The success of the Department of Health and the NHS in minimising the risk of diabetic complications has stalled, according to new research.
The report, compiled by the National Audit Office (NAO), did find that the risk of death from diabetes had successfully been lowered. However, very few patients are receiving important structured education that could prevent complications in the future.
In addition to these findings, the report identifies significant regional variations across England when it comes to key care delivery. Not for the first time, the report indicates the existence of a “postcode lottery” of diabetes care in England. The delivery of recommended care processes ranged from 76 per cent of diabetes patients in some clinical commissioning groups (CCGs) to 30 per cent in others. The extra risk of death from diabetes ranges from 10 per cent to 65 per cent.
Since the NAO last reported on the subject, there has been no change in the levels of diabetes specialist staff, although more hospital beds are occupied by people with diabetes than in 2010 – from 14.8 per cent to 15.7 per cent.
The NAO has expressed concern that the stall in care improvements could lead to worse health outcomes for people with diabetes.
“Our previous report of diabetes services showed that there was an improvement in delivering the nine key care processes that the NHS has identified as essential for diabetes patients,” said Amyas Morse, head of the National Audit Office.
“Data available since then shows that these improvements have been reflected in an uplift in long-term outcomes for these patients.
“However, the improvements in delivery of these key care processes have stalled, and this is likely to be reflected in a halt to outcomes improvement for diabetes patients.”
Meg Hillir MP, chair of the Public Accounts Committee, echoed the report’s concerns that diabetes care has not progressed since 2012, even though the government spends £5.6bn annually in England. Hillier observed that two-thirds of the government’s annual budget for diabetes is spent on largely preventable complications: “With proper education and support, many people with diabetes can manage their conditions themselves. Yet just 16 per cent of people who are diagnosed each year are recorded as being offered education about their condition, and fewer than four per cent are recorded as taking up this offer.
“Given [diabetes’] association with serious and potentially life-threatening complications and the lack of progress in improving patient care and support in some key areas, the Department of Health and NHS England still have much to do.”
Although stalling, the NHS is performing well on diabetes care, according to Professor Jonathan Valabhji, national clinical director for obesity and diabetes at NHS England. Valabhji said:
“Performance of the NHS in England on diabetes remains strong. People with diabetes are less likely than a few years ago to either die or develop heart failure. We are also seeing trends for lower rates of angina, heart attack, stroke, major amputation and kidney failure.
“This is with a backdrop of more and more people developing type 2 diabetes every year and constraints on funding.”

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