Part 6: Working with local diabetes teams

Improving the effectiveness of local diabetes teams

6.1
In our Get Checked report, we found that none of the LDTs we visited were as effective as they could have been. For example, none of the LDTs were fully meeting the requirements set out in the LDT service specification. We recommended that DHBs ensure that their LDT was as effective as possible.

6.2
Many DHBs told us in 2009 that they were working to review or improve the effectiveness of their LDTs. For example, Southland DHB told us that the management of its LDT moved from the DHB’s Planning and Funding team to the PHO in January 2009 to provide greater independence for the LDT. Waitemata DHB reported that it had reviewed its LDT in 2008 and created a new group called the Diabetes Clinical Advisory Group that includes all the roles of the LDT. This group includes representatives of all stakeholders and has an increased strategic role.

Analysis by local diabetes teams of secondary diabetes service gaps

6.3
In our Get Checked report, we considered that LDTs should meet the service specification requirement to include analysis of primary care data and other clinical information in their annual report. For "other clinical information", LDTs are required to collect and analyse information from specialist diabetes services. Analysing this information would enable shortages in services provided at a secondary care level to be identified. This would also allow a picture of patients diagnosed with diabetes treated in secondary care to be established and enable comparisons between secondary care units throughout the country.

6.4
In 2009, 18 out of 21 DHBs had LDTs. Only a few of the 18 DHBs reported that their LDTs were identifying shortages at both the primary and secondary care levels. However, we have reviewed the annual reports from these few LDTs for the 2008/09 year, and they do not indicate that they have analysed the demand and supply for secondary diabetes services.

Listening to your local diabetes team

6.5
In our Get Checked report, we reported that most of the LDTs we talked to found it hard to get DHBs to listen to their recommendations. We recommended that DHBs give due consideration to recommendations that their LDTs make so that the resources that are dedicated to LDTs are not going to waste. We consider that DHBs responding to their LDT’s reports in a timely manner is good practice.

6.6
In 2009, many DHBs told us that they were working with their LDTs to include their advice when planning diabetes services. Several DHBs told us that their LDTs’ recommendations were put into effect through the direct involvement of the DHB’s planning and funding staff in the LDT, or through the annual planning process. For example, Canterbury DHB has a dedicated staff member within its Planning and Funding division who liaises with the LDT. Also, the DHB’s planned diabetes outputs for 2009/10 were aligned with working towards the LDT’s recommendations.

6.7
Waitemata DHB told us that there was an agreed expectation that the DHB will provide a response to the LDT’s recommendations but that the recommendations cannot be binding. Waikato DHB reported that, when its LDT submitted its next report to the DHB Community and Public Health Advisory Committee, the DHB would submit an action plan detailing the DHB’s response to the recommendations made.