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CCGs should review diabetes performance

Diabetes UK calls for end to postcode lottery on standards of care

Louise Prime

Tuesday, 10 December 2013

Clinical commissioning groups should review how well their diabetes services achieve the NICE-recommended care processes and outcome measures, and put in place an action plan to improve performance so that people with diabetes get the care they should, insists Diabetes UK. The charity has uncovered huge variation in care across England, with the best-performing CCGs offering 78% of people with diabetes all eight checks that they need, compared with just 19% of patients in the worst CCG area. Even for the three most important measures – monitoring blood glucose, blood pressure and cholesterol – compliance varied from 28% in the best-performing CCG to 17% in the worst.

The charity also found that there has been little overall improvement in standards of care. It welcomed the increase in the proportion of children and young people receiving all care processes, but pointed out that it is still only 5.8%. What is more, only 16% of this age group achieved the recommended HbA1c target of less than 7.5%.

Barbara Young, the charity’s chief executive, said in her foreword to today’s State of the Nation report: “People who live in the best performing CCG area are four times more likely to be given eight of the vital health checks recommended by NICE as compared to people living in the worst performing area. This geographical variation has a direct effect on clinical outcomes for people with diabetes.”

She asked: “If somewhere like Tower Hamlets, which has significant health challenges, is able to give three-quarters of people with diabetes the annual checks they need, why are there so many areas where less than half of people get these checks? …We know that healthcare professionals are already working hard to make a difference and we need all CCGs to take that opportunity.”

She added that although, as new bodies, CCGs cannot be blamed for the “major health crisis” being fuelled by the postcode lottery in diabetes care, they do have responsibility for fixing it.

Diabetes UK has asked the Health Secretary and NHS England for “an urgent review of the wide geographic variation in achievement of the NICE recommended care processes and outcome measures and an action plan to ensure the poorest performing CCG areas are brought up at least to the standard of the median.”

The report found that about half of people newly diagnosed with diabetes in some areas are offered structured education, but almost none in other areas – even though this can improve access to services, and reduce the rate of complications – and demanded “radical improvement” in supporting people to self-manage.

Its authors also called on local commissioners and their providers to act to improve access to available treatments, including insulin pumps for both adults and children with type 1 diabetes; and to improve the skills of staff in primary care in the management of diabetes, in particular ensuring that primary care teams are aware of the symptoms of type 1 diabetes and ensure the referral of people with type 1 diabetes to specialist teams for their care.

Barbara Young concluded: “The Secretary of State has already spoken compellingly about the postcode lotteries that exist around important issues such as cancer survival and public health; we now need to see him show the same kind of leadership in tackling the inequality that exists around access to integrated diabetes healthcare.”

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