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Quality of healthcare for people with diabetes "a question of location"


The quality of healthcare that people with diabetes get is "a question of location", according to a new Diabetes UK report that has highlighted how a postcode lottery of diabetes healthcare in England is fuelling a "major health crisis".

TheState of the Nation report, published today (Tuesday), has highlighted huge regional variations in people's ability to access quality integrated diabetes care, from GP care to hospital treatment.

"Postcode lottery"

Examples of this postcode lottery include:

  • People with diabetes in the best-performing area are four times more likely to have the annual checks they need to manage their condition than in the worst performing area.
  • In the best performing area, 28 per cent of people with diabetes have their condition under control, which is defined as meeting targets for blood glucose, blood pressure and cholesterol. In the worst-performing areas, it is just 17 per cent.
  • In the best-performing areas, about half of people newly diagnosed with diabetes are offered structured education, but in many areas almost no one at all is offered structured education. This is despite the fact that structured education, together with giving people the support they need to manage their own condition, is seen as one of the most important ways of ensuring people access services and reduce their risk of complications.

Little overall improvement

As well as highlighting a wide variation in standards of care, the report also shows there has been little overall improvement. While there have been some successes – such as more people meeting the target level for blood pressure – in some aspects of care, things have got worse. This is despite the fact that diabetes accounts for about 10 per cent of the entire NHS budget, with around 80 per cent of this being spent on treating complications that could in many cases be prevented.

The report calls for the Government and NHS England to carry out a review into the reason for the large geographical variation and to put in place an action plan to improve healthcare for people living in the worst-performing areas. It also wants clinical commissioning groups (CCGs) in areas where performance is below average to take urgent action to bring standards up to the standards that already exist in the average (median) performing areas.

"Large numbers getting inadequate care"

Barbara Young, Chief Executive of Diabetes UK, said, "This report shows that while there have been improvements in some aspects of care, we have not seen the overall improvement that people with diabetes so badly need. But perhaps the most alarming aspect of this report is that it lays bare how, from what happens in GP surgeries to treatment in hospitals, the quality of diabetes healthcare people receive is a question of location. While some areas are delivering good care that is a credit to the NHS, in many areas large numbers of people are getting care that is inadequate.

Annual checks

"If somewhere like Tower Hamlets, which has significant health challenges, is able to give three quarters of people with diabetes the annual checks they need, why are there so many areas where less than half of people get these checks? And if people with diabetes go to hospital with a foot problem, why should their chances of having their foot amputated vary so dramatically depending on the hospital they are in?

"Many thousands of people have to endure appalling health problems, and in many cases die before their time, as a direct result of this postcode lottery of care. We know that healthcare professionals are already working hard to make a difference and we need all CCGs to take that opportunity.

"CCGs are new bodies and so cannot be blamed for this crisis. But they do have responsibility for fixing it. We want to see CCGs in poorly performing areas take urgent action to bring their performance up to the average.

A need for leadership

"The Government also has an important role to play in challenging those areas to get better. The Secretary of State has already spoken compellingly about the postcode lotteries that exist around important issues such as cancer survival and public health; we now need to see him show the same kind of leadership in tackling the inequality that exists around access to integrated diabetes healthcare.

"Getting the worst-performing areas to bring their performance up to the average should be eminently achievable. Because we are already spending a huge amount of money on treating complications that could often be prevented through better management of the condition, we do not need lots of lots of extra money to make things better. But it will only happen if those areas and the Government make diabetes a much higher priority. After a year of significant turmoil, let's make 2014 the year when everyone with diabetes finally start getting the standards of healthcare they deserve."

Takeda UK Ltd has financially supported the production of the State of the Nation report; it has had no input into its development or content.

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