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Diabetes care “depressingly poor”

Department of Health must outline how improvements will be made under new NHS structure

Ingrid Torjesen

Tuesday, 06 November 2012

Too many people with diabetes are developing complications because the level of care and support they receive is “depressingly poor”, a report by MPs has found.

The report‘The management of adult diabetes services in the NHS’ by the Committee of Public Accounts found that progress in delivering the recommended standards of care and in achieving treatment targets had been slow because there no strong national leadership, no effective accountability arrangements for commissioners, and no appropriate performance incentives for providers.

Most importantly the report pointed out there was no evidence to suggest that the Department of Health will address these failing effectively in the new NHS structure. Failure by it to do so would lead to higher costs to the NHS as well as less than adequate support for people with diabetes, it warned.

The Department of Health published the National Service Framework for Diabetes in 2001 setting out clear minimum standards for what constitutes good diabetes care, including nine basic care processes which should be carried out every year to check for the early signs of avoidable diabetic complications, such as blindness and kidney disease. The Department also set treatment targets for the management of blood glucose, blood pressure and cholesterol to minimise the risk of diabetic complications developing. The expected levels of care outlined in the national Framework were reinforced in 2011 by a National Institute for Health and Clinical Excellence (NICE) ‘Quality Standard’ for diabetes in adults.

Margaret Hodge, chair of the Committee of Public Accounts, said: “Fewer than half of people with diabetes are receiving all nine of these tests. Fewer than one in five people with diabetes have the recommended levels of blood glucose, blood pressure and cholesterol, leaving an unacceptably high number at risk of developing complications, being admitted to hospital and costing the NHS more money.

“The Department gave local NHS organisations freedom to decide how to deliver diabetes services and did not introduce mandatory performance targets as it did for cancer, stroke and heart disease. There is no strong national leadership and no effective accountability arrangements for commissioners.

“Variation in the level of progress across the NHS also means that there is an unacceptable ‘postcode lottery’ of care, whereby the quality of diabetes care varies dramatically across the NHS.”

She said that the Department of Health “must set out how improvements in diabetes care will be delivered under the new arrangements and what steps it will take, alongside Public Health England, to improve public awareness of the risk factors for diabetes such as obesity.”

The Department of Health estimates that 24,000 people with diabetes die prematurely each year because their diabetes has not been managed effectively. An estimated 80% of the costs of diabetes in the NHS are attributable to the treatment and management of serious, yet avoidable, diabetic complications. Unless diabetes care improves significantly the NHS will continue to incur ever-increasing costs as the number of people with the disease rises and individuals will continue to die prematurely, the report said.

Barbara Young, chief executive of Diabetes UK, said: “It is baffling that the low priority the NHS has given to diabetes has allowed this situation to develop when there is nothing controversial about how to deliver quality healthcare.

“We hope this report finally leads to an end of the inaction that has existed. Unless there is urgent action on diabetes, thousands more people a year will be condemned to debilitating complications and early death.”

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