NHS Long-Term Plan
Amidst all the chaos around Brexit in January, the government issued its 10-year plan for the NHS. In summary, the plan says: “The NHS will increase its contribution to tackling some of the most significant causes of ill health, including new action to help people stop smoking, overcome drinking problems and avoid Type 2 diabetes, with a particular focus on the communities and groups of people most affected by these problems.”
Naturally a lot of pages to read but clearly, what it says about diabetes is particularly interesting to all of us. Considering that we are frequently told that diabetes costs the NHS more than 10% of the NHS budget, it is surprising to see the 10-year plan contains two pages on obesity and how it relates to Type 2 diabetes and only 3 relatively short paragraphs entitled ‘Diabetes’. Looking at these 3 paragraphs, the thing that is obvious to all of us is that with the exception of CGM for pregnant women, which is very welcome, there are no target dates for achieving these aims. It is all in ‘the future’, unlike Stroke Care which has milestone dates by which the points in the plan will be delivered. So when can we expect diabetes care and treatment to improve?
Obesity and Type 2 diabetes – the NHS plan promises:
- To halve childhood obesity and to significantly reduce the gap between children from the most and least deprived areas by 2030. By 2022/23 an expectation of treating up to a further 1,000 children a year for severe complications related to their obesity, including diabetes.
- To provide targeted support and access to weight management services in primary care for people for people with Type 2 diabetes or hypertension with a BMI of 30+.
- A commitment to fund a doubling of the NHS Diabetes Prevention Programme over the next 5 years, including a new digital option, as this is key to tackling health inequalities and the increased risk of Type 2 diabetes in ethnic groups.
- To continue to support local health systems to address inequality of access to multidisciplinary foot care teams and specialist nursing support for people who have diabetes.
- To test an NHS programme supporting very low-calorie diets for obese people with Type 2 diabetes.
- To continue to take action on NHS premises with the next version of the hospital food standards being published in 2019 for staff and patients. All trusts will have to conform to these standards in their contract.
- To ensure that nutrition has a greater place in professional training so that frontline NHS staff feel equipped to talk to patients about nutrition and achieving and maintaining a healthy weight.
‘Diabetes’ – the plan promises:
- For people living with a diagnosis of Type 1 or Type 2 diabetes, the NHS will enhance its support offer. The NHS will support those newly diagnosed by expanding provision of structured education and digital self-management support tools.
- People with Type 1 diabetes will benefit from flash glucose monitors from April 2019 in line with clinical guidelines to end the variation of availability across the country.
By 2020/2021, all pregnant women with Type 1 diabetes will be offered continuous glucose monitoring (CGM) to help to improve neonatal outcomes.
- Continuing investment in primary care the NHS will enable more people to achieve the recommended diabetes treatment targets to minimise the risk of future complications. In addition, for people who periodically need in-patient hospital care, the NHS will ensure that all hospitals in future provide access to multidisciplinary footcare teams and in-patient specialist nursing teams to improve recovery and reduce lengths of stay and readmission rates.
- The statement about the FreeStyle Libre being available on the NHS in April 2019, was announced on November 2014, so not news.
- IDDT welcomes all pregnant women with Type 1 diabetes being offered continuous glucose monitoring (CGM) by 2020/2021.
- It is also to be welcomed that all hospitals will have multidisciplinary footcare teams “in the future” – when? However, it completely fails to address the need for podiatry services to be available in primary care for everyone to help to prevent early problems and the need for emergency treatment by hospital multidisciplinary footcare teams.
- A doubling of the NHS Diabetes Prevention Programme over the next 5 years – this is only 200,000 people which is a drop in the ocean of over 3 million people who have Type 2 diabetes!
Of course, it has to be said that the plan does not cover the necessary increase in numbers of health professionals to bring this about and the training they need to treat and care for the increasing number of people with both types of diabetes.
If you want to read more of the NHS Long-term Plan, it is available online at