Tackling variation in diabetes

Read the detailed report here.

Health services must be prepared to learn from the good practice of others if they are to improve diabetes care across the board, according to national leader Partha Kar.

Speaking to HSJ, Professor Kar, the national speciality advisor, diabetes, and co-lead of diabetes Getting it Right First Time (GIRFT) with NHS England and Improvement, warns that while integrated care systems (ICSs) have an opportunity to reduce variation and transform care for people with diabetes, there is a risk that “toxic localism” will get in the way.

“The biggest mystery in the NHS is that it says it is ‘national’ but not many people want to adopt best practice nationally,” he says. “It’s the biggest surprise. For example you have an amazing example of a pharmacist delivering amazing care – but then they go to another region and they say they don’t want pharmacists doing that, they want doctors – and they don’t have doctors, and they know that.”

The attitude of “I don’t want to do what others are doing” is a fundamental problem, says Professor Kar, who is also a consultant in diabetes and endocrinology in Plymouth. “That sort of localism in the NHS is very toxic, and stops a lot of good progress.”

Diabetes remains a major issue for health services. According to Diabetes UK, cases have doubled in the last 15 years, hitting an all-time high of around 4.9 million. By 2030, one in ten adults will be living with the condition.

“Diabetes is one of the fastest-growing health crises in the UK, and the NHS currently spends £10 billion each year on it,” says Diabetes UK policy manager Nikki Joule. “Diabetes is a serious, relentless condition that needs to be carefully managed to avoid potentially life-altering complications. However, with the right support and care, it is possible to live well with all types of diabetes.”

Diabetes UK is calling for ICSs to prioritise diabetes and to redouble efforts to ensure routine diabetes care is returned to pre-pandemic levels by the end of 2022. Ms Joule says it’s also vital that it remains a priority in NHSE’s long-term plan refresh. This is crucial not just for individuals with diabetes, but for health services and the economy more widely.

Every week diabetes leads to more than 190 amputations, 770 strokes, 590 heart attacks and more than 2,300 cases of heart failure, she adds. “Complications of diabetes can also lead to early death, with strokes and heart disease being the most common causes.” 

People with diabetes can lead long and healthy lives, says Ms Joule, but they need the right treatment and support. The pandemic has meant that many people have been denied this. “Early diagnosis and access to regular healthcare appointments are crucial in ensuring people have the support and tools they need to manage their condition effectively and reduce their risk of complications.” Many people living with diabetes haven’t had their routine health checks for more than two years, she adds, and ICSs need to address this urgently.

Professor Kar says there is no doubt that diabetes will be a priority for ICSs and that they will be focusing on tackling the backlog. But, for him, the real question is how they will go about tackling existing variation. Again, he stresses, that means being prepared to share and adopt best practice, such as making best use of the available workforce, focusing on prevention, and encouraging self-management.

“There’s a massive backlog to catch up on and that’s the worry right now,” he says. “But the two things that I would say are focus on self-management and learn from others – really genuinely say ‘look, these guys have done well, here are the outcomes’ and just do what they are doing.”

Read the detailed report here.