Huge variation in care for diabetics across country

Treatment for diabetic patients has a huge variation in quality of care from one region to another, a report says.

In some regions, only six per cent of sufferers received the recommended levels of care compared with 69 per cent in the highest-achieving primary care trusts (PCTs), a National Audit Office (NAO) report found.

But not a single PCT delivered the nine basic care processes which reduce the risk of diabetes-related complications such as blindness, amputation or kidney disease.

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The worst offenders were Mid Essex and Swindon PCTs where less than nine per cent of patients were given the nine basic tests which are recommended by the Department of Health (DH).

The report said: “The department holds information to assess performance but there is a lack of accountability for PCTs who fail to ensure that the recommended standards of care are met.”

It says the NHS does not “clearly understand” the costs of diabetes at a local level and is finding it difficult to deliver diabetes services in the most effective way.

Across England only half of people with diabetes received the recommended standards of care in 2009 to 2010.

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The report says: “People with diabetes require regular review of clinical indicators of disease progression. Despite the DH setting clear standards for good diabetes care, analysis from general practice records in the 2009-10 National Diabetes Audit found that under half (49 per cent) of people with diabetes received all the care processes recommended for the monitoring of risk factors for tissue damage.

“Without regular monitoring and treatment, this damage can lead to complications such as blindness, amputation and kidney disease.”

The review into the management of adult diabetes services in the NHS in England states that up to 24,000 people die each year from avoidable causes.

It said there is poor performance in expected levels of care, low achievement of treatment standards and high numbers of avoidable deaths and that diabetes services are not delivering value for money.

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While the DH estimates it spent £1.3bn on diabetes services in 2009 to 2010, the NAO claimed the figure was a “substantial underestimate” and was more likely to be in the region of £3.9bn.

The authors of the report recommend that services for the growing number of people suffering from the disease are “adequate” to help minimise additional costs which are generated by diabetes-related complications.

Amyas Morse, head of the NAO, said: “The DH has failed to deliver diabetes care to the standard it set out as long ago as 2001.

“This has resulted in people with diabetes developing avoidable complications, in a high number of preventable deaths and in increased costs for the NHS.

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“The expected 23 per cent increase by 2020 in the number of people in England with diabetes will have a major impact on NHS resources unless the efficiency and effectiveness of existing services are substantially improved.”