Memorandum submitted by Diabetes UK (CP
5)
Diabetes UK is one of Europe's largest patient
organisations. Our mission is to improve the lives of people with
diabetes and to work towards a future without diabetes through
care, research and campaigning. With a membership of over 170,000,
including over 6,000 health care professionals, Diabetes UK is
an active and representative voice of people living with diabetes
in the UK.
FACTS ABOUT
DIABETES
— There are two million people with
diabetes in the UK, equivalent to 3% of the population.
— Diabetes is set to increase. It is
predicted that diabetes prevalence will double world-wide, rising
to at least 5% by 2010, accounting for 3.07 million people in
the UK. [7]
— Diabetes affects the young and old,
and has particularly poor outcomes in those of lower socio-economic
status and in those from black and minority ethnic groups.[8],[9]
— Evidence is available supporting
the need for improved education of people with diabetes and their
carers if better control and improved outcomes are to be achieved.[10],[11]
,[12]
— Diabetes, if undetected or not well
managed, can lead to many complications and have a devastating
impact on quality of life.
INTRODUCTION
The NHS makes charges for certain treatments,
for example prescriptions, dentistry and optical services and
for certain amenities for example TV and telephone use and for
care parking at some hospitals. These charges (sometimes known
as co-payments) have not been systematically or thoroughly examined
for many years. Their rationale is unclear. Patients are often
unaware of the rules surrounding charges and of exemptions. Accordingly
the Health Committee has decided to undertake an inquiry into
the subject with the following terms of reference:
Treatments, including prescriptions, dentistry
and optical services; and
Hospital services (such as telephone and TV use
and car parking)
are equitable and appropriate?
— What is the optimal level of charges?
— Whether the system of charges is
sufficiently transparent?
— What criteria should determine who
should pay and who should be exempt?
— How should relevant patients be made
more aware of their eligibility for exemption from charges?
— Whether charges should be abolished?
Whether charges for:
Treatments, including prescriptions, dentistry
and optical services; and hospital services (such as telephone
and TV use and car parking) are equitable and appropriate?
— Many people with diabetes have informed
us that they have had problems getting access to blood glucose
testing strips on prescription. Some PCTs and GPs have tried to
limit the number of blood glucose testing strips that are given
on prescription in order to save money. The National Institute
for Clinical Excellence (NICE) has issued guidelines for Type
2 diabetes and the management of blood glucose[13].
The recommendations state that: "Self-monitoring can be used
in conjunction with appropriate therapy as part of integrated
self-care". The guidelines focus on the use of HbA1c for
giving healthcare professionals and people with diabetes a good
picture of overall control and for that control to be stable.
It is difficult, however, to make recommendations and take action
on treatment adjustment, without at least some home monitoring.
To use the guideline as a basis to restrict access to home monitoring
is a misinterpretation of the guideline and was not the intention
of the Guideline Development Group and it is both inequitable
and inappropriate.
— Diabetes UK believes that people
with diabetes should have access to home blood glucose monitoring
based on individual clinical need, informed consent and not on
ability to pay. Home monitoring is essential in the context of
diabetes education for self-management in order to enable the
person to make appropriate treatment or lifestyle choices. Blood
glucose testing enables self-care in order to maintain optimum
control. Key to this is being able to maintain blood glucose levels
at as near normal levels as possible. The only way this can be
accurately assessed and actions taken, is by monitoring blood
glucose levels regularly. HbA1c is a valuable method of assessing
overall control and is a good indicator of the risk of developing
long term complications, however, a person with diabetes can have
good HbA1c results and have poor day to day control with extremes
in blood glucose levels. Stability of glucose levels is only measurable
and achievable through home monitoring.
— Individual need, choice and circumstances
will dictate, the most appropriate form and frequency of testing.
There are times when it will be appropriate for people to test
more frequently than is usual for them. It is unacceptable that
people with diabetes should be restricted or deprived of home
blood glucose testing equipment and supplies because of postcode
prescribing, blanket bans or restrictions imposed by Primary Care
Trusts (PCTs) or through clinicians' inadequate knowledge of diabetes
or the individual patient's needs.
— People with diabetes value being
able to monitor their blood glucose levels for themselves as it
enables them to better manage their diabetes, help prevent devastating
and potentially costly complications, and take control of their
own diabetes. Restrictions on the type and numbers of testing
strips is unacceptable as this does not meet individual needs
and circumstances. Such a policy is against Standard 3 of the
National Service Framework (NSF) for diabetes relating to patient
empowerment4.
— There are considerable cost savings
to be made from supporting self management, by reducing the frequency
of support needed from the NHS and preventing people with diabetes
from needing hospital treatment either with diabetes emergencies
or long term complications.
What is the optimal level of charges?
— All people with diagnosed with diabetes
(on insulin, tablet and diet treatment) should have access to
blood glucose testing strips free on prescription. However, the
costs of blood glucose monitoring are considerable. In order not
to waste resources therefore it is important that people with
diabetes are able to utilise home monitoring effectively through
diabetes education. Without this education to know when and how
to test, and what to do with the results, there is little point
in home monitoring. The purpose of improving and facilitating
people's ability to self-manage their diabetes is to improve their
blood glucose control, with a view to preventing complications
both long and short term. There are potentially, considerable
cost savings to be made from reducing the number of people with
diabetes needing to be admitted to hospital either with diabetic
emergencies or with the consequences of long term complications
eg for treatment of foot ulcers. There are also cost savings to
be made on reducing the number of visits to GPs and other primary
care professionals, if people are able to manage the condition
more independently.
— It has been cited that more is spent
on testing strips than on oral glycaemic agents. The implication
being therefore that this is not a good use of resources. What
this does not consider is that for some people with diabetes,
being able to monitor blood glucose levels may be as beneficial
to them as taking the tablets. In any case to restrict blood glucose
testing strips when they are used effectively for self-management
is, in our view, contrary to Standard 3 of the National Service
Framework for diabetes on patient empowerment[14].
What criteria should determine who should pay
and who should be exempt?
— All people diagnosed with diabetes
(on insulin, tablets and diet treatments) should be able to receive
free blood glucose testing strips on prescription.
How should relevant patients be made more aware
of their eligibility for exemption from charges?
— When people are diagnosed, they should
receive more information about their eligibility for exemption
from charges.
Whether charges should be abolished?
— Prescription charges for blood glucose
testing strips should be abolished for all people with diabetes
(on insulin, tablet and diet treatment).
Diabetes UK
2 December 2005
Guideline for Type 2 diabetes—management of
blood glucose, September 2002, National Institute for Clincal
Excellence. Available at URL:http://www.nice.org.uk
7 Amos AF, McCarty DJ, Zimmet P. The Rising Global
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9
Mather HM, Chaturverdi N, Fuller JH. Mortality and morbidity
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10
UK Prospective Study Group (UKPDS). Effect of intensive blood
glucose control with metformin on complications in overweight
patients with type 2 diabetes (UKPDS 34) The Lancet. Vol 352,
12 September 1998. Back
11
Diabetes Control and Complications Trial (DCCT) Research Group.
The effect of intensive treatment of diabetes on the development
and progression of long-term complications in insulin-dependent
diabetes mellitus. The New England Journal of Medicine. Vol 329:
14. 30 September 1993. Back
12
UK Prospective Diabetes Study Group (UKPDS). Tight blood pressure
control and risk of macrovascular and microvascular complications
in type 2 diabetes (UKPDS 38). BMJ Volume 317, 12 September 1998. Back
13
McIntosh A, Hutchinson A, Home PD, Brown F, Bruce A, Damerell
A, Davis R, Field R, Frost G, Marshall S, Roddick J, Tesfaye S,
Withers H, Suckling R, Smith S, Griffin S, Kaltenthaler E, Peters
J, Feder G (2001) Clinical guidelines and evidence review for
Type 2 diabetes: management of blood glucose. Sheffield: ScHARR,
University of Sheffield. Back
14
National Service Framework for Diabetes: Standards, Department
of Health, London. December 2001, available at: URL:http//www.doh.gov.uk/nsf/diabetes.htm. Back
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