National Paediatric Diabetes Audit NPDA
National Paediatric Diabetes Audit Report 2011-12
December 2013 

# National Paediatric Diabetes Audit Report 2011-12 Care Processes And Outcomes

December 2013
Report produced by the National Paediatric Diabetes Audit Project Board, Royal College of Paediatrics and Child Health

## Contents

| FOREWORD	    |                                                                                      |
|----|--------------------------------------------------------------------------------------|
| 3  |                                                                                      |
| 1. | SUMMARY OF KEY FINDINGS                                                              |
| 4  |                                                                                      |
| 2.	 INTRODUCTION.    |                                                                                      |
| 5  |                                                                                      |
| 3.	 COVERAGE AND PARTICIPATION    |                                                                                      |
| 7  |                                                                                      |
| 4.	 DEMOGRAPHIC AND POPULATION ASSESSMENT.    |                                                                                      |
| 8  |                                                                                      |
|    | 4.1                                                                                  |
|    |                                                                                      |
|    |                                                                                      |
|    |                                                                                      |
|    |                                                                                      |
|    | 4.2                                                                                  |
|    |                                                                                      |
| 5.	 CARE PROCESSES AND TREATMENT TARGETS    |                                                                                      |
| 15 |                                                                                      |
|    | 5.1                                                                                  |
|    | 5.2                                                                                  |
| 6.	 OUTCOMES OF CARE    |                                                                                      |
| 20 |                                                                                      |
|    | 6.1                                                                                  |
|    |                                                                                      |
|    |                                                                                      |
| 7. | CONCLUSIONS AND FUTURE DIRECTIONS.                                                   |
| 29 |                                                                                      |
| 8.	 ACKNOWLEDGMENTS AND COLLABORATORS    |                                                                                      |
| 30 |                                                                                      |
| 9.	 REFERENCES    |                                                                                      |
| 32 |                                                                                      |
| 10.	 APPENDIX A:    |                                                                                      |
|    |                                                                                      |
|    | Data on Paediatric Diabetes Units in the 2011-12 National Paediatric Diabetes Audit. |

## Foreword

We are pleased to introduce the second annual report from the National Paediatric Diabetes Audit (NPDA), prepared by the Royal College of Paediatrics and Child Health. The report covers the period 2011-2012 for paediatric diabetes units in England and Wales. Findings from this year's Audit are both heartening, and troubling. On the positive side, nearcomplete national coverage of paediatric diabetes units has been achieved, and the number of infants, children and young people with diabetes under the age of 25 years reported to the NPDA has increased. Measurements of HbA1c have also improved, and the percentage of patients with HbA1c values in the target range <58mmol/mol (7.5%) has risen. Despite these achievements, fewer than one in five patients overall reach this level of diabetes control. We also note that the extent to which children and young people receive the care processes recommended by the National Institute for Health and Care Excellence remains low. The NPDA illustrates the quality of care delivered and it is clear there are many improvements to be made. We hope that clinical teams, NHS managers, and commissioners will use the findings from the Audit to improve both the organisation and delivery of diabetes care. We thank the NHS clinical teams that submitted data for their participation in the 2011-2012 Audit, and the important role played by the regional paediatric diabetes networks across England and Wales. We applaud the clinical leadership that has helped paediatric diabetes units submit high quality, complete data, and acknowledge this is sometimes difficult. We recognise the pressures faced by busy clinical teams and, going forward, aim to implement further improvements to facilitate data submission. We remain confident that with the strong support shown by clinical teams and with further development of the paediatric diabetes networks around the country, the NPDA will continue to be a powerful tool for driving improvements in the delivery of care and improving outcomes for infants, children, and young people with diabetes. Neena Modi	
	
                                                          Justin Warner Vice President for Science and                                     RCPCH Clinical Lead for the NPDA Research RCPCH and Chair NPDA

## 1.   Summary Of Key Findings

The 2011-12 National Paediatric Diabetes Audit (NPDA) report represents a transition to a new dataset and a new electronic web platform for data submission. We are pleased to have been able to implement the submission of information from multiple patient visits over the audit period. Though this has provided many challenges to Paediatric Diabetes Units submitting data, and to the NPDA, we believe this will strengthen the quality of the Audit. Coverage of children and young people with diabetes by the NPDA has increased. Records from 25,390 children and young people with diabetes were submitted to the 2011-12 NPDA, an increase of 7.2% compared with 23,676 in 2010-11. Some of this may be a real increase in diabetes incidence. For England and Wales combined, there were a total of 25,199 children and young people under the age of 25 years cared for in Paediatric Diabetes Units with a diagnosis of diabetes, and with a valid age and sex attached to their record, reported by 177 Paediatric Diabetes Units. An additional five Units registered with the NPDA, but did not submit data. In 2011-12 a new dataset and data collection process was adopted. The new dataset has many improvements over the previous version, including provision for multiple HbA1c and other tests, and more accurate recording of dates and data. Improvements to individual aspects of this report and methodological changes are discussed in the relevant section. For example, the HbA1c results now represent medians of several submitted values per patient, as opposed to a single value in 2010-11. This means caution should be taken when comparing some results with previous audit years. Despite improvements in the recording of some individual care processes from previous years, the percentage of children and young people diagnosed with diabetes for at least one year and over the age of 12 years at the start of the audit year with all care processes recorded, as recommended by the National Institute for Health and Care Excellence (NICE), has increased marginally to 6.7% in 2011-12, up from 5.8% in 2010-11. This proportion falls well short of similar data from the 

2011-12 National Diabetes Audit (NDA) report for adults with diabetes, which shows for England and Wales, the proportion receiving all eight adult care processes in 2011-12 is 60.5% for all diabetes and 42.4% for Type 1 diabetes. In England, 89% of boys and girls under the age of 25 years had their HbA1c measured, and 87% in Wales. This is a small improvement from the 85% who had their HbA1c measured in 2010-11. The percentage of children and young people with diabetes achieving an HbA1c <58 mmol/mol (7.5%) has increased from 14.5% in 2009-10 and 15.8% in 2010-11 to 17.4% in 2011-12. The greatest numbers of patients have an HbA1c between 58 mmol/mol (7.5%) and 80 mmol/mol (9.5%). Over a quarter of children and young people have an unacceptable HbA1c of >80 mmol/mol (9.5%). Admissions to hospital with Diabetic Ketoacidosis will be published as a supplement to this report in February 2014.

## 2.   Introduction

The National Paediatric Diabetes Audit (NPDA) report highlights the main findings on the quality of care for children and young people with diabetes mellitus in England and Wales. This is the ninth report and covers data submitted for patients under the age of 25 years who were being cared for in Paediatric Diabetes Units (PDUs) during the audit year 2011-12. This is the second report from the Royal College of Paediatric and Child Health (RCPCH), awarded the contract to conduct the NPDA from May 2011. The NPDA is commissioned and sponsored by the Healthcare Quality Improvement Partnership (HQIP) as part of the national clinical audit programme. The programme is funded by NHS England and the Welsh Government. The NPDA covers the components of the National Service Framework for Diabetes and includes details on the number of children and young people with diabetes in England and Wales, the care processes they receive and outcome measures, including inpatient admissions for diabetic ketoacidosis. This report covers the care process and outcome data only, with complications data to follow in a separate report. The National Diabetes Audit (NDA) for adults reports on the provision of core diabetes care for everyone with diabetes, whereas the NPDA reports only on individual participation of PDUs and children and young people attending such services. Those reviewing the NDA and the NPDA reports side by side need to be aware of these differences but, equally, those wanting to get the most complete picture of local needs and service provision should consider the two reports together. 2011-12 has seen the launch of a new dataset, the development of a new electronic web platform (EWP) for submitting data and a new online data quality reporting tool. The new dataset has been developed to allow more scope for data analysis. Based on feedback the EWP has undergone some developmental changes to improve data collection and quality reporting for the 2012-13 NPDA. There is a clear recognition that 2011-12 has been a year of transition to this new dataset and relevant GP report. The NDA integrates data from participating specialist and GP services for adults with diabetes so that if a care process or treatment target is recorded by one but not the other, both get the complete data reported back to them i.e. a 'whole person' view. This reflects the fact that there is no clinical value in duplicating something carried out elsewhere. The population level NDA reports include all people with diabetes in a geographical area, irrespective of their mix of provider services, and use integrated data where they are available. The NPDA runs independently of the NDA and of GP services, so its data are not integrated. It is, therefore, possible that GP reports do not include all care processes or treatment targets measured in specialist paediatric units, and vice versa. Specialist PDUs are primarily responsible for the care of most children and young people with diabetes, and for the collection of their care process and outcome data. Although GPs do not provide the majority of care for children and young people living with diabetes, they do prescribe all their medications. Therefore it is this age group, and also adults with Type 1 or complex diabetes, that attend specialist services not participating in NDA, where lack of data integration is most likely to result in a slightly deficient 'whole systems' view. Furthermore, for under-17s, the age cut-off for the Quality and Outcomes Framework (QOF) GP incentive scheme means that there is no financial value to the practice in replicating results from external services. Nonetheless, because fewer than 10% of all people with Type 1 diabetes, and fewer than 1% of people with diabetes in general are under 17years, the overall impact on population level NDA results is minimal.

submission process. It has presented many challenges to PDUs who are now asked to submit patient data for multiple visits over the audit year. Despite these challenges the number of PDUs submitting data has remained stable and the number of patient records has increased. The new dataset has also presented challenges to the NPDA in terms of providing timely data quality reports back to submitting PDUs, and the extraction and analysis of multilevel patient data. However, this new dataset will come into line with many other international audits and registries, making comparisons more valid. Over the nine years that the NPDA has been the basis for data collection on process and outcome measures of care for children and young people with diabetes, there have been many changes in the way services are structured and delivered. In England, with the help of the former NHS Diabetes, ten Regional Networks have been established and are geographically located in the former Strategic Health Authorities. The development of these Networks has helped considerably in the collection of annual audit data. They have also helped facilitate monitoring and benchmarking of services within region. Participation in the NPDA is now a mandatory standard for a PDU to receive its tariff in England. No such commissioning arrangements exist in Wales. Over the last few years there has been a move towards intensification of therapy, including insulin dose adjustment for carbohydrate intake using multiple daily injections and/or continuous subcutaneous insulin infusions. There is also recognition of the need for continuous structured educational programmes starting from diagnosis and continuing throughout childhood, adolescence and transition into adult services. The NPDA will act as the measuring tool for the implementation of such initiatives. This report has demonstrated a significant improvement in the number of children and young people with diabetes achieving an HbA1c of <58mmol/mol (7.5%), which is anticipated to be the beginning of year-on-year improvement as quality of care escalates. The peer review process established in England, and under negotiation in Wales, will act as a quality assurance tool to ensure nationally agreed standards are met. The NPDA hopes that PDUs will use the data presented in this report to benchmark their own centres against others, and explore methods of driving up quality of care for their patients. The Royal College of Paediatrics and Child Health and the NPDA would like to thank PDUs that have submitted data to the 2011-12 audit. Finally, data quality is of paramount importance when submitting data and PDUs are reminded to check the data quality report provided and act on any outstanding issues. The NPDA can only analyse data that fulfil the data entry criteria. Patients must have a valid NHS number, date of birth, date of diagnosis and gender submitted to be included in analyses of care processes and outcomes. Furthermore, they must be assigned a PDU PZ code. Care processes and outcomes can only be analysed if the result is a valid response and the date of measurement falls within the audit year. Much data submitted have to be excluded because it does not fulfil these criteria. The NPDA would urge submitting PDUs to check their data quality to ensure it is accurate and avoid any data being excluded.

## 3.   Coverage And Participation

A total of 177 PDUs in England and Wales successfully submitted data to the 2011-12 NPDA, representing 25,199 patients. A Paediatric Diabetes Unit is defined as a unit which delivers a paediatric diabetes healthcare service. It may represent one or more hospitals, as some services provide care across multiple sites. Data were received from 163 PDUs in England, which represents 97% of those registered with the NPDA (168), and from 14 PDUs within the six Health Boards in Wales, comprising 100% of services registered with the NPDA in Wales. Figure 1 shows the geographical spread of the 177 PDUs in England and Wales. 

## 4.   Demographic And Population Assessment 4.1   Registrations

Records from 25,390 children and young people with diabetes were submitted to the 2011-12 NPDA, an increase of 7.2%, compared with 2010-11. There were 417 patients who had visited (and as a result were recorded at) more than one PDU. A total of 191 records have been excluded from the 2011-12 analysis, as 114 were related to patients over the age of 25 years, or without a valid age; 65 did not have a valid record of gender, and 12 did not have a valid PDU code attached to them. Therefore, for England and Wales combined, there were a total of 25,199 children and young people under the age of 25 years registered with diabetes and with a valid age and sex attached to their record, reported from 177 PDUs, which were used in the analysis for the 2011-12 Report. Table 1 shows the breakdown in registration by country, age and English region. The age breakdown categories have been changed from 2010-11 to allow comparisons to be made with the same age groups represented in the Census and other Office for National Statistics publications. Within England, the maximum number of registrations across all age groups was observed in the North West and East of England regions. In both England and Wales, age groups 10-14 and 15-19 years comprised the two largest groups of registered children and young people with diabetes.

|                          |       |        |        | Area   | Age group   |
|--------------------------|-------|--------|--------|--------|-------------|
| 0-4                      | 5-9   | 10-14  | 15-19  | 20-24  | Total       |
| England and Wales        | 1,354 | 4,861  | 10,987 | 7,764  | 233         |
| England                  |       |        |        |        |             |
| 1,282                    | 4,618 | 10,314 | 7,287  | 229    | 23,730      |
| Wales                    |       |        |        |        |             |
| 72                       | 243   | 673    | 477    | <5     | 1,469       |
| Regions in England       |       |        |        |        |             |
| East of England          | 150   | 571    | 1,180  | 997    | 21          |
| East Midlands            | 97    | 399    | 808    | 433    | 0           |
| London                   | 172   | 500    | 916    | 676    | 83          |
| North East               | 60    | 243    | 555    | 436    | 0           |
| North West               | 173   | 612    | 1,484  | 908    | 60          |
| South Central            | 114   | 376    | 855    | 600    | 41          |
| South East               | 135   | 562    | 1,275  | 875    | 5           |
| South West               | 111   | 382    | 925    | 662    | 5           |
| West Midlands            | 135   | 487    | 1,190  | 850    | 12          |
| Yorkshire and the Humber | 135   | 486    | 1,126  | 850    | <5          |

## 4.1.1   Registrations By Age And Sex

Table 2 and Figure 2  shows registrations for boys and girls in each age band. Slightly more boys have been registered with diabetes than girls.

| 0-4            | 5-9   | 10-14   | 15-19   | 20-24   | Total  Under 25   |
|----------------|-------|---------|---------|---------|-------------------|
| Boys           |       |         |         |         |                   |
| 704            | 2,587 | 5,674   | 4,097   | 113     | 13,175            |
| Girls          |       |         |         |         |                   |
| 650            | 2,274 | 5,313   | 3,667   | 120     | 12,024            |
| Total under 25 | 1,354 | 4,861   | 10,987  | 7,764   | 233               |

## 4.1.2   Registrations By Ethnicity And Region

Of the 25,199 records analysed, 681 do not specify a valid ethnic origin as part of their registration. For PDUs in Wales, 98.9% of records provide ethnic origin; the corresponding figure from England is 97.0% which is significantly improved from 2010-11 when just 72.6% of registrations from England specified ethnic origin. Table 3 and Figure 3 show the percentage of children and young people registered with diabetes by ethnic group for 2011-12. In both England and Wales the largest group was White. In England, Asians and Blacks were the two next largest patient ethnic groups. Note that some ethnic groups with very small populations have not been shown, so the percentages may not add up to 100%. 'Not stated' is offered as a specific response when parents or children do not wish to provide ethnicity information. However, the NPDA cannot validate this response as it may also be entered by a PDU when ethnicity is unknown or not recorded. In addition, there are some records with missing data on ethnicity which are also not shown.

|                          |   White |   Mixed |   Asian |   Black |   Other |   Not stated |
|--------------------------|---------|---------|---------|---------|---------|--------------|
| England and Wales        |    76   |     1.8 |     4.3 |     2.8 |     1.3 |         13.9 |
| England                  |    74.6 |     1.8 |     4.5 |     2.9 |     1.4 |         14.7 |
| Wales                    |    96.9 |     1.2 |     0.2 |     0.1 |     0.1 |          1.5 |
| Regions in England       |         |         |         |         |         |              |
| East of England          |    81.9 |     1.8 |     2.6 |     1.1 |     0.7 |         11.9 |
| East Midlands            |    86.3 |     1.8 |     5.2 |     1.8 |     1.5 |          3.4 |
| London                   |    39.2 |     5.2 |    11   |    17.6 |     4.8 |         22.2 |
| North East               |    53.9 |     0.2 |     0.5 |     0.1 |     0.1 |         45.2 |
| North West               |    74.9 |     1   |     3.4 |     1.1 |     1   |         18.6 |
| South Central            |    83.8 |     0.8 |     1.8 |     0.9 |     0.4 |         12.2 |
| South East               |    77.9 |     2.8 |     5.2 |     3.8 |     2.4 |          8   |
| South West               |    84.7 |     0.8 |     0.8 |     1.3 |     0.3 |         12.1 |
| West Midlands            |    71.4 |     2.2 |     6.5 |     1.9 |     1   |         16.9 |
| Yorkshire and the Humber |    82.8 |     1   |     6.4 |     0.7 |     1   |          8.1 |

## 4.1.3   Registrations By Diabetes Type

Over 98% of the records submitted to the Audit had a diabetes type recorded. 308 of those records did not specify ethnicity. Table 4 shows the breakdown of diabetes type by sex, nation and region in England. The vast majority of children and young people have Type 1 diabetes, although there is variability across regions in England. In both England and Wales there were slightly more boys with Type 1 diabetes.  The second major group was those with Type 2 diabetes. 

forms of  
Not Specified 
Diabetes Mellitus
Mellitus
Other specified 
forms of Diabetes 
(gene unknown)
Monogenic forms 
of Diabetes Mellitus 
(gene known)
Monogenic forms 
of Diabetes Mellitus 
Mellitus
Cystic Fibrosis 
Related Diabetes 
Type 2 
Mellitus
Diabetes 
Type 1 
Mellitus
Diabetes 
 
 
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
England and Wales 
97.4
95.2
1.1
2.6
0.4
0.6
0.3
0.4
0.1 0.1
0.4
0.8
0.3
0.5
England
97.4
95.1
1.1
2.6
0.4
0.5
0.3
0.4
0.0
0.1
0.4
0.8
0.4
0.5
Wales
97.6
95.6
0.9
2.4
0.8
1.3
0.4
0.3 0.3
0.1
0.0
0.3
0.0 0.0
Regions in England
East of England
97.9
96.4
0.5
0.8
0.3
0.5
0.3
0.4
0.1
0.0
0.3
0.9 0.6
1.1
East Midlands
98.0
95.7
0.8
2.0
0.0
0.2
0.5 0.5
0.0
0.1
0.3
1.1
0.4 0.4
London
96.4
91.6
2.2
6.3
0.7
0.7
0.0
0.3
0.0
0.0
0.3
0.5
0.3
0.6
North East
98.4
96.4
0.9
3.1
0.0
0.0
0.1
0.0 0.0
0.0
0.4
0.3
0.1
0.2
North West
96.8
95.3
0.9
1.6
0.7
1.0
0.7
0.3
0.0
0.2
0.4
0.7
0.5
0.8
South Central
98.4
96.2
0.5
1.4
0.5
0.6
0.2
0.8
0.1
0.1
0.3
0.6
0.1
0.2
South East
98.1
97.0
1.2
1.6
0.0
0.1
0.1 0.1
0.0
0.0
0.1
0.4
0.6
0.7
South West
97.7
95.8
1.0
2.0
0.3
1.2
0.2
0.7
0.1
0.0
0.5
0.1
0.2
0.1
West Midlands
97.6
93.6
1.5
4.4
0.3
0.1
0.1
0.3
0.0
0.0
0.4
1.5
0.1
0.2
Yorkshire and the 
Humber
95.8
93.9
1.3
3.3
0.6
0.4 0.4 0.4
0.1
0.2
1.3
1.4
0.5
0.5

*Due to rounding to one decimal place, the total may not add to 100.0 per cent.

## 4.1.4   Registrations By Diabetes Type And Ethnicity

Table 5 shows the breakdown of children and young people with diabetes by type and ethnicity. There are a much higher proportion of children and young people with Type 2 diabetes in Asian, Other and Black ethnicities compared to White and Mixed ethnic groups.

| Diabetes type     |   White |   Asian |   Black |   Mixed-ethnic group |   Other | Not stated      |
|-------------------|---------|---------|---------|----------------------|---------|-----------------|
| Type 1 Diabetes   |    97.4 |    96.3 |    85.5 |                 91.7 |    91.6 | 95.4            |
| Type 2 Diabetes   |     1   |     2.1 |     8.7 |                  6.2 |     7.1 | 2.7             |
| 0.5               |     0.2 |     0.4 |     0   |                  0.3 |     0.6 | Cystic Fibrosis |
| Related Diabetes  |         |         |         |                      |         |                 |
| 0.4               |     0   |     0.7 |     0.3 |                  0   |     0.1 | Monogenic forms |
| of Diabetes       |         |         |         |                      |         |                 |
| (gene known)      |         |         |         |                      |         |                 |
| 0.0               |     0   |     0.3 |     0.1 |                  0   |     0   |                 |
| England           |         |         |         |                      |         |                 |
| and               |         |         |         |                      |         |                 |
| Wales             |         |         |         |                      |         |                 |
| Monogenic forms   |         |         |         |                      |         |                 |
| of diabetes (gene |         |         |         |                      |         |                 |
| unknown)          |         |         |         |                      |         |                 |
| 0.5               |     0.2 |     3   |     1   |                  0.3 |     0.6 | Other specified |
| Diabetes          |         |         |         |                      |         |                 |
| 0.3               |     1.2 |     1.5 |     0.6 |                  0.6 |     0.6 | Not specified   |
| Diabetes          |         |         |         |                      |         |                 |

## 4.2   Incidence Rates 4.2.1   Incidence Rates By Country For Type 1 Diabetes

This section includes age and sex-specific diabetes population incidence rates for Type 1 diabetes for 2011-12. Recent evidence suggests that the incidence of Type 1 diabetes in children is rising and may double by 2020, which has important health care implications1. NPDA incidence time trends need to be interpreted with caution, as the increase may be due to better reporting coverage of patients with diabetes, rather than to a true increase in incidence. The age-specific incidence rate is defined as the number of newly diagnosed cases of diabetes in a specific age group over a specific time period (i.e. 2011-12 year period) per total number of children and young people in that age group in the general population. Table 6 and Figure 4 a and b show incidence rates by age and sex for England and Wales and combined in 2011-12. The 10-14 age group years had the highest rate of incidence of Type 1 diabetes. In England and Wales, boys had a marginally higher rate of incidence than girls for 2011-12, except in the 0-4 year age group. Note that the number of patients in the age group 20-24 years is small and only represents patients in this age group still being cared for at a PDU. By this age many patients will have moved to adult services and the rate in this age group will not represent a true rate. The reader should compare the rates published in the adult NDA 2011-12 for more information on this age range2.

|                |      |       |      | England   | Wales   | England and Wales   |
|----------------|------|-------|------|-----------|---------|---------------------|
| Age group      | Boys | Girls | Boys | Girls     | Boys    | Girls               |
| 0-4            |      |       |      |           |         |                     |
| 12.5           | 13.8 | 9.8   | 11.5 | 12.4      | 13.6    |                     |
| 5-9            |      |       |      |           |         |                     |
| 24.8           | 20.6 | 17.9  | 31.5 | 24.5      | 23.5    |                     |
| 10-14          |      |       |      |           |         |                     |
| 35.5           | 28.3 | 40.6  | 40.4 | 35.8      | 29.0    |                     |
| 15-19          |      |       |      |           |         |                     |
| 6.6            | 5.4  | 5.9   | 4.1  | 6.5       | 5.4     |                     |
| 20-24          |      |       |      |           |         |                     |
| 0.1            | 0.0  | 0.9   | 0.0  | 0.2       | 0.0     |                     |
| Total under 25 |      |       |      |           |         |                     |
| 15.2           | 13.4 | 14.3  | 16.3 | 15.2      | 13.6    |                     |

Figure 5 shows the incidence rate (numbers of new cases per 100,000 age-specific population) in 2011-12, by country and by English region. For each region, the age group 10-14 years had the highest incidence per 100,000 persons in that age group, followed by those in age group 5-9 years. In addition, the incidence rate in England for all children and young people under 25 years is lower than the rate in Wales. Among all the regions in England, London has the lowest incidence rate of Type 1 diabetes.

## 5. Care Processes And Treatment Targets Audit Question: What Proportion Of Children And Young People With Diabetes Are Getting The Key Age-Specific Processes Of Diabetes Care, And What Proportion Achieve Treatment Targets?

The NPDA collects information on the key care processes, recommended by the National Institute for Health and Care Excellence (NICE), for children and young people with diabetes3.  
The NPDA measures the percentage of children and young people with diabetes who are receiving the key processes of care which include:

•	
Glycated Haemoglobin A1c (HbA1c)
•	
Body Mass Index (BMI) (from 2011-12 both height and weight were recorded and BMI calculated)
•	
Blood pressure
•	
Urinary albumin
•	
Cholesterol
•	
Eye screening
•	
Foot examination
Key care processes are recorded to monitor diabetes management and detect long-term complications at the earliest treatable stage.  Guidelines specify a starting age of 12 years for commencing all care processes with the exception of HbA1c, which should be recorded in children and young people of all ages with diabetes. The NPDA incorporates data collection for the age-relevant care process and provides analysis on this information. The measurement of blood creatinine was removed from the dataset for 2011-12, as it was deemed to be poorly representative as a care process in children and young people with diabetes. In the analysis, children and young people were included if they had had a complete year of care, i.e. for 2011-12 had been diagnosed prior to 1st April, 2011 and for all care processes except HbA1c were 12 years of age or older on 1 April, 2011. Furthermore, the data entered needed to be valid and have a date of measurement recorded that was within the audit year.

## 5.1   Care Processes

There has been a steady year-on-year improvement in the recording of all care processes individually, apart from HbA1c and BMI (Table 7).  For 2011-12 multiple HbA1c data were collected on each patient, whereas previously it was a single data point. For BMI both height and weight were collected for 2011-12, which is more representative of the data collected by PDUs. In the 2011-12 NPDA, the percentage of children and young people over the age of 12 years with all care processes recorded has increased to 6.7% (Table 7 and Figure 6). Although this represents an improvement, the figure remains low. The NPDA is unable to validate this figure against patient records, as there may be significant under-reporting of the care processes being performed, but not recorded for audit purposes. The proportion receiving all checks is significantly less than the proportion in the NDA 2011-12 for adults receiving all eight adult care processes, which shows an uptake of 60.5% for all diabetes and 42.4% for Type 1 diabetes4.

| 2004-05          |   2005-06 |   2006-07 |   2007-08 |   2008-09 |   2009-10 |   2010-11 |   2011-12 |
|------------------|-----------|-----------|-----------|-----------|-----------|-----------|-----------|
| HbA1c            |           |           |           |           |           |           |           |
| 73.2             |      77.6 |      84.7 |      89.1 |      89.6 |      90.1 |      92.8 |      89.3 |
| BMI              |           |           |           |           |           |           |           |
| 50.5             |      53   |      60.5 |      73.2 |      66   |      70.2 |      75.3 |      64.7 |
| Blood pressure   |           |           |           |           |           |           |           |
| 44.1             |      40.6 |      53.3 |      60.1 |      57.1 |      58.8 |      62.7 |      67.7 |
| Urinary albumin  |           |           |           |           |           |           |           |
| 18.7             |      23.3 |      30.3 |      34.1 |      32.2 |      36.5 |      40.3 |      40.7 |
| Cholesterol      |           |           |           |           |           |           |           |
| 18.2             |      17.5 |      22.6 |      32.1 |      30.5 |      29.9 |      34.9 |      44.4 |
| Eye screening    |           |           |           |           |           |           |           |
| 17.7             |      15.3 |      25.2 |      25.7 |      26.9 |      25.8 |      35.8 |      36.9 |
| Foot examination |           |           |           |           |           |           |           |
| 17.4             |      15.4 |      21.3 |      23.5 |      23.1 |      24.5 |      31.9 |      34.4 |
| 2.0              |       2.6 |       3.6 |       5   |       5.2 |       4.1 |       5.8 |       6.7 |
| % with all care  |           |           |           |           |           |           |           |
| processes        |           |           |           |           |           |           |           |
| recorded         |           |           |           |           |           |           |           |

Figure 7 shows the percentage of care processes incomplete (apart from HbA1c), by PDU.  These care processes include measurement of cholesterol, blood pressure, urinary albumin, body mass index (both height and weight), eye screening and foot examination.  Individual Units can be identified in Appendix A by their PZ code. There are only four PDUs that returned results of 100% incompleteness, with a wide variation for others. This is much improved on 2010-11, when there were 20 such units.

*A list of PDU PZ codes and corresponding Unit names can be found in Appendix A.

## 5.2   Hba1C Analysis

This section focuses specifically on HbA1c as it is recommended as the best indicator of long-term diabetes control.3 The following analysis examines the percentage of children and young people, of all ages, who had their HbA1c checked and recorded. For the 2011-12 Audit, multiple recordings of HbA1c could be submitted for each patient. This differs from previous audits where the last recorded HbA1c was submitted to the NPDA during the audit year.  In the analysis, children and young people were included if they had had a complete year of care, i.e. for 2011-12 had been diagnosed prior to 1st April, 2011. Table 8 and Figure 8 show the percentage of children and young people in different age groups by sex and nation who had their HbA1c measured. In England 89.5% of boys and 89.4% of girls under the age of 25 years had their HbA1c measured, and 86.4% of boys and 88.6% of girls in Wales. 

|                |       | England   | Wales   |
|----------------|-------|-----------|---------|
| Boys           | Girls | Boys      | Girls   |
| 0-4            |       |           |         |
| 92.9           | 90.1  | 94.7      | 92.9    |
| 5-9            |       |           |         |
| 92.0           | 90.9  | 95.3      | 95.7    |
| 10-14          |       |           |         |
| 90.3           | 91.5  | 96.0      | 96.5    |
| 15-19          |       |           |         |
| 87.8           | 87.0  | 69.8      | 75.8    |
| 20-24          |       |           |         |
| 53.4           | 56.3  | 0.0       | 0.0     |
| Total Under 25 |       |           |         |
| 89.5           | 89.4  | 86.4      | 88.6    |

process completed, by PDU. The chart is similar to 2010-11 where 8 PDUs submitted less than 50% of their HbA1c data. 

9
18 24 29 38 47 50 57 62 72 86 96
111 119 130 153 167 178 186 215 223 238
5
171 231 242
49 64
156
33 99
7
175
101
30
183 113 121
10 32
225
94 76
127 177 141
31
4
168
91 20
173 159
82
202 128 157
12 36
109 137 163 213
74
230
1
226 145 219
14 59 68 97
151 190
22
132 193 187 122 228
220
56
110 191 108
75
107 139

*A list of PDU DU codes and corresponding Unit names can be found in Appendix A.

## 6.   Outcomes Of Care 6.1   Treatment Targets

Treatment targets can be viewed as part of the process of care or as an 'intermediate outcome', i.e. an intermediary step between a care process (what is done to the patient) and a 'hard' endpoint such as development of complications. For 2011-12 the NPDA has reported HbA1c values in accordance with the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) standardised concentrations of mmol/mol, indicating the Diabetes Control and Complications Trial (DCCT) aligned measures of percentage shown in brackets (%). For 2011-12, multiple HbA1c's were submitted on each patient to give a more representative measure of diabetes control over the year of care, and to come into line with other international reporting audits and registries. HbA1c values recorded less than three months from diagnosis were excluded as they are not representative of a patients overall diabetes control. In keeping with other international audits and registries the median HbA1c value for the year for each patient was used in the analysis. Furthermore, there was little difference between means and medians for each patient.

## 6.1.1   Hba1C Target Achievement

Table 9 shows the percentage of children and young people with diabetes achieving the HbA1c target ranges of <58 mmol/mol (7.5%), ≥58 mmol/mol (7.5%) to ≤80 mmol/mol (9.5%), and >80 
mmol/mol (9.5%) by country and sex in 2011-12. Only 16.7% of boys and 18.1% of girls achieve a target HbA1c of <58 mmol/mol (7.5%) nationally. The greatest number of patients have their HbA1c recorded as between 58 mmol/mol (7.5%) and 80 mmol/mol (9.5%). There is virtually no difference in the percentage of children and young people within the HbA1c categories between England and Wales.  Around one quarter of children and young people with diabetes have an HbA1c of >80 mmol/mol (9.5%). Figure 10 shows the percentage of children and young people with diabetes achieving the NICE 
recommended HbA1c targets of <58 mmol/mol (7.5%), ≥58 mmol/mol (7.5%) to ≤80 mmol/mol 
(9.5%), and >80 mmol/mol (9.5%) by country in 2011-12.  

≥58 mmol/mol (7.5%) to 
 
<58 mmol/mol (7.5%)
>80 mmol/mol (9.5%)
≤80 mmol/mol (9.5%)
 
Boys
Girls
Total
Boys
Girls
Total
Boys
Girls
Total
England
1,721
1,444
3,165
5,474
4,963
10,437
2305
2,238
4,543
%
16.7
18.1
17.4
57.4
57.6
57.5
25.9
24.3
25.0
Wales
109
101
210
348
348
696
161
148
309
%
16.9
17.6
17.3
58.3
56.3
57.2
24.8
26.1
25.5
England and 
1,545
1,830
3,375
5,311
5,822
11,133
2,386
2,466
4,852
Wales %
16.7
18.1
17.4
57.5
57.5
57.5
25.8
24.4
25.1
|                                |         |         |         | England   | Wales   | England and Wales   |
|--------------------------------|---------|---------|---------|-----------|---------|---------------------|
| HbA1c Target Band              | 2010-11 | 2011-12 | 2010-11 | 2011-12   | 2010-11 | 2011-12             |
| <48 mmol/mol (6.5%)            | 4.3     | 3.8     | 4.6     | 3.8       | 4.3     | 3.8                 |
| >48 mmol/mol (6.5%)  and <58   |         |         |         |           |         |                     |
| mmol/mol (7.5%)                | 11.4    | 13.6    | 12.9    | 13.5      | 11.5    | 13.6                |
| Total <58 mmol/mol (7.5%)      | 15.7    | 17.4    | 17.5    | 17.3      | 15.8    | 17.4                |
| >58 mmol/mol (7.5%) and <80    |         |         |         |           |         |                     |
| mmol/mol (9.5%)                | 55.5    | 56.2    | 56.8    | 55.4      | 55.5    | 56.2                |
| >80 mmol/mol (9.5%) and <102   |         |         |         |           |         |                     |
| mmol/mol (11.5%)               | 21.0    | 19.5    | 17.8    | 20.1      | 20.8    | 19.5                |
| >102 mmol/mol (11.5%) and <124 |         |         |         |           |         |                     |
| mmol/mol (13.5%)               | 5.6     | 5.0     | 6.0     | 5.3       | 5.7     | 5.1                 |
| >124 mmol/mol (13.5%) and      |         |         |         |           |         |                     |
| <147mmol/mol (15.5%)           | 2.0     | 1.7     | 1.9     | 1.9       | 2.0     | 1.7                 |
| >147mmol/mol (15.5%) and <169  |         |         |         |           |         |                     |
| mmol/mol (17.5%)               | 0.2     | 0.1     | 0.0     | 0.0       | 0.2     | 0.1                 |
| >169 mmol/mol (17.5%)          | 0.0     | 0.0     | 0.0     | 0.1       | 0.0     | 0.0>                |

Table 11 and Figure 11 show HbA1c target band achieved (percentage and number) by ethnic group, in 2011-12. The 'Other' ethnic group has the highest percentage achieving the target HbA1c of <58 mmol/mol (7.5%), with the lowest in the 'Black' ethnic group. 'Black' and 'Mixed' ethnic groups had the highest percentage of children and young people with HbA1c >80 mmol/mol (9.5%). 

| HbA1c target band       | White   |   Mixed |   Asian |   Black |   Other | Not stated   |
|-------------------------|---------|---------|---------|---------|---------|--------------|
| Number                  | 2,496   |    56   |   131   |    70   |    49   | 520          |
| <58 mmol/mol (7.5%)     |         |         |         |         |         |              |
| %                       | 17.0    |    16.2 |    16.9 |    13.9 |    21.8 | 20.2         |
| Number                  | 8,559   |   177   |   436   |   205   |   122   | 1,481        |
| >58 mmol/mol (7.5%) and |         |         |         |         |         |              |
| <80 mmol/mol (9.5%)     |         |         |         |         |         |              |
| %                       | 58.3    |    51.3 |    56.3 |    40.8 |    54.2 | 57.5         |
| Number                  | 3,617   |   112   |   207   |   227   |    54   | 574          |
| >80 mmol/mol (9.5%)     |         |         |         |         |         |              |
| %                       | 24.7    |    32.5 |    26.7 |    45.2 |    24   | 22.3         |

Note: Due to rounding, percentages in Table 11 do not all add to 100 percent. Please note: where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%) for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome. Incomplete HbA1c data for a patient is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period. See Appendix A for further details for each PDU. 

48 88 118 144 40 75 107 135 139 143 29 226 20 76 31 152 140 73 120 220 156 78 200 170 33 105 203 230 38 167 84 173 232 125 19 225 113 138 169 213 202 82 146 193 190 176 178 174 80 188 191 68 215 64 53 114 131 67 11 89 60 222 26 52 55 160
163
172 121 221 240 18 41 127 162 182 65 134 151 189 24 56 47 150 238 128 102
1 22 199 106 122 177 183 94 157 186 50 28 58 86 136 10 2 15 74 216
9 90 99
126 164 175 137
14 62
112 231 45 141 111 185 159 242 149 181 72 133 158 12
16 218
5 97 180 54 168 27 34 91 49 100 153 104 132 32 4
129 36 184 130 171 119 42 101 109
6 35 145 228 69 179
223
96 7 17 110 57 219 92 59 30 206 187 23 234 108

*A list of PDU PZ codes and corresponding Unit names can be found in Appendix A.

## 6.1.2   Paediatric Diabetes Unit Variation In Hba1C

Table 12 shows mean and standard deviation, median and interquartile ranges for HbA1c for England, Wales and the English Regions. The mean and median for each region are similar, with means ranging between 68 and 76 mmol/mol (8.4% to 9.1%), and medians between 67 and 73 mmol/mol (8.3% to 8.8%).  

| Mean                     | Median        | Standard    | 25        |
|--------------------------|---------------|-------------|-----------|
| th                       |               |             |           |
|                          | 75            |             |           |
| th                       |               |             |           |
|                          | Interquartile |             |           |
| deviation                | percentile    | percentile  | range     |
| England                  |               |             |           |
| 73 (8.8%)                | 71 (8.6%)     | 18 (1.6%)   | 62 (7.8%) |
| Wales                    |               |             |           |
| 73 (8.8%)                | 71 (8.6%)     | 18 (1.7%)   | 62 (7.8%) |
| Regions in England       |               |             |           |
| East of England          |               |             |           |
| 75 (9.0%)                | 72 (8.7%)     | 18 (1.6%)   | 63 (7.9%) |
| East Midlands            |               |             |           |
| 71 (8.6%)                | 68 (8.4%)     | 16 (1.5%)   | 60 (7.6%) |
| London                   |               |             |           |
| 74 (8.9%)                | 71 (8.6%)     | 20 (1.8%)   | 61 (7.7%) |
| North East               |               |             |           |
| 73 (8.8%)                | 71 (8.6%)     | 17 (1.6%)   | 62 (7.8%) |
| North West               |               |             |           |
| 72 (8.7%)                | 68 (8.4%)     | 17 (1.6%)   | 61 (7.7%) |
| South Central            |               |             |           |
| 68 (8.4%)                | 67 (8.3%)     | 15 (1.4%)   | 59 (7.5%) |
| South East               |               |             |           |
| 74 (8.9%)                | 71 (8.6%)     | 17 (1.6%)   | 63 (7.9%) |
| South West               |               |             |           |
| 73 (8.8%)                | 71 (8.6%)     | 17 (1.6%)   | 62 (7.8%) |
| West Midlands            |               |             |           |
| 76 (9.1%)                | 73 (8.8%)     | 19 (1.7%)   | 63 (7.9%) |
| Yorkshire and the Humber |               |             |           |
| 73 (8.8%)                | 71 (8.6%)     | 17 (1.6%)   | 61 (7.7%) |

The following box plots (Figure 13 to Figure 22) show the median, interquartile range and outlying values of HbA1c measurements by PDU (refer to Appendix A for the identification of each unit). 

The 5 Units which submitted incomplete HbA1c data are excluded from the box plots. The PDUs have been separated by the various countries and regions in England. Please note: Where the % of incomplete HbA1c data is high, or the number of submitted patients low, care must be taken in the interpretation of the results for an individual PDU. Refer to Appendix A for details of incomplete HbA1c data and patient numbers.

*Reference lines represent the upper and lower NICE HbA1c targets of 58mmol/mol (7.5%) and 80mmol/mol (9.5%), respectively *Reference lines represent the upper and lower NICE HbA1c targets of 58mmol/mol (7.5%) and 80mmol/mol (9.5%), respectively

## 7.   Conclusions And Future Directions

The increased participation in the 2011-12 National Paediatric Diabetes Audit is an indicator that those delivering care to children and young people with diabetes value the importance of the annual audit. There have been some improvements in the recording of individual care processes, although the proportion of patients receiving all seven care processes remains low. The increased number of children and young people with an HbA1c <58 mmol/mol (7.5%) is an encouraging sign that the tide has turned and marks the start of a year on year improvement in this outcome measure. There is of course much variability in this figure across England and Wales, which needs addressing through quality assurance programmes such as the peer review process, already established in England. The development of the Regional Networks and the introduction of the Best Practice Tariff in England will contribute towards delivery of a high-quality service to children and young people with diabetes. The NPDA will continue to monitor this process by mapping the recording of care processes and clinical outcomes. The NPDA team is aware that the new dataset and the new EWP for submission of data established for 2011-12 needs time to bed in, but we believe that in the long term it will provide an improved Audit that can be benchmarked equally against Audits and Registries internationally. 

## 8. Acknowledgments And Collaborators National Paediatric Diabetes Audit Project Board

•	
Professor Neena Modi,  Professor of Neonatal Medicine, Imperial College London (Project Executive, Project Board Chair)
•		
Dr Justin Warner, Consultant in Paediatric Endocrinology and Diabetes, Cardiff and
Vale University Health Board (RCPCH Lead)
•	
Dr Jeremy Allgrove, Consultant Paediatric Endocrinologist, Barts Health NHS Trust (IT Solutions Adviser)
•	
Mr Siôn Morris (Project Manager, RCPCH)
•	
Ms Katie Beddows, Paediatric Diabetes Specialist Nurse, Stockport NHS Foundation Trust (Senior User)
•	
Ms Rita Ranmal (Programme Lead, RCPCH)

## Project Support

•	
Ms Naima Hussein (Project Administrator, RCPCH)

## Data Analysis

•	
Dr Michael Soljak (Clinical Research Fellow, Imperial College London)
•	
Ms Swarna Khare (Research Assistant, Imperial College London)

## National Paediatric Diabetes Audit Dataset Working Group

•	
Dr Fiona Campbell, Consultant Paediatric Diabetologist, Leeds Teaching Hospitals NHS Trust (Chair)
•	
Dr Rakesh Amin, Consultant in Paediatric and Adolescent Endocrinology and Diabetes, Great Ormond Street Hospital for Children NHS Trust
•	
Dr James Greening, Consultant Paediatric Endocrinologist and Diabetologist, University Hospitals Leicester NHS Trust
•	
Dr Piyusha Kapila, Consultant Paediatrician, North Middlesex University Hospital NHS 
Trust
•	
Mr Gavin Terry, Policy Manager, Diabetes UK
•	
Ms Helen Thornton, Paediatric Diabetes Specialist Nurse, St Helens and Knowsley Teaching Hospitals NHS Trust

## National Paediatric Diabetes Audit Patient Reported Experience And Outcome Measures Working Group

•	
Dr Deborah Christie, Consultant Clinical Psychologist and Reader in Paediatric and Adolescent Psychology, University College London Hospitals NHS Foundation Trust (Chair)
•	
Ms Judith Campbell, Paediatric Diabetes Specialist Nurse, Central Manchester University Hospitals NHS Foundation Trust
•	
Ms Kate Fazakerley, Parent representative
•	
Ms Tat Gray, Experience Consultant
•	
Professor Peter Hindmarsh, Professor of Paediatric Endocrinology, University College London
•	
Mr Neil Musgrove, Parent representative
•	
Dr Shakeel Rahman, Consultant Paediatrician, Harrogate Health Care NHS Trust
•	
Mr Gavin Terry, Policy Manager, Diabetes UK
•	
Dr Nicola Trevelyan, Consultant Paediatrician, Southampton University Hospitals NHS Trust

## National Paediatric Diabetes Audit Collaborators

•	
Association of Children's Diabetes Clinicians
•	
British Society for Paediatric Endocrinology and Diabetes
•	
Diabetes UK
•	
Juvenile Diabetes Research Foundation
•	
Royal College of Nursing
•	
The British Dietetic Association
•	
The British Psychological Society

## 9.   References

1.  Department of Health. National Service Framework for Diabetes: London: Department 
of Health, 2001.
2.	 Patterson CC, Dahlquist GG, Gyürüs E, Green A, Soltész G. Incidence trends for 
childhood Type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005– 20: a multicentre prospective registration study. *The Lancet* 2009;373(9680):2027-33.
3.	 National Institute for Clinical Excellence. Clinical Guideline 15: Type 1 diabetes: Diagnosis 
and management of Type 1 diabetes in children, young people and adults. In: Excellence NIfC, editor. London: National Institute for Clinical Excellence, 2004.
4.	 NHS Health and Social Care Information Centre, Diabetes UK. National Diabetes Audit 
2011-12: Report 1 Care Processes And Treatment Targets. *National Diabetes Audit:* The Health and Social Care Information Centre, 2013.

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
Me­
dian 
HbA1c 
(%)
Median 
HbA1c 
(mmol/
mol)
Mean 
HbA1c 
(%)
Mean 
HbA1c 
(mmol/
mol)
(7.5%)
% with 
HbA1c<58 
mmol/mol 
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
155
138
17
11.0
16.7
73
8.8
67
8.3
55.8
ted
291
102
189
64.9
17.6
74
8.9
69
8.5
34.2
194
170
24
12.4
22.9
70
8.6
67
8.3
43.3
no. of 
submit­
patients 
University Health Board, Wales
Norfolk and Norwich University Hospital Trust, 
East of England
PZ001
Singleton Hospital, Abertawe Bro Morgannwg 
PZ002
Norfolk and Norwich University Hospital, 
PZ004
Northampton General Hospital,  Northampton 
PDU code
PDU name
Total 

## 10.   Appendix A: Data On Pdus In The 2011-12 . National Paediatric Diabetes Audit

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

117
103
14
12.0
13.6
79
9.4
75
9.0
50.5
94
89
5
5.3
18.0
70
8.6
66
8.2
26.3
133
120
13
9.8
17.5
75
9.0
73
8.8
24.1
149
124
25
16.8
25.0
72
8.7
69
8.5
33.5
109
88
21
19.3
20.5
74
8.9
69
8.4
61.6
336
306
30
8.9
27.8
66
8.2
64
8.0
25.3
254
233
21
8.3
21.0
70
8.6
68
8.4
75.9
General Hospital NHS Trust, East Midlands
NHS Foundation Trust, East Midlands
Bassetlaw Hospitals NHS Foundation Trust, 
Yorkshire and the Humber
Hospitals NHS Trust, South Central
Cheshire NHS Trust, North West 
Dunstable Hospital NHS Foundation Trust, 
East of England
Cadwaladr University Health Board, Wales
Hospitals NHS Trust, London and South East
PZ011
Glan Clwyd District General Hospital, Besti 
PZ012
Barnet Hospital, Barnet and Chase Farm 
PZ010
Luton and Dunstable Hospital, Luton and 
PZ007
John Radcliffe Hospital, Oxford Radcliffe 
PZ005
Derbyshire Children's Hospital, Derby Hospitals 
PZ006
Doncaster Royal Infirmary, Doncaster and 
PZ009
Macclesfield District General Hospital, East 

 *For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 
  less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
Me­
dian 
HbA1c 
(%)
Median 
HbA1c 
(mmol/
mol)
Mean 
HbA1c 
(%)
Mean 
HbA1c 
(mmol/
mol)
(7.5%)
% with 
HbA1c<58 
mmol/mol 
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
81
74
7
8.6
17.6
70
8.6
68
8.4
82.9
75
43
32
42.7
18.6
74
8.9
68
8.4
73.8
92
86
6
6.5
27.9
68
8.4
65
8.1
61.8
66
58
8
12.1
20.7
70
8.6
69
8.5
31.7
116
105
11
9.5
15.2
74
8.9
69
8.5
37.7
ted
240
219
21
8.8
10.5
77
9.2
74
8.9
77.2
no. of 
submit­
patients 
Hospitals NHS Trust, London and South East
of South Manchester NHS Foundation Trust, 
North West
Hospitals NHS Foundation Trust, Yorkshire and 
the Humber
Hospital NHS Foundation Trust, South Central
NHS, London and South East
University Hospitals NHS Foundation Trust, 
PZ017
Dorset County Hospital, Dorset County 
PZ015
Wythenshawe Hospital, University Hospital 
PZ018
Worthing Hospital, Western Sussex Hospitals 
PZ016
Bassetlaw Hospital, Doncaster and Bassetlaw 
PZ019
Basildon Hospital, Basildon and Thurrock 
PZ014
Chase Farm Hospital, Barnet and Chase Farm 
PDU code
PDU name
Total 

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

58
36
22
37.9
16.7
74
8.9
75
9.0
34.8
65
60
5
7.7
21.7
69
8.5
66
8.2
45.9
122
107
15
12.3
4.7
81
9.6
75
9.0
54.6
317
298
19
6.0
16.1
74
8.9
72
8.7
34.0
145
5
140
96.6
40.0
63
7.9
63
7.9
66.7
262
243
19
7.3
14.0
76
9.1
73
8.9
78.9
East of England
Lincolnshire and Goole Hospitals NHS 
Foundation Trust, Yorkshire and the Humber
University Hospitals NHS Trust, North West
NHS Trust, London and South East
Hospitals University NHS Foundation Trust, 
London and South East
Hospitals NHS Trust, Yorkshire and the Humber
Trust,  Yorkshire and the Humber/ North East
PZ027
Friarage Hospital, South Tees Hospitals NHS 
PZ023
St George's Hospital, St George's Healthcare 
PZ022
West Cumberland Hospital, North Cumbria 
PZ026
Hull Royal Infirmary, Hull and East Yorkshire 
PZ024
East Kent Hospitals NHS Trust, East Kent 
PZ020
Diana Princess Of Wales Hospital, Northern 

 *For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 

  less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
Me­
dian 
HbA1c 
(%)
Median 
HbA1c 
(mmol/
mol)
Mean 
HbA1c 
(%)
Mean 
HbA1c 
(mmol/
mol)
(7.5%)
% with 
HbA1c<58 
mmol/mol 
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
83
81
2
2.4
17.3
73
8.8
72
8.7
13.5
54
48
6
11.1
4.2
77
9.2
76
9.1
44.0
119
104
15
12.6
8.7
75
9.0
72
8.8
61.1
ted
103
87
16
15.5
5.7
77
9.2
73
8.8
69.6
105
98
7
6.7
30.6
66
8.2
65
8.1
33.3
324
301
23
7.1
22.6
72
8.7
69
8.5
54.3
no. of 
submit­
patients 
Hospitals NHS Trust, South Central
Hospitals NHS Trust, North West
Trust, North West
Hospitals NHS Trust, London and South East
Tyne Hospital Trust, North East
PZ031
St Richard's Hospital, Western Sussex 
PZ033
Queens Hospital, Burton Hospitals NHS Trust, 
PZ032
Royal Victoria Infirmary, The Newcastle Upon 
PZ028
Stoke Mandeville Hospital, Buckinghamshire 
PZ029
Fairfield General Hospital, The Pennine Acute 
PZ030
Leighton Hospital, Mid-Cheshire Hospitals NHS 
PDU code
PDU name
Total 

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

100.0
NO 
DATA
NO 
DATA
NO 
DATA
NO 
DATA DATA
151
129
22
14.6
21.7
72
8.7
69
8.5
64.8
116
104
12
10.3
23.1
69
8.5
66
8.2
67.5
110
64 46
41.8
9.4
75
9.0
75
9.0
14.2
216
0
216
100.0
NO 
322
289
33
10.2
23.9
68
8.4
66
8.2
63.1
259
210
49
18.9
15.2
74
8.9
70
8.6
62.1
205
186
19
9.3
25.3
65
8.1
63
7.9
35.0
West Midlands
and Eastleigh Healthcare NHS Trust, South 
Central
Foundation Trust, South Central
Cross University NHS Trust, London and South 
East
NHS Trust, South Central
England NHS Foundation Trust, West Midlands
Hospitals NHS Foundation Trust, East of 
England
University Hospitals NHS Trust, East Midlands
PZ041
Addenbrooke's Hospital, Cambridge University 
PZ035
Royal Berkshire Hospital, Royal Berkshire NHS 
PZ038
Wycombe General, Buckinghamshire Hospitals 
PZ036
Whipps Cross University Hospital, Whipps 
PZ034
Royal Hampshire County Hospital, Winchester 
PZ042
Nottingham Children's Hospital, Nottingham 
PZ040
Birmingham Heartlands Hospital, Heart of 

 *For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 

  less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
Me­
dian 
HbA1c 
(%)
Median 
HbA1c 
(mmol/
mol)
Mean 
HbA1c 
(%)
Mean 
HbA1c 
(mmol/
mol)
(7.5%)
% with 
HbA1c<58 
mmol/mol 
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
111
4
107
96.4
0.0
79
9.4
79
9.4
88.9
72
68
4
5.6
16.2
70
8.6
66
8.2
30.7
75
73
2
2.7
19.2
75
9.0
70
8.6
47.5
93
86
7
7.5
14.0
76
9.1
70
8.6
30.1
118
99
19
16.1
17.2
77
9.2
73
8.8
15.9
ted
147
136
11
7.5
22.1
67
8.3
66
8.2
42.8
no. of 
submit­
patients 
NHS Trust, London and South East
Hospital NHS Trust, Yorkshire and the Humber
Hospitals NHS Trust, East Midlands
Halton Hospitals NHS Foundation Trust, North 
West
and St Helier University Hospitals NHS Trust, 
London and South East
Board, Wales
PZ052
Nevill Hall Hospital, Aneurin Bevan Health 
PZ047
Airedale General Hospital, Whittington 
PZ045
Whittington Hospital, Whittington Hospital 
PZ048
Lincoln County Hospital, United Lincolnshire 
PZ049
Warrington General Hospital, Warrington and 
PZ050
Queen Mary's Hospital for Children, Epsom 
PDU code
PDU name
Total 

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

82
76
6
7.3
13.2
77
9.2
76
9.1
38.1
85
56
29
34.1
16.1
69
8.5
66
8.2
53.1
114
98
16
14.0
17.3
76
9.1
75
9.0
61.4
195
156
39
20.0
30.1
68
8.4
66
8.2
42.8
136
126
10
7.4
28.6
65
8.1
64
8.0
77.1
198
182
16
8.1
21.4
69
8.5
69
8.5
28.3
347
171
176
50.7
14.0
72
8.7
70
8.6
87.0
Lincolnshire and Goole Hospitals NHS 
Foundation Trust, Yorkshire and the Humber
Trust, South Central
Leicester NHS Trust, East Midlands
Health Board, Wales
Trust, London and South East
Hospital NHS Trust, London and South East
London NHS Trust, London and South East
PZ057
Kingston Hospital, Kingston Hospital NHS 
PZ053
Scunthorpe General Hospital, Northern 
PZ055
Leicester Royal Infirmary, University Hospitals 
PZ058
Newham General Hospital, Newham University 
PZ059
The Royal London Hospital, Barts and the 
PZ056
West Wales General Hospital, Hywel Dda 
PZ054
Poole General Hospital, Poole Hospital NHS 

 *For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 

  less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
Me­
dian 
HbA1c 
(%)
Median 
HbA1c 
(mmol/
mol)
Mean 
HbA1c 
(%)
Mean 
HbA1c 
(mmol/
mol)
(7.5%)
% with 
HbA1c<58 
mmol/mol 
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
174
166
8
4.6
13.9
75
9.0
73
8.8
99.2
ted
142
131
11
7.7
13.0
74
8.9
70
8.6
36.7
120
108
12
10.0
15.7
76
9.1
74
8.9
52.6
104
91
13
12.5
18.7
76
9.1
74
8.9
14.3
203
185
18
8.9
13.5
72
8.7
70
8.6
40.4
no. of 
submit­
patients 
Exeter NHS Foundation Trust, South West
Services NHS Trust, London and South East
Hospital NHS Foundation Trust, East Midlands
Staffordshire NHS Foundation Trust, West 
Midlands
Hospitals NHS Trust, South West
PZ067
Royal Cornwall Hospital, Royal Cornwall 
PZ062
Croydon University Hospital, Croydon Health 
PZ065
Staffordshire General Hospital, Mid-
PZ064
Chesterfield Royal Hospital, Chesterfield Royal 
PZ060
Royal Devon and Exeter, Royal Devon and 
PDU code
PDU name
Total 

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

100.0
NO 
DATA
NO 
DATA
NO 
DATA
NO 
DATA DATA
98
95
3
3.1
20.0
67
8.3
66
8.2
100.0
99
90
9
9.1
6.7
85
9.9
82
9.7
32.1
46
0
46
100.0
NO 
141
131
10
7.1
26.0
67
8.3
65
8.1
80.3
176
150
26
14.8
12.7
74
8.9
72
8.7
43.5
182
149
33
18.1
4.7
80
9.5
79
9.4
59.1
342
39
303
88.6
17.9
75
9.0
73
8.9
65.3
220
190
30
13.6
7.9
78
9.3
76
9.1
56.1
Hospital Bath NHS Trust, South West
Foundation Trust, North West
NHS Trust, East of England
Hospitals NHS Trust, West Midlands
Foundation Trust, North West
NHS Trust, South Central
Hospital University NHS Foundation Trust, East 
of England
Hospital of North Staffordshire NHS Trust, 
West Midlands
PZ073
Alexandra Hospital, Worcestershire Acute 
PZ074
Alder Hey Hospital, Alder Hey Children's NHS 
PZ075
St. Mary's Hospital, Isle of Wight Healthcare 
PZ072
West Suffolk Hospital, West Suffolk Hospital 
PZ078
North Staffordshire Hospital, University 
PZ076
Colchester General Hospital, Colchester 
PZ068
Royal United Bath Hospital, Royal United 
PZ069
Stepping Hill Hospital, Stockport NHS 

 *For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 

  less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
Me­
dian 
HbA1c 
(%)
Median 
HbA1c 
(mmol/
mol)
Mean 
HbA1c 
(%)
Mean 
HbA1c 
(mmol/
mol)
(7.5%)
% with 
HbA1c<58 
mmol/mol 
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
59
51
8
13.6
9.8
81
9.6
79
9.4
33.9
94
66
28
29.8
12.1
80
9.5
75
9.0
68.0
118
3
115
97.5
0.0
73
8.8
73
8.8
94.3
ted
139
110
29
20.9
13.6
78
9.3
76
9.1
57.6
170
159
11
6.5
12.6
73
8.8
72
8.7
47.6
105
98
7
6.7
17.3
73
8.8
72
8.7
28.3
no. of 
submit­
patients 
Sunderland NHS Trust, North East
Hospital, Guy's and St Thomas' NHS 
Foundation Trust, London and South East
Worcestershire Acute Hospitals NHS Trust, 
West Midlands
Health Care NHS Trust, East of England
Surrey County Hospital NHS Foundation Trust, 
London and South East
PZ082
Evelina Children's Hospital at St Thomas 
PZ088
Royal Surrey County Hospital, The Royal 
PZ089
Northwick Park Hospital, North West London 
PZ086
Hinchingbrooke Hospital, Hinchingbrooke 
PZ084
Kidderminster General Hospital, 
PZ080
Sunderland Royal Hospital, City Hospitals 
PDU code
PDU name
Total 

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

92
60
32
34.8
30.0
68
8.4
65
8.1
52.8
60
52
8
13.3
21.2
74
8.9
69
8.5
41.0
231
207
24
10.4
16.9
70
8.6
69
8.5
38.5
198
182
16
8.1
18.1
72
8.7
68
8.4
35.1
227
211
16
7.0
27.5
66
8.2
64
8.1
29.4
244
225
19
7.8
21.8
69
8.5
67
8.3
62.1
Hospitals NHS Trust, London and South East
Yorkshire Hospitals NHS Trust, Yorkshire and 
the Humber
Lancashire Hospitals NHS Trust, North West
Morgannwg University Health Board, Wales
Hospitals NHS Trust, West Midlands
Trust, South West
West Birmingham Hospitals NHS Trust, West 
Midlands
PZ091
East Lancashire Diabetic Service, East 
PZ097
City Hospital Birmingham, Sandwell and 
PZ092
Princess of Wales Hospital, Abertawe Bro 
PZ096
Derriford Hospital, Plymouth Hospitals NHS 
PZ094
The Princess Royal, Royal Shrewsbury 
PZ090
Pontefract General Infirmary, The Mid-

 *For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 

  less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
Me­
dian 
HbA1c 
(%)
Median 
HbA1c 
(mmol/
mol)
Mean 
HbA1c 
(%)
Mean 
HbA1c 
(mmol/
mol)
(7.5%)
% with 
HbA1c<58 
mmol/mol 
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
73
63
10
13.7
22.2
73
8.8
70
8.6
37.6
ted
158
139
19
12.0
16.5
75
9.0
73
8.8
40.9
129
102
27
20.9
22.5
76
9.1
74
9.0
32.8
345
286
59
17.1
24.1
67
8.3
66
8.2
23.7
209
193
16
7.7
18.1
68
8.4
67
8.3
40.9
no. of 
submit­
patients 
and North Hertfordshire NHS Trust, East of 
England
Healthcare NHS Trust, South West
Hospitals NHS Trust, Yorkshire and the Humber
Trust, London and South East
Wigan and Leigh NHS Foundation Trust, North 
West
PZ101
Leeds Children's Hospital, Leeds Teaching 
PZ102
Hillingdon Hospital, Hillingdon Hospital NHS 
PZ104
Royal Albert Edward Infirmary, Wrightington, 
PZ100
North Devon District Hospital, Northern Devon 
PZ099
East and North Hertfordshire NHS Trust, East 
PDU code
PDU name
Total 

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

89.9
NO 
DATA
NO 
DATA
NO 
DATA
NO 
DATA DATA
76
0
76
100.0
NO 
63
57
6
9.5
19.3
69
8.5
66
8.2
32.8
93
85
8
8.6
18.8
68
8.4
66
8.2
44.0
117
68
49
41.9
27.9
69
8.5
63
8.0
43.9
112
95
17
15.2
16.8
69
8.5
68
8.4
47.9
185
166
19
10.3
9.0
76
9.1
74
9.0
53.5
335
5
330
98.5
60.0
57
7.4
56
7.3
81.5
248
209
39
15.7
24.4
68
8.4
67
8.3
25.4
Hospitals NHS Trust, Yorkshire and the Humber
Hospitals NHS Trust, North West
NHS Foundation Trust, North East
Children's Hospital NHS Foundation Trust, 
West Midlands
University Hospitals NHS Trust, South Central
and Ormskirk NHS Trust, North West
Trust, West Midlands
Teaching Hospital NHS Foundation Trust, 
Yorkshire and the Humber
PZ111
Hereford County Hospital, Wye Valley NHS 
PZ112
Scarborough General Hospital, Yorkshire 
PZ110
Ormskirk District General Hospital, Southport 
PZ107
Queen Elizabeth Hospital, Gateshead Health 
PZ105
St Luke's Hospital, Bradford Teaching 
PZ108
Birmingham Children's Hospital, Birmingham 
PZ106
Victoria Hospital, Blackpool, Fylde and Wyre 
PZ109
Southampton General Hospital, Southampton 

 *For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 

  less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
Me­
dian 
HbA1c 
(%)
Median 
HbA1c 
(mmol/
mol)
Mean 
HbA1c 
(%)
Mean 
HbA1c 
(mmol/
mol)
(7.5%)
% with 
HbA1c<58 
mmol/mol 
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
76
68
8
10.5
14.7
75
9.0
75
9.0
32.4
98
2
96
98.0
0.0
64
8.0
63
8.0
8.3
121
107
14
11.6
7.5
77
9.2
72
8.7
75.9
101
89
12
11.9
23.6
69
8.5
67
8.3
50.4
187
165
22
11.8
10.9
77
9.2
75
9.0
36.8
ted
159
152
7
4.4
13.2
74
8.9
70
8.6
68.7
no. of 
submit­
patients 
University Health Board, Wales
NHS Foundation Trust, Yorkshire and the 
Humber
Healthcare NHS Trust, London and South East
Gravesham NHS Trust, London and South East
Shields, Northumbria Healthcare NHS 
Foundation Trust, North East
NHS Trust, West Midlands
PZ113
University Hospital of Wales, Cardiff and Vale 
PZ121
George Eliot Hospital, George Elliot Hospital 
PZ118
University Hospital Lewisham, Lewisham 
PZ119
Darent Valley Hospital, Dartford and 
PZ114
York District Hospital, York Teaching Hospital 
PZ120
North Tyneside General Hospital, North 
PDU code
PDU name
Total 

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

72
70
2
2.8
22.9
70
8.6
69
8.5
80.5
76
61
15
19.7
16.4
67
8.3
69
8.5
52.8
115
105
10
8.7
15.2
75
9.0
72
8.7
27.9
170
131
39
22.9
16.8
78
9.3
75
9.0
70.1
106
97
9
8.5
10.3
72
8.7
69
8.5
63.3
224
215
9
4.0
18.1
70
8.6
69
8.5
70.2
Hospitals Coventry and Warwickshire NHS 
Trust, West Midlands
Wells Area and NHS Trust, London and South 
East
Foundation Trust, London and South East
Hospitals NHS Foundation Trust, East of 
England
NHS Trust, East Midlands
District NHS Foundation Trust, Yorkshire and 
the Humber
PZ127
James Paget Hospital, James Paget University 
PZ122
University Hospital Coventry, University 
PZ125
Maidstone Hospital, Maidstone and Tunbridge 
PZ128
Pilgrim Hospital, United Lincolnshire Hospitals 
PZ126
Medway Maritime Hospital, Medway NHS 
PZ129
Harrogate General Hospital, Harrogate and 

 *For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 

  less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
Me­
dian 
HbA1c 
(%)
Median 
HbA1c 
(mmol/
mol)
Mean 
HbA1c 
(%)
Mean 
HbA1c 
(mmol/
mol)
(7.5%)
% with 
HbA1c<58 
mmol/mol 
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
46
44
2
4.3
15.9
72
8.7
69
8.5
23.9
167
152
15
9.0
13.2
75
9.0
73
8.8
47.4
ted
169
142
27
16.0
23.2
72
8.7
71
8.6
34.8
144
128
16
11.1
20.3
69
8.5
66
8.2
74.3
108
89
19
17.6
22.5
69
8.5
68
8.4
52.3
no. of 
submit­
patients 
and Westminister Hospital NHS Trust, London 
and South East
Stamford Hospitals NHS Trust, East of England
University Health Board, Wales
Hospitals NHS Trust, North East
NHS Trust, North West
PZ131
Peterborough General, Peterborough and 
PZ133
James Cook University Hospital, South Tees 
PZ132
Ysbyty Gwynedd Hospital, Besti Cadwaladr 
PZ134
Trafford General Hospital, Trafford Healthcare 
PZ130
Chelsea and Westminster Hospital, Chelsea 
PDU code
PDU name
Total 

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

50.2
89.6
NO 
DATA
NO 
DATA
NO 
DATA
NO 
DATA
NO 
DATA
NO 
DATA
NO 
DATA
NO 
DATA
DATA
DATA
58
52
6
10.3
19.2
73
8.8
69
8.5
15.9
69
61
8
11.6
6.6
80
9.5
78
9.3
44.9
185
162
23
12.4
18.5
74
8.9
72
8.7
56.8
165
0
165
100.0
NO 
214
185
29
13.6
17.3
73
8.8
70
8.6
62.3
105
90
15
14.3
11.1
77
9.2
74
9.0
59.1
429
0
429
100.0
NO 
University Hospitals NHS Trust, London and 
South East
Central Manchester University Hospitals NHS 
Foundation Trust, North West
Somerset NHS Foundation Trust, South West
Foundation Trust, West Midlands
Hospitals Bristol NHS Foundation Trust, South 
West
Foundation Trust, North West
Tyneside NHS Foundation Trust, North East
PZ141
South Tyneside District Hospital, South 
PZ137
Musgrove Park Hospital, Taunton and 
PZ135
Royal Alexandra Hospital, Brighton and Sussex 
PZ138
Warwick Hospital, South Warwickshire NHS 
PZ139
Bristol Royal Hospital for Children, University 
PZ136
Royal Manchester Children's Hospital, 
PZ140
Tameside General, Tameside Hospital NHS 

 *For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 

  less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
100.0
Me­
dian 
HbA1c 
(%)
NO 
DATA
Median 
HbA1c 
(mmol/
mol)
NO 
DATA
Mean 
HbA1c 
(%)
NO 
DATA
Mean 
HbA1c 
(mmol/
mol)
NO 
DATA
(7.5%)
% with 
HbA1c<58 
mmol/mol 
DATA
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
111
105
6
5.4
16.2
73
8.8
70
8.6
73.1
82
71
11
13.4
25.4
69
8.5
67
8.3
66.7
64
31
33
51.6
3.2
84
9.8
84
9.8
71.0
ted
128
1
127
99.2
NO 
156
99
57
36.5
12.1
76
9.1
71
8.7
66.7
134
131
3
2.2
19.8
72
8.7
70
8.6
27.3
no. of 
submit­
patients 
Redbridge University Hospitals NHS Trust, 
London and South East
Foundation Trust, West Midlands
NHS Foundation Trust, South Central
University Hospital NHS Foundation Trust, East 
of England
Hospital NHS Foundation Trust, Yorkshire and 
the Humber
PZ143
King George Hospital, Barking, Havering and 
PZ145
Milton Keynes Hospital, Milton Keynes Hospital 
PZ149
Barnsley District General Hospital, Barnsley 
PZ146
Southend General Hospital, Southend 
PZ150
Cumberland Infirmary, Cumbria Partnership 
PZ144
Good Hope Hospital, Heart of England NHS 
PDU code
PDU name
Total 

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

61
54
7
11.5
20.4
67
8.3
65
8.1
10.4
88
69
19
21.6
15.9
77
9.2
76
9.1
62.2
69
59
10
14.5
16.9
73
8.8
70
8.6
25.5
156
144
12
7.7
22.2
72
8.7
68
8.4
27.4
149
131
18
12.1
7.6
80
9.5
78
9.3
44.6
105
98
7
6.7
6.1
79
9.4
77
9.2
31.2
NHS Foundation Trust, North West
Healthcare NHS Trust, London and South East
Foundation Trust, South West
Teaching Hospitals NHS Trust, North West
Hospitals NHS Trust, East of England
Royal Free Hampstead NHS Trust, London and 
South East
University Hospitals NHS Trust, London and 
South East
PZ151
Queen Elizabeth Hospital, South London 
PZ157
Royal Free and University College Hospital, 
PZ152
Torbay Hospital, South Devon Healthcare NHS 
PZ153
Whiston Hospital, St Helens and Knowsley 
PZ158
Epsom General Hospital, Epsom and St Helier 
PZ156
Queen Elizabeth, Kings Lynn, Queen Elizabeth 

 *For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 

  less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
Me­
dian 
HbA1c 
(%)
Median 
HbA1c 
(mmol/
mol)
Mean 
HbA1c 
(%)
Mean 
HbA1c 
(mmol/
mol)
(7.5%)
% with 
HbA1c<58 
mmol/mol 
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
151
128
23
15.2
19.5
70
8.6
67
8.3
58.8
118
105
13
11.0
15.2
73
8.8
70
8.6
83.8
ted
147
124
23
15.6
14.7
73
8.8
70
8.6
62.7
143
121
22
15.4
14.0
74
8.9
70
8.6
39.4
no. of 
submit­
patients 
Basingstoke and North Hampshire NHS 
Foundation Trust, South Central
Durham and Darlington NHS Foundation Trust, 
North East
Durham and Darlington NHS Foundation Trust, 
North East
Hartlepool NHS Trust, North East
PZ163
North Tees General Hospital, North Tees and 
PZ162
University Hospital North Durham, County 
PZ159
Basingstoke and North Hampshire Hospital, 
PZ160
Bishop Auckland General Hospital, County 
PDU code
PDU name
Total 

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

41
37
4
9.8
21.6
66
8.2
63
7.9
58.3
98
94
4
4.1
8.5
76
9.1
72
8.7
63.3
112
105
7
6.3
18.1
74
8.9
70
8.6
27.9
191
183
8
4.2
23.5
67
8.3
65
8.1
62.7
110
54
56
50.9
11.1
73
8.8
72
8.8
89.4
135
127
8
5.9
9.4
74
8.9
70
8.6
24.6
203
179
24
11.8
14.5
74
8.9
72
8.7
18.4
NHS Foundation Trust, Yorkshire and the 
Humber
Foundation Trust, University Hospitals of 
Morecambe Bay NHS Trust, North West
Lincolnshire Hospitals NHS Trust, East 
Midlands
Foundation Trust, South Central
Teaching Hospital NHS Foundation Trust, 
North West
Services NHS Trust, East of England
Hospitals NHS Trust, East of England
Broomfield Hospital, Mid-Essex Hospital 
PZ172
Watford General Hospital, West Herts 
PZ167
University Hospitals of Morecambe Bay NHS 
PZ168
Grantham and District Hospital, United 
PZ169
Salisbury District Hospital, Salisbury NHS 
PZ170
Arrowe Park Hospital, Wirral University 
PZ164
Rotherham General Hospital, The Rotherham 

 *For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 

  less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
Me­
dian 
HbA1c 
(%)
Median 
HbA1c 
(mmol/
mol)
Mean 
HbA1c 
(%)
Mean 
HbA1c 
(mmol/
mol)
(7.5%)
% with 
HbA1c<58 
mmol/mol 
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
82
71
11
13.4
9.9
77
9.2
73
8.8
28.4
121
104
17
14.0
18.3
68
8.4
69
8.4
32.5
112
104
8
7.1
26.0
70
8.6
66
8.2
50.7
116
96
20
17.2
12.5
75
9.0
74
9.0
30.6
114
106
8
7.0
12.3
73
8.8
70
8.6
45.5
ted
108
95
13
12.0
16.8
72
8.7
68
8.4
46.2
160
130
30
18.8
12.3
69
8.5
69
8.4
76.8
no. of 
submit­
patients 
NHS Foundation Trust, South West
Hospital Trust, East Midlands
Healthcare NHS Trust, London and South East
Hospitals NHS Trust, London and South East
Foundation Trust, North West
West Midlands
Trust, Countess Of Chester Hospital NHS 
PZ173
Yeovil District Hospital, Yeovil District Hospital 
PZ174
Kettering General Hospital, Kettering General 
PZ175
Queen Mary's Hospital, South London 
PZ177
Royal Bolton Hospital, Bolton Hospital NHS 
PZ178
Manor Hospital, Walsall Healthcare NHS Trust, 
PZ176
St Peter's Hospital, Ashford and St Peter's 
PZ179
Countess of Chester Hospital NHS Foundation 
PDU code
PDU name
Total 

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

48
39
9
18.8
23.1
69
8.5
70
8.6
36.1
48
36
12
25.0
19.4
72
8.7
71
8.7
22.0
188
173
15
8.0
16.8
73
8.8
70
8.6
32.4
145
132
13
9.0
21.2
68
8.4
66
8.2
29.7
102
91
11
10.8
15.4
77
9.2
75
9.0
59.0
225
196
29
12.9
19.9
75
9.0
71
8.6
84.8
Foundation Trust, North West
NHS Foundation Trust, East Midlands 
Trust, East of England
Middlesex University Hospital NHS Trust, 
London and South East
Hospitals NHS Foundation Trust, North West
Sussex NHS Trust, London and South East
Health Board, Wales
PZ181
Ipswich Hospital, The Ipswich Hospital NHS 
PZ183
Royal Preston Hospital, Lancashire Teaching 
PZ182
West Middlesex University Hospital, West 
PZ185
Bronglais General Hospital, Hywel Dda Local 
PZ184
Eastbourne District General Hospital, East 
PZ180
King's Mill Hospital, Sherwood Forest Hospitals 

 *For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 

  less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
Me­
dian 
HbA1c 
(%)
Median 
HbA1c 
(mmol/
mol)
Mean 
HbA1c 
(%)
Mean 
HbA1c 
(mmol/
mol)
(7.5%)
% with 
HbA1c<58 
mmol/mol 
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
55
49
6
10.9
12.2
75
9.0
72
8.7
37.3
93
75
18
19.4
16.0
73
8.8
71
8.7
46.3
ted
186
170
16
8.6
17.1
73
8.8
70
8.6
17.9
106
79
27
25.5
34.2
66
8.2
63
7.9
43.2
203
174
29
14.3
12.6
77
9.2
73
8.8
71.3
no. of 
submit­
patients 
Huddersfield NHS Foundation Trust, Yorkshire 
and the Humber
University Health Board, Wales
Board, Wales
Board, Wales
Board, Wales
PZ187
Wrexham Maelor Hospital, Besti Cadwaladr 
PZ188
Royal Gwent Hospital, Aneurin Bevan Health 
PZ189
Royal Glamorgan Hospital, Cwm Taf Health 
PZ186
Huddersfield Royal Infirmary, Calderdale and 
PZ190
Withybush General Hospital, Hywel Dda Health 
PDU code
PDU name
Total 

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

78
67
11
14.1
11.9
74
8.9
70
8.6
22.4
65
54
11
16.9
16.7
70
8.6
70
8.6
37.5
88
73
15
17.0
8.2
81
9.6
80
9.5
37.5
46
33
13
28.3
12.1
69
8.5
68
8.4
39.9
156
142
14
9.0
11.3
72
8.7
70
8.6
49.8
180
72
108
60.0
30.6
67
8.3
65
8.1
77.5
283
111
172
60.8
12.6
80
9.5
80
9.5
91.5
338
22
316
93.5
9.1
70
8.6
69
8.5
62.2
London and South East
Morgannwg University Health Board, Wales
Middlesex University Hospital NHS Trust, 
London and South East
Alexandra Hospital NHS Trust, East of England
NHS Trust, London and South East
London Hospitals NHS Foundation Trust, 
London and South East
Hospitals NHS Trust, North West
Trust, London and South East
PZ191
Ealing Hospital, Ealing Hospital NHS Trust, 
PZ213
East Surrey Hospital, Surrey and Sussex NHS 
PZ193
Neath Port Talbot Hospital, Abertawe Bro 
PZ199
North Middlesex University Hospital, North 
PZ203
University College Hospital, University College 
PZ202
St Marys Hospital, Imperial College Heathcare 
PZ206
Rochdale Infirmary, The Pennine Acute 
PZ200
The Princess Alexandra, The Princess 

 *For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 

  less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
Me­
dian 
HbA1c 
(%)
Median 
HbA1c 
(mmol/
mol)
Mean 
HbA1c 
(%)
Mean 
HbA1c 
(mmol/
mol)
(7.5%)
% with 
HbA1c<58 
mmol/mol 
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
35
28
7
20.0
17.9
67
8.3
68
8.4
38.5
211
189
22
10.4
29.6
66
8.2
65
8.1
39.9
119
80
39
32.8
7.5
80
9.5
79
9.4
83.9
ted
133
121
12
9.0
20.7
69
8.5
67
8.3
55.8
159
133
26
16.4
12.8
83
9.7
77
9.2
49.6
156
135
21
13.5
14.8
79
9.4
76
9.1
53.0
no. of 
submit­
patients 
Hospital NHS Trust, London and South East
Tunbridge Wells Area and NHS Trust, London 
and South East
NHS Trust, London and South East
Children's NHS Foundation Trust, Yorkshire 
and the Humber
East of England
Hospitals NHS Foundation Trust, South West
PZ221
The Great Western Hospital, Great Western 
PZ215
King's College Hospital, King's College 
PZ218
Frimley Park Hospital, Frimley Park Hospital 
PZ216
Tunbridge Wells Hospital, Maidstone and 
PZ219
Sheffield Children's Hospital, Sheffield 
PZ220
Bedford Hospital, Bedford Hospital NHS Trust, 
PDU code
PDU name
Total 

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

59
43
16
27.1
9.3
75
9.0
69
8.5
35.6
84
67
17
20.2
4.5
77
9.2
74
8.9
47.3
90
71
19
21.1
25.4
64
8.0
63
8.0
35.0
173
165
8
4.6
18.8
72
8.7
67
8.3
24.4
125
114
11
8.8
10.5
79
9.4
78
9.3
32.6
193
166
27
14.0
13.9
78
9.3
74
8.9
32.4
103
98
5
4.9
26.5
67
8.3
65
8.1
14.3
Hospitals NHS Trust, West Midlands
West Birmingham Hospitals NHS Trust, West 
Midlands
Hospitals NHS Trust, West Midlands
Yorkshire Hospitals NHS Trust, Yorkshire and 
the Humber
Board, Wales
London and South East 
Foundation Trust, North West
PZ231
Salford Royal Hospital, Salford Royal NHS 
PZ223
Sandwell General Hospital, Sandwell and 
PZ222
New Cross Hospital, The Royal Wolverhampton 
PZ225
Worcester Hospital, Worcestershire Acute 
PZ228
Prince Charles Hospital, Cwm Taf Health 
PZ226
Dewsbury and District Hospital, The Mid 
PZ230
Conquest Hospital, East Sussex NHS Trust, 

less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.

*For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 

% of incom­
plete records 
of  care pro­
cesses except 
HbA1c
Me­
dian 
HbA1c 
(%)
Median 
HbA1c 
(mmol/
mol)
Mean 
HbA1c 
(%)
Mean 
HbA1c 
(mmol/
mol)
(7.5%)
% with 
HbA1c<58 
mmol/mol 
analysis*
outcome 
excluded 
from HbA1c 
% of patients 
sis*
HbA1c out­
Total no. of 
patients ex­
cluded from 
come analy­
Total no. of 
patients used 
come analysis
for HbA1c out­
33
2
31
93.9
50.0
55
7.2
55
7.2
75.8
ted
185
131
54
29.2
9.9
79
9.4
76
9.1
60.7
193
178
15
7.8
16.3
70
8.6
69
8.5
53.0
143
100
43
30.1
15.0
74
8.9
74
8.9
95.5
279
147
132
47.3
19.7
69
8.5
66
8.2
51.8
no. of 
submit­
patients 
Redbridge University Hospitals NHS Trust, 
London and South East
Pennine Acute Hospitals NHS Trust, North 
West
Hospitals NHS Trust, South West
of Hospitals NHS Foundation Trust, West 
Midlands
PZ232
Queens Hospital, Barking, Havering and 
PZ238
Queen Alexandra Hospital, Portsmouth 
PZ242
Cheltenham and Gloucester Hospital, 
PZ234
North Manchester General Hospital, The 
PZ240
Russells Hall Hospital, The Dudley Group 
PDU code
PDU name
Total 

PLEASE NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 mmol/mol (7.5%), mean and median HbA1c for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period*.

Gloucestershire Hospitals NHS Trust, South 
West
less than 3 months from diagnosis were not included. Where more than one HbA1c value was submitted for a patient the median value was calculated for the audit year.
*For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value, a date of submission which was within the audit year. Values obtained 

## *The Following Pdus Submitted Their Data Through Other Units:

PZ003 Pinderfields General Hospital, Wakefield (submitted via PZ090) The Mid Yorkshire Hospitals NHS Trust
PZ003
PZ013 Furness General Hospital (submitted via PZ167) University Hospitals of Morecambe Bay NHS Foundation Trust
PZ013 
PZ043 St Mary's Hospital for Women and Children Manchester (submitted via PZ136) Central Manchester University Hospitals NHS Foundation Trust NW
PZ043
PZ044 Royal Oldham Hospital (submitted via PZ206) The Pennine Acute Hospitals NHS Trust
PZ044 PZ046
PZ046 Horton Hospital (submitted via PZ007) Oxford Radcliffe Hospitals NHS Trust SC PZ095 Royal Shrewsbury Hospital (submitted via PZ094) The Shrewsbury and Telford Hospital NHS Trust WM
PZ095
PZ116 Nottingham University Hospital (submitted via PZ042) Nottingham University 
Hospitals NHS Trust EM
PZ116
PZ123 Ryegate Children's Centre (submitted via PZ219) Sheffield Children's NHS Foundation Trust YandH
PZ123
PZ155 St James University Hospital (submitted via PZ101) Leeds Teaching Hospitals NHS Trust YandH
PZ155
PZ161 Darlington Memorial Hospital (submitted via PZ162) County Durham and Darlington NHS Foundation Trust
PZ161
PZ166 Calderdale Royal Hospital, Halifax (submitted via PZ186) Calderdale and Huddersfield NHS Foundation Trust
PZ166
PZ208 Westmoreland General Hospital (submitted via PZ167) University Hospitals of Morecambe Bay NHS Foundation
PZ208
PZ210 University Hospital of Hartlepool (submitted via PZ163) North Tees and Hartlepool NHS Trust NE
PZ210

## Royal College Of Paediatrics And Child Health 5-11 Theobalds Road, London, Wc1X 8Sh

The Royal College of Paediatrics and Child Health (RCPCH) is a registered charity in England and Wales (1057744) and in Scotland (SC038299).