Sunday 15 May 2016

Brick Dust

I used to work for a company who produced and sold a very popular blood thinning drug.  At the time there was a sudden flood of counterfeit product which had mixed in brick dust! Horrifying!  A lifesaving drug, padded out with brick dust. I don’t think anyone would question that perhaps the patient getting the counterfeit drug may not be getting optimal treatment.

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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