A decade in diabetes specialist services, 2000 to 2011, in England: the views of consultant diabetologists and diabetes specialist nurses amidst persistent healthcare delivery change.
OBJECTIVE
To assess the impact of continual major National Health Service reorganization on commissioning, organizational and delivery arrangements for secondary care diabetes services. To explore how consultant diabetologists and diabetes specialist nurses perceive the issues facing diabetes specialist services in 2011 and how these have changed in the preceding decade.


METHODS
We used a longitudinal case study approach that combined quantitative and qualitative methods. Five locations in England were purposively selected to represent the wider diabetes specialist community, and seven semi-structured interviews were conducted. Interviews were recorded, transcribed verbatim and analysed using Framework analysis. Findings were compared with and contrasted to results from national quantitative surveys of diabetes specialist services undertaken in 2000 and 2006.


RESULTS
Clinicians viewed positively the expertise and commitment of multidisciplinary teams and their ability to adapt to new situations. Negative perceptions persisted throughout the decade, relating to the continual change that threatens to dismantle relationships and services which had taken many years to establish. Lack of resources, inadequate manpower planning and poor access to psychological support for people with diabetes remained constant themes from 2000 to 2011.


CONCLUSIONS
A willingness to innovate and work differently to improve services was identified; however, clinicians must be supported through organizational changes to ensure people with diabetes receive high-quality care. The disruptive nature of organizational change was a recurrent theme throughout the decade. Periods of stability must exist within commissioning to allow relationships, which are key to integration, to be maintained and permit service improvements to develop.
Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
C A
CA
Gosden
Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
K
K
Barnard
College of Medicine, Swansea University, Swansea, UK.
D R R
DR
Williams
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
T
T
Tinati
Diabetes UK, London, UK.
B
B
Turner
Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
R I G
RI
Holt
D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D003131:Combined Modality Therapy / Q000451:nursing / Q000592:standards / Q000639:trends; D003253:Consultants; D003920:Diabetes Mellitus / Q000628:therapy*; D004739:England; D018166:Health Care Reform / Q000639:trends; D019538:Health Care Surveys; D006801:Humans; D008137:Longitudinal Studies; D009013:Morale; D009720:Nurse Clinicians; D019982:Organizational Case Studies; D010348:Patient Care Team / Q000592:standards* / Q000639:trends; D010820:Physicians; D011787:Quality of Health Care / Q000639:trends; D013038:Specialization; D013222:State Medicine