The NICE Diabetes Quality Standards, Statement
2 says:
“People with diabetes receive
personalised advice on nutrition and physical activity from an appropriately
trained healthcare professional or as part of a structured educational programme.”
The NICE criteria for structured education has 6 of components/ingredients:
1.
It is evidence‑based, and suits the needs of the person.
2.
It has specific aims and learning objectives, and
supports the person and their family members and carers in developing
attitudes, beliefs, knowledge and skills to self‑manage diabetes.
3.
It has a structured curriculum that is theory‑driven,
evidence‑based and resource‑effective, has supporting materials, and is written
down.
4.
It is delivered by trained educators who have an
understanding of educational theory appropriate to the age and needs of the
person, and who are trained and competent to deliver the principles and content
of the programme.
5.
It is quality assured, and reviewed by trained,
competent, independent assessors who measure it against criteria that ensure
consistency.
6.
The outcomes are audited regularly.
NICE “Technology appraisals” are recommendations on the
use of new and existing medicines and treatments within the NHS. Structured education is a NICE technology appraisal
recommendation. It is a treatment. It is
a very important part of diabetes care. Like
with a drug, nationally available structured education programmes such as,
DAFNE, DESMOND and XPERT have been through rigorous Randomised Controlled Trials
(RTC) to evidence that the ‘treatment’ improves patient outcomes.
The CCG Improvement and Outcomes Framework challenges us
to significantly increase the attendance of people attending structured
education.
Denying that commissioners aren’t struggling with balancing
the books would be like denying that Jeremy Hunt is having trouble over the
Junior Doctor contract.
There might be a massive temptation to dilute the content/ingredients
of structured education. Is there a
utilitarian argument that by diluting we could do the greatest good for the greatest
number of people? After all, it is a treatment,
like a pill. And some pills, for some people, are hard to swallow. Certainly for those that cannot swallow the
treatment we should do our best to offer an alternative option but surely you
would first offer the best recommended treatment? Surely you would offer structured education
that meets the NICE criteria.
Otherwise might we be offering – brick dust?
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