Diabetes is quickly becoming the greatest health challenge of the 21st century. In 2010, it was estimated that 3.1 million people in England had diabetes. This figure is set to increase to 4.6 million by 2030, with the rise in obesity playing a significant part.
Together with a host of complications and a lifelong package of care for each person with the condition, the potential burden on the NHS is huge.
The economic facts highlighting the scale of the challenge keep piling up:
- Diabetes and its complications cost the NHS around 10% of its annual spend.
- £725m a year is spent on diabetes medication – 8.4% of the NHS drugs spend.
- An additional £600 million is estimated to be spent on inpatient care for people with diabetes, compared to those without the condition.
- The cost to the NHS of foot ulcers and amputations in people with diabetes is estimated at £450 to £580 million a year.
But the biggest cost of all is to the person with diabetes. The clinical complications associated with diabetes are startling:
- One in three amputations occurs in people with diabetes – of these, eight out of ten are probably preventable.
- One in three inpatients with diabetes experiences a medication error, leading to longer lengths of stay.
- Diabetic retinopathy is the leading cause of sight loss among the working-age population in the UK.
- People with diabetes are five times more at risk of cardiovascular disease (CVD) compared to those without the condition.
People with diabetes should expect to be routinely assessed on nine diabetes care processes recommended by NICE as part of an annual review. However, the 2009-2010 National Diabetes Audit found almost half of people with type 2 and two thirds of people with type 1 diabetes still did not achieve this basic standard of care.
Another hurdle that the diabetes community needs to overcome is in the unacceptable variation that exists across the country. The latest NHS Atlas of Variation revealed that people with diabetes in some parts of the country are six times more likely to have a major lower limb amputation (defined as above the ankle), than in other parts of the country.
NHS Diabetes – providing support to improve care
NHS Diabetes provides the essential link between diabetes strategy and frontline service improvements for patients. Through their integrated work programmes they provide national leadership and direction and support local teams working to champion good quality diabetes care. As a national support team, NHS Diabetes is leading the way in improving diabetes care and targeting unacceptable variation in care.
Commissioning
Commissioning first class diabetes services will help people with diabetes avoid complications, leading to improved quality of life and a reduction in unnecessary spend.
Trudi Akroyd, Head of Commissioning at NHS Diabetes, is leading this work. “We understand commissioning a diabetes service may feel daunting. The nature of the condition means the care areas involved are extremely wide reaching – perhaps more so than for any other long-term condition,” she says.
NHS Diabetes has built an online commissioning resource to help primary care commissioners. It describes eight practical steps which enable service providers to carry out the key commissioning tasks and deliver high-quality, efficient and cost-effective diabetes services. This process is underpinned by the world’s largest diabetes information and data resource.
Dr James Kingsland OBE, the National Clinical Lead for the NHS Clinical Commissioning Community, and a Senior Partner in General Practice, Merseyside, is a high-profile fan of the resource and comments: “We use this site and resource locally on a regular basis and it has helped us shape and refocus diabetes care within our developing clinical commissioning group's community.”
Specialist networks
NHS Diabetes also manages a series of specialist networks to ensure effective two-way sharing of the most up-to-date guidance, tools, best practice and resources.
The networks vary in size and shape but all focus on bringing together health communities to reduce variation of care and deliver better outcomes for people with diabetes, their families and carers.
Led and supported by experts working in frontline diabetes services, they promote innovative and proactive approaches and resources to improve quality and cost effectiveness.
Safety
Insulin training is a requirement for all healthcare professionals who administer, prescribe or prepare insulin. NHS Diabetes has a free online training course on the safe use of insulin, taken by nearly 80,000 frontline healthcare staff in just under two years. To register, click here.
NHS Diabetes will continue to ensure NHS organisations improve shared learning and reduce unacceptable variations in care by supporting them to deliver tangible, lifelong benefits to the ever-increasing numbers of people with, or at risk of, this complex condition. Examples of good practice will be shared nationally by the team’s new Innovation Hub. Find out more at www.diabetes.nhs.uk.