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Stalled NHS diabetes performance threatens patient outcomes – NAO

Performance by the Department of Health, its arm’s-length bodies and the NHS in achieving treatment standards that help minimise the risk of diabetes patients developing future complications is no longer improving, the National Audit Office (NAO) has found.

The NAO has found that, although progress has been made in reducing the extra risk of death for people with diabetes, there are very few newly-diagnosed diabetes patients recorded as attending structured education that could help them manage their condition and reduce the risk of developing complications.

There are also significant variations across England in delivering key care processes, achieving treatment standards and improving outcomes for patients with diabetes.

Across CCGs, the percentage of people with diabetes receiving all the recommended care processes, apart from eye screening, ranged from 30% to 76% in 2012-13, for example, and the extra risk of death within a one-year follow-up period varied from 10% to 65%.

Diabetes specialist staffing levels have also not changed since the NAO last reported on diabetes services, despite the fact that the percentage of beds in acute hospitals occupied by people with diabetes increased from 14.8% in 2010 to 15.7% in 2013.

The auditor therefore recommended that NHS England set out how it intends to hold CCGs to account for poor performance in delivering key care processes, the three treatment standards and longer-term outcomes.

Amyas Morse, NAO head, said: “Our previous report on diabetes services showed that there was an improvement in delivering the nine key care processes that the NHS has identified as essential for diabetes patients.

“Data available since then shows that these improvements have been reflected in an uplift in long-term outcomes for these patients.

“However, the improvements in delivery of these key care processes have stalled, and this is likely to be reflected in a halt to outcomes improvement for diabetes patients.”

The findings also echo last week’s warnings from two expert healthcare bodies that 40% of people with diabetes believe the NHS has worsened since 2010, and that systematic failures were denying them of relevant self-care education.

And Meg Hillier MP, chair of the Public Accounts Committee, said she was deeply disappointed that the department had made such little progress since 2012 in helping those with diabetes, a disease that needs to be carefully managed.

This is despite £5.6bn being spent annually in England on diabetes. The condition has also been accused of posing a bankruptcy threat to the NHS as the number of people with diabetes has soared by almost 60% in the last 10 years.

Hillier noted that more than two-thirds of this cash pool is due to complications such as amputation, blindness, kidney failure or stroke, and the amount of people developing these complications is rising. A total of 135 people every week in England have an amputation as a result of diabetes, for example.

“With proper education and support, many people with diabetes can manage their conditions themselves. Yet just 16% of people who are diagnosed each year are recorded as being offered education about their condition, and fewer than 4% are recorded as taking up this offer.

“Given [diabetes’] association with serious and potentially life-threatening complications and the lack of progress in improving patient care and support in some key areas, the Department of Health and NHS England still have much to do,” she added.

But responding to the NAO’s report, Prof Jonathan Valabhji, national clinical director for obesity and diabetes at NHS England, said: “Performance of the NHS in England on diabetes remains strong.

“People with diabetes are less likely than a few years ago to either die or develop heart failure. We are also seeing trends for lower rates of angina, heart attack, stroke, major amputation and kidney failure.

“This is with a backdrop of more and more people developing type 2 diabetes every year and constraints on funding.”