.cqc.org.uk/usingcareservices/healthcare/patientsurveys/servicesforpeoplewithdiabetes.cfm
34. York and Humber integrated IT systemhttp://www.diabetes.nhs.uk/
35. National Diabetes Information Service,www.diabetes-ndis.org
36. Quality and Outcomes Framework,http://www.nice.org.uk/aboutnice/qof/qof.jsp
37. Myocardial Ischaemia Audit Project (MINAP)www.rcplondon.ac.uk/CLINICAL-STANDARDS/ORGANISATION/PARTNERSHIP/Pages/MINAP-.aspx
38. Hospital Episode Statistics,www.ic.nhs.uk/statistics-and-data-collections/hospital-care/hospital-activity-hospital-episode-statistics--hes
39. National Diabetes Continuing Care Dataset,www.ic.nhs.uk/webfiles/Services/Datasets/Diabetes/dccrdataset.pdf
25
This specification forms Schedule 2, Parts 1-4,‘The Services - Service Specifications’ of theStandard NHS Contract for AmbulanceServicesa.
This specification forms Schedule 2, Parts 1-4 ,‘The Services - Service Specifications’ of theStandard NHS Contract for Ambulance Services .
Service specifications are developed in partnershipbetween commissioners and provider agenciesand are based on agreed evidence-based care andtreatment models. Specifications should be opento scrutiny and available to all service users/carersas a statement of standards that the user/carercan expect to receive.
The following documentation, developed bythe Diabetes Commissioning Advisory Groupprovides further detail/guidance to supportthe development of this specification:
• The intervention map for diabetes andcardiovascular services
• The contracting framework for diabetes andcardiovascular services
This specification template assumes that theservices are compliant with the contractingframework for diabetes and cardiovascularservices.
This template also provides examples of whatcommissioners may wish to consider whendeveloping their own service specifications.
Part 1:Section A: Base ServicesDescription of emergency care for peoplewho have cardiovascular events:
This involves emergency care for people who havecardiovascular conditions and includes theimmediate assessment, stabilisation, initialtreatment of people who have cardiovascularevents such as myocardial infarction, angina,strokes and Transient Ischaemic Attacks (TIA).
The care may also include the requirement fortransfer to designated stroke units, percutaneouscoronary intervention centres and otheremergency hospital services for continuedmanagement as appropriate.
Please noteb:
• Peripheral vascular disease is included in thediabetes foot care commissioning guide
• This template service specification should bedeveloped with the following diabetescommissioning guides in mind to ensureintegrated care:
o Children and young peopleo Diagnosis and continuing care o Older peopleo Emergency and in patient care
Standard Service SpecificationTemplate for Emergency Care forCardiovascular Events to beprovided by Ambulance Services
a Standard NHS Contractshttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124324
b NHS Diabetes, diabetes commissioning guides, 2011 http://www.diabetes.nhs.uk/commissioning_resource/
26
The final specification should take intoaccount:
• national, network and local guidance andstandards for emergency services forcardiovascular events.
• local needs.
This specification is supported by other relatedwork in diabetes commissioning such as:
• the web-based Diabetes Community HealthProfiles (Yorkshire and Humber Public HealthObservatory)
• the web-based Health Needs Assessment Tool(National Diabetes Information Service).
These provide comprehensive information forneeds assessment, planning and monitoring ofdiabetes services
Introduction• A general overview of the services identifying
why the services are needed, includingbackground to the services and why they arebeing developed or in place.
• A statement on how the services relate to eachother within the whole system should beincluded describing the keystakeholders/relationships which influence theservices, e.g. multi-disciplinary diabetes teametc
• Any relevant diabetes clinical networks andscreening programmes applicable to theservices
• Details of all interdependencies or sub-contractors for any part of the service and anoutline of the purpose of the contract shouldbe stated, including arrangements for clinicalaccountability and responsibility, as appropriate
Purpose, Role and Clientele1. A clear statement on the primary purpose of
the services and details of what will beprovided and for whom:
• Who the services are for (e.g. young people,adults and older people who havecardiovascular emergencies in thecommunity)
• What the services aim to achieve within agiven timeframe
• The objectives of the services
• The desired outcomes and how these aremonitored and measured
Scope of the Services2. What does the service do? This section will
focus on the types of high level therapeuticinterventions that are required for the types ofneed the services will respond to.
• How the services responds to age, culture,disability, and gender sensitive issues
• Assessment – details of what it is and co-morbidity assessment and referrals to allrelevant specialties
• Service planning – High level view of whatthe services are and how they are used; howpatients enter the pathway/journey; what arethe stages undertaken, e.g. assessment,stabilisation, initial treatment and transfer toappropriate specialist units, e.g. stroke units,percutaneous coronary intervention centresetc. The aims of service planning are to:
o develop, manage and reviewinterventions along the patient journey
o ensure access to other specialities /care,as appropriate
• Holistic review of patients in themanagement of their diabetes andcardiovascular conditions using the principlesof an integrated care model for people withlong term conditions that is patient-centred,including self care and self management,clinical treatment, facilitating independence,psychological support and other social careissues
• Risk assessment procedures
• Detail of evidence base of the service – i.e. thecontracting framework for diabetes andcardiovascular services, guidance produced bythe Royal College of Physicians, Diabetes UK,etc
27
c Acute coronary syndromehttp://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/prehospitalcare/jrcalcstakeholderwebsite/guidelines/acute_coronary_syndrome_2006.pdf
Stroke/Transient Ischaemic Attackhttp://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/prehospitalcare/jrcalcstakeholderwebsite/guidelines/stroke-transient_ischaemic_attack_tia_2006.pdf
d http://www.nice.org.uk/guidance/qualitystandards/qualitystandards.jsp
e http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122944
Service Delivery3. Patient Journey/pathway
Flow diagram of the patient pathway showingaccess and exit/transfer points – see the patientintervention map for diabetes andcardiovascular services as a starting point
4. Treatment protocols/interventionsInclude all individual treatment protocols inplace within the services or planned to be used,e.g. Joint Royal Colleges Ambulance LiaisonCommittee, UK Ambulance Service ClinicalPractice Guidelines 2006, acute coronarysyndrome and stroke/ transient ischaemicattackc
5. This will include a breakdown of how thepatient will receive the services and fromwhom. It should be a clear statement of staffqualifications/experience and/or training (ifappropriate) and clinical or managerialsupervision arrangements. It should specify, asappropriate:
• Geographical coverage/boundaries – i.e. theservices should be available for youngpeople, adults and older people who live inthe clinical commissioning group area
• Hours of operation
• Minimum level of experience andqualifications of staff (i.e. nursing staff, alliedhealth professionals and other support andadministrative staff)
• Staff induction and development training.
6. Equipment – see Clause 5 of the Standard NHSContract for Ambulance Services – ‘Servicesenvironment, vehicles and equipment’.
Identification, Referral andAcceptance criteria7. This should make clear how patients will be
assessed and accepted to the services.Acceptance should be based on types of needand/or patient.
8. How are patients referred?
• Who is acceptable for referral and fromwhere
• Details of evaluation process - Are there clearexclusion criteria or set alternatives to theservice? How might a patient be transferred?(insert call centre and triage processes andprotocols)
• Response time detail and how are patientsprioritised (insert Ambulance response times)
Discharge/Service Complete/Patient Transfercriteria – see Part 2: Transfer of and Dischargefrom Care Protocol (below)
Quality Standards9. The service is required to deliver care according
to the standards for clinical practice set by theNational Institute for Health and ClinicalExcellenced
10. As a minimum, the Provider is required toagree a local Commissioning for Quality andInnovation scheme for services for peoplewith diabetes. (Insert details of the CQUINScheme agreed)
11. The service is required to deliver the outcomesfor diabetes as determined by the NHSOutcomes Frameworke
28
Activity and PerformanceManagement12.This must include performance indicators,
thresholds, methods of measurement andconsequences of breach of contract. These willbe set and agreed prior to the signing of theoverall agreement.
13. Activity plans – Where appropriate, identifythe anticipated level of activity the servicemay deliver; provide details of any activitymeasures and their description /method ofcollection, targets, thresholds andconsequences of variances above or belowtarget.
Continual Service Improvement14. As part of the monitoring and evaluation
procedures, the service will identify a methodof agreeing measurements for continuousimprovement of the service being offeredand work to ensure unmet need is bothidentified and brought to the attention of thecommissioner.
15. ReviewThis section should set out a review date anda mechanism for review.
The review should include both thespecifications for continuing fitness forpurpose and the providers’ delivery againstthe specification.
This should set out the process by which thisreview will be conducted.
This should also identify how complianceagainst the specification will be monitored inyear.
16. Agreed by
This should set out who agrees/accepts thespecification on behalf of all parties. This should include the diabetes providers,commissioner and network
Section B: Additional ServicesComplete according to local needs
Part 2: Transfer of andDischarge from Care ProtocolInsert locally agreed Transfer of and Dischargefrom Care Protocol
The intention of this section is to make clearwhen a patient should be transferred from theambulance service to another service ordischarged and when this point would bereached.
• How does the service decide that a patient isready for discharge?
• What procedure is followed on discharge,including arrangements for follow-up
• If the patient requires continued care, what isthe process for transferring to other care,e.g. stroke unit, percutaneous coronaryintervention centre, other hospital emergencyservices etc?
Part 3: Emergency PreparednessComplete as required in the guidance for theStandard NHS Contract for Ambulance Services
Part 4: Essential ServicesComplete according to local needs
29
Standard Service SpecificationTemplate for Diabetes andCardiovascular CareThis specification forms Schedule 2, Part 1, orsection 1 (module B), ‘The Services - ServiceSpecifications’ of the Standard NHSContracts.a
Service specifications are developed in partnershipbetween commissioners and provider agenciesand are based on agreed evidence-based care andtreatment models. Specifications should be opento scrutiny and available to all service users/carersas a statement of standards that the user/carercan expect to receive.
The following documentation, developed bythe Diabetes Commissioning Advisory Groupprovides further detail/guidance to supportthe development of this specification:
• The intervention map for diabetes andcardiovascular services
• The contracting framework diabetes andcardiovascular services
This specification template assumes that theservices are compliant with the contractingframework diabetes and cardiovascular services.
This template also provides examples of whatcommissioners may wish to consider whendeveloping their own service specifications.
Description of cardiovascular servicesfor people with diabetes:Cardiovascular care for people with diabetesincludes a cardiovascular risk assessment (i.e.smoking, hypertension, lifestyle factors and bloodcholesterol levels), identification of peripheralvascular disease and initial management of thesecardiovascular complications of diabetes. It also
includes the emergency and in patient care ofpeople with diabetes who present withcardiovascular complications, e.g. myocardialinfarction, angina, strokes and TransientIschaemic Attacks (TIA).
Please noteb:
• Peripheral vascular disease is included in thediabetes foot care commissioning guide
• This template service specification should bedeveloped with the following diabetescommissioning guides in mind to ensureintegrated care :
o Children and young peopleo Diagnosis and continuing care of
diabeteso Older peopleo Emergency and in patient care
The final specification should take intoaccount:
• national, network and local guidance andstandards for cardiovascular services forpeople with diabetes.
• local needs.
This specification is supported by other relatedwork in diabetes commissioning such as:
• the web-based Diabetes Community HealthProfiles (Yorkshire and Humber Public HealthObservatory)
• the web-based Health Needs Assessment Tool(National Diabetes Information Service).
These provide comprehensive information forneeds assessment, planning and monitoring ofdiabetes services
a Standard NHS Contractshttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124324
b NHS Diabetes, Diabetes commissioning guides, 2011 http://www.diabetes.nhs.uk/commissioning_resource/
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Introduction• A general overview of the services identifying
why the services are needed, includingbackground to the services and why they arebeing developed or in place.
• A statement on how the services relate to eachother within the whole system should beincluded describing the keystakeholders/relationships which influence theservices, e.g. multi-disciplinary team etc
• Any relevant diabetes clinical networks andscreening/risk assessment programmesapplicable to the services, e.g. NHS HealthCheck
• Details of all interdependencies or sub-contractors for any part of the service and anoutline of the purpose of the contract shouldbe stated, including arrangements for clinicalaccountability and responsibility, as appropriate
Purpose, Role and Clientele1. A clear statement on the primary purpose of
the services and details of what will beprovided and for whom:
• Who the services are for (e.g. people withdiabetes who require cardiovascular care)
• What the services aim to achieve within agiven timeframe
• The objectives of the services
• The desired outcomes and how these aremonitored and measured
Scope of the Services2. What does the service do? This section will
focus on the types of high level therapeuticinterventions that are required for the types ofneed the services will respond to.
• How the services responds to age, culture,disability, and gender sensitive issues
• Assessment – details of what it is and co-morbidity assessment and referrals to allrelevant specialties
• Service planning – High level view of what theservices are and how they are used; howpatients enter the pathway/journey; what arethe stages undertaken, e.g. risk assessmentand initial management. The aims of serviceplanning are to:
o Develop, manage and reviewinterventions along the patient journey
o Ensure access to other specialities /care,as appropriate
o Ensure that care planning is undertakenby the diabetes multi-disciplinary team(as defined locally) with a clear care co-ordination function
• Holistic review of patients in the managementof their diabetes and cardiovascular conditionsusing the principles of an integrated caremodel for people with long term conditionsthat is patient-centred, including self care andself management, clinical treatment, facilitatingindependence, psychological support and othersocial care issues
• Risk assessment procedures
• Detail of evidence base of the service – i.e. thecontracting framework diabetes andcardiovascular services, guidance produced bythe Royal College of Physicians, Diabetes UK,etc
Service Delivery3. Patient Journey/pathway
Flow diagram of the patient pathway showingaccess and exit/transfer points – see the patientintervention map for diabetes andcardiovascular services as a starting point
4. Treatment protocols/interventionsInclude all individual treatment protocols inplace within the services or planned to be used
5. This will include a breakdown of how thepatient will receive the services and fromwhom. It should be a clear statement of staffqualifications/experience and/or training (ifappropriate) and clinical or managerial
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supervision arrangements. It should specify, asappropriate:
• Geographical coverage/boundaries – i.e. theservices should be available for children andyoung people, adult and older people wholive in the clinical commissioning group area
• Hours of operation including, week-end, bankholiday and on-call arrangements
• Minimum level of experience andqualifications of staff (i.e. doctors –diabetologists, cardiologists, stroke caremedical consultants and GPs, Nursing staff –diabetes nurse specialists, acute care nursesetc, other allied health professionals, e.g.dietitians etc, health care scientists e.g.pharmacists and other support andadministrative staff)
• Confirmation of the arrangements to identifythe Care Co-ordinator for each patient withdiabetes (i.e. who holds the responsibility androle).
• Staff induction and developmental training
6. Equipment
• Upgrade and maintenance of relevantequipment and facilities
• Technical specifications (if any)
Identification, Referral andAcceptance criteria7. This should make clear how patients will be
identified (including people with previouslyunknown diabetes), assessed, and accepted tothe services. Acceptance should be based ontypes of need and/or patient.
8. How should patients be referred?
• Who is acceptable for referral and from where
• Details of evaluation process - Are there clearexclusion criteria or set alternatives to theservice? How might a patient be transferred?
• Response time detail and how are patientsprioritised
Discharge/Service Complete/PatientTransfer criteria9. The intention of this section is to make clear
when a patient should be transferred from oneaspect of the diabetes service to another andwhen this point would be reached.
• How is a treatment pathway reviewed?
• How does the service decide that a patient isready for discharge
• How are goals and outcomes assessed andreviewed?
• What procedure is followed on discharge,including arrangements for follow-up
Quality Standards10. The service is required to deliver care
according to the standards for clinical practiceset by the National Institute for Health andClinical Excellencec
11. As a minimum, the Provider is required toagree a local Commissioning for Quality andInnovation scheme for services for peoplewith diabetes. (Insert details of the CQUINScheme agreed)
12. The service is required to deliver the outcomesfor diabetes as determined by the NHSOutcomes Frameworkd
Activity and PerformanceManagement13.This must include performance indicators,
thresholds, methods of measurement andconsequences of breach of contract. These will beset and agreed prior to the signing of the overallagreement.
14. Activity plans – Where appropriate, identify theanticipated level of activity the service maydeliver; provide details of any activity measuresand their description /method of collection,targets, thresholds and consequences ofvariances above or below target.
c http://www.nice.org.uk/guidance/qualitystandards/qualitystandards.jsp
d http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122944
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Continual Service Improvement15. As part of the monitoring and evaluation
procedures, the service will identify a methodof agreeing measurements for continuousimprovement of the service being offeredand work to ensure unmet need is bothidentified and brought to the attention of thecommissioner.
16. ReviewThis section should set out a review date anda mechanism for review.The review should include both thespecifications for continuing fitness forpurpose and the providers’ delivery againstthe specification.This should set out the process by which thisreview will be conducted.
This should also identify how complianceagainst the specification will be monitored inyear.
17. Agreed byThis should set out who agrees/accepts thespecification on behalf of all parties.This should include the diabetes providers,commissioner and network
Further copies of this publication can be ordered from Prontaprint, by emailing [email protected] or tel: 0116 275 3333, quoting DIABETES 137
www.diabetes.nhs.uk