Diabetes UK has just published a report on the state of diabetes services in the UK (Diabetes UK, 2007). We are used to reports being issued for individual countries in the UK but one of the advantages of Diabetes UK is that they have a wider perspective that, in this instance, enables the comparison of services in England, Northern Ireland, Scotland and Wales.
Another advantage of this report is that much of the information was gleaned from its members; approximately 29?000 responded to the survey. Users’ views of diabetes services are obviously important and are frequently not considered: this report does much to rectify this situation.
The report focuses on the early identification of people with diabetes; emotional and psychological support; education for self-care; retinal screening; children and young people; and treatment and care. Some of these topics are ‘hot’ – in as much as diabetes nurses working in all areas are currently discussing them and attempting to address deficits in services. Others are less so, for instance the early identification of people with diabetes. The report states that opportunities for identifying people at risk of developing diabetes and then discussing with them how to reduce those risks are not being optimised.
Most of us involved in diabetes care are aware there are often significant problems in coming to terms with having diabetes and inadequate specialist psychological care services for those who need them; this report affirms this health professional view. It also advocates that health professionals should promote peer support systems and improve signposting and referrals to those services that already exist. The situation with regard to those who needed psychological support and those who received it within the 12 months prior to the survey was found to be similar across all the nations.
Although there has been a huge effort recently to improve structured education for people with diabetes, only half of Diabetes UK’s respondents were aware of any courses to help them. Again, the figures were similar in all countries.
Retinal screening coverage has improved in all the nations, according to the report. This is perhaps not surprising considering it was one of the targets in the delivery strategy for the diabetes National Service Framework (DoH, 2003), but it is reassuring nonetheless that the efforts made to improve these services seem to be paying dividends.
The care of children and young people with diabetes is another hot topic. The report identifies that children’s diabetes specialist nurses are overstretched because of their huge – and growing – caseloads. Again, recommendations are made to improve the care of children and young people. Investment in specialist nurses is one of these.
In the treatment and care section, the report states that, in general, there is an improvement in outcomes for people with diabetes in all the nations, although there are also some local variations in services.
The Diabetes UK report raises several issues which diabetes nurses perhaps need to think about. One possible response to dealing with the topics discussed is to say that more cannot be done without more money (a perennial cry in the NHS!). Although this is undoubtedly true in relation to some of the needs identified, Diabetes UK, however, make several useful suggestions about making the best of what does exist and using these resources better. They also suggest, by implication, thinking how relatively untapped ones could be used; for example, the notion of using people with diabetes themselves to improve peer support for those newly diagnosed with diabetes or experiencing psychological difficulties.
It is also gratifying to learn that variations between the four countries of the UK are not large and that we therefore still have a national health service in relation to diabetes!
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