2Supporting the delivery of diabetes care
Prevention of diabetes
14.An estimated 200,000 people are newly diagnosed with diabetes every year and by 2030, the percentage of the adult population with diabetes is set to rise to 8.8%, up from 7.8% in 2013–14. NHS England told us that this percentage could be higher unless effective action is taken to reduce the number of people being diagnosed with diabetes.19 Being overweight is the main modifiable risk factor for type 2 diabetes, and the most effective way of reducing the long-term costs of diabetes will be to reduce the number of obese and overweight people.20
15.Since April 2013, local authorities have had to offer an NHS Health Check, a cardiovascular assessment, to those aged 40 to 74 who have not been diagnosed with a existing vascular disease or are being treated for certain risk factors, every five years. NHS England told us that while these health checks identify those at risk of developing type 2 diabetes, the NHS has not been empowering those at risk to do something about it when they receive this information.21
16.In March 2015, NHS England, Public Health England and Diabetes UK launched the NHS Diabetes Prevention Programme, which targets people at high risk of developing type 2 diabetes. Public Health England told us that the programme aims to build on international evidence that a sustained intervention, over at least nine months with a significant amount of face-to-face time, can reduce the risk of developing type 2 diabetes. In 2015–16, the programme aims to support up to 10,000 people, through local initiatives on weight loss, physical activity and cooking and nutrition. NHS England told us that the programme will eventually help 100,000 people a year.22
17.Public Health England told us that it was working closely with the Secretary of State for Health on developing the government’s obesity strategy, which is due to be published in early 2016. Public Health England also told us that it had published evidence that indicates the introduction of a sugar tax of 10% to 20% would reduce sugar consumption, noting that to date the government has ruled out introducing such a tax.23
18.Public Health England also told us that it plans to take broader action to tackle obesity, such as using social marketing campaigns to try to influence behaviour around changing diet and exercise. In 2014–15, it spent £53 million on social marketing - £38 million was spent on individual campaigns, such as Smokefree and Change 4 Life, with the rest spent on infrastructure, including evaluation. Individual campaigns use a range of different channels including TV, radio, print, digital, and billboards. Public Health England acknowledged that it had not targeted the adult population with messages about their health for a long time, with the focus in recent years being on smoking, families and children, but plans to target adults with messages on diet, obesity and exercise in 2016.24
Financial incentives to deliver better diabetes care
19.NHS England recognises that the NHS has fragmented funding streams with disconnections between primary and specialist services, between physical and mental health services and between health and social care. It told us that implementation of the NHS five-year forward view aims to address this issue and that it has established 50 ‘vanguard’ sites to test new delivery models that join up these services and funding flows. Best practice tariffs are encouraging different clinical teams to work together within hospitals, but there are no financial incentives to encourage secondary care clinicians to work with primary care clinicians. Some areas outside of the vanguard sites, have found workarounds to the current funding arrangements and are delivering integrated diabetes care.25
20.The reward and incentive scheme for GP practices, the Quality and Outcomes Framework, is based on the percentage of patients at GP practices receiving recommended care and achieving specific clinical indicators, including diabetes, to improve health outcomes. NHS England told us that these incentives had helped to improve performance in delivering the nine care process, from 6.5% in 2003–04 to 60% in 2010–11, and achieving the three treatment standards, but to improve performance further an additional lever would be needed to tackle variation across the system.26
Quality of care in hospitals
21.The percentage of beds in acute hospitals in England occupied by people with diabetes continues to rise, from 14.8% in 2010 to 15.7% in 2013. However, the level of diabetic specialists has not significantly changed over this period. In 2013, nearly one-third of hospitals in England taking part in the audit had no diabetes inpatient specialist nurse and 6% did not have any consultant time for diabetes impatient care. NHS England told us that an increase in nursing numbers isn’t likely in the next year or two. Although many aspects of diabetes care in hospital are improving, the percentage of patients with a severe low blood sugar episode requiring injectable treatment—a life-threatening event—has remained at just over 2%, and patient satisfaction has not improved.27
© Parliamentary copyright 2015
Prepared 19 January 2016