Parliamentary Committees and Public Enquiries
‘Significant action’ needed now to combat diabetes
The Public Accounts Committee sets out new measures intended to improve treatment for diabetes patients and bolster prevention of the condition.
- Report: Management of adult diabetes services in the NHS: progress review inquiry
- Report: Management of adult diabetes services in the NHS: progress review inquiry (PDF 220KB)
- Inquiry: Management of adult diabetes services in the NHS: progress review inquiry
- Public Accounts Committee
In its report, the Committee finds weaknesses in the approach of the Department for Health and NHS England mean "the costs of diabetes to the NHS will continue to rise".
It finds that while progress has been made since the Committee last examined diabetes services, there remain "unacceptable variations in the take up of education programmes, delivery of recommended care processes, achievement of treatment standards and in outcomes for diabetes patients".
These include geographic variations across clinical commissioning groups, as well as variations between different groups of diabetes patients.
Complications continue to rise
While the number of diabetes patients experiencing complications continues to increase, diabetes specialist staffing levels in hospitals are not keeping pace with the increasing percentage of beds occupied by diabetes patients.
The Committee calls on the Department and NHS England to take rapid action to improve the spread of best practice in preventing and treating the condition.
It recommends that by April 2016, diabetes data should be used to identify clinical commissioning groups performing poorly compared to the national average, and "establish interventions to help them improve".
Also by April this year, 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.
By July, the Committee urges the Department and NHS England to put in place a separate timetable "to reduce geographical variations and variations between different patient groups".
Other recommendations in the Report include making it 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 years or older with diabetes in England. The condition is estimated to cost the NHS £5.6 billion a year.
Meg Hillier MP, Chair of the PAC, said recently:
"The NHS and Department for Health have been too slow in tackling diabetes, both in prevention and treatment.
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.
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."
Since the previous Committee of Public Accounts reported in 2012, the Department of Health and NHS England have made progress in improving outcomes for diabetes patients. International evidence now available also suggests that the UK performs well compared to other countries in terms of outcomes for diabetes patients.
However, there are significant variations in the routine care and support that diabetes patients receive, and in outcomes for diabetes patients.
"Unduly healthy picture" painted
We are concerned that the witnesses from the Department and NHS England painted an unduly healthy picture of the state of diabetes services in England. 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.
In addition, very few new diabetes patients are taking up education that could help them manage their condition, and the number of diabetes patients experiencing complications (which account for over two-thirds of the cost of diabetes to the NHS) continues to rise.
This all means that the costs of diabetes to the NHS will continue to rise. In order to control these costs, the Department and NHS must take significant action to improve prevention and treatment for diabetes patients in the next couple of years.
There are two main types of diabetes, a chronic condition where the body does not produce enough insulin to regulate blood glucose levels. Around 10% of people diagnosed have type 1 diabetes, which occurs when the body produces no insulin. The remaining 90% have type 2 diabetes, which occurs when the body cannot produce enough insulin to function properly, or when the body’s cells do not react to insulin.
Being overweight is the main modifiable risk factor for type 2 diabetes and 90% of adults with type 2 diabetes are overweight or obese.
With education and appropriate support most people with diabetes can manage their condition themselves. They also need regular checks to monitor treatable risks for diabetic tissue damage and to detect the early damage itself, so that treatment can be given to prevent deterioration.
The risk of developing diabetic complications can be minimised by early detection and management of high levels of blood glucose, blood pressure and cholesterol. The cost of complications accounts for over two-thirds of the £5.6 billion a year that diabetes is estimated to cost the NHS.
The Committee last took evidence on diabetes services in 2012. Its Report concluded that too many people with diabetes were developing complications because they were not receiving the care and support they needed.
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