In the December 2012 issue, we reported the findings of the Public Accounts Committee into the management of adult diabetes. No one could fail to recognise that people with diabetes are being let down by the system. While some people may live in areas where care is excellent, many others are being badly let down by the quality of care, which varies dramatically across the country.

This is happening despite numerous documents with recommendations for standards of care – from the National Service Framework for Diabetes in 2001 to the NICE Quality Standards for adult diabetes in 2011. Yet Diabetes UK recently published results from a survey which showed that last year there were no improvements in standards of care – they rightly call it ‘the lost year’.

How many more ‘lost years’ can we afford?
This question is easily answered – none. The health of so many people with diabetes is being adversely affected and they are truly losing years because they are not receiving the care they need to manage their diabetes.

But we also have to look at the costs and question whether NHS funds are being spent in the wisest way?

A report issued in August 2012, Prescribing for Diabetes in England: 2005-06 to 2011-12’ highlighted the increased costs of diabetes to the NHS for 2011-12 compared to 2005-06.

  • Diabetes prescriptions have for the first time topped 40 million in year, a rise of nearly 50% on six years ago.
  • The net cost of diabetes drugs also rose by just under 50% in the same period – faster and greater than for prescriptions overall, where items increased by 33%.
  • The overall cost of all drugs to the NHS fell last year by just over 1% but the diabetes drugs bill increased by nearly 5%.
  • Diabetes drugs accounted for a net ingredient cost of £760.3 million, a 4.8% (£35.2 million) rise on 2010/11 and a 47.9% (£246.3 million) rise on 2005/06.

These differences are too great to simply put down to the increase in numbers of people with diabetes.

What is missing?
Certainly not reports on the situation – there are plenty of those! Lacking is the will, political or otherwise, to follow these up with ACTION to bring about change. Reports are of little value unless they are acted upon and that certainly does not seem to be the case.

The reaction of the then Health Minister to the report on costs was: “the rise in the cost of the diabetes drugs bill is also being driven by new more expensive medication, which is effective at helping diabetes sufferers…" [Does he actually KNOW that the new, expensive drugs are more effective? Many of them have not been around long enough to gather the evidence for such a statement and research does show that the cheapest Type 2 drug, metformin, is still the most effective!] He goes on: “We know the risk of developing Type 2 diabetes can be reduced by eating a healthy diet and increasing activity levels. That’s why last year we launched a call to action to wipe five billion calories off the nation’s waistline each day and through Change4Life we are encouraging everyone to eat less and move more."
Do Ministers and Department of Health really believe that Change4Life is goingto sort out all the problems?

Diabetes UK’s Chief Executive, Barbara Young responded with “We need a government-funded awareness-raising campaign on the risk factors and symptoms of Type 2 diabetes and we need to get much better at identifying people at high risk so they can be given the support they need to prevent the condition." Awareness alone is not going to do it. While we do need to diagnose people at risk and help them to prevent diabetes developing, we actually need positive action to provide better care and treatment for the people who are actually living with diabetes now!

The action we are seeing is negative – diabetes is being downgraded!
NHS Diabetes is being closed down at the end of March 2013
For 12 months diabetes will be looked after by a ‘Transition body’ before being moved to the ‘New Improvement Body’. Diabetes is not being treated separately but simply put in the category of ‘long-term conditions’. So with the closure of NHS Diabetes, diabetes is effectively being downgraded to just another long-term condition.  

Strategic Clinical Networks are not viewing diabetes as a priority
These Networks were set up for specific patient groups or conditions in 12 geographical areas to improve health services and reduce variations in services across the country. The first Clinical Networks are for the following conditions: cancer, cardiovascular disease, maternity and children’s services and mental health.
Once again, diabetes is not being seen as a separate condition with its own Strategic Clinical Network but in this case, it is being put into the Cardiovascular Disease Network. While there may be some logic to Type 2 diabetes being put in with cardiovascular disease, Type 1 diabetes does not belong in this category because it is an autoimmune condition.

So who is going to do the innovative thinking to improve the health of people with diabetes?
Without specific organisations within the NHS dedicated to diabetes, this is a question that must be answered. Despite the huge costs of diabetes, all the technological advances and new expensive drugs and insulins, blood glucose level targets are not being met by the majority of people. Surely Government and the Department of Health should be asking why this is the case – it’s too easy just to blame the patient!

We need to see investigations into ways of changing behaviour to help people improve the self-management of their diabetes and ways to help doctors and healthcare professionals to provide better support for people living with diabetes. The World Health Organisation suggests that improving self-management “may have a far greater impact on the health of the population than any improvement in specific medical treatments”. Improving such skills helps people with diabetes develop confidence to manage their condition more effectively and make better use of their consultations with their doctor or healthcare professional. Some researchers and doctors are already doing this but in an ad hoc way, making it a long way off becoming national policy.

We have to conclude…

  • Services for people with diabetes are failing, or at best there are no improvement,
  • blood glucose targets not being met by the majority,
  • both Type 1 and Type 2 diabetes are predicted to rise and
  • diabetes is a huge cost to the NHS.

Yet diabetes is not being seen as a priority but just another long-term condition or a cardiovascular condition.

IDDT is calling on you, our members and readers, to take action NOW by writing to your MP! We need to ensure that people with diabetes are not sidelined, that the NHS structure is in place to ensure they are given priority within the NHS to provide the much needed improvement in their treatment and care.

Included with this Newsletter is a draft letter for you to use to write to your MP and instructions on how to lobby. If we can help you, do call IDDT on 01604 622837.