As we near the publication of the landmark NICE appraisal we're calling on the Department of Health and Social Care to support NHS England with funding to ensure it is fairly and equally available.
We’re at a hugely exciting and pivotal time for diabetes technology, with the NICE appraisal of the most advanced diabetes tech commercially available - hybrid closed-loop for people with type 1 diabetes - set to conclude by the end of the year.
This appraisal will make recommendations about who in England and Wales should have access to this life-changing technology, and there is also a process for the guidance to be formally adopted in Northern Ireland.
The situation in Scotland is slightly different, but the Scotland Health Technologies Group already published guidance on this last year which is being supported by investment from the Scottish government to accelerate its distribution.
Hybrid closed-loop works by connecting compatible insulin pumps and continuous glucose monitors (CGM) with a computer algorithm that can calculate most adjustments automatically – though manual inputs are still needed to account for things like meals and exercise - and has been shown to help people with type 1 greatly improve both their diabetes management and quality of life.
Key questions still to be answered
At the moment, we know who with type 1 diabetes may be recommended hybrid closed-loop as an option to help them manage under the upcoming guidance, and have seen initial proposals on how NHS England plan to offer the technology to eligible people over the next few years as part of the NICE appraisal – but there are some key questions still to be answered.
Firstly, NHS Supply Chain are currently negotiating with the companies who make the available hybrid closed-loop systems.
This is being done with the aim of agreeing a price for the systems that meets the threshold for cost-effectiveness set by NICE and creates a framework that allows all local systems across the country to procure the devices in a clear and consistent way.
Secondly, but also of key importance, is how the implementation plan will be supported with resources.
Funding is needed not just for the hybrid closed-loop systems themselves, but the wider support package needed to make sure that people who use them are properly supported. This tech is the next stage on from insulin pumps and CGMs, and there are areas in the country currently who are not as experienced in initiating insulin pumps as others, due to the specialist support required. It will take time to train and recruit staff with the specialist skills needed to optimise its use.
Though there is a legal requirement for the recommendations of NICE technical appraisals like this to be followed by the NHS, there isn’t any additional funding that comes with the guidance, which can impact how effectively it can be followed in practice.
For example, we have previously seen that despite a NICE appraisal for insulin pumps published in 2008, which would make around 40% of people with type 1 diabetes currently eligible, far fewer people actually use pumps, with major variations depending on where you are in the country.
Making our ambitions a reality
It is vital that we mitigate the risks of this happening again, and that is why we are making a call to the Secretary of State for Health and Social Care, Steve Barclay, as part of our Tech Can’t Wait campaign urging him to commit to funding the implementation of this tech.
We want to show how much of a difference hybrid closed-loop can make to the type 1 diabetes community, and how significant the funding will be in driving progress and making this country a world leader in widely offering this ground-breaking technology.
It is also essential to avoid creating the unfair and unequal levels of access we’ve seen in the past with other types of diabetes technology.
Although there are other factors at play and some eligible people may not be able to get access to hybrid closed-loop straight-away under the proposed implementation plan, this is an incredible chance to get this right and make a difference to hundreds of thousands of people with type 1 diabetes lives.
Decades of research have gone into developing closed-loop tech and a great deal of time and effort has put in over the past few years to get us to this stage in the NICE appraisal.
Now is the time to ensure that all that hard work behind the scenes is backed by funding that can make the massive potential benefits of hybrid closed-loop a reality.