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Still too many ‘unacceptable’ variations in diabetes care, say MPs

Swift action required to stave off disease complications and curb spiralling NHS costs

Caroline White

Friday, 22 January 2016

Despite improvements in diabetes care in England there are still far too many “unacceptable” variations in prevention, treatment, and outcomes, across clinical commissioning groups, as well as among different groups of patients, concludes a cross party panel of MPs today.

Unless the Department of Health and NHS England take swift and comprehensive action on prevention and treatment, the costs of diabetes to the NHS will continue to spiral, says the parliamentary Public Accounts Committee (PAC) in its latest report.

The report points out that since PAC last looked at the issue in 2012, outcomes for patients with diabetes in England have improved, with international evidence suggesting that the UK’s performance is on a par with that of other comparable countries.

But the evidence presented by the Department of Health and NHS England paints “an unduly healthy picture of the state of diabetes services in England,” it says.

“Although an individual diabetes patient’s prospects are getting better, the number of people with diabetes is rising by 4.8% a year, and performance in delivering the nine care processes and achieving the three treatment standards, which help to minimise the risk of diabetes patients developing complications in the future, has stalled,” it insists.

Furthermore, few patients are taking up education programmes that could help them manage their condition, and the number of those experiencing complications as a result of their disease, which make up two thirds of the cost of diabetes to the NHS, is still rising, it says.

Added to which diabetes specialist staffing levels in hospitals are not keeping pace with the increasing percentage of beds occupied by patients with the disease.

The report recommends that by April 2016, diabetes data should be used to identify clinical commissioning groups whose performance is below the national average, and "establish interventions to help them improve."

NHS England and Public Health England should set out a timetable "to ramp up participation in the national diabetes prevention programme" to 100,000 people a year, starting this April, it says.

And, by July, the Department and NHS England should put in place a separate timetable "to reduce geographical variations and variations between different patient groups."

Among the raft of other recommendations, the report says that it should be mandatory for GP practices to submit data for the National Diabetes Audit, and for NHS England to develop a "better and more flexible range of education support" for diabetes patients.

In 2013-14, there were an estimated 3.2 million people aged 16 and above with diabetes in England. The condition is estimated to cost the NHS £5.6 billion a year.

"The NHS and Department of Health have been too slow in tackling diabetes, both in prevention and treatment,” commented Meg Hillier, Chair of the PAC.

“The number of people with diabetes is increasing, as is the number of patients who develop complications. It is a very serious condition that can have a huge impact on people’s lives. Yet support available to patients and those at risk varies hugely across the country,” she said.

“There’s clear evidence of what works and as a priority action must be taken to ensure best practice in treatment and education is adopted across the board. Taxpayers must have confidence that support is available when and where they need it, rather than by virtue of where they live," she emphasised.

Chris Askew, who heads up charity Diabetes UK, said: “Diabetes costs the NHS £10 billion every year and if we don’t get better at supporting people with the condition to live well this figure threatens to rise to unsustainable levels. This is why it is essential that the NHS acts on the report’s recommendations and ensures that all people with diabetes get the care and education they need to manage their condition well and that poorly performing areas are held to account.”

He added: “We only know about the differences between the quality of local services because of the National Diabetes Audit, which gathers this information. However, the number of GP practices submitting their data has been falling and now only covers 57 per cent of them. The committee is absolutely right to say that it should be mandatory for GP practices to submit data.”

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