While there has been progress in reducing the additional risk of death for people with diabetes and that of diabetes-related complications, a new report by the National Audit Office estimates there are still 22,000 people dying each year from related causes that could potentially be avoided.
Moreover, the report also concluded that the National Health Service, Department of Health and its arms-length-bodies have failed to secure any improvement in delivering key care processes recommended by the National Institute for Heath and Care Excellence, and achieving treatment standards, which are crucial to minimising the risk of future diabetes-related complications.
In 2012-13, only 60% of patients received all care processes (except eye screening), and just 36% managed to achieve all three treatment standards to control blood glucose, blood pressure and cholesterol levels. Less than 4% of newly diagnosed patients were recorded as attending structured education to improve their management of the disease.
“This has serious implications as people who are not getting their annual checks and are not being supported to reach their treatment targets are, as a result, put at increased risk of developing serious diabetes-related complications, such as amputation, heart disease, kidney failure and stroke,” noted Chris Askew, Diabetes UK’s Chief Executive. And aside from the human cost, the economic impact of mismanagement is huge, with the majority of the NHS’ annual £5.6 billion spend in England alone going on treating these complications.
Postcode lottery of care
Unsurprisingly, there was also significant variation across England in delivering key diabetes care processes, achieving treatment standards and improving outcomes. For one, the number of diabetics receiving all the whole care package (minus eye care) ranged from 30%-76% in 2012-13, while the additional risk of death (within a one-year follow-up period) ranged from 10% to 65%.
The findings have spurred the NAO to ask NHS England to set out how it intends to hold clinical commissioning groups to account for poor performance in delivering key care processes, the three treatment standards and longer-term outcomes. Other recommendations include filling in gaps in data (particularly at GP level), improving education, considering separate targets for different subsets of patients, and incentives for integrating diabetes care.
“This report must act as a wake-up call to the NHS and the government to take action,” said Askew. “With the NHS facing a huge funding shortfall and the number of people with Type II diabetes rapidly increasing, and in turn the number of diabetes-related complications rising, the NHS and the government must commit to improving diabetes healthcare as a priority now.”