The Audit Commission review of diabetes services in England and Wales, 1998-2001.
AIMS OF THE AUDIT COMMISSION: The Audit Commission has a statutory duty to promote the best use of public money. It does this through value for money studies, such as that reported in Testing Times[1]. This work has been followed with a review of innovative practice in commissioning. These initiatives aim to support the implementation of the diabetes national service framework. The Audit Commission also appoints external auditors to NHS organizations who assess probity and value for money in the NHS; the latter by applying national studies locally and by carrying out local studies.


METHODS
Research for Testing Times consisted of structured visits to nine acute trusts, a telephone survey of 26 health authorities and a postal survey of 1400 people with diabetes and 250 general practitioners. Local audits used a subset of the original research tools. Case studies were identified through a cascade approach to contacts established during Testing Times and through self-nomination.


RESULTS
Rising numbers of people with diabetes are placing increasing pressure on hospital services. Some health authorities and primary care organizations have reviewed patterns of service provision in the light of the increasing demands. These reviews show wide variations in patterns of routine care. In addition, there is a widespread lack of data on the delivery of structured care to people with diabetes. People with diabetes report delays in gaining access to services, and insufficient time with staff. There are insufficient arrangements in place for providing information and learning opportunities to support self-management.


CONCLUSIONS
As the number of people with diabetes continues to rise, the potential for providing more care in a primary care setting needs to be explored. This will enable specialist services to focus more effectively on those with the most complex needs.
Public Services Research Directorate, The Audit Commission, London, UK. b-fitzsimons@audit-commission.gov.uk
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D003920:Diabetes Mellitus / Q000628:therapy*; D005194:Family Practice / Q000592:standards*; D017048:Health Care Costs; D006801:Humans; D008485:Medical Audit; D011320:Primary Health Care / Q000592:standards*; D013222:State Medicine / Q000592:standards; D006113:United Kingdom