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Government must tackle growing diabetes postcode lottery by April – PAC  

Diabetes data should be used to identify poorly performing CCGs by April 2016 to establish interventions, or the disease’s cost drain on the NHS will continue to rise, an inquiry has said.

The Commons Public Accounts Committee (PAC), publishing its findings from an investigation launched in November, said the rising cost of diabetes treatment seems here to stay, thanks to weaknesses in the approach of NHS England and the Department of Health.

Despite some progress made since the Committee’s last examination, there are still “unacceptable variations in the take up of education programmes, delivery of recommended care processes, achievement of treatment standards and in outcomes for diabetes patients”, it said.

Committee chair Meg Hillier MP said: “The NHS and [the DH] have now 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.”

Part of this stems from geographic disparities across CCGs, with the percentage of people achieving treatment standards varying widely. For example, treatment standards for blood glucose, blood pressure and cholesterol levels ranged from 28% to 48% in 2012-13, and the additional risk of death amongst patients with diabetes within a one-year follow-up period ranged from 10% to 65%.

There are also significant differences between certain groups of diabetes patients, with younger people with either type of diabetes and people with type 1 diabetes both receiving fewer than the recommended care processes, and being less likely to achieve treatment standards.

“The extent of these variations illustrates that best practice is not being spread effectively,” the Committee’s report said.

After using diabetes data available from this month to identify CCGs performing below the national averages by April, the PAC recommended that NHS England and the department set up a timetable by July exploring how to soften variations.

They must also clarify which diabetes targets remain in place and develop a strategy for sharing best practice, including on using GP IT systems effectively to support the delivery of care.

Also by April, NHS England and Public Health England (PHE) should define a timetable to “ramp up the participation” in the national diabetes prevention programme to 100,000 people per year.

“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,” Hillier continued.

“Taxpayers must have confidence that support is available when and where they need it, rather than by virtue of where they live.”

Other recommendations include making it mandatory for GP practices to submit data to the National Diabetes Audit and for NHS England to create a more flexible range of education support for people with diabetes.

Referring to the inquiry in November – which grilled NHS England boss Simon Stevens and other representatives from PHE and the department – the PAC said witnesses “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,” the report said.

Yet an NHS England spokesperson, responding to today’s findings, said: “NHS diabetes care is better than ever, as even the committee themselves state when they report that ‘individual diabetes patients’ prospects are getting better’.

“But a fundamental challenge which the Committee implicitly draw attention to is the obesity-fuelled jump in type 2 diabetes. This threatens to overwhelm GP services, and puts the spotlight firmly on the need for no-holds barred national action on prevention by the NHS, government, employers, schools and in particular the food industry.”