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Right Decision Service newsletter: April 2024

Welcome to the Right Decision Service (RDS) newsletter for April 2024. 

Issues with RDS and Umbraco access

Tactuum has been working hard to address the issues experienced during the last week. They have identified a series of three mitigation measures and put the first of these in place on Friday 3rd May.  If this does not resolve the problems, the second mitigation will be actioned, and then the third if necessary.

Please keep a lookout for any slowing down of the system or getting locked out. Please email myself, mbuchner@tactuum.com and onivarova@tactuum.com if you experience any problems, and also please raise an urgent support ticket via the Support Portal.

Thank you for your patience and understanding while we achieve a full resolution.

Promotion and communication resources

A rotating carousel presenting some of the key RDS tools and capabilities, and an editable slideset, are now available in the Resources for RDS providers section of the Learning and Support toolkit.

Redesign and improvements to RDS

The redesign of RDS Search and Browse is still on-track for delivery by mid-June 2024. We then plan to have a 3-week user acceptance testing phase before release to live. All editors and toolkit owners on this mailing list will be invited to participate in the UAT.

The archiving and version control functionality is also progressing well and we will advise on timescales for user acceptance testing shortly.

Tactuum is also progressing with the deep linking to individual toolkits within the mobile RDS app. There are several unknowns around the time and effort required for this work, which will only become clear as the work progresses. So we need to be careful to protect budget for this purpose.

New feature requests

These have all been compiled and effort estimated. Once the redesign work is complete, these will be prioritised in line with the remaining budget. We expect this to take place around late June.

Evaluation

Many thanks to those of you completed the value and impact survey we distributed in February. Here are some key findings from the 65 responses we received.

Figure 1: Impact of RDS on direct delivery of care

Key figures

  • 93% say that RDS has improved evidence-informed practice (high impact 62%; some impact 31%)
  • 91% report that RDS has improved consistency in practice (high impact 65%, some impact 26%)
  • 85% say that RDS has improved patient safety (high impact 59%, some impact 26%)
  • Although shared decision-making tools are only a recent addition to RDS, and only represent a small proportion of the current toolset, 85% of respondents still said that RDS had delivered impact in this area (53% high impact, 32% some impact.) 92% anticipate that RDS will deliver impact on shared decision-making in future and 85% believe it will improve delivery of personalised care in future.

Figure 2 shows RDS impact to date on delivery of health and care services

 

Key figures

These data show how RDS is already contributing to NHS reform priorities and supporting delivery of more sustainable care.

Saving time and money

  • RDS clearly has a strong impact on saving practitioner time, with 90% of respondents reporting that this is the case. 65% say it has a high impact; 25% say it has some impact on time-saving.
  • It supports devolved decision-making across the multi-professional team (85% of respondents)
  • 76% of respondents confirm that it saves money compared, for example, to investing in commercial apps (54% high impact; 22% some impact.)
  • 72% believe it has impacted already on saving money and reducing waste in the way services are delivered – e.g. reducing costs of referral management, prescribing, admissions.

Quality assurance and governance

  • RDS leads are clear that RDS has improved local governance of guidelines, with 87% confirming that this is the case. (62% high impact; 25% some impact.)

Service innovation and workforce development

  • RDS is a major driver for service innovation and improvement (83% of respondents) and has impacted significantly on workforce knowledge and skills (92% of respondents – 66% high impact; 26% some impact).

New toolkits

A few examples of toolkits published to live in the last month:

Toolkits in development

Some of the toolkits the RDS team is currently working on:

  • SARCS (Sexual Assault Response Coordination Service)
  • Staffing method framework – Care Inspectorate.
  • SIGN 171 - Diabetes in pregnancy
  • SIGN 158 – British Guideline on Management of Asthma. Selected sections will be incorporated into the RDS, and complemented by a new chronic asthma pathway being developed by SIGN, British Thoracic Society and NICE.
  • Clinical pathways from NHS Fife and NHS Lanarkshire

Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.

Quality audit of RDS toolkits

Thanks to all of you who have responded to the retrospective quality audit survey and to the follow up questions.  We still have some following up to do, and to work with owners of a further 23 toolkits to complete responses. An interim report is being presented to the HIS Quality and Performance Committee.

Implementation projects

Eight clinical services and two public library services are undertaking tests of change to implement the Being a partner in my care app. This app aims to support patients and the public to become active participants in Realistic Medicine. It has a strong focus on personalised, person-centred care and a library of shared decision aids, as well as simple explanations and videoclips to help the public to understand the aims of Realistic Medicine.  The tests of change will inform guidance and an implementation model around wider adoption and spread of the app.

With kind regards

Right Decision Service team

Healthcare Improvement Scotland

Risk factors

The key risk factors for developing type 2 fall into two categories:

Modifiable risk factors

These are risk factors that you can change and control. 

Non-modifiable risk factors

These are risk factors you cannot change yourself. However you can still reduce your risk of developing type 2 diabetes by acting on the modifiable risk factors such as weight loss.

Find out more about each of these types of risk factor by clicking on the links below.

 

Modifiable risk factors

1.Excess body weight

Bathroom scales        tape measure

Your weight plays a large role in developing  type 2 diabetes, especially if your extra weight is around your waist. 

What is a healthy weight to aim for?

This is about working out your Body Mass Index (BMI).  BMI uses your height and weight to work out if you're a healthy weight.  You can work your BMI out for yourself using this NHS tool  – it will show you your target range.

For many people living with obesity, aiming for a healthy BMI may not be realistic. Research shows that  even losing just 5% of extra weight will improve your health. The more weight you lose, the greater the health benefits.

What is a healthy waist size?

BMI  doesn’t look at how much fat you have around the middle. That is why you need to measure your waist too.

Healthy weight size all depends on your gender and ethnicity. For a healthy measurement you need to aim to be less than:

  • 80cm (31.5in) for all women
  • 94cm (37in) for most men
  • 90cm (35in) for South Asian men.

This video from Diabetes UK shows you how to measure your waist size.

2. Physical activity 

physical activity

 It is estimated that 1 in 3 women, and 1 in 4 men in the UK do not undertake enough activity to stay healthy.

It is recommended that we all undertake at least 150 minutes of moderate-intensity exercise, or 75 minutes of high-intensity exercise per week.

Being active can:

  • Contribute to weight loss
  • Increase the way your body uses insulin, reducing the period of time blood glucose levels remain high. 
  • Use fat for fuel in endurance exercise such as running or swimming. This reduces levels of fat around your waist.

Exercise videos

This playlist of short videos from Diabetes UK gives you lots of exercise options to choose from. They range from gentle arm and leg movements to dance and a full body workout.

3. Smoking

smoking

In the UK, 15% of people aged 18 years and over are said to be active smokers. This means that there are  some 7.2 million active smokers that are putting themselves at risk of type 2 diabetes.

Smokers are estimated to be 30% to 40% more likely to develop T2DM than nonsmokers. Cigarette smoke has been found to contain more than 7000 harmful chemicals, many of which can decrease the effectiveness of insulin as a result of  inflammation and damage cells as a consequence of oxidative stress.

Additionally, the nicotine from smoking can reduce the effectiveness of insulin, resulting in active smokers finding it harder to manage blood glucose levels. 

If you have prediabetes or a previous diagnosis of gestational diabetes, you already have an increased chance of developing cardiovascular disease, such as a heart attack, stroke or circulatory problems in the legs.

Combine this with smoking and you make the chances of developing these diseases and their complications even higher.

Help to stop smoking

NHS inform provides a suite of support and resources to help you to stop smoking. This includes the Quit your Way Scotland service. This is staffed by a team of trained advisors who will give you advice tailored to your needs.  

4. Stress 

 stress

Stress  hormones cause an increase in blood glucose levels and reduce the effectiveness of insulin. 

For some people, stress can also trigger overeating behaviours. The change in body chemicals resulting from eating “comfort foods'' can dampen stress related responses and emotions. Over time, this can lead to prolonged levels of comfort eating and, ultimately, an increase in body weight and the development of T2DM. 

Non-modifiable risk factors

1.Age

image of ageing

You’re more at risk of developing type 2 diabetes if you’re:

  • White and over 40 years old
  • African-Caribbean, Black African, or South Asian and over 25 years old.

As we age, our bodies naturally begin to function less efficiently than they did when we were younger. This includes our body becoming less efficient in producing insulin. That can increase our risk of developing type 2 diabetes as we get older. 

2.Genetics

image of DNA

  • You’re two to six times more likely to get type 2 diabetes if you have a parent, brother, sister or child with diabetes.

The genetic risk comes from changes in the parts of our DNA that help to control our blood glucose levels. Some of these changes can reduce our body's ability to release insulin. This leads to increases in blood glucose levels. Over time, elevated levels of blood glucose increases the risk of developing T2DM. 

3.Ethnicity

image representing ethnic diversity

  • Type 2 diabetes is two to four times more likely in people of South Asian descent and African-Caribbean or Black African descent.

While the exact cause of this increased risk among different ethnicities is not fully understood, it is likely that our genetics that are passed down to us and determine who we are play a large role.