NPDA 2020-21 Annual Report
Source: data.gov.uk (2024-05-31)

National Paediatric Diabetes Audit 2020 - 2021. The excel file contains unit, regional and national level data obtained from the National Paediatric Diabetes Audit 2020-2021.
Specifically, it includes information on patient characteristics, completion of health checks and outcomes achieved (as recommended by the National Institute for Clinical Excellence) for infants, children and young people with type 1 diabetes, under the age of 25, who attended paediatric diabetes units in England and Wales between 1 April 2020 and the 31 March 2021.
Data are included for the seven key health checks:
• Glycated Haemoglobin A1c (HbA1c)
• Body Mass Index (BMI)
• Thyroid
• Blood pressure
• Urinary albumin
• Foot examination
• Eye screening.

Data on other health checks include:
• Psychological assessment
• Offering of immunisation against influenza
• Advice about managing diabetes (‘sick-day rules’)
• Using (or trained to use) blood ketone testing strips and a meter
• Cholesterol
• Additional dietetic support

Data are included for health checks at diagnosis
• Screening for autoimmune disease (coeliac and thyroid disease) 
• Provision of Level 3 carbohydrate-counting education

Data on outcomes of care include:
• HbA1c target measurements
• Small vessel (microvascular) disease
• Large vessel (macrovascular) disease
• Autoimmune disease (coeliac and thyroid disease)

The data were first published in 2022 alongside the National Paediatric Diabetes Audit Report 2020-2021 Data suppressed due to small numbers (<5).

For further information and details on the audit please refer to:
• National Paediatric Diabetes Audit Annual Reports: https://www.rcpch.ac.uk/resources/npda-annual-reports
• NPDA results online: http://npda-results.rcpch.ac.uk/default.aspx
• The RCPCH website: https://www.rcpch.ac.uk/npda

Royal College of
Paediatrics and Child Health
RCPCH
Annual report 2020-21:
Care processes and outcomes
Audits
RCPCH
National Paediatric
Diabetes Audit
NPDA

National Paediatric Diabetes Audit
(NPDA) National report 2020/21:
Care processes and outcomes
Citation: National Paediatric Diabetes Audit Annual Report 2020-21: Care Processes and Outcomes.
London: Royal College of Paediatrics and Child Health, 2022.
© Healthcare Quality Improvement Partnership 2022

8.2.7
Hospital admissions
16
8.2.8
Treatment regimen
16
8.2.9
Continuous blood glucose
monitoring
17
8.2.10 Thyroid and coeliac disease
17
8.3
Key findings: Type 2 diabetes
17
8.3.1
Incidence, prevalence, and patient
characteristics
17
8.3.2
Completion of health checks
18
8.3.3
Blood glucose diabetes control
targets (HbA1c)
18
8.3.4
Microvascular complications
18
8.3.5
Macrovascular complications
and risk factors
18
8.3.6
Outcomes of psychological
assessment
18
8.3.7
Treatment regimen
18
9.
NPDA resources to support
the use of the audit results
for quality improvement
19
9.1
Reviewing results
19
9.2
Communicating results
and planning improvements
as a team
20
9.3
Engaging families in
improving care
21
9.4
Other NPDA publications
20
10.
Conclusion
22
11.
Glossary
23
12.
Acknowledgements
25
Contents
1.
Foreword
4
2.
Introduction to the
National Paediatric
Diabetes Audit
5
3.
Background to the audit
6
4.
Commissioners of
the NPDA
7
5.
Scope of the 2020/21
NPDA report
8
5.1
Key audit questions
8
6.
Key messages
9
7.
Recommendations
12

Case study 1: Improving take up
and recording of retinal screening 13

Case study 2: Adapting to
restrictions on face to face care
with drive through clinics
13
8.
Summary of results
14
8.1
Overall National HbA1c results
14
8.2
Key findings: Type 1 diabetes
14
8.2.1
Incidence, prevalence, and patient
characteristics
14
8.2.2
Completion of health checks
14
8.2.3
Blood glucose diabetes control
targets (HbA1c)
15
8.2.4
Microvascular complications
15
8.2.5
Macrovascular complications
15
8.2.6
Outcomes of psychological
assessment
16

4
NPDA National report 2020/21: Care processes and outcomes
1.
Foreword

I am delighted to introduce this 2020/21 National Paediatric Diabetes Audit (NPDA) report; the
eleventh to be published by the Royal College of Paediatrics and Child Health, and the 18th since
the audit’s inception. The report highlights the care and outcomes of children and young people
living with diabetes in England and Wales in 2020/21. It covers incidence and prevalence, diabetes-
related outcomes and complications, use of diabetes-related technologies, compliance with health
care checks recommended by the National Institute for Health and Care Excellence (NICE), and
recommendations for improvements in care.

This report covers the first year of the COVID-19 pandemic; a year where the day to day lives of children
and young people were transformed by lockdowns and school closures, and healthcare including
paediatric diabetes care faced unprecedented disruption and a shift towards remote consultations.

The impact of disruption to care is evident in the health check completion rates achieved during
this year, which this report shows to be lower than in previous audit years. However, there is still
much to celebrate within this report, including lower national average HbA1c than in previous
years, increases in the use of diabetes related technologies within all ethnic and socio-economic
groups, and a participation rate of 100% amongst paediatric diabetes teams in England and Wales,
despite suspension of mandatory participation in national clinical audits during the same time.
Participation by all teams, despite the challenges of delivering, recording, and submitting details
of care delivered and outcomes achieved, is a testament to the commitment to data driven
improvement within the paediatric diabetes clinical community.

The rising incidence of Type 1 diabetes within the audit year evidenced within this report, on the other
hand, provides cause for concern. Whilst audit data cannot be used to determine the cause of the
spike in incidence observed across the 2020/21 audit year, it must provide impetus for research into
these causes, and paediatric diabetes units must be resourced properly to provide the best possible
care at onset of diabetes within the context of rising numbers and higher caseloads.

The continuing trend for year on year increases in the numbers of children and young people with
Type 2 diabetes receiving care from paediatric diabetes teams, also evidenced within this report,
shows that national efforts to reduce childhood obesity and associated complications have so far
not had the impact required. Type 2 diabetes in the young is an aggressive form of the condition,
and this report coupled with the NPDA spotlight audit on Type 2 diabetes published late in 2021
suggest that more support is required to prevent or delay the onset of this condition for those
living in the most deprived areas of the country who are most at risk, and in supporting those with
the condition to achieve its remission.

I would like to thank all those involved in writing the report and developing its recommendations,
including the NPDA Project Board, Methodology and Dataset Group, the audit team, and Clinical
Lead, Professor Justin Warner. I would like to thank the paediatric diabetes teams across England
and Wales for their support for the audit, and for their ongoing efforts to make improvements in
their local services.

Professor Camilla Kingdon

President, Royal College of Paediatrics and Child Health

5
NPDA National report 2020/21: Care processes and outcomes
2. Introduction to the National
Paediatric Diabetes Audit

The NPDA is delivered by the Royal College of Paediatrics and Child Health (RCPCH) and has been
reporting for 18 years. Data is submitted by healthcare professionals in Paediatric Diabetes Units
(PDUs) in England and Wales about the care received by the children and young people with
diabetes using their service. The effectiveness of diabetes care is measured against NICE guidelines
(NG18, NICE 2015) and includes treatment targets, health checks, patient education, psychological
wellbeing, and assessment of diabetes related complications including acute hospital admissions,
all of which are vital to monitoring and improving the long-term health and wellbeing of children
and young people with diabetes.

The NPDA is designed to measure and motivate change at local, regional network and national
levels across England and Wales. It also has a role in assuring patient safety, as data from the audit
are used to inform hospital inspections by the Care Quality Commission (CQC) in England and by
the Healthcare Inspectorate Wales in Wales. The audit encourages everyone with an interest in
improving the lives of children and young people with diabetes to work together including
healthcare managers, commissioners, children, young people, and their families as well as all
members of the multi-disciplinary team.

In the last six years, NPDA outcome data have also been benchmarked against certain other
European, North American and Australasian countries, providing insights into areas where
international comparisons can drive improvements (McKnight et al., 2015; Maahs et al., 2015; Sherr
et al., 2016; Anderzen et al., 2020, Prigge et al., 2021).

6
NPDA National report 2020/21: Care processes and outcomes
3. Background to the audit

Diabetes mellitus occurs when blood glucose levels are elevated because the body is unable to
metabolise it. The UK has the highest number of children and young people aged 0-14 with Type 1
diabetes in Europe (International Diabetes Federation, 2019). Complications associated with
suboptimal diabetes management include damage to small and large blood vessels and nerves
which over time can result in blindness, kidney failure, heart disease, stroke, and amputations. With
good diabetes care and blood glucose management, the risks of complications are reduced,
enabling children and young people to enjoy a healthy and longer life.

Diabetes care is complex and requires collaboration between healthcare professionals, children
and young people and their families, carers and friends. Good quality care requires adequate
resources and training of the workforce (Campbell & Waldron, 2013) to support the medical,
emotional and psychological needs of children, young people and their families. In addition,
families need ongoing and appropriate age-related structured patient education on self-
management to provide knowledge, skills and competencies to manage their diabetes on a daily
basis (Waldron & Campbell, 2014). Ensuring that patients and families are provided with a thorough
understanding of the targets associated with good diabetes management and the need for
regular health checks to prevent complications is an essential part of high-quality care (NICE, 2015).

7
NPDA National report 2020/21: Care processes and outcomes
4. Commissioners of the NPDA

The RCPCH is commissioned by the Healthcare Quality Improvement Partnership (HQIP) to deliver
the NPDA as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).
HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing,
and National Voices. Its aim is to promote quality improvement in patient outcomes, and in
particular, to increase the impact that clinical audit, outcome review programmes and registries
have on healthcare quality in England and Wales. HQIP holds the contract to commission, manage,
and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP), comprising
around 40 projects covering care provided to people with a wide range of medical, surgical and
mental health conditions. The programme is funded by NHS England, the Welsh Government and,
with some individual projects, other devolved administrations and crown dependencies
www.hqip.org.uk/national-programmes.

8
NPDA National report 2020/21: Care processes and outcomes
5. Scope of the 2020/21 NPDA report

This 2020/21 report covers the health checks (care processes) and outcomes for children and young
people with diabetes who have attended PDUs during the period from 1st April 2020 through to
31st March 2021, aged 0 – 24 on the first day of the audit period.

The period covered by this audit year corresponds to the first year of the COVID-19 pandemic.
During this year, in-person paediatric diabetes clinics were suspended for months at a time, and
some families were reluctant to come to clinic once restrictions were eased. Despite the challenges
associated with delivering and recording care in the 2020/21 audit year, 100% of all paediatric
diabetes teams submitted data for all patients receiving care from their services in the audit year.
5.1 Key audit questions

This report aims to address a series of questions relating to paediatric diabetes care, which include:

•
Are numbers of children and young people with Type 1 and Type 2 diabetes receiving care
from PDUs increasing?

•
What proportion of children and young people with diabetes are reported to be receiving key
age-specific processes of diabetes care, as recommended by NICE?

•
How many children and young people achieve outcome measures within specified treatment
targets?

•
Are children and young people with diabetes demonstrating evidence of small vessel disease
(microvascular) and/or abnormal risk factors associated with large vessel disease
(macrovascular) prior to transition into adult services?

•
Are there inequalities in care and outcomes between PDUs, regional networks, or between
different patient groups?
5.2 Full audit results

Appendix 1 to this publication provides full details of the results and analyses informing the key
findings and recommendations set out within this report, and can be found on the annual
reports page of the NPDA website: https://www.rcpch.ac.uk/resources/npda-annual-reports

9
NPDA National report 2020/21: Care processes and outcomes
6. Key messages

1. Paediatric diabetes teams should be commended for achieving 100%
participation in the 2020/21 NPDA, despite all the challenges associated
with delivering, recording, and submitting details of care provided
during the contemporaneous COVID-19 pandemic.

2. Incidence of Type 1 diabetes increased significantly in 2020/21 amongst those aged 0-15, from
25.6 new cases per 100,000 in 2019/20 to 30.9 in 2020/21 – an increase of 20.7% (p<0.001).

Figure 1: Incidence of Type 1 diabetes per 100,000 general population among children aged 0-15
years by sex, 2013/14 to 2020/21

3. There were 3,662 children and young people newly diagnosed with Type 1 diabetes receiving
care from paediatric diabetes units in 2020/21. This is 789 more than the average number newly
diagnosed and being managed in a PDU between 2013/14-2019/20. This increase was over four
times the size of the average caseload for PDUs in 2020/21. The consistent seasonal pattern of
new cases of Type 1 diabetes observed in previous audit years was also disrupted in 2020/21.

Figure 2: Number of new cases of Type 1 diabetes amongst children and young people receiving
care from a PDU by month, 2013/14-2020/21
100%

10
NPDA National report 2020/21: Care processes and outcomes

4. Numbers of children and young people with Type 2 diabetes being managed
within a PDU increased from 866 in 2019/20 to 973 in 2020/21, with the
numbers diagnosed within the audit year having increased from 201 in
2019/20 to 230 in 2020/21.

5. The impact of the pandemic on paediatric diabetes care can be seen in lower completion rates
of all recommended health checks and the smaller percentage of children and young people
starting insulin pump therapy if diagnosed in 2020/21, compared to previous years.
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
2012/13
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
2019/20
2020/21
All types of diabetes
Type 1 only
Type 1 only
(excluding eye
screening)
% of children and young people who completed
a full year of care
Audit year
HbA1c
Blood
pressure*
BMI
Urinary
albumin*
Cholesterol*
Eye screen*
Foot Exam*
Thyroid

Figure 3: Percentage of children and young people with Type 1 diabetes who completed a full year
of care recorded as receiving individual health checks, 2004/05 to 2020/21

6. National median HbA1c (a measure of blood glucose control) reduced from 61.5 mmol/mol to
61.0mmol/mol between 2019/20 and 2020/21 following several years of year on year decreases
(improvement) in the national median (combining results from PDUs in England and Wales).
58
60
62
64
66
68
70
72
74
2009/10
2010/11
2011/12
2012/13
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
2019/20
2020/21
Median HbA1c (mmol/mol)
England
Wales

Figure 4: Median HbA1c for children and young people with all types of diabetes in England and
Wales 2009/10 to 2012/21
+14%

11
NPDA National report 2020/21: Care processes and outcomes

7. There was wide variation in the completion rates of all key annual health checks at PDU level,
with some achieving close to 100% and others achieving less than 10%.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage of children and young peopke with
Type 1 diabetes receiving each health check per
PDU
PDUs
HbA1c 1+ in audit
Thyroid
Body mass index
Blood pressure (aged 12+)
Albuminuria (aged 12+)
Foot examination (aged 12+)

Figure 5: Percentage of children and young people with Type 1 diabetes receiving each key health
check by PDU, 2020/21

8. There was an increase in use of real time continuous glucose
monitors (rtCGM) from 19.4% in 2019/20 to 27.9% in 2020/21, with
increases observed across all deprivation quintiles and ethnic
groups. The highest percentage increase between the audit years
was amongst Black children and young people with Type 1 diabetes,
from 11.7% in 2019/20 to 21.9% in 2020/21 – an increase of 87.2%.
However, 21.9% was still the lowest percentage out of all ethnic
groups, with those of mixed ethnicity having the highest rate of
usage, at 29.3%.

9. Lower use of insulin pumps was associated with ethnic minority
status, with Black children and young people having the lowest use
(27.4%) compared to 40.2% of White children. Higher use of insulin
pumps was associated with living in a less deprived area, with 44.0%
of those in the least deprived areas using a pump compared to 32.5%
in the most deprived areas.

12
NPDA National report 2020/21: Care processes and outcomes
7. Recommendations

Hospital commissioners, NHS Regional Offices, Regional Partnership Boards, NHS England,
and NHS Wales should:

1. Commission and fund, local and regional services, taking into account local demographic and
socioeconomic factors and inequities in outcomes highlighted by this report.

Trusts and Health Boards should:

2. Ensure PDUs have appropriate staffing levels in paediatric multi-disciplinary teams (MDT) to
provide excellent care to young patients with diabetes in the context of increasing numbers of
children and young people with diabetes being diagnosed and managed within PDUs.

This must include:

•
Dedicated admin and IT support for recording good quality data

•
Provision for all children and young people for whom multiple daily insulin injections are not
appropriate to use an insulin pump from diagnosis, and to be trained and able to do so

3. Ensure that alternative arrangements for delivering and recording routine paediatric care are in
place when in person hospital visits are suspended.

4. Support paediatric diabetes services to reset, restore and recover following disruption to services
caused by the COVID-19 pandemic, with reference to RCPCH principles for doing so.

5. Ensure that parents and patients have access to appropriate psychological support as required
and in line with NICE guidance.

Paediatric diabetes teams and hospital commissioners should:

6. Ensure that a real time continuous glucose monitor is available to all children and young people
with diabetes who wish to use one, supported by an education programme to ensure optimal use.

Paediatric diabetes teams should:

7. Review their annual NPDA results as a team within a month of receipt, and work together to
identify priorities for on-going quality improvement activities.

8. Regularly upload data collected as part of routine diabetes care (monthly) by members of the
paediatric diabetes (MDT) into the NPDA data capture system. Data uploaded should be:

•
Checked for completeness and quality.

•
Used to monitor performance against HbA1c and health check completion targets throughout
the audit year.

•
Used to identify patients at risk of missing key health checks by the end of the audit year, so
that they may be followed up at their next clinic appointment.

9. Ensure that they produce consistent messages about glucose and HbA1c targets and have a
mechanism to ensure all team members are aware of and are communicating the same targets
to their families.

13
NPDA National report 2020/21: Care processes and outcomes
Case study 1: Improving take up and recording of retinal
screening

In 2018/19 the paediatric Diabetes team at the University Hospitals Coventry and Warwickshire
NHS Trust were a negative outlier for retinal screening, with a completion rate of 56.3%. This was
due to a process change meaning that we no longer had access to the external screening provider’s
database, due to data protection restrictions.

To overcome this challenge, we got in touch with the retinal screening provider to find out about
how their process works and came up with a solution. We now send an updated active patient list
to the team every three months and when a patient on that list has had retinal screening, we are
sent a copy of their results letter electronically via email. The patient list we send is also populated
with the date last attended or did not attend (DNA), and any future appointments booked. This
means that we can also remind patients of their upcoming appointment when they are in clinic.

We also utilise Diamond (a diabetes-specific electronic patient record system) to add notes to the
clinic episode of those who have missed retinal screening appointments, this then prompts the
consultant to remind the patient to book their screening when they attend clinic. At the end of the
audit year a letter and information leaflets are sent to patients who did not attend screening,
reminding them of the importance of these appointments. A copy of this letter is also sent to the GP.

Following these changes our retinal screening completion rate went up to 75% in 2019/20, which
was above the regional and national average of 69% and 74%.

Laura Bambrick

Paediatric Diabetes Specialist Administrator

University Hospitals Coventry and Warwickshire NHS Trust
Case study 2: Adapting to restrictions on face to face care
with drive through clinics

During lockdown in 2020, the Grimsby Paediatric Diabetes team held drive-through HbA1C testing
which was very successful and enabled us to keep contact with our families.

The patient/parent drove up to the front of the clinic, with the children usually bringing their testing
kit. We approached the car in our PPE, and the child did the finger prick after cleaning their finger.
If they didn’t have wipes, we provided wet and dry cotton wool. The child held their arm out of the
window, we took the blood sample for the HbA1c analyser and then, using a wipeable cuff, we also
took their blood pressure.

Patients requiring profile changes did the same thing and passed the devices out to us. We took
the device in an antiseptic wipe, cleaned the devices, changed our PPE and then reset the pump
and returned it.

Rebecca Bennett

Paediatric Diabetes Specialist Nurse

Northern Lincolnshire and Goole NHS Foundation Trust

14
NPDA National report 2020/21: Care processes and outcomes
8. Summary of results
8.1 Overall National HbA1c results

•
The national median HbA1c for children and young people with all types of
diabetes fell from 61.5mmol/mol in 2019/20 to 61.0 mmol/mol in 2020/21.
8.2 Key findings: Type 1 diabetes
8.2.1 Incidence, prevalence, and patient
characteristics1

•
There were 29,892 children and young people with Type 1 diabetes receiving
care from a PDU in 2020/21, making up 94.6% of the audit cohort.

•
In 2020/21 there were 3,662 children and young people newly diagnosed with Type 1 diabetes,
of whom 3,526 (96.3%) were aged 0-15 years old. This is 789 more than the average number
newly diagnosed and being managed in a PDU between 2013/14-2019/20 (2873). For
comparison, the mean number of children and young people with all types of diabetes being
managed within a PDU in 2020/21 was 185.

•
The consistent seasonal pattern of new cases of Type 1 diabetes observed in previous years was
disrupted in 2020/21, however the reason for this is unknown.

•
Incidence of Type 1 diabetes increased significantly in 2020/21 amongst those aged 0-15, from
25.6 new cases per 100,000 in 2019/20 to 30.9 in 2020/21 – an increase of 20.7%.

•
The increase from 2019/20 to 2020/21 was higher amongst boys, amongst whom there was a
27.4% increase, compared to a 12.6% increase in girls.

•
The estimated prevalence rate of Type 1 diabetes in England and Wales was 204.5 per 100,000
of the general population. It was higher among boys (208.3 per 100,000) compared to girls
(200.4 per 100,000).
8.2.2 Completion of health checks

•
After years of annual improvement, the completion rates of all key annual
health checks decreased between 2019/20 and 2020/21.

•
The percentage of children and young people with diabetes aged 12 and
above receiving all six key health checks was 40.5%.

•
Following changes to guidance on screening frequency in 2020, the percentage of those age
12 and above with Type 1 diabetes receiving retinal screening decreased from 74.5% in 2019/20
to 24.3% in 2020/21. Of those with results in both years, 49.1% with an abnormal result in 2019/20
received a screen in 2020/21.

•
Less than a fifth (14.9%) of children and young people with Type 1 diabetes had four or more
measurements recorded in 2020/21, down from 54.1% in 2019/20, and a quarter (26.0%) only
had one HbA1c recorded in the audit year.
1 The NPDA and the National Diabetes Audit (NDA) have undertaken a quality assurance exercise around case ascertainment of
new cases of Type 1 diabetes. The NPDA collects data on children and young people with diabetes from PDUs where care is provided
whereas the NDA collects data from the General Practice Extraction Service (GPES) covering whole populations. Although there are
slight differences in the number of new cases from these two data sources, the increasing incidence is demonstrated in both, thus
validating the data for audit and QI purposes.

15
NPDA National report 2020/21: Care processes and outcomes

•
Four fifths (82.6%) of children and young people with Type 1 diabetes were offered an additional
dietetic appointment outside of multidisciplinary team meetings, compared to 89.0% in 2019/20.
The percentage of appointments attended decreased with age and duration of diabetes, from
56.3% of those four years old or younger, to 44.5% in the group aged 15 or older.

•
Completion rates of psychological assessment, flu vaccine recommendation, ‘sick day rules’
advice and blood ketone testing advice all decreased from 2019/20 to 2020/21, with the
percentage receiving psychological screening decreasing most, from 84.4% in 2019/20 to 71.6%
in 2020/21.

•
Rates of screening for thyroid and coeliac diseases at diagnosis of Type 1 diabetes increased
from 85.2% and 81.3% in 2019/20 to 86.6% and 83.8% in 2020/21, respectively.

•
The percentage of children and young people receiving Level 3 carbohydrate counting advice
at diagnosis of Type 1 diabetes remained stable between 2019/21 and 2020/21, with 82.5%
receiving this in 2019/20 and 82.1% in 2020/21.
8.2.3 Blood glucose diabetes control targets (HbA1c)

•
The national mean and median HbA1c for children and young people with Type 1
diabetes decreased from 65.0 and 62.0 mmol/mol in 2019/20 to 64.2 and 61.0
mmol/mol, respectively in 2020/21.

•
A tenth (11.8%) of children and young people with Type 1 diabetes had an HbA1c
equal to or lower than 48 mmol/mol, and 37.9% had an HbA1c lower than 58
mmol/mol.

•
Higher HbA1c was associated with female sex, Black, mixed or Asian ethnicity, longer duration
of diabetes, living in a deprived area, and adolescence.
8.2.4 Microvascular complications

•
A tenth (10.3%) of children and young people with Type 1 diabetes had
micro- or macro- albuminuria.

•
There was little variation in the presence of albuminuria by duration of
diabetes, age, or deprivation, although the presence of albuminuria was
associated with poorer HbA1c outcomes, and boys had higher prevalence at
most ages.

•
The percentage of children and young people with Type 1 diabetes with an
abnormal eye screen increased from 12.0% in 2019/20 to 16.9% in 2020/21,
possibly because services were asked to prioritise those with known
retinopathy.

•
Of those with retinal results recorded in 2019/20 and 2020/21, a tenth (10.3%) with a normal
result in 2019/20 were found to have retinopathy in 2020/21, whilst two fifths (42.4%) of those
with retinopathy in 2019/20 had a normal result in 2020/21.
8.2.5 Macrovascular complications

•
Nearly one third of young people (31%) with Type 1 diabetes had high blood
pressure (hypertension) in 2020/21; an increase compared to the figure reported
in 2019/20 (26.7%).

•
A fifth (19.8%) of those with Type 1 diabetes had a total blood cholesterol of
5mmol/l or higher.

16
NPDA National report 2020/21: Care processes and outcomes

•
In England, 40.4% of children aged 4 to 5 years old with Type 1 diabetes were overweight or
obese (an increase from 32.5% in 2019/20) - higher than the 27.7% in the National Child
Measurement Programme for England 2020/21.

•
The prevalence of overweight and obesity in children aged 10 to 11 years old with Type 1
diabetes in England 2020/21 was 42.1% (an increase from 38.7% in 2019/20) compared to 40.9%
of the wider cohort within the National Child Measurement Programme for England 2020/21.

•
In Wales, 57.2% of children with Type 1 diabetes aged 4 to 5 years were overweight or obese (an
increase from 47.2% in 2019/20) - more than double the 26.9% recorded in the Child
Measurement Programme for Wales in 2018/19 (the latest data available).

•
Overweight and obesity were associated with higher deprivation. Girls aged under 12 were less
likely to be overweight or obese compared to boys, whereas this trend was reversed in girls
and boys aged 12 and above.
8.2.6 Outcomes of psychological assessment

•
Almost a half (46.5%) of children and young people with Type 1 diabetes were
assessed as requiring additional psychological or Child and Adolescent
Mental Health Services (CAMHS) support outside of multi-disciplinary team
(MDT) clinics, an increase from 43.9% in 2019/20.

•
The percentages of younger boys and girls assessed as requiring additional
psychological support were similar up to age 12. Rates diverged thereafter, as more adolescent
girls were recorded as requiring additional support compared to adolescent boys.

•
Children and young people with Type 1 diabetes who required additional psychological
support were more likely to have an HbA1c in the higher target range compared to those who
did not require additional psychological support.
8.2.7 Hospital admissions

•
In 2020/21, 165 out of 171 PDUs submitted admissions data, up from 155 in 2019/20.

•
A quarter (25.8%) of the children and young people diagnosed within the audit
year receiving care from PDUs submitting admissions data in 2020/21 had DKA
at diagnosis of Type 1 diabetes, an increase from 22.9% in 2019/20.
8.2.8 Treatment regimen

•
The percentage of children and young people with Type 1 diabetes using an
insulin pump was 38.5% - unchanged from 2020/21.

•
Insulin pump usage decreased with duration of diabetes, with 86.1% of those
in their first year of diagnosis of Type 1 diabetes using insulin injections,
compared to less than half (48.9%) of those after five to nine years post
diagnosis.

•
The percentage of those using insulin pumps in the first year of Type 1
diabetes reduced by almost a half, from 24.8% in 2019/20 to 13.9% in 2020/21.

•
Lower use of insulin pumps was associated with ethnic minority status, with Black children
and young people having the lowest use (27.4%) compared to 40.2% of White children. Higher
use of insulin pumps was associated with living in a less deprived area, with 44.0% of those in
the least deprived areas using a pump compared to 32.5% in the most deprived areas.

17
NPDA National report 2020/21: Care processes and outcomes
8.2.9 Continuous blood glucose monitoring

•
Use of real time continuous glucose monitors (rtCGM) with alarms
amongst children and young people with Type 1 diabetes increased
markedly between 2019/20 and 2020/21, with 27.9% using one in 2020/21
compared to 19.4% in 2019/20.

•
Increased use was found across all deprivation quintiles and ethnic groups, with the highest
percentage increase between the audit years being amongst Black children and young
people with Type 1 diabetes, from 11.7% in 2019/20 to 21.9% in 2020/21 - an increase of 87.2%.
However, 21.9% was still the lowest percentage out of all ethnic groups, with those of mixed
ethnicity having the highest rate of usage, at 29.3%.

•
Children and young people with Type 1 diabetes living in the least deprived areas were more
likely to be using rtCGM compared to those living in the most deprived areas, although the
percentage increase between the audit years was highest amongst those living in the most
deprived areas, with a 70.0% increase in use between 2019/20 and 2020/21.

•
Children and young people with Type 1 diabetes using rtCGM were more likely to achieve
lower HbA1c targets compared to those who were not using rtCGM.
8.2.10 Thyroid and coeliac disease

•
One in 20 (5.2%) of children and young people in England and Wales with
Type 1 diabetes had been recommended a gluten-free diet, indicative of
coeliac disease; and 2.7% were receiving treatment for thyroid disease.

•
The prevalence of thyroid disease was twice as high amongst girls (3.7%) compared to boys
(1.8%) with Type 1 diabetes.

•
The prevalence of coeliac disease was one and a half times higher amongst girls (6.5%)
compared to boys (4.1%) with Type 1 diabetes.

•
The prevalence of coeliac disease was highest amongst White children and young people with
Type 1 diabetes, while the prevalence of thyroid disease was highest amongst Asian children
and young people with Type 1 diabetes.
8.3 Key findings: Type 2 diabetes
8.3.1 Incidence, prevalence, and patient
characteristics

•
The audit found 973 children and young people with Type 2 diabetes being cared for in a PDU,
of whom 230 (23.6%) were newly diagnosed within the audit year

•
There was an increase of 107 (12.4%) compared to the total number reported in 2019/20.

•
Higher risk of Type 2 diabetes was found in girls, those of non-white ethnicity, and those living
in the most deprived areas, consistent with previous NPDA findings.

18
NPDA National report 2020/21: Care processes and outcomes
8.3.2 Completion of health checks

•
The completion rates of all recommended health checks for Type 2 diabetes
decreased between 2019/20 and 2020/21.

•
Only a quarter (24.1%) of those with a complete year of care and Type 2
diabetes received all six key recommended health checks in the audit year

•
The percentage of those with a complete year of care receiving four or more
HbA1c measurements during the audit year decreased from 33.0% in 2019/20
to 10.7% in 2020/21.
8.3.3 Blood glucose diabetes control targets (HbA1c)

•
The mean and median HbA1c of children and young people with Type 2 diabetes
in England and Wales receiving care in a PDU in 2020/21 were 61.0 and 53.0
mmol/mol, increases from 58.6 and 51 mmol/mol, respectively, in 2019/20.

•
Two fifths (40.9%) were achieving the recommended target of lower or equal to
48 mmol/mol, a decrease from 44.3% in 2019/20.

•
Higher HbA1c was associated with longer duration of diabetes, Black ethnicity,
and living in a more deprived area.
8.3.4 Microvascular complications

•
Albuminuria was present in 23.4% of children and young people with Type
2 diabetes – over twice that recorded for young people with Type 1
diabetes (10.3%) – indicating that children and young people with Type 2
diabetes are at greater risk of kidney disease.

•
A small number (3.5%) of young people with Type 2 diabetes aged 12 years
and above had an abnormal retinopathy screening result. The rate of
retinopathy found amongst young people with Type 1 diabetes was 16.9% by comparison.
8.3.5 Macrovascular complications and risk factors

•
Half (49.3%) of children and young people with Type 2 diabetes had high
blood pressure

•
Almost a third (28.0%) met or exceeded the higher target for total blood
cholesterol (>=5 mmol/l).

•
The majority (84.6%) of those with Type 2 diabetes were obese.
8.3.6 Outcomes of psychological assessment

•
Over half (59.5%) of children and young people with Type 2 diabetes were
assessed as requiring additional psychological support.
8.3.7 Treatment regimen

•
A tenth (11.4%) of children and young people with Type 2 diabetes were managing their
diabetes through diet alone, and half (48.1%) were using dietary management in combination
with blood glucose lowering medication.

•
A fifth (23.2%) were using insulin injections with other blood glucose lowering medication.

19
NPDA National report 2020/21: Care processes and outcomes
9. NPDA resources to support the
use of the audit results for quality
improvement
9.1 Reviewing results

•
Comprehensive PDU level reports comparing performance between audit years and against
regional and national averages are available to download from via a pdf generator on the NPDA
website.
Figure 1: Radar plot showing unit, region and national performance on the six key health checks, % achieving an
HbA1c of below 58 mmol/mol and % achieving an HbA1c of below 80 mmol/mol
Figure 2: Radar plot showing unit performance in 2019/20 and 2020/21 on the six key health checks, % achieving an
HbA1c of below 58 mmol/mol and % achieving an HbA1c of below 80 mmol/mol
0%
20%
40%
60%
80%
100%
HbA1c health
check (%)
Unadjusted HbA1c
<58 mmol/mol (%)
Unadjusted HbA1c
<80 mmol/mol (%)
Health check completion
rate*
(aged 12+)
Foot exam health check
(aged 12+)
(%)
Albuminuria health check
(aged 12+) (%)
BP health check
(aged 12+)
(%)
BMI
health check
(%)
Thyroid
health check
(%)
PZ045
London and South East
England and Wales
Goal target
0%
20%
40%
60%
80%
100%
HbA1c health
check (%)
Unadjusted HbA1c
<58 mmol/mol (%)
Unadjusted HbA1c
<80 mmol/mol (%)
Health check completion
rate*
(aged 12+)
Foot exam health check
(aged 12+)
(%)
Albuminuria health check
(aged 12+) (%)
BP health check
(aged 12+)
(%)
BMI
health check
(%)
Thyroid
health check
(%)
PZ045 - 2020/21
PZ045 - 2019/20
Goal target
This section includes a summary of the additional recommended health check data collected by the NPDA.
Figure 11: Percentage of children and young people with Type 1 diabetes with a complete year of care who received
additional health checks
*When interpreting this result, please note that a low take-up rate is not reflective of underperformance on this
metric. Patients may choose not to take up or attend the additional dietetic appointment offered to them, if they
feel the dietetic support they are already receiving is sufficient for their needs.
Figure 12: Percentage of children and young people with Type 1 diabetes with a complete year of care who were
offered an additional dietetic appointment, who attended an additional dietetic appointment, and the proportion
who were offered and subsequently attended an appointment (take-up rate)
52.8%
23.6%
44.7%
83.0%
52.0%
62.6%
82.6%
49.1%
59.5%
0%
20%
40%
60%
80%
100%
Appointment
offered
Appointment
attended
Take-up rate*
% of children and young people with Type 1
diabetes who completed a full year of care
PZ045
London and South East
England and Wales
12.5%
69.4%
100.0%
9.7%
74.8%
86.2%
14.9%
71.6%
88.2%
0%
20%
40%
60%
80%
100%
4+ HbA1c
measurements
Assessment for psychological
support
Smoking status
recorded
All ages
Aged 12+
% of children and young people with Type 1 diabetes who completed
a full year of care
PZ045
London and South East
England and Wales

20
NPDA National report 2020/21: Care processes and outcomes

•
Unit, regional, and CCG level results are available for comparison on the NPDA’s interactive
reporting web tool, NPDA Results Online. Results for specific measures can be compared
across each reporting level, and between audit years.

•
The NPDA also provides Excel files of each audit years results presented at PDU, regional, CCG,
and STP level on the NPDA website.
9.2 Communicating results and planning
improvements as a team

Team work is essential for successful, sustained quality improvement activity, and so the NPDA
has developed a slide deck for clinical leads to use to present their results to their teams, identify
areas of achievement and for improvement, and raise awareness of the audit’s key findings and
recommendations. The slide deck contains links to resources to support quality improvement,
including case studies and presentations from NPDA annual conferences.
2020/21 NPDA Key Findings – Type 2 diabetes
•
The NPDA national report contains a comprehensive list of key findings and recommendations in
addition to in-depth analysis of audit measures. Presented here are a selection:
24.1%
of young people with
T2D age 12+ with a
complete year of
care received all six
key health checks in
the audit year
23.4%
of young people
with T2D had
albuminuria
compared to
10.3%
of those with
T1D
49.3%
of young people
with T2D had high
blood pressure
973
children and young
people with T2D
were included in the
audit, up from 866 in
2019/20
59.5%
of CYP with T2D were
assessed as requiring
additional
psychological or
CAMHS support
outside of MDT
clinics, up from 53.6%
in 2018/19
Which units in the region have shown the most improvement on this measure?
What changes have underpinned this improvement?
How might the regional network structure/ National Diabetes Quality
Programme/NPDA support other teams to learn from their success? Speak to
your network manager or email xxx@xxx.xx or
xxx@xxx.xx with any suggestions
How does our
HbA1c
trajectory
compare with
other units in
our region?
On NPDA results online,
select: Longitudinal data >
Median HbA1c > Name of
your clinic > Date range
2014-15 to 2012-21 > ‘Show
units in region’ and ‘national
median’
[Name of Paediatric
Diabetes Unit]
National Paediatric Diabetes Audit results
2020/21
HbA1c QI Examples
• How can parents, carers and patients be best involved in informing improvements to your service?
Reducing HbA1c via Carb Counting from diagnosis
and staff education - Sunderland Royal Hospital (7 mins
26)
How can good results be even better? - Dr Gun
Forsander- University of Gothenburg (39 mins 46)
Achieving national HbA1c reduction in Sweden via a
QI collaborative - Dr Lena Hanburger, University of
Linkoping (34 mins 52)
Achieving HbA1c positive outlier status - Royal
Cornwall Hospitals NHS Trust
Diabetes QI
Collaborative
Podcast Series
A new open-access podcast series from the
National Children and Young People’s Diabetes
Quality Programme providing information and
inspiration for quality improvement in children
and young people’s diabetes services. Link here.
QI in a time of Covid
Dr Nivedita Aswani blogs about her team’s journey
to lower average HbA1c here.
“Improving HbA1c or children and young people living with diabetes (CYPD) who are
treated with continuous subcutaneous insulin infusion (CSII) – Hillingdon Hospital
(For Powerpoint slides and further video resources, please visit the conference section of our website)
Case study: Improving clinic HbA1c using quality
improvement methodology and a whole team approach
– Alder Hey Children’s Hospital (pg 18, NPDA 2018/19
core report)

21
NPDA National report 2020/21: Care processes and outcomes
9.3 Engaging families in improving care

We believe that quality improvement activities are most successful when clinical teams and service
users work together, so our parent and patient focussed outputs are designed to empower them
to recognise good care and meaningfully collaborate with clinicians to support required
improvements where identified. For this core, care process and outcome audit, these include:

•
Parent and carer versions of the report in English and Welsh

•
Bespoke clinic posters showing PDU performance against key audit measures and national
and regional results.

•
Animations explaining the function of the audit, and key results and messages arising from
the audit.
9.4 Other NPDA publications

In addition to the core annual report on health checks and outcomes of children and young people
with diabetes, the NPDA has also produced a range of reports on other aspects of paediatric
diabetes care including:

•
In depth spotlight reports on the:

– Care and outcomes of children and young people with Type 2 diabetes

– The workforce in paediatric diabetes units

– Use of diabetes related technologies in children and young people with diabetes

•
Patient and parent experience

•
Diabetes related hospital admissions
National Paediatric
Diabetes Audit
NPDA
Parents and Carers Report 2019-2020
Published 2021

22
NPDA National report 2020/21: Care processes and outcomes
10. Conclusion

The 2020/21 audit year was unprecedented in terms of increased incidence of Type 1 diabetes, and in
terms of the impact of the COVID-19 pandemic on routine paediatric diabetes care. This impact is
seen in the lower rates of health check completion, and the smaller numbers of children and young
people diagnosed with Type 1 diabetes in 2020/21 starting insulin pump therapy in this audit year.

However, despite the unique pressures and restrictions faced by PDUs in 2020/21, there is much to
celebrate in this report. Whilst the trend for year on year improvements in health check completion
seen in previous audit years was reversed, the trend for lower year on year national median HbA1c
amongst children and young people with diabetes continued; and whilst inequalities in use of insulin
pump and real time continuous glucose monitors persisted, there is evidence that the gaps in use
between different ethnic groups and those living in the least and most deprived areas is closing.

It must also be celebrated that every single PDU in England and Wales participated in the NPDA
for this year despite the challenges associated with delivering, recording and submitting details of
care provided, and with participation not mandated during this period. This commitment to data
driven improvement amongst the paediatric diabetes clinical community has made this report
possible, which now must provide an impetus to reset, restore and recover excellent service to all
children and young people with diabetes and their families.

23
NPDA National report 2020/21: Care processes and outcomes
11. Glossary

Autoimmune disorder – an autoimmune disorder occurs when the body’s immune system
attacks and destroys healthy body tissue by mistake. There are more than 80 types of autoimmune
disorder.

Body Mass Index (BMI) – a measure of someone’s size based on their weight and height. BMI is a
value derived from the weight and height of an individual and is calculated by the weight divided
by the square of the body height, and is expressed in units of kg/m2. BMI is used to determine if
someone is a healthy weight for their height.

Cardiovascular disease (CVD) is a general term that describes a disease of the heart or blood
vessels. Blood flow to the heart, brain or body can be reduced as the result of a blood clot
(thrombosis), or by a build-up of fatty deposits inside an artery that cause the artery to harden and
narrow (atherosclerosis) causing heart disease and strokes.

Care processes – these are the various medical tests that healthcare professionals should take to
measure things in the blood or screen various parts of the body to ensure they are not damaged.
They are also referred to as health checks.

Cholesterol – a fatty substance which is vital for the normal functioning of the body. Cholesterol
levels in the blood should be within a particular range and excessively high levels of cholesterol can
contribute towards diabetes complications.

Coeliac disease – an autoimmune disease caused by the gut’s reaction to gluten. It is treated by
omitting gluten from the diet. Gluten is found in wheat, barley, and rye.

Diabetes mellitus (DM) is commonly referred to as diabetes. It is a condition where the blood
glucose levels remain high because the body cannot use the glucose properly without treatment.
If left untreated diabetes complications will occur, the common ones include eye and kidney
damage, cardiovascular disease, strokes and foot damage.

Glucose – a simple sugar with a specific chemical formula and is classed as a monosaccharide.
Glucose is the sugar that is found in blood and blood glucose acts as a major source of energy for
the body.

HbA1c (Glycated haemoglobin) – The term HbA1c refers to glycated haemoglobin. By measuring
glycated haemoglobin (HbA1c), clinicians are able to get an overall picture of what our average
blood sugar levels have been over a period of weeks/ months. For people with diabetes this is
important as the higher the HbA1c, the greater the risk of developing diabetes-related complications.
(Diabetes.co.uk)

Health checks – the various medical tests that health care professionals should take to measure
things in the blood or screen various parts of the body to ensure they are not damaged. They are
also referred to as care processes.

Key health checks – Seven health checks for children with Type 1 or Type 2 diabetes recommended
for annual completion by NICE guidance (NG18, 2015) that monitor diabetes management and
screen for diabetes-related complications.

24
NPDA National report 2020/21: Care processes and outcomes

Macrovascular complications – regular elevation of blood glucose levels over a long period of
time leads to damage of blood vessels. Over time the lining of the large blood vessels (arteries)
become weaker resulting in macrovascular disease. Damage to the large vessels will contribute to
cardiovascular disease and strokes.

Micro/macro albuminuria – as kidney disease progresses, more albumin leaks into the urine, a
condition called microalbuminuria or proteinuria. As the amount of albumin in the urine increases,
the kidneys’ ability to filter the blood decreases.

Mean – a measure of the ‘average’ of a set of numbers. Add up all the numbers, then divide by how
many numbers there are in the sample.

Median – the median is the middle number of a list of numbers when they are sorted from the
smallest to the largest number.

Microalbuminuria – small amounts of protein in the urine. It is the first sign of kidney damage
(nephropathy) caused by many years of high blood glucose levels. Microalbuminuria is reversible if
blood glucose levels are improved.

Microvascular complications – regular elevation of blood glucose levels over a long period of time
leads to damage of blood vessels. Over time the lining of the small blood vessels become weaker
resulting in microvascular disease. This can be found at the back of the eye (retinopathy) and in the
kidneys when they become damaged.

Normoalbuminuria – the presence of the normal amount of albumen in the urine.

Retinopathy – a complication of diabetes, caused by high blood glucose levels damaging the back
of the eye (retina). It usually takes several years for diabetic retinopathy to reach a stage where it
could threaten your sight. Retinopathy can cause blindness if left undiagnosed and untreated.

Thyroid disease – a disease which causes the thyroid to produce either too much or too little of the
thyroid hormone.

Urinary albumin – a test to check urine for the presence of a protein called albumin. Small amounts
of albumin leak into the urine when the kidney is damaged. Therefore, urinary albumin can be
used as a test for kidney disease.

25
NPDA National report 2020/21: Care processes and outcomes
12. Acknowledgements

Report Editors

•
Professor Justin Warner, Clinical Lead, RCPCH and Consultant in Paediatric Endocrinology and
Diabetes, Cardiff and Vale University Health Board

•
Ms Holly Robinson, NPDA Manager, RCPCH

•
Ms Jiumei Gao, NPDA Analyst, RCPCH

Quantitative Analysis

•
Ms Saira Pons Perez, NPDA Analyst, RCPCH

•
Ms Jiumei Gao, NPDA Analyst, RCPCH

National Paediatric Diabetes Audit Clinical Lead

•
Professor Justin Warner, Clinical Lead, RCPCH and Consultant in Paediatric Endocrinology and
Diabetes, Cardiff and Vale University Health Board

Project Management

•
Ms Holly Robinson, NPDA Manager, RCPCH

Project Support

•
Ms Karina Green, NPDA Coordinator, RCPCH

•
Mr Simon Duncan, Audit Administrator, RCPCH

•
Mr Tom Keiller, Administrative Assistant, RCPCH

•
Mr Calvin Down, Clinical Standards Programme Manager, RCPCH

•
Ms Adele Picken, Information Governance Manager, RCPCH

National Paediatric Diabetes Audit Project Board

•
Professor Nick Bishop, Vice President for Science and Research, RCPCH (Chair)

•
Dr Fiona Campbell, Consultant Paediatric Diabetologist, Leeds Teaching Hospitals NHS Trust

•
Professor Justin Warner, Clinical Lead, RCPCH and Consultant in Paediatric Endocrinology and
Diabetes, Cardiff and Vale University Health Board

•
Dr Kemi Lokulo-Sodipe, Specialty Registrar in Paediatrics, Southampton Children’s Hospital

•
Ms Rachel Harris, Paediatric Diabetes Specialist Nurse, Cardiff and Vale University Health Board

•
Ms Kate Cullen, Parent Representative

•
Mr Simon Lewthwaite, Parent Representative

•
Dr Neil Hopper, Consultant Paediatrician, South Tyneside And Sunderland NHS Foundation
Trust

•
Dr Mark Deakin, Consultant Paediatrician, Alder Hey Children’s Hospital NHS Foundation Trust

•
Mr Daniel Howarth, Head of Care, Diabetes UK

•
Dr Caroline Schmutz, Research Partnerships Manager, JDRF

26
NPDA National report 2020/21: Care processes and outcomes

National Paediatric Diabetes Audit Methodology and Dataset Working Group

•
Dr Fiona Campbell, Leeds Teaching Hospitals NHS Trust (Chair)

•
Dr Nivedita Aswani, Consultant in General Paediatrics and Diabetes, Derby Hospitals NHS
Foundation Trust

•
Dr Bill (William) Lamb, Consultant Paediatric Diabetologist

•
Professor Justin Warner, Consultant in Paediatric Endocrinology and Diabetes, Cardiff and Vale
University Health Board

•
Ms Francesca Annan, Dietitian, Clinical Specialist Paediatric/Adolescent Diabetes Dietitian,
University College London Hospital Foundation Trust

•
Dr Halina Flannery, Clinical Psychologist, University College London Hospital NHS Foundation Trust

•
Dr Alex De Costa, Specialty Registrar in Paediatrics, Queen Mary University

•
Ms Kate Cullen, Parent Representative

•
Mr Simon Lewthwaite, Parent Representative

•
Ms Rachel Harris, Paediatric Diabetes Specialist Nurse, Cardiff and Vale University Health Board

•
Ms Nicky Moor, Paediatric Diabetes Specialist Nurse, Barts and the London NHS Trust

•
Dr Neil Hopper, Consultant Paediatrician, South Tyneside And Sunderland NHS Foundation Trust

•
Dr Mark Deakin, Consultant Paediatrician, Alder Hey Children’s Hospital NHS Foundation Trust

•
Dr Evelien Gevers, Consultant Paediatrician, Barts and the London NHS Trust

HQIP Support

•
Ms Vivien Dunne, Project Manager, NCAPOP, Healthcare Quality Improvement Partnership

•
Dr Sasha Hewitt, Associate Director, NCAPOP, Healthcare Quality Improvement Partnership

•
Ms Emma Skipper, Associate Director, NC

The Royal College of Paediatrics and Child Health (RCPCH) is a registered charity in England and Wales (1057744) and in
Scotland (SC038299).
Royal College of Paediatrics
and Child Health
5-11 Theobalds Road,
London, WC1X 8SH
Healthcare Quality
Improvement Partnership (HQIP)
Dawson House, 5 Jewry Street,
London EC3N 2EX
Royal College of
Paediatrics and Child Health
RCPCH
Published by RCPCH April 2022