Agenda setting and developing proposals in the policy stream
The group followed a rational process through priority setting, analysis of alternatives in subgroups and selec- tion of proposals to put forward to the HSE for approval. The relatively quick formulation of proposals within the group was facilitated by agreement on the main priorities which were considered a ‘no-brainer’. As one interviewee commented “it stands out a mile what needs to be done. Anyone that’s involved in diabetes care could see what was missing.” Priorities identified at the first meeting included the need for national retinopathy screening, improvement of podiatry services, a national diabetic register, support
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for patient education, a national model of care, and agreed guidelines for management.
The proposals considered by the EAG were heavily in- fluenced by previous reports, local loyalties, and existing care arrangements. The reiteration of existing proposals is part of the ‘softening up’ process in the policy stream in which ideas are floated and acceptance is built up over time. The EAG was established against a backdrop of previous attempts to improve the provision of dia- betes services. The timeline in Figure 2 illustrates the ac- cumulation and alignment of bottom-up and top-down activities by various groups including professional orga- nisations, academic groups, and diabetes charities. It also illustrates the frequency with which these reports and recommendations were published. In 2000, the Irish St Vincent Group identified priorities including a national retinopathy screening programme, enhanced paediatric services, and better integration between providers. These priorities, and others such as podiatry services and patient education, emerged in several reports over the course of the next decade [32,34]; by 2008, there were “3 different processes saying the same thing”.
Agenda setting and developing proposals in the policy streamThe group followed a rational process through priority setting, analysis of alternatives in subgroups and selec- tion of proposals to put forward to the HSE for approval. The relatively quick formulation of proposals within the group was facilitated by agreement on the main priorities which were considered a ‘no-brainer’. As one interviewee commented “it stands out a mile what needs to be done. Anyone that’s involved in diabetes care could see what was missing.” Priorities identified at the first meeting included the need for national retinopathy screening, improvement of podiatry services, a national diabetic register, supportPage 5 of 11for patient education, a national model of care, and agreed guidelines for management.The proposals considered by the EAG were heavily in- fluenced by previous reports, local loyalties, and existing care arrangements. The reiteration of existing proposals is part of the ‘softening up’ process in the policy stream in which ideas are floated and acceptance is built up over time. The EAG was established against a backdrop of previous attempts to improve the provision of dia- betes services. The timeline in Figure 2 illustrates the ac- cumulation and alignment of bottom-up and top-down activities by various groups including professional orga- nisations, academic groups, and diabetes charities. It also illustrates the frequency with which these reports and recommendations were published. In 2000, the Irish St Vincent Group identified priorities including a national retinopathy screening programme, enhanced paediatric services, and better integration between providers. These priorities, and others such as podiatry services and patient education, emerged in several reports over the course of the next decade [32,34]; by 2008, there were “3 different processes saying the same thing”.
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