Admissions avoidance and diabetes: guidance for clinical commissioning groups and clinical teams (December 2013)

The NHS faces a relentless and unsustainable rise in emergency hospital admissions, and reversing this trend is an absolute priority for the NHS. However, only a minority of primary care trusts (PCTs) in England managed to reduce overall emergency admissions, despite the intense focus on this area by commissioners and health care planners. This problem has had a substantial impact on elective capacity and waiting times, is an issue in across all UK nations, and is of increasing importance in the context of A&E pressures and out of hours (OOH) care.

We now know from the National Diabetes Inpatient Audit (NaDIA) that about 1 in 6 hospital beds in England are occupied by someone with diabetes and health economic analysis suggests diabetes admissions in England alone accounted for 607,581 excess bed days (compared to the equivalent population without diabetes), at a total estimated excess tariff expenditure of £573 million in one year. This is due to increased admission (and readmission) rates, a prolonged length of stay once admitted, disease specific admissions, and a bias against day case surgery in the diabetes population.

We also know there is substantial variability between clinical commissioning groups (CCGs) and Acute Trusts in diabetes admission rates. There is strong evidence for models that reduce variability and overall admission rates, but which are often not commissioned, or are not available. This makes diabetes a priority for commissioning attention, with the potential for real and rapid improvement in admission rates from the UK diabetes population of more than 3 million.

This document has been produced by the Joint British Diabetes Societies for Inpatient Care (JBDS – IP) on behalf of Diabetes UK, the Association of British Clinical Diabetologists (ABCD), and the Diabetes Inpatient Specialist Nurse (DISN) UK Group, in collaboration with NHS Diabetes, and the Primary Care Diabetes Society (PCDS).

This document is not a clinical guideline, but a summary document for health care planners and commissioners in the UK which complements the recent Best Practice for Commissioning Diabetes Services.

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