DO YOU WANT TO JOIN ME TO MAKE A CHANGE TO CURRENT GUIDELINES?

[Listlad]

My problem is that I don't think the the NHS can afford to provide testing equipment for T2s.
The money simply isn't there.

I totally agree that it is a wonderful ideal. Every T2 should have access to testing if they are willing to put in the time and effort to learn how to use those tests to control their blood glucose via appropriate methods. Yes. Absolutely.

But I simply don't think the money is there. There isn't the money to provide many urgent services that would be beneficial to people. Budgets are getting tighter and tighter all the time.

We may all consider that by testing now, and testing appropriately, vast amounts of money could be saved on avoiding future complications. That is a powerful logic. But NHS budgets focus on THIS financial year, not what MAY happen in 20 years. The bean counters and number crunchers don't plan that far ahead. Never have. Never will.

And I certainly wouldn't want to take money from other current services, some of which are urgent and ongoing, to provide testing equipment to T2s. Cancer treatments, vaccinations, heart surgeries, clinics...

And how much would it cost to train the NHS staff to reach the point where they could train the new T2s on how to use their tests effectively? I have not yet met an NHS staff member at any of my appts who has understood that the prick tests can be used to modify diet and control bgs. They all seem to think in terms of testing to avoid hypos and inform medication choices/doses. So there would have to be a national program of NHS staff training to educate them all to the point where they could help the T2s test effectively and benefit from the process. That would have significant cost.

My own situation is that I pay prescription charges, yet I can buy a tub of 50 test strips for £7 whereas the cost to me of an NHS prescription charge is currently £9 https://www.nhs.uk/common-health-qu...-treatments/how-much-nhs-prescription-charge/
I can't in all conscience ask the NHS to provide me with test strips under those circumstances. Plus, of course, the NHS probably pay more than £9 for 50 strips, plus the admin costs associated with processing the prescription, plus seeing the doc for reviews, etc. etc. The costs would just spiral upwards.

I might be open to supporting the NHS provision of test strips for a fixed term after diagnosis, for those who are unable to afford to fund their own testing. But how on earth would you set that up? Means testing NHS patients goes against everything the NHS stands for, and the cost of administrating it would make it absurdly expensive.

The money is there if it means less money spent on medicines, nursing time and GP time. It pays for itself in the long run.

 

[Listlad]

Now, the net cost to the NHS of metformin on prescription may be less than meter/strips over a 2-3 month period, but over the longer term, savings from those who successfully implement lifestyle changes will far outstrip any short term cost. Dr Unwin’s figures should help to demonstrate that.

Agreed.

 

[HSSS]

The money is there if it means less money spent on medicines, nursing time and GP time. It pays for itself in the long run.

I think we all agree on that.

The problem is the single tax year view of spending, not even the few years it would take for savings to be made after a 6 month prescription let alone the decade or two costs.

 

[Debandez]

Great idea @Debandez

i utterly fail to see how measuring the toxicity of the foods we ARE clearly allergic to,
can be anything BUT beneficial.

While it would be a cost.( .isn't it always. ) if we weigh up the inital cost with the lifetime costs, it works out pretty cheap,
AND it's the RIGHT thing to do...what right does anyone have to just write us off, without even giving us a chance to prove or attempt a way of managing our T2D that is clearly showing great promise.
(source: Dr Unwins surgery, Most of the posters on here with T2D.)

Given the argument WILL be it's just TOO expensive..
(today, perhaps..., but who cares what it costs us tomorrow.. Cash and Health wise )

Wouldn't a halfway house of allowing each NEW T2D, ONE set of low end glucose meter + 50 strips...(think codefree)

Then if those taking up the offer benefited, they now have an option of providing further strips for themselves AFTER seeing the efficacy of the Meters and all the impact certain foods have on them

for those who take but don't follow up or use well for whatever reason, that seems a small cost to pay, to give someone the CHANCE of a more successful (and by dint , less costly interventions) future as a Type 2.

Add in with the cost implication, pretty sure some accountant somewhere will be monitoring the success or not of the program and roll out..

IF we can mainly buck the trend of it being progressive, it follows many others once aware, COULD also follow in our footsteps..and surely THAT in itself could make it become the de facto tool for that all important first interventions ?

Thus freeing up those who agree but are currently oppressed in giving us freely information that contradicts the outmoded guidelines, dictated at present.

I like the high level 'celeb' type 2's being targeted..much easier if we have a successful role model fighting our case, i think.

Keep us posted @Debandez

Thanks for this great reply.

 

[Debandez]

i'd agree, but we have to start somewhere jim.

And it's always going to be that cost ratio, that will win it for us,

Once we get beyond the initial payment, and others can see proof that PEOPLE can improve their control,
and thus require less medication/interventions and live healthier lives,..that is the dream and where we need to be

THAT is the moss on our rolling stone, the more it works the less resistance we'll get to this new faddy idea of eating
less of the Toxic food stuffs that cause us harm.

While those who can influence will certainly try, others who can see the benefits, will then join us in our clamour to be heard

We have nothing to lose really.

It does feel like a dream, but dreams can come true.

 

[Debandez]

I wonder about including some sort of cost benefit analysis in the letter - money talks!

Dr Unwin has published his own data - results and savings in his surgery. Analysis of cheapest meters/strips for a suggested timeframe vs potential savings would make a strong case.

@Mbaker I think I recall you mentioning (quite some time ago) that you'd looked into this.

Good idea. Maybe I will just quote dr unwins as an example. I'm sure he wont mind! No point reinventing the wheel his stats are mighty impressive.

 

[Debandez]

I’m up for that if it’s kept simple, something I can copy and paste, writing letters isn’t my strong point. And a dummies guide to finding out where I need to send it.

Brilliant. I can do as much as necessary.

 

[Debandez]

I’m in. is it worth actually explaining how a type 2 uses a meter and why though? So many hcp think it’s only for insulin dosing and hypo avoidance/ treatment and have no idea it’s uses for assessing food suitability

@Rachox did a brilliant leaflet for our Birmingham event last year. Could enclose that. My surgery are almost up to speed with low carb advice and testing now and just yesterday when I was there (meeting with social prescriber) DN confirmed this and my other leaflets are being given out all the time. Music to my ears.

 

[Debandez]

Count me in as well - sent from sunny Portugal. I understand it's a bit wet at home.

And windy! Enjoy the sunshine.

 

[Debandez]

Great idea.

Meters and Freestyle Libres should be demo-ed on DESMOND courses by good video examples to illustrate the salient benefits of using a meter.

I feel at dx we are left high and dry. If pts were given even a you tube video link to the benefits of testing, that might help. A positive video that shows the results of good testing. How uplifting would that be at such a scary time.

 

[Debandez]

I understand where you are coming from. That said you only have to Google 'wasted money NHS' and the results are quite shocking.

For example 5.6 million on expensive rubber gloves. There are numerous articles on the waste. And there has been many programmes on it.

My problem is that I don't think the the NHS can afford to provide testing equipment for T2s.
The money simply isn't there.

I totally agree that it is a wonderful ideal. Every T2 should have access to testing if they are willing to put in the time and effort to learn how to use those tests to control their blood glucose via appropriate methods. Yes. Absolutely.

But I simply don't think the money is there. There isn't the money to provide many urgent services that would be beneficial to people. Budgets are getting tighter and tighter all the time.

We may all consider that by testing now, and testing appropriately, vast amounts of money could be saved on avoiding future complications. That is a powerful logic. But NHS budgets focus on THIS financial year, not what MAY happen in 20 years. The bean counters and number crunchers don't plan that far ahead. Never have. Never will.

And I certainly wouldn't want to take money from other current services, some of which are urgent and ongoing, to provide testing equipment to T2s. Cancer treatments, vaccinations, heart surgeries, clinics...

And how much would it cost to train the NHS staff to reach the point where they could train the new T2s on how to use their tests effectively? I have not yet met an NHS staff member at any of my appts who has understood that the prick tests can be used to modify diet and control bgs. They all seem to think in terms of testing to avoid hypos and inform medication choices/doses. So there would have to be a national program of NHS staff training to educate them all to the point where they could help the T2s test effectively and benefit from the process. That would have significant cost.

My own situation is that I pay prescription charges, yet I can buy a tub of 50 test strips for £7 whereas the cost to me of an NHS prescription charge is currently £9 https://www.nhs.uk/common-health-qu...-treatments/how-much-nhs-prescription-charge/
I can't in all conscience ask the NHS to provide me with test strips under those circumstances. Plus, of course, the NHS probably pay more than £9 for 50 strips, plus the admin costs associated with processing the prescription, plus seeing the doc for reviews, etc. etc. The costs would just spiral upwards.

I might be open to supporting the NHS provision of test strips for a fixed term after diagnosis, for those who are unable to afford to fund their own testing. But how on earth would you set that up? Means testing NHS patients goes against everything the NHS stands for, and the cost of administrating it would make it absurdly expensive.

 

[Debandez]

False economy
Cheap is dear in the end
Speculate to accumulate
You dont ask you dont get

All expressions my dear mum used.

I understand that implementing this (or reimplementing as I think @DCUKMod said it used to be practice) would be costly. Although I'm not aubfait with the finances of the NHS it does appear they have got money for things that are going to make things better. New initiatives (ie social prescribing). So we could be in luck.

Boris has said he is going to ensure 40 new hospitals are built. Where's that money being conjured up from! It's out there and we need it. Are they still sending all equipment no longer needed (Zimmer frames, disability chairs eg) to landfill? They wouldnt take my mums stuff back when she passed away and almost new.

 

[Debandez]

Thanks everyone. Really appreciate your feedback. Food for thought.

I'm really busy for about 2 weeks in the final stages of a house renovation but once it's finished I will be free for a few weeks and can concentrate on putting a letter together. It just feels the right thing to do.

 

[Listlad]

I feel at dx we are left high and dry. If pts were given even a you tube video link to the benefits of testing, that might help. A positive video that shows the results of good testing. How uplifting would that be at such a scary time.

Yes, as in this is what happens when you eat a bowl of rice or a banana : watch the video. Sort of thing.

 

[Listlad]

I hardly visit my doctor now. This wasn’t the case 6 months to 5 years ago. I was in every few weeks for something related to high blood sugar. The costs other than an occasional HbA1c are being born by me these days in terms of time and effort and a larger food budget. I even require half as much blood pressure related medicines compared to before.

It must be blindingly obvious to my surgery that I am not so much of a time or financial burden to them now?

Also I would say I am more fit for work now than before. Another hidden cost saving.

 

[LittleGreyCat]

I fully support the offering of BG monitoring kit to T2s.
Those motivated enough to make use of it can see big gains in understanding of how their body works and reactions to food and medication.
They should be fully supported in this.

I suspect the cost won't be that high in real life.
Any costings based on the total number of T2s will be misleading, because as far as I can tell the people motivated to use testing are likely to be in a minority.
I know this was used in the past to justify not supplying testing materials ("They'll just ignore it/Sell the strips on eBay") but we must still be aware of the general low level of involvement by T2s in changing their lifestyle to control their condition.

I would go further with funding.
Established T2s (more than a year from diagnosis, and at least every 5 years) should be offered a training course on the latest diabetes knowledge (a lot has changed over the last 5 years; even more over 10) and the opportunity as part of the course to wear a Freestyle Libre (or similar) with the results being discussed as part of the course.
This would be an enormous step forward in education and hopefully show long term benefits.
I am assuming, of course, that anyone taking part is motivated enough to take regular scans of the sensor which will then be visible to the surgery/training organisation.
£50 per participant and the up front cost of a reader must be trivial compare to all the other ongoing costs.
The information gathered is far more comprehensive than finger pricks.
At a minimum this could be part of the annual review every 5 years, say.

 

[Member496333]

Any costings based on the total number of T2s will be misleading, because as far as I can tell the people motivated to use testing are likely to be in a minority.

You're probably correct, but this would surely be in no small part due to the current lack of education in both patients, and the healthcare professionals who are supposed to be helping them. As awareness of self-monitoring increases, it's not unreasonable to predict that so too would the number of takers for the requisite equipment and consumables.

I'm with @Brunneria on this one. I don't think we're likely to see NHS-funded monitors and strips for T2 any time soon. It would probably take decades before we were on the downhill slope of the bellcurve of expense, and no one is likely to be willing to watch their bottom line suffer in the meantime. I do, however, still think we definitely need to stop discouraging testing among those who wish to do so. That should be nothing short of malpractice, in my view.

 

[Listlad]

You're probably correct, but this would surely be in no small part due to the current lack of education in both patients, and the healthcare professionals who are supposed to be helping them. As awareness of self-monitoring increases, it's not unreasonable to predict that so too would the number of takers for the requisite equipment and consumables.

I'm with @Brunneria on this one. I don't think we're likely to see NHS-funded monitors and strips for T2 any time soon. It would probably take decades before we were on the downhill slope of the bellcurve of expense, and no one is likely to be willing to watch their bottom line suffer in the meantime. I do, however, still think we definitely need to stop discouraging testing among those who wish to do so. That should be nothing short of malpractice, in my view.

Point taken.

I think that what Deb is seeking to achieve can help change mindsets and tip the balance towards better support. It may not happen overnight but over the course of time (hopefully sooner rather than later) the benefits will be seen to outweigh the costs paving the way for blanket coverage.

Incidentally @Debandez wouldn’t it be great to see a BBC or ITV documentary on this whole thing?

 

[Member496333]

I think that what Deb is seeking to achieve can help change mindsets and tip the balance towards better support. It may not happen overnight but over the course of time (hopefully sooner rather than later) the benefits will be seen to outweigh the costs paving the way for blanket coverage.

I agree absolutely. This a noble cause and should be applauded.

 

[Dr Snoddy]

At least a starting point would be to include the low carb approach as a valid and in many cases, successful, dietary option on DESMOND courses. Then at least newly diagnosed T2's would be allowed to make intelligent and informed choices. This would require additional training of facilitators and, probably the biggest problem, a change of mindset. It is also something that could be done without any additional prescription costs.
I had my annual review yesterday and tried to sow the seeds of a more open-minded approach. I was up against the usual 'against NHS guidelines' and 'everyone is different'.