Paediatric Diabetes Networks and Tariff Trudi Akroyd NHS Diabetes diabetes.nhs.uk

1. Paediatric DiabetesNetworks and TariffTrudi AkroydNHS Diabeteswww.diabetes.nhs.uk

2. The networks have agreed nationally a set of initial outcomes and are working toward a memorandum of understanding across the networks to ensure that they deliver against these outcomes Networks

3. Other Groups Learning Difficulties Children in care Language barriers Young offenders Schools training and support Education accreditation New Technologies – CGMS, Text IT Systems NDA2 Submission Register DiabetesE What Makes a Good Service

4. Pumps and consumables Transition Specification Inpatient care Admissions and contractual guarantees What Makes a Good Service

5. The service has to ensure basic care required by all CYP & Families – and to be in touch if there are problems day to day Basic care covers the entire MDT and also Psychological support Quality Pathwaysand Specifications

7. The guidelines and specifications required to deliver a quality service have been in place and continually updated since 2007 when the ‘Making Every Young Person with Diabetes Matter’ document was published and the DoH Implementation Group formed The NHS Diabetes Commissioning Guides and Implementation Map along with the Emotional and Psychological Support and Care in Diabetes Report both published in 2010 provide the latest standards required Quality Pathwaysand Specifications

8. Membership is representative from all MDT’s, colleges and professional bodies delivering Paediatric Diabetes care nationally and DEN, Diabetes UK and JDRF Development of Core Curriculum - training of HCP’s This continues to be developed. Based on Knowledge, skills and competency levels using Skills for Health as a framework Academic units that presently supply training have agreed to a core curriculum Development of learning workbooks for aspects of paediatric care Ensuring the link with current RCT’s for education programmes Development of training standards and components for patients NHS Diabetes Education Task and Finish Group

9. Funding Mechanisms October 2010 From April this year a non-mandatory tariff was put in place for paediatric diabetes. Work has continued to develop a pricing structure reflecting the resources actually required to deliver the service and start to put this in place for April 2011. However, this staged approach to change will only be fully realised if we have the full commitment of regional networks, the commissioners and the Department of Health.

10. Funding Mechanisms The Decision The Department of Health will ensure a mandatory tariff for paediatric diabetes is in place for April 2011 and the minister has stated this in a parliamentary debate. As part of this process, representations have been made to the department to uplift the current non-mandatory tariff price particularly for follow up. The level of uplift would ideally reflect the issues identified within the services costed specifically for this purpose or at the very least to be in excess of general paediatrics and paediatric endocrinology, to make it worthwhile for trusts to move activity.

11. Funding Mechanisms and Tariff • Basic Yearly Tariff plus complexity payment per child for the following in year - April to April; • Newly diagnosed in year • Education required in year • Pump required in year • Pump user • Child protection • Over 12 years old • Transition year over 19

12. Funding Mechanisms and Best Practice Tariff Future Development This is toward a more appropriate funding mechanism is supported and PbR governance groups at the department are keen that our work goes forward and proposals moving towards a ‘Best Practice – Clinical Pathway Tariff’ will be supported but are not guaranteed. This work needs to be completed and submitted by March 2011 so that it can be assessed and tested to see if it is viable and deliverable. Over the coming months NHS Diabetes will be working with many of you and the networks to develop all the aspects of this approach and will need the support of the networks to help communicate this to all stakeholders.

13. Funding Mechanisms and Best Practice Tariff Best Practice Tariffs The objective of the best practice tariff policy is to reduce unexplained variation in clinical quality and to universalise best practice Issues to consider: • References to relevant clinical guidelines. • Are there significant variations in practice? • Information, which would, as a minimum, allow for an assessment to be made of the gap between current and best practice. • Information on the impact on outcomes of the gap between current and best practice. • Is the area being looked at a high volume service area? • Information, which would, as a minimum, allow for an assessment to be made the volume of activity being carried out. • Information on the relevant HRGs/TFCs to be affected. • Estimate of potential gain - expressed qualitatively or quantitatively or, • Estimate of potential gain - expressed on a monetary basis, or on a benefits to patients basis.

14. Funding Mechanisms The Decision At this point we are awaiting a final decision and confirmation that all aspects will be in place to be contracted against for April 2011.

16. Where Now For Paediatric DiabetesNetworks And TariffIs It Up To You?