Diabetes: policy context
In 2000 the Scottish Executive issued a Health Department Letter, HDL(2000)12, which outlined plans to compile an annual survey of diabetes in Scotland. The HDL included a requirement for NHS Boards to ensure there is a register of patients with diabetes in their health board area. The aim was to improve the availability of data, as many of the complications of diabetes can be prevented or delayed by effective monitoring of diabetic patients.
In 2002 the Scottish Executive Health Department published the Scottish Diabetes Framework, which set out a programme of action to improve the quality of services for diabetes in Scotland. The Framework highlighted seven 'first stage priority issues' (information, education and empowerment; heart disease; eye care; strategy, leadership and team working; education and training for professionals; information management and technology (IM&T) and diabetes registers; implementation and monitoring). A multi-disciplinary, national advisory group - the Scottish Diabetes Group - was established to support and monitor the implementation of the Diabetes Framework. The group is also responsible for the Scottish Diabetes Survey, which has published annual reports since 2001.
Healthcare Improvement Scotland published Diabetes Clinical Standards in 2002. These standards were reviewed during 2003 and a National Overview of findings was published in 2004. A further follow-up report was published in March 2008.
Plans for a national retinopathy screening programme for diabetic retinopathy (eye disease) were announced in 2003. The programme uses digital photography and covers all patients aged 12 years and over in Scotland.
The new General Medical Services contract for UK general practices, introduced in 2004, provides a set of quality indicators within a Quality and Outcomes Framework (QOF). The 2013/14 version of the QOF includes 16 indicators for diabetes care. It provides significant incentives to encourage better care for people with diabetes and also generates useful information about diabetes.
Delivering for Health, published in 2005, set out the then Scottish Executive's programme of action for the NHS. It highlighted the importance of better management of people with long term conditions (section 2.2) focussing on the example of diabetes.
The UK National Institute for Health and Clinical Excellence published a clinical guideline (NG28) on the management of type 2 diabetes in December 2015. This updates and replaces a number of previous NICE guidelines on the management of type 2 diabetes.
The Scottish Intercollegiate Guidelines Network (SIGN) published the SIGN 116 guideline in March 2010. This covers the management of diabetes and its complications in adults and children and supersedes previous SIGN guidelines on diabetes.
In August 2010 the Scottish Government published the Diabetes Action Plan 2010, a follow up to the previous (2006) Scottish Diabetes Framework Action Plan (2MB). The 2010 plan focuses on prevention and screening, improving the quality of care for diabetes and support for people with diabetes.
In February 2012 the Scottish Government issued a letter (279KB) asking NHS Boards to develop local plans to increase the provision of insulin pumps so that 25% of people under 18 years with type 1 diabetes would be using pumps by March 2013. The recommendation is based on guidance from NICE (TA151) and SIGN (SIGN116).
The Diabetes Improvement Plan was published in November 2014, focusing on improving the care of diabetes patients in Scotland.