Prime Minister and the Libre

Other CGM are not yet at a low enough cost, and until DVLA approves a libre like system the NHS can't save the cost of test strips.

Remote reporting of CGM data needs the NHS to have a setup that provides REAL support and training given by people who understand diabetes and carbs. This clearly should be done, and then CGM is likely to become a very cost effective. But without solving the training and support problems I expect that CGM will remain a useful tool for the few.

I would like an easy way for people to include photos of all food/drink with their CGM data, but the NHS can't require people to have smartphones.....

Let's remember that per year the libre costs the NHS about the same as half a day of nurse time, so if the money was spent on support/training would it get a better result?

dbr10 said:

I'm surprised the we can't afford it mantra took hold so easily. Government is using Austerity as the excuse for reducing the size if the State as a proportion of GDP. There was never any economic basis for it. It was a political choice to hurt the poor. A growing economy reduces deficits; a slowing economy increases them. The recent increase to NHS funding in the budget was a sticking plaster. Social care continues to be cut.

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I don't think it just an excuse, this has been happening for years. Even twenty years ago my GP at the time, having diagnosed a leg infection (caused by a mosquito bite) told me that it was cheaper to give me oral antibiotics, rather than hospitalise me and give me IV antibiotics. Six months later and my lower legs look awful because of the damage done. Maybe a problem I could have avoided if I'd gone the IV route.

As for increasing NHS funding, that's happened every year for decades and it used to be much more in line with demand, that is not the case now.

As for social care being cut, are you sure? My mother had to use her savings to pay for her care and her weekly bill was substantially more than those who were not paying for themselves (we inadvertently received the wrong invoice). Therefore was she subsidising some of the others. I'm hoping that social care coming under government auspices will improve things because it seems unfair that the care of the elderly is a local cost, especially when retired people move to certain parts of the country. Even in High Wycombe there is a large number of retirement homes/complexes being built, I hope that doesn't increase my council tax when they need more care.

http://content.digital.nhs.uk/article/5261/Spending-on-adult-social-care-statistics-published for more info. It's a big subject and it needs discussing sensibly and without anybody in government fudging, like I get the impression they do now. There must be a degree course in "Being economic with the truth", probably called "politics".

ringi said:

Let's remember that per year the libre costs the NHS about the same as half a day of nurse time, so if the money was spent on support/training would it get a better result?

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Yup. And cost is often confused with price. So I saw the Libre starter kit was £150, so that's Abbott's RRP. If the NHS was purchasing them in bulk, the price of Libre kits and sensors could come down. Or so could the cost of other CGMs, especially if the NHS uses it's purchasing power wisely.

But that's all back to making a compelling business case. On the cost side, there's the procurement, training and support. On the benefit, potentially less resources needed for management, or more efficient management. I had my first review yesterday, which was 30mins of my GP's time to basically tell me I'm managing my T2 well. If they had the data, that could just be a letter saying it's all good, keep it up. Then there's the bigger savings from people who aren't managing as well. I really want to keep my foot and eyesight. If I lose those, that'll cost the NHS a lot of money, not to mention the personal cost to me.

first14808 said:

I guess it might if it's made into an issue.

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Apologies for my negativity, I think I've probably lost faith in the system all together. It always seems to me that the most cost effective, most sensible idea is rarely pursued.

It seems to me that the obvious savings in things like test strips, medical complications as a result of poor BG controlled aren't considered because they're in a different budget, within the overall NHS budget.

DavidGrahamJones said:

It seems to me that the obvious savings in things like test strips,

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Most people don't use enough test strips for there to be savings until there is at least a CGM with libre like pricing that is approved by the DVLA.

Most people also don't use the data they already have, so it is hard to say there will be fewer complications if they are given more data.....

DavidGrahamJones said:

Apologies for my negativity, I think I've probably lost faith in the system all together. It always seems to me that the most cost effective, most sensible idea is rarely pursued.

It seems to me that the obvious savings in things like test strips, medical complications as a result of poor BG controlled aren't considered because they're in a different budget, within the overall NHS budget.

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I try to stay positive, but then again, I've also done a bit of public sector consulting & contracting, so tinged with cynicism. Usually that's because there's a huge gulf between the people doing the procurement, and the people who'll end up using the services.. Which also probably explains why a lot of public sector procurements don't end well. There's a distinct lack of joined up thinking.

The frustrating part is a lot of the 'problems' seem obvious, and something statisticians and actuarial types could quantify. So cost of current diabetes (and potentially obesity) management vs cost savings by having some better tools to manage and minimise those costs.

But until the "fat is bad" belief is removed from HCP's mind, and hence the public start to see carbs and not fat as the primary issue for obesity and Type2, giving people better tools will not do much good!

ringi said:

But until the "fat is bad" belief is removed from HCP's mind, and hence the public start to see carbs and not fat as the primary issue for obesity and Type2, giving people better tools will not do much good!

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Yup. We know excessive carb consumption can lead to both diabetes and obesity, and obesity may be a symptom of diabetes rather than cause. In an ideal world, we'd have evidence-based policy, and CGMs being data collectors would provide evidence. Then it's just a simple political decision to set policy based on that evidence.

Except of course we don't live in an ideal world and there's a very large lobby that makes a lot of money from flogging us unhealthy things, because they don't pick up the bill for any 'lifestyle' issues from the products they promote. And having deep pockets, are quite happy to sponsor favorable research to counter any changes.

ringi said:

But until the "fat is bad" belief is removed from HCP's mind, and hence the public start to see carbs and not fat as the primary issue for obesity and Type2, giving people better tools will not do much good!

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I can't blame the public for it's beliefs, it's been drummed into them for so many years. It will need a dramatic news story to sway the nation and then another tens years for the manufacturers to catch up with what's going on, if at all.

The PM and the cost? She gets a salary of apprx 140,000 a year

DavidGrahamJones said:

I don't think it just an excuse, this has been happening for years. Even twenty years ago my GP at the time, having diagnosed a leg infection (caused by a mosquito bite) told me that it was cheaper to give me oral antibiotics, rather than hospitalise me and give me IV antibiotics. Six months later and my lower legs look awful because of the damage done. Maybe a problem I could have avoided if I'd gone the IV route.

As for increasing NHS funding, that's happened every year for decades and it used to be much more in line with demand, that is not the case now.

As for social care being cut, are you sure? My mother had to use her savings to pay for her care and her weekly bill was substantially more than those who were not paying for themselves (we inadvertently received the wrong invoice). Therefore was she subsidising some of the others. I'm hoping that social care coming under government auspices will improve things because it seems unfair that the care of the elderly is a local cost, especially when retired people move to certain parts of the country. Even in High Wycombe there is a large number of retirement homes/complexes being built, I hope that doesn't increase my council tax when they need more care.

http://content.digital.nhs.uk/article/5261/Spending-on-adult-social-care-statistics-published for more info. It's a big subject and it needs discussing sensibly and without anybody in government fudging, like I get the impression they do now. There must be a degree course in "Being economic with the truth", probably called "politics".

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It's certainly the case that people who fund themselves privately pay considerably more than the cost to local authorities when they pick up the bill. In Shropshire local authority social care teams for the elderly were disbanded and my own father had care paid for by the hospital. I don't know whether that came out of the hospital budget or not.
I'll have to read that on a bigger screen

first14808 said:

Yup. And cost is often confused with price. So I saw the Libre starter kit was £150, so that's Abbott's RRP. If the NHS was purchasing them in bulk, the price of Libre kits and sensors could come down. Or so could the cost of other CGMs, especially if the NHS uses it's purchasing power wisely.

But that's all back to making a compelling business case. On the cost side, there's the procurement, training and support. On the benefit, potentially less resources needed for management, or more efficient management. I had my first review yesterday, which was 30mins of my GP's time to basically tell me I'm managing my T2 well. If they had the data, that could just be a letter saying it's all good, keep it up. Then there's the bigger savings from people who aren't managing as well. I really want to keep my foot and eyesight. If I lose those, that'll cost the NHS a lot of money, not to mention the personal cost to me.

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Totally agree.

videoman said:

The PM and the cost? She gets a salary of apprx 140,000 a year

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Yes but the real issue is, clinical need. It does not matter to me whether someone can afford to self fund or not. A wealthy person would have aleady contributed more in taxes to fund the NHS.
It became popular after the 2010 election, even with people who should have know better, to argue that we just cannot afford universal benefits, and that these must be restricted to those who really need them. The truth is that wealthier people pay out the money in taxes with one hand and get it back as benefits with the other. It is just a transfer payment. Plus there is no administration waste in means testing.

Jo_the_boat said:

http://www.dailymail.co.uk/news/article-5242733/Diabetics-denied-access-life-changing-monitor.html

"A Department of Health spokesman said the device is ‘available for prescribing’, and that guidance has been issued, ‘suggesting a careful start to its use and data collection to better understand the benefits’."

In other words Gps, don't use up your budget.
Is it fair to say that the PM is a good role model for T1s leading a full, busy life? (whatever you think of her politics.)
There's also a comment at the bottom that says refills work out at a fiver per day?? Sounds a lot.

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Most of type 1 diabetics are good role models i was diagnosed age 13 50 years ago with no complications at all to date i go to the gym twice a day 6 days per week weight training nothing better for you helps watch what you eat etc

Am I the only one here who does not know what a Libre is. I know it is for testing blood but how is it different to a normal meter and how is it helpful

edited for a typo

Continuous glucose monitoring device - a sensor attaches to the arm and constantly reads the glucose level in interstitial ( sp?) tissue which is similar to blood level but with a delay between the two Much more expensive (£100 per month if self funding) and variable reliability but invaluable info re trends ets, particularly ( but not only) when its working well

Let's get this right most MP's have private medical care and the Tories are made up of wealthy people so for them to get the treatment they need is not a worry. Mrs May tried to move Mr Hunt but he threw his toys out of the pram and got to keep his job and is now in charge of social care, so who is running the country? For the past 15 years we have been building new hospitals with less beds than the old hospitals, why are we doing this when people are living longer, a natural growth in birth rates and we are letting in migrants in as well. So we need more beds, doctors, nurses and HCA in hospitals and more social care for them who need it so what are the government doing, nothing no long term plan or even short term plan. When the government puts figure out about the NHS the people on the front line say the figures are not right so who do we trust Mrs May and Mr Hunt or the people who are there dealing with the problems. I have had two problems when i have been in hospital in the past year, one was when i went in with the novo virus the doctor gave me some medication which he had been told by the people who run the hospital not to give as it was too expensive and the other thing was i needed to go in for a infusion overnight, when i got to the ward there was no bed so they put me in the treatment room and i was there for 12 hours so i went to see the transplant team and told them what had been happening by the time i walked back to the ward a bed was free. I fear for the NHS and feel sorry for the doctors and nurses who are fighting to help people but with no reward, yet MP's can give themselves a pay rise. Diabetes takes up over 10% of the health budget which you would think they would be trying to find out a better plan to cut the costs but we have a diabetic PM who has done nothing for diabetics. With Mr Hunt intent on bringing down the health service i am more than surprised that someone has not tried to do something to get him out of power. Would we be better with Labour in power i don't no but it cannot get any worse and when there is picture in the papers showing people on waiting in ambulances and PM still says everything is fine. All MP's should have to answer a question yes or no and not what they do now of telling a story for 5 mins with no answer, we may as well get some random people off the street and let them have a go at running the country. We laughed in this country when Mr Trump got elected but they are trying everything to get him out, yet we have the muppets running our country and are doing nothing.

I just want to point out that many of these "migrants" we are "letting in" are the ones working in the NHS as your nurses, doctors and porters.

Pinkorchid said:

Am I the only one here who does not know what a Libre is. I know it is for testing blood but how is it different to a normal meter and how is it helpful

edited for a typo

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CGM device.

BunsenHoneydew said:

I just want to point out that many of these "migrants" we are "letting in" are the ones working in the NHS as your nurses, doctors and porters.

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Exactly so. EU migrants who work here make a net contribution to the economy. The country would be poorer without them. The problem has been that their taxes were not spent on schools and the NHS.
Now the numbers deciding to leave the NHS will make staff shortages even worse.