Responsibility for improving the quality of diabetes care sits with NHS England and Clinical Commissioning Groups (CCGs). Through the Mandate, the Department has asked NHS England to demonstrate progress towards making the NHS among the best in Europe at supporting people with ongoing health problems such as diabetes to live healthy and independent lives, with better control over the care they receive. National performance on diabetes will be monitored through the NHS Outcomes Framework. Diabetes is mentioned specifically in an indicator which focuses on enhancing the quality of life for people with long-term conditions and is relevant to all five domains of the Framework. Alongside this, the CCG Outcomes Indicator Set 2013-14 will enable NHS England and local authorities to monitor variations in the quality of diabetes services and health outcomes achieved through commissioning. General practitioners and other doctors and nurses are at the centre of making local NHS decisions, enabling CCGs to create more integrated care for all patients with long-term health problems. Local commissioners within CCGs have the responsibility to determine what local diabetes services will be provided and should follow the evidence-based guidelines for good diabetes care, including providing adequate support to patients whose condition worsen. Diabetes is included in the Cardiovascular Disease Outcome Strategy, published in March 2013, which reiterates our commitment to the NHS Health Check programme. To increase the early diagnosis of disease, NHS Health Check assesses everyone between 40 and 74 for their risk of heart disease, stroke, diabetes and kidney disease. In July, Public Health England published a review of the NHS Health Check implementation and action plan. NHS England will be working with Public Health England to make the NHS Health Check programme as effective as possible. NHS Improving Quality (NHS IQ), as part of NHS England, is working with Strategic Clinical Networks to support commissioners and providers deliver appropriate services and treatment to people with diabetes. NHS IQ has cited improved public awareness and early diagnosis as a key improvement programme. The risk of diabetes related complications can be reduced through careful monitoring and management of the disease. There are a number of national and locally developed patient education programmes available to diabetes patients, as well as a range of tools and guidance to help local services choose the best programmes to meet the needs of their local population. To encourage improved management of diabetes, the Government has set dear objectives for the NHS to increase universal coverage of the nine National Institute for Care Excellence (NICE) recommended care processes to 80% by 2018 (from 49% in 2010). The National Diabetes Audit measures the percentage of diabetes patients who receive all nine checks. The 2010-11 Audit, published in September 2012, found that 54.43% of people with diabetes had records showing all nine checks had been completed between January 2010 and March 2011, up by almost 3% from 2009-10. The data for 2011-12 is expected to be published in October.