Robin Hewings: False economies in how we fund fighting diabetes

The NHS is spending £10bn on diabetes and its complications. But as our new Cost of Diabetes report highlights, we can spend it in much better ways.

That’s because 80 per cent of it goes on complications rather than getting things right in the first place. These complications, which include amputations, blindness, kidney failure and stroke, are not only devastating for the person involved, but
they also cost a lot of money
 to treat. Many could be prevented.

The sad fact of the matter is – as Parliament’s authoritative Public Accounts Committee has pointed out – many people with the condition are not getting the care or support they need. This leads to a cycle of even more costs.

There are currently 341,408 people living with diabetes in Yorkshire. Across the country, the number of people with the condition is going up and up. In fact, by 2025, five million people are expected to have the condition in the UK.

If the cost of treating a patient with diabetes remains the same, the costs of diabetes and its complications figure will rise from £10bn to £17bn within 20 years. It is hard to see where this £7bn is going to come from. It is more than twice what the Government gets from inheritance tax. We fear serious consequences for health and social care services if we do not get on top of this issue.

So what can we do? Acting early prevents complications, improves lives and saves the NHS money. A new report from Diabetes UK highlights a series of things we can do.

The quickest win is in hospitals. People with diabetes are also more likely to be admitted to hospital than people without the condition and have longer hospital stays – sometimes things go badly wrong with their care. This can be countered with specialist teams. They reduce complications and help people get out of hospital more quickly. This cuts costs.

But at the moment many people with diabetes struggle to see a specialist once problems have been identified, or they 
fall foul of medical errors in hospital. This is completely unacceptable.

People with diabetes have 
look after their condition day 
in, day out.

For example, people with Type One – and those who have Type Two on insulin – are constantly having to monitor their food and drink while adjusting their insulin to ensure their blood sugar levels are about right. It can be really, really tough. They may only come into contact with doctors or nurses a few times a year.

So it is obvious that education programmes to give people the knowledge and motivation to manage their condition are essential. But only a small fraction are offered them – and even fewer go. One of these saves over £2,000 for every person who goes. Because the individual is the one managing their condition, they need GPs who will work with them to plan their care over a year. Many people see their GP more frequently but in 
a less organised way with less good outcomes.

Sadly, we hear of examples of cutting costs in the short-term, such as by cutting diabetes specialist nurses or restricting access to vital treatments. This can lead to more money being spent in the long term and can have a devastating impact on the lives of people with the conditions.

Type 1 diabetes cannot be prevented. But a key way to halt the relentless march of diabetes is to prevent Type 2 diabetes in the first place by ensuring that the NHS Health Check, which everyone aged 40 to 74 should receive, is delivered more effectively.

At the moment, we have seen patchy implementation of the check with many people not being invited to attend. This would help identify the seven million people who are at high risk of Type 2 diabetes; so that they can get the lifestyle advice
 and support they need to prevent it.

This would also help to diagnose the estimated around 60,000 people who have Type 2 diabetes in Yorkshire but do not know it. About half of these people already have complications by the time they are diagnosed and they would have a much better outlook if their condition was diagnosed before this happens.

As well as specific services for people at high risk of developing Type 2 diabetes, we need to develop an environment in which it is not so hard to have a healthy weight.

We need town planning that makes it easier to exercise, regulation of food marketing and clearer labelling of food and drink.

The challenge of diabetes is undoubtedly huge. But with better patient care and help for people to look after themselves we can have better health and at a lower cost.

• Robin Hewings is head of policy at Diabetes UK.