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‘False economy’ as 200 frontline diabetes specialist nurses go in NHS cost-cutting

An audit by Diabetes UK has revealed over 200 diabetes specialist nurse (DSN) positions are unfilled – twice the figure reported in 2009.

The audit was based on responses from 385 trusts, foundations and PCTs, as the data is not collected centrally. We have launched 'Diabetes Watch' to ensure transparency over the levels of care and support for people affected by diabetes at a time of unprecedented change in the NHS.

False economy harms patient care

Barbara Young, Diabetes UK Chief Executive, described the shortfall as "a false economy which harms patient care and will increase costs to the NHS".

"We are very concerned that at a time when numbers of people with diabetes are increasing, there is a decrease in frontline diabetes specialist nurses. This will mean longer waiting times for specialist support, more unnecessary amputations, more people losing their sight and far poorer health outcomes. This is simply not acceptable.

DSNs play vital role in preventing complications

"DSNs are crucial in supporting independence and in helping people self-manage their diabetes more effectively. They play a vital role in preventing expensive complications, in supporting people with complex needs and, critically, in providing primary care teams with specialist expertise that reduces emergency hospital care.

“Diabetes costs the NHS £9bn a year and that can only increase as a result of these short-sighted and harmful actions”, said Young.

Investment in specialist services "the smart solution"

Dr Peter Carter, Chief Executive and General Secretary of the Royal College of Nursing, said, “It really is worrying that despite repeated warnings, NHS trusts are still making short-sighted decisions which risk leaving patients high and dry. Our own survey showed that more than one in ten specialist nurses may already be at risk of redundancy – something which we know would have a serious impact on patient care. Not only does this put patients at risk of needless complications, but by doing so it wastes money. The smart solution for trusts would be to keep investing in specialist services which can keep patients as well as possible and, above all, out of hospital."

Reductions in DSN staffing levels will compromise quality of care

June James, audit author and a diabetes consultant nurse, said, "There is a mass of evidence proving the clinical effectiveness of DSNs and their ability to reduce medication errors, the numbers of people needing admission to hospital, and length of hospital stays.

"Reductions in DSN staffing levels will continue to compromise the quality of care received by people with diabetes, complicated by associated health problems such as heart and kidney disease, or during pregnancy. Worryingly, even when DSNs are in post, they are being asked to cover shortfalls elsewhere. At a recent national meeting of around 100 hospital DSNs, I asked how many of those in attendance were being asked to work on general wards to help with staff shortages there, and nearly everyone put their hand up."

Clear evidence of the human and economic benefit

The National Diabetes Inpatient Audit found that people with diabetes account for 15 per cent of inpatients. According to a previous survey by Diabetes UK, the average diabetes patient reported a twofold increase in their ability to manage their condition before and after seeing a specialist nurse. Another study at Liverpool’s Aintree Hospital showed how an entirely nurse-led diabetes clinic can increase ‘good’ cholesterol levels as well as significantly reduce high blood pressure levels, a strong risk factor for heart disease – which accounts for around half of all deaths among people with diabetes.

Research presented at the Diabetes UK Annual Professional Conference in March 2011 shows the effectiveness and cost savings of diabetes specialist nursing input. An ongoing project run by Portsmouth Hospitals NHS Trust, enables a diabetes specialist team, including diabetic specialist nurses and a consultant, to provide proactive and reactive treatment to inpatients with diabetes. Data extrapolated from this project shows a reduced hospital stay of 1.4 days and the researchers calculated that in their 1,000-bed hospital, this equated to a potential cost saving of between £1.5 and £4.4 million a year, with staffing cost for this project to be around £170,000.

Poorly controlled diabetes can lead to short-term complications of low blood glucose (hypoglycaemia) and high blood glucose (hyperglycaemia), which, in extreme cases, can require urgent hospital treatment. Changing blood glucose levels over the long term can increase the risk of blindness, kidney failure, stroke, heart disease and amputation.

Diabetes UK: Stop cutting DSN posts to support short-sighted cost savings

Diabetes UK is calling on commissioners and NHS Trusts to stop cutting or freezing DSN posts to support short-sighted cost saving initiatives. The charity has written to Secretary of State for Health Andrew Lansley urging that the Department of Health questions Trusts who cut posts to ensure people with diabetes receive the highest quality care they deserve in the most cost effective way.

Read the full '2010 Diabetes Specialist Nursing Workforce Audit Report'.

Download Diabetes UK's letter to Secretary of State for Public Health, Andrew Lansley(PDF, 123KB).

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