Thank you very much for this. I've read some of the earlier posts about advantages and disadvantages. But what I find really annoying is the postcode lottery element, when some (a lot) of us are denied even the chance to try a pump, in my case after nearly 43 years of injections. Just basing the decision on predicted HbA1 is so one dimensional and short sighted. I'm wondering if there's some way of getting a petition going, or similar, to expose those responsible for making these decisions.
I once heard a former UK Secretary of State for Health (who was a qualified doctor) say that healthcare in the United Kingdom has
always been rationed.
By extension, healthcare in the UK - particularly since the Health and Social Care Act 2012 (known more familiarly as the Lansley Reforms) - has always been a postcode lottery. This is in large part because local health authorities in England are required by law to balance their budgets each year so they don't spend more money than they have income coming in.
That leads inevitably to different decisions being made by different local health authorities about what they can and cannot afford to provide their patients with during the course of a financial year.
It shouldn't be this way. The NHS so called "
10 year forward plan" announced on 3 July 2025 does
not propose to change the requirement of local health authorities to balance their budgets each year,
nor to give local health authorities "multi-year funding" arrangements. In my opinion a multi-year funding arrangement would ease the pressures to ration care.
By contrast, the current government committed in their manifesto before the 4 July 2024 general election that they wanted to give local councils a multi-year central government funding arrangement, which makes budgeting for local councils significantly easier (although the current government has yet to make good on that pledge to local councils).
The above is generally what I believe is the main problem with healthcare in this country.
Turning specifically to the criteria issued by NICE in the rollout in England of hybrid closed loops and the timeframe, NICE have given local health authorities five years, i.e. until the end of the NHS's financial year (31 March) in 2029, to give everyone who meets the eligibility criteria set out in the NICE
technical appraisal document 943, the hybrid closed loop they are eligible for.
Unfortunately the eligibility criteria are strict, so if you are not a Type 1 diabetic and not:
1. Under the age of 18;
or
2. Pregnant, or planning to become pregnant,
or
3. 18 or older with a HbA1c of 58mmol/l (or 7.5%) or more,
or you do
not have
disabling hypoglycemia (which I understand to mean frequent or unwarned episodes of hypoglycemia causing constant anxiety),
AND despite the best possible management to date with at least
either an insulin pump,
or a continuous glucose monitor,
or a flash glucose monitor
then one's local health authority is entitled to refuse to fund a hybrid closed loop.
Anecdotal evidence suggests that in a number of local health authorities it doesn't even matter if you are Type 1 and have complications which might be improved or stabilised if you were to be put on a hybrid closed loop - even when consultants in other specialities dealing with diabetes complications are supportive of your being put on a hybrid closed loop.
When NICE approved and published
TA943 in December 2023, I think the newspapers suggested that up to 100,000 Type 1 diabetics might meet the current criteria between 1 April 2024 and 31 March 2029.
I understand that even the current NHS England Diabetes Technology Lead, who was instrumental in getting
NICE TA943 implemented, would like the current rather strict hybrid closed loop eligibility criteria relaxed. My understanding is that clinical trials/studies are happening in the background to achieve that.
Of course, you can get a petition going and/or write to your MP. I even understand that it may be possible to have your diabetes care transferred to another hospital, or to seek and pay for privately a private consultation with a diabetes consultant who may be prepared to state in writing that they disagree with your current consultant about whether you meet the current eligibility criteria.
For now at least, the narrow eligibility criteria in
NICE TA943 are what they are.
With a government that is now far more focused on spending much more on defence, and bearing in mind that spending on diabetes is I understand already 10% of the entire National Health Service budget, I'm not sure how persuasive a petition would be at this moment in time.