29 Apr 2022
This new national guidance for care home operators and their staff has been created by an eminent panel of UK healthcare professionals led by Professor Alan Sinclair FRCP and including Professor Gerry Rayman FRCP who is a well-known and respected expert in diabetic foot disease and pioneer of the ‘Touch the Toes’ Test (TTT) for the detection of sensory neuropathy which is a complementary test to Neuropad.
The new guidance includes in Appendix A (pages 14-16) a recommendation for care home staff to screen residents with diabetes at risk of developing peripheral neuropathy with Neuropad in conjunction with the TTT.
Guidance background and purpose (extract from the document)
‘There is no doubt that older people living with diabetes represent a substantial global health burden in ageing societies. In those countries which provide residential care for people with disabilities or who are unable to look after themselves, residents with diabetes occupy more than one in four beds. These residents are a highly vulnerable group with challenging medical and nursing needs. Many are frail with and without dementia, and their diabetes condition is often complicated by high rates of hypoglycaemia and preventable and unnecessary hospital admissions for diabetes-related acute and chronic complications.
‘We have known for some time that there are considerable shortfalls in diabetes care within UK care home settings associated with suboptimal treatment, poor clinical outcomes, poor quality of life, and reduced survival. The Covid-19 pandemic has had a dramatic effect on care homes causing a major increase in morbidity and mortality associated with a significant toll on both health and social care resources, 6 and highlighted a wide range of health inequalities.
‘Local authorities, the NHS, and independent care providers many of which are represented by Care England, as well as by the National Care Association (NCA), play important roles in the way care is delivered in the community for the most vulnerable in society. The Care Quality Commission (CQC) has a key role in regulation of care homes and setting of quality standards. Guidance on managing diabetes in care homes has been available from Diabetes UK for more than a decade, and in 2015, diabetes guidance for CQC Inspectors of Care Homes was released, but regrettably, despite their robust recommendations, implementation and uptake of these guidances has been variable. In addition, providing only clinical care recommendations may have a limited effect in enhancing care and that improvements in medical technology, communication between stakeholders, and workforce development of care staff are also important factors in bringing about more sustained positive changes.
‘Therefore, the NAPCHD was established as a multi-professional group of specialists working with PLWD and other key stakeholders in July 2020 with a key purpose of examining the whole area of diabetes care provision from a clinical care perspective to the perspective of existing communication channels between stakeholders, care home workforce development, community and primary care liaison, and the emergence of digital health support. By producing the Strategic Document of Diabetes Care by the NAPCHD initiative, we hope to provide a set of potentially implementable recommendations that will ultimately enhance the quality of diabetes care delivered and lead to important improvements in the wellbeing, quality of life, and clinical outcomes of all residents with diabetes. We anticipated that this would require a fundamental change in care provision for residents with diabetes particularly those who require complex care interventions, and would represent a new model of health and social care for residents with diabetes in care homes.’