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Improving diabetes services could reduce pressure on hospitals

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There are tens of thousands of people with diabetes a year who are not receiving the support they need to manage their condition from primary care or do not have sufficient access to specialist diabetes teams once they get to hospital, according to a new report that has called on the NHS to do more both to prevent diabetes-related hospital admissions and to make hospital stays shorter.

According to the new report, from a coalition of diabetes organisations, including Diabetes UK and the Association of British Clinical Diabetologists, there are more than 600,000 "excess bed days" a year in people with diabetes. The large regional variation strongly suggests that this can be reduced through improved coordination of care and support outside hospital.

Ongoing diabetes care and support

The report concludes that this variation in hospital admissions is likely to be due to the quality of ongoing diabetes care and support available in the community to help people prevent health complications that require emergency hospital admission. And once people with diabetes are in hospital, the evidence shows their stay is reduced if specialist teams are in place.

Strained NHS finances

The Joint British Diabetes Societies for Inpatient Care has called on commissioners to ensure people are getting access to well co-ordinated and quality care – including timely access to specialist foot care services to help prevent amputations – and for every hospital to have a specialist diabetes team in place to reduce length of stays. As well as being harmful to people's health, with the excess bed days already costing an estimated £573 million per year and the number of people with diabetes projected to rise, the issue is likely to put an increasing strain on NHS finances.

Recommendations

The report recommends that the NHS should ensure it is commissioning adequate diabetes inpatient specialist nurse numbers, as well as identifying and supporting individuals who are frequently re-admitted with diabetes specific emergencies and commissioning teams of foot specialists to help prevent amputation (as people with diabetes are 23 times more likely to have an amputation than the rest of the population).

Access to better-quality care

Dr Belinda Allan, Consultant Diabetologist at Hull and East Yorkshire Hospitals NHS Trust and one of the authors of the report, said, "The fact that people with diabetes are spending so much more time in hospital than people without the condition is a real concern, both in terms of their health and also because of the strain that this is putting on the NHS's finances.

"But the fact that the picture varies dramatically from area to area shows that this is a problem that is at least partly fixable. Particularly in areas with high numbers of excess bed days, the NHS needs to make it a priority to reduce hospital admissions in the first place through access to better-quality care outside hospital, and to ensure that hospitals make available the diabetes specialist care that can reduce the length of hospital stays appropriately."

Potential for real and rapid improvement

Professor Mike Sampson, from Norfolk and Norwich University Hospitals NHS Foundation Trust and a co-author, said, "This guidance document holds out the potential for real and rapid improvement in reducing emergency admission rates for people with diabetes.

"We know there are established ways of delivering services that work and which can be put in place relatively quickly. We now hope commissioners will take on board the evidence and grasp the opportunity to give people with diabetes a quality primary care service that offers them the best chance to manage their condition, without them having to resort to emergency visits to hospital that could have been avoided. We call on the NHS to implement the recommendations set out in the guidance document."

Structured education and care planning support

Barbara Young, Chief Executive of Diabetes UK, said, "The fact that people with diabetes are spending so much time in hospital is bad news for them because it means they are having serious health problems and it is bad news for the NHS because looking after people in hospital is extremely expensive. There has to be a better way.

"The solution is to be found in giving people the structured education and care planning support they need to be able to manage their condition and, when hospital admission is needed, ensuring hospitals have the specialist teams that can help people get better more quickly. This report is a clarion call to improve the care standards people with diabetes get, right from the moment they are diagnosed with the condition. It is also a reminder that it is unacceptable that we have a postcode lottery where one of the biggest predictors for how likely someone with diabetes is to end up in hospital is where they live."

Full report

Admissions avoidance and diabetes: guidance for clinical commissioning groups and clinical teamsis produced by 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).

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