Addressing diabetes care challenge

In 2001, the Department of Health (DH) published the National Service Framework for Diabetes, which set out the key interventions necessary to raise the standard of care provided by NHS organisations and healthcare professionals involved in delivering diabetes services, including, as a minimum, nine basic checks, or care processes, to detect the early signs of complications. The National Institute for Health and Clinical Excellence (NICE) has also set treatment standards for blood glucose, cholesterol and blood pressure, which, when achieved, reduce the risk of a person with diabetes developing complications. A 2012 National Audit Office (NAO) report entitled ‘The management of adult diabetes services in the NHS’ focused on the provision of these recommended standards of care from the NHS for adults with diabetes. It found that, despite some improvements since 2006/2007, there is poor performance against expected levels of care, low achievement of treatment standards and high numbers of avoidable deaths. The report concluded that diabetes services in England, for those aged 16 or over and diagnosed with either type 1 or type 2 diabetes, are not delivering value for money. Amyas Morse, head of the National Audit Office, said: “The Department of Health has failed to deliver diabetes care to the standard it set out as long ago as 2001. This has resulted in people with diabetes developing avoidable complications, a high number of preventable deaths and increased costs for the NHS.” The DH has estimated that up to 24,000 people die each year from avoidable causes related to their diabetes. In 2009/10, there were an estimated 3.1 million adults in England with diabetes and this figure is expected to increase by around 23% by 2020. Analysis by the charity Diabetes UK indicates that the number of people in Britain with diabetes could rise by 700,000 by the end of the decade, indicating 4.4 m people in the UK alone by 2020. It predicts that the majority of new cases will be type 2 diabetes which puts them at an increased risk of amputation, blindness, kidney failure, stroke and ultimately early death. Commenting on the figures, Barbara Young, chief executive of Diabetes UK, said: “The healthcare system is already at breaking point in terms of its ability to provide care for people with diabetes. The result is that many people are developing health complications that could have been avoided, and are dying early as a result. “If our projected increase becomes reality, it would be a calamity for the healthcare system and a disaster for public health. But the Government and the NHS do not seem to have grasped the scale of the impending crisis and, at the moment, we seem to be sleepwalking towards it.” The NAO estimated that NHS spending on diabetes services in 2009/10 was at least £3.9 billion, around 4% of the NHS budget. “The expected 23% increase by 2020 in the number of people in England with diabetes will have a major impact on NHS resources unless the efficiency and effectiveness of existing services are substantially improved,” said Mr Morse.

Recommended standards not being met

Ms Young’s fears would appear to be well-founded as data from the DH shows that only half of people with diabetes received the recommended standards of care in 2009/10, even though this is an increase from 36% in 2006/07. The standards set by the DH in 2001 state that people with diabetes should receive nine basic care processes each year (see Fig. 1). These care processes can reduce the risk of diabetes-related complications, such as blindness, amputation and kidney disease. Through earlier detection and management of diabetes-related complications in primary care, fewer people with diabetes would require more costly specialist treatment, said the report. It is estimated that the NHS could save £170 million a year by reducing hospital activity and changing the way that diabetes patients are managed. The report examined this figure further: