Diabetes Times

[DunePlodder]

Two sub headlines in the Diabetes Times coverage of EASD 2019
https://diabetestimes.co.uk/easd-highlights/

"Poor diabetes control cost NHS £3 billion in 2017/18"

"CGM shown to be beneficial in type 1 diabetes"

A total of 94 adults with type 1 diabetes were followed for three years. Those who used CGM saw significantly better HbA1c levels – 7% and 6.9% for the multiple daily injection and insulin pump groups, respectively – versus 7.7% and 8.0% for conventional self-monitors.
CGM users also saw significantly more time spent in range, as well as less time spent in hypoglycaemia.

The NHS can't afford to fund CGMs. Possibly because it's spending so much on the effects of poor control?
I'm sure I'm being very simplistic here but....

 

[MeiChanski]

Hello, I think that's a very small side of it, there's a lot of issues because of people wasting appointments, people going to A&E for a small scratch/common colds, diabetes complications because of wrong dietary advice, etc etc and NHS being underfunded and some of the spending is not just for diabetes. I also know that CGMs aren't routinely funded, but I am hopeful one day we'll have access to it because it shows some benefits of using it.

 

[ringi]

there's a lot of issues because of people wasting appointments, people going to A&E for a small issue.

Let be carefull, it takes very little staff time, hence low cost to deal with someone who goes to A&E with a cold etc. The costs that are quoted are wrong, as they assume everyone who is seen at A&E has the same cost. There are no great saving to be had from stopping people misusing A&E, but their health may improve by seeing a GP as A&E have a limited skill set.

Most missed appointments have little cost, as most clinics are overbooked and would run very late if everyone turned up. Likewise with GPs, GPs also use missed appointments to catch on checking blood test results etc.

 

[MeiChanski]

Let be carefull, it takes very little staff time, hence low cost to deal with someone who goes to A&E with a cold etc. The costs that are quoted are wrong, as they assume everyone who is seen at A&E has the same cost. There are no great saving to be had from stopping people misusing A&E, but their health may improve by seeing a GP as A&E have a limited skill set.

Most missed appointments have little cost, as most clinics are overbooked and would run very late if everyone turned up. Likewise with GPs, GPs also use missed appointments to catch on checking blood test results etc.

There's no way to stop people misusing A&E, but you can educate people to only save it for emergencies. A cold isn't an emergency. It might be "small costs" but every little bit counts. If clinics are overbooked and you cannot go to your appointment, it's only polite to reschedule it so someone else can have that appointment. My diabetes clinic was fully booked and I had to wait either someone to reschedule their appointment or to cancel their appointment or agree to a 2-3 month wait.

 

[ringi]

The problem is that policy maker claiming the A&E problems are due to people misusing A&E destruct from the reel issue of the "back door problems" with socal care etc leading to many people remaining in hospital for many weeks more then they should. This then results in no bed space, so people remain in A&E for a long time waiting for a bed. A lot of the A&E staff time is spend dealing with people who should have already been moved onto a ward. Also remember that "having the diabetes box ticked on the records" is related to people spending 2 days longer in hospital on average regardless of the reason they were admitted.

Yet most of the national costing data for A&E just devide the total cost of "walk in cases" by the number of "walk in cases" and then claims all the problems will be solved by removing the least demanding walk in cases.

 

[ringi]

https://www.england.nhs.uk/2019/01/missed-gp-appointments-costing-nhs-millions/
https://www.telegraph.co.uk/news/he...cessary-AandE-visits-costing-100m-a-year.html

This so all based on very misleading use of the data. For example it does not take into account that GPs often run late, and even when not running late they often use the time in a productive way if an appointment is missed. The A&E claimed cost is based on assuming all A&E visits take the same amount of staff time.

 

[ringi]

If clinics are overbooked and you cannot go to your appointment, it's only polite to reschedule it so someone else can have that appointment. My diabetes clinic was fully booked and I had to wait either someone to reschedule their appointment or to cancel their appointment or agree to a 2-3 month wait.

Making a case for people not to miss appointments and to only use the services they truely need is best done as you are doing by stating the effect it has on other users of the NHS.

(Experimenting with out of hours GPs at my local hospital A&E has not saved money, but at little cost it has improved healthcare. A new building is now being considered to move all out of hours GP services to the site, however it will reduce the income the hospital gets by much more then the reduction in A&E costs, hence increase financial problems of the hospital. )