The Health Secretary, Jeremy Hunt, has outlined new measures that will make it clearer how local NHS services are performing. This includes new “Ofsted-style” ratings for the delivery of key services. NHS England is still consulting on its plans, but the intention is that diabetes is one of six clinical areas that the new system focuses on. This is the highest profile that diabetes has received from this kind of national measurement framework. Nevertheless, there are only two indicators for diabetes out of a total of 28 measures that cover the health of the population, clinical care, finance and leadership.
The first diabetes indicator is the percentage of people achieving all three NICE targets for HbA1c, blood pressure and cholesterol. The other is the level of diabetes structured education in each area. Clearly, these two measures do not describe anything like the whole of diabetes care. The idea is to focus attention on areas with the biggest scope for improvement, and improvement is the point of the new framework. There is no point in just attacking NHS staff who are already working hard in increasingly difficult circumstances. Instead, the aim is to focus support on areas that need it most.
Diabetes UK has been calling on NHS England to provide better scrutiny of the quality of diabetes services and the new framework is a big step towards that. I believe it is really good news for people with diabetes. All too often, despite the many very dedicated people working in the service, healthcare for people with diabetes simply is not good enough and is marked by significant variation between services serving similar populations.
This was recently highlighted in the report from the influential House of Commons committee that investigates value for money in public spending. The Public Accounts Committee (2016) were struck by the variation in diabetes services and called on the Government and the NHS to make improvements to the current delivery of diabetes healthcare in England.
As the recent National Diabetes Audit highlighted, less than 40% of people with type 1 and less than 60% of people with type 2 are getting the eight recommended annual checks that can identify problems early enough to do something about them. Furthermore, only 18% of people with type 1 diabetes and 41% of people with type 2 diabetes are meeting the recommended treatment targets for blood glucose, cholesterol and blood pressure (Health and Social Care Information Centre [HSCIC], 2016).
Too many children and young people with type 1 and type 2 diabetes receive poor care. In 2012–13, only 12% of young people aged between 12 and 19 in England and Wales had all their annual care checks and are even less likely to have their condition under control (Royal College of Paediatrics and Child Health, 2015).
It is good news that the framework is also likely to focus on diabetes education courses. We need the NHS to get better at educating people with diabetes to manage their condition well. Many people with diabetes will only see their healthcare professional a few times a year and have to manage their condition every day. Evidence shows that giving people the knowledge and skills to manage their diabetes effectively leads to improvements in their control of the condition and, therefore, reduces their long-term risk of complications.
Current figures indicate, however, that less than 2% of newly diagnosed people with type 1 diabetes and just 5.4% with type 2 diabetes attend a diabetes education course (HSCIC, 2016). The NHS must ensure that everyone with diabetes is given the opportunity to attend a diabetes education course.
Overall, the new framework cannot cover the full range of diabetes services and that is not its purpose. But it does mean diabetes will be more of a priority for the NHS than ever before. That can only be a good thing.