State of the Nation 2013 (December 2013)

Last year our State of the Nation report highlighted a major health crisis. More and more people were living with or at risk of Type 1 and Type 2 diabetes. Growing numbers of them were experiencing devastating complications, but the NHS still struggled to deliver the care and education people with diabetes need to manage their condition.

This year’s report shows that diabetes continues to be a major challenge for the NHS. It is still a huge drain on resources, quality of care still depends on where you live, and the crisis is still not being taken seriously. The key problems we highlighted last year remain, and these will only worsen as the numbers involved increase.

Almost a quarter of a million people were diagnosed with diabetes last year; couple these with our estimates for undiagnosed diabetes and that means a massive 7.4 per cent of England’s population live with the condition.

The quality of diabetes care across the country is still patchy and risks making the already unacceptable ‘postcode lottery’ in standards of prevention and care worse.

Looking at the standards for diabetes care recommended by NICE, people who live in the best-performing Clinical Commissioning Group (CCG) area are four times more likely to be given eight of the vital health checks recommended by NICE as compared to people living in the worst-performing area.

Diabetes education, care planning and support for self management are vital to improving people’s day-to-day control. But only 4.2 per cent of all people with diabetes are being offered education.

The challenge is not funding. Diabetes care already takes up 10 per cent of NHS spending – much of it on treating complications. This money would be better spent on delivering higher-quality standards of care to help prevent complications in the first place.

We know what needs to happen:

  • more focus on ensuring people know about diabetes and its serious consequences
  • more effective programmes of risk assessment and early diagnosis
  • provision and promotion of effective self-management support for people living with diabetes
  • delivery of better care, meeting NICE-recommended essential standards
  • integrated care planned around the needs of the individual and underpinned by multidisciplinary local diabetes networks to co-ordinate timely access to specialist care
  • effective promotion of lifestyle change for those at risk of developing the condition.

There have been some improvements. Blood pressure outcomes have improved, there have been real changes in the focus placed on foot care services, and more hospitals report access to multidisciplinary specialist foot care teams. This is really good news.

Our State of the Nation report gives clear evidence that some areas are performing better than others, and that in many CCG patches there is considerable room for improvement. Some areas can and do deliver diabetes care well. Others can too.