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Urgent action needed to support diabetes services

Our Head of Policy, Campaigns and Mobilisation, Helen Kirrane, sets out why we are calling on government and local health system leaders to urgently improve outcomes for people living with diabetes and support health professionals working on the frontline. 

We are calling on the UK government and Integrated Care Board (ICB) leaders to put diabetes at the heart of their plans to improve health outcomes and address inequalities. On Wednesday we reported that 1.9 million people living with diabetes in England are still missing out on vital care, with the sobering consequences becoming clear.

The impact of the coronavirus (Covid-19) pandemic continues to be felt across the NHS. While health professionals on the frontline work tirelessly to do the best for those coming through their doors, services are struggling to cope with the backlog, alongside unprecedented demand and workforce shortages.

Fewer than half (47%) of people living with diabetes in England received their eight NICE recommended care processes in 2021-22. And this masks wide variation that exists when we look at the data at a more local level, with only 25% of people with diabetes receiving all eight care processes in the lowest performing ICB compared to 62% in the highest performing area.

In our recent survey of over 11,000 people living with diabetes, almost half of respondents told us they experienced difficulties managing their condition in 2022, with the most commonly reported cause being access to their diabetes healthcare teams. Healthcare professionals have also told us how challenging the current climate is for them.

"Many staff currently feel that they are not providing the care they wish to wish the pandemic recovery pressures. The burden to the individual and NHS of night getting this right is huge." Diabetes Clinical Lead.

The serious consequences of the last three years of disrupted access to routine diabetes care are indicated through a shocking increase in excess diabetes deaths. In 2022 there were more than 7,000 excess deaths involving diabetes in England, 13% more than expected and the majority of these were not attributable directly to coronavirus. Worryingly, the situation has worsened in the first part of 2023, with 1,461 excess deaths between January and March, three times as high as the same period in 2022.

Studies have shown the association between increased mortality during the pandemic and missed diabetes care processes. And NHS England has acknowledged this worrying link between disruption to routine and emergency care and significant increased demand and mortality and called on ICBs to increase their focus on secondary prevention.

“Non-Covid related excess mortality over the past year was primarily driven by cardiovascular disease (CVD), liver disease and diabetes, and the sustained period of high urgent and emergency care (UEC) demand is understood to be driven primarily by respiratory disease and CVD of which diabetes is a major risk factor.” NHS England Board paper, December 2022

This is why we are calling on the UK government to ensure there is a strong focus on diabetes in their forthcoming Major Conditions Strategy, including plans to tackle the backlog in diabetes care, reduce health inequalities and provide more support to help people prevent type 2 diabetes.

We are also calling on ICBs to commit to providing the support needed for primary care and diabetes teams to urgently address the diabetes backlog and inequalities in access to care in their Joint Forward Plans which are being finalised in the coming weeks. They should also ensure type 2 diabetes prevention is firmly embedded in these plans.

Collaborative and ambitious action between the government, NHS England and ICBs is needed without delay. Failure to act will only lead to more devastating and complex consequences down the line.  

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