There are four million people living with diabetes in the UK today, and someone is diagnosed on average every two minutes. The NHS spends about £10 billion on diabetes every year – 10% of its budget – and 80% of those costs are spent on avoidable complications.
So this is a major issue for the future of our health service – but of course it is even more serious for the individuals involved. One in five hospital admissions for heart failure, heart attack and stroke are in people with diabetes, and the condition leads to over 135 amputations a week, as well as being the leading cause of preventable sight loss in people of working age, and the single most common cause of kidney failure. Even worse, every year over 24,000 people die prematurely due to diabetes and its complications.
That is why I instigated a Commons debate earlier this week, calling on the government to take action for the sake of both those people and the future of our NHS as well.
Firstly, they could step in to reduce avoidable amputations. There are over 7,000 diabetes-related amputations every year in England, and foot ulcers and amputations cost £1 in every £150 spent in the NHS. In 2013, Health Secretary Jeremy Hunt committed to reducing the rate of diabetes-related amputations by 50% over five years. But the rate has remained steady since.
There is action that could be taken to keep their promises, however, if the government ensured that clinical guidance is properly implemented and followed.
NICE recommends all people with diabetes have their feet checked every year, but in the worst performing Clinical Commissioning Groups, one in four people still aren’t receiving their annual foot check.
Those at increased risk of foot problems should be referred for assessment by a foot protection service. Having multidisciplinary foot care teams in place can reduce risk of amputation but almost one third of hospital sites do not have a multi-disciplinary foot care team.
This is of particular significance to me because along with my colleague Liz McInnes MP, I recently visited King’s College Hospital Diabetic Foot Clinic, which provides some of the best diabetic foot care in the country. The care being provided at King’s, however, is not universal. It is time that ministers stepped in to ensure that such teams operate more widely, and that all CCGs follow the guidance.
There is a similar need to improve in-patient care. One in six people in hospital now has diabetes, but one in three hospitals has no diabetes specialist nurse and an unacceptable number of inpatients experience diabetes-related harm whilst in hospital.
Diabetes UK have pointed to evidence showing that specialist diabetes inpatient teams save three times what they cost to the NHS to provide. They make fewer prescribing errors and deliver better outcomes, so there are fewer complications in hospital and a shorter stay. But although most hospitals report increasing referrals and patient contacts, there has been no increase in diabetes specialists and 1 in 10 hospital sites did not have any consultant time for diabetes inpatient care at all. These figures simply have to improve.
It also makes sense both clinically and financially to improve access to diabetes self-management education. Managing diabetes well is time consuming and can be complicated, but 69% of diabetics say they don’t fully understand their condition.
On average, people with diabetes only spend three hours a year with a healthcare professional. For the remaining 8,757 hours they manage their diabetes themselves, for which they need the right skills and knowledge, not to mention the confidence.
Diabetes self-management courses empower people with diabetes to take charge of their own care. Nine out ten (89%) of people with diabetes who attended a course felt more confident about managing their diabetes afterwards.
Evidence collated by Diabetes UK shows that diabetes educations courses reduce individuals’ risk of developing serious and costly complications and are cost effective.
But over a third of CCGs do not currently commission specific courses and less than 2% of people newly diagnosed with Type 1 diabetes, and just 5.9% with Type 2, attend a diabetes education courses.
Investing in diabetes education is the big missed opportunity in diabetes care.
Finally, I believe we must tackle the variations in the care and support received by people living with diabetes. The postcode lottery is exacerbated by additional differences according to age and type of diabetes.
People with Type 1 diabetes, and of working age are receiving considerably worse routine care than other people with diabetes.
Because of this variation, far too many people are experiencing complications that have a huge impact on their health and quality of life and which are incredibly costly to the NHS.
The universal provision of healthcare is one of the founding principles of our NHS, and we have warned of the impact of wider government policies on this.
As a former NHS worker and a member of the Health Select Committee, I see this as a critical issue for the future of our health service as a whole, as well of course for the many thousands of my constituents, and millions across the country, who live with diabetes.
On this issue, we can help save lives and limbs as well helping to save our NHS, and it’s about time we got on with it.
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