The most important issue in the upcoming general election is the NHS, according to the British public. Everyone’s talking about it, and everyone has an opinion on how it should be approached.[1] But the fact is, it’s a massively complicated issue. Even just diabetes, which is only one aspect of NHS management, is a head-scratcher.
But the public is concerned. We care about our care. And all the major parties have responded, devoting significant sections of their manifesto to healthcare. The Conservative party and the Liberal Democrats have said they will increase NHS funding by £8 billion[2] [3] (which is the figure requested by the head of NHS England, Simon Stevens), Labour by £2.5 billion[4], UKIP £3 billion[5], and the Green Party £12 billion.[6]
Diabetes – particularly type 2 diabetes – remains one of the biggest issues facing the NHS, costing £13.75 billion a year in 2012.[7] Unsurprisingly, all of the parties have in their manifestos discussed the prevention of obesity and improvements to public health. But amid all the rhetoric and promises it’s unclear – at least, at first – as to how the healthcare policies of each party will actually affect the treatment of diabetes.
Prevention
Central to the diabetes election rhetoric has been prevention – that is, encouraging lifestyle changes that would reduce the risk of type 2 diabetes in the first place. Amputations are avoidable, the idea goes. This is largely true – an emphasis on improving diets rather than treating complications as they arise would certainly save money and lead to fewer cases of type 2 diabetes, but sometimes this kind of thinking sounds a bit like a shrugging off of responsibility. Unless there are realistic prevention measures in the pipeline, it sounds like the patients are being blamed.
The Labour Party’s manifesto outlines the importance of prevention when it comes to treating type 2 diabetes:
To take one example, the substantial recent growth in obesity has begun to translate itself into increases in the levels of [type 2] diabetes. Unless firm action is taken to halt the rise in diabetes, the proportion of the NHS budget spent on treating the condition and its complications is likely to rise from approximately 10 per cent now to 17 per cent by 2035/36 – which is unsustainable. So improving public health will be an essential part of ensuring the NHS remains sustainable for the next generation.
Labour’s manifesto concedes that eating healthily isn’t easy, what with “families being bombarded with advertising for unhealthy foods,” and the companion “10-Year Plan for Health and Care” offers a few solutions. Labour plans to set limits on sugar, fat, and salt content in foods such as cereals, crisps, and soft drinks; to use a traffic-light system that ensures consumers have the information they need; and to have a crackdown on cheap alcohol.
The current government has introduced several diabetes prevention programmes. In March, it was announced that people throughout England who are at risk of developing type 2 diabetes will be provided with free cooking and exercise classes, as well as telephone and online support from trained professionals.
The Green Party aims to “[deal] with problems before they become acute” by increasing taxes on alcohol and cigarettes – both of which increase the likelihood of diabetic complications when indulged in excessively – and taxing less healthy foods. The money raised, according to the manifesto, will go towards subsidies for fresh fruits and vegetables.
The Liberal Democrats plan to prevent illness through the restriction of junk food marketing to children, encouraging the “traffic light” nutrition system on food packaging, and enforcing a minimum price per unit of alcohol.
The parties have, on the whole, been vague on the subject of how they will approach the prevention of obesity and type 2 diabetes. The intention is clearly there – and why wouldn’t it be; preventing diseases from occurring in the first place is a great way to save money – but not the specific plans.
Perhaps this is because it’s such a complex issue. It’s one thing to make junk food more expensive, but that doesn’t necessarily make up for a basic lack of education. Ultimately, poor diet is a social issue, a knock-on effect of basic inequalities and structural issues within society.[8] When these problems are addressed, we might see significant progress in the prevention of type 2 diabetes.
Understandably, most of the parties are focusing on the prevention of type 2 diabetes, rates of which are increasing almost uncontrollably. Regarding type 1 diabetes, little has been said. Nevertheless, the prevalence of type 1 diabetes is on the up, and a recent study suggested that more young people die in the UK from type 1 diabetes than in most of Europe. It is not an issue to be ignored.
Type 1 diabetes care is largely a social issue, according to most research. Studies reveal a “postcode lottery” in which the quality of care and education varies massively depending on where you live. If politicians want to improve type 1 diabetes care, then, they must address some issues in society.
Mental health
But diabetes isn’t just a physical problem. People with diabetes are twice as likely to experience depression, not to mention related mental health issues such as diabetes burnout.[9] Historically, mental health has been stigmatised[10], the emotional impact of diabetes neglected[11], but this attitude appears to be changing.
The Liberal Democrats, in particular, have stressed the significance of providing support for people with emotional problems, and their manifesto promises an extra £500 million to NHS-provided mental health support.
UKIP’s manifesto states an intention to “[offer] direct access to specialist mental health treatment for pregnant women and mothers of children under 12 months of age,” – good news for women who have struggled with diabetes during pregnancy – and “fighting the stigma around mental illness and supporting those seeking to get back into work.”
Labour offers “the same right to psychological therapies as they currently have to drugs and medical treatments. To help address the problem of undiagnosed mental illness, NHS staff training will include mental health.” There are also Labour plans to ensure that all children can access counselling at school – good news for kids with type 1 diabetes, for whom the emotional impact of diabetes can often be particularly stressful.
The Green Party manifesto – which describes mental health as the “crisis of our time” – places a great deal of emphasis on addressing mental health issues, promising that:
No one waits more than 28 days for access to talking therapies; everyone experiencing a mental health crisis, including children and young people, should have safe and speedy access to quality care, 24 hours a day, 7 days a week; a campaign to end the discrimination and stigma associated with mental health through supporting the Time for Change programme and offering employment support to those with mental health problems; support is available for all affected [by dementia]
The parties unanimously emphasise the need for greater support for people with dementia. This is good news for people with diabetes, who can experience dementia – Alzheimer’s disease in particular – as a diabetic complication.
Complex conditions
This article is supposed to explain how the different parties aim to address the issues of and relating to diabetes. It has already covered smoking, alcohol, mental health, exercise classes, and diet. Clearly, “diabetes care” encompasses a lot of different things, and the parties recognise this, hence their focus on “complex conditions”: those health issues that require multiple forms of treatment.
Diabetes is one of the most obvious examples of a complex condition – it can affect the entire body, from brain to eyes to kidneys. And increasingly, politicians are recognising that transitions between departments for people with complex conditions are incredibly clumsy, which is especially problematic in light of the increased numbers of complex conditions.
A lot of healthcare discussio, therefore, has centred on how these processes can be made smoother. With a change of approach, it is hoped that treatment can be holistic, so a person with diabetes who needs treatment for their eyes and for their heart will be able to get both more easily. The NHS, in its “Five Year Forward Pla,” describes this as:
breaking down “artificial boundaries between hospitals and primary care, between health and social care, between generalists and specialists…services fragmented, patients having to visit multiple professionals for multiple appointments, endlessly repeating their details because they use separate paper records.
The manifestos reflect a much-needed change in attitude, a recognition that the problem of diabetes – both type 1 and type 2 – cannot be properly addressed while the healthcare service remains so fragmented.
Nor can it be solved in one sweep. Diabetes affects and is affected by everything: marketing; lack of industry regulation; mental health; social inequality – the list goes on. And the major political parties, in the holistic attitudes to healthcare they promote, seem to realise it. It’s taken a long time – too long, really. But things look promising.
