The Big Interview – Sir Muir Gray CBE
Sir Muir Gray CBE, one of the UK’s most eminent public health doctors, will address the issue of population accountability for people with type 1 and type 2 diabetes at next week’s Diabetes Professional Care (DPC2017).
He tells The Diabetes Times what he thinks the future holds for diabetes care and what healthcare professionals should be doing to help their patients.
You’re speaking at DPC, how did you become involved?
I’ve been working with aspects of diabetes for a number of years and DPC approached me and asked whether I might talk about where I see the future of healthcare for people with diabetes heading.
In terms of the future, well we don’t really know where we are. I worked on the Atlas of Variation looking at the variation of care and treatment of diabetes around the country and we still can’t answer simple questions such as ‘why is the service for type 1 diabetes better in Liverpool than it is in Manchester?’ or ‘why is the type 2 diabetes service in Dorset better than in Cornwall?’ and ‘how many diabetes services are there in London?’
So we’re starting to think about the big population. That would mean bringing all the resources together, so you can start to find a system of care that works for people with type 1 and type 2 diabetes.
Once people have been diagnosed we need to give people all the support and encourage people get on the prevention programme. All we seem to do is just given pills to people who have the disease, rather than take other action.
What are you talking about and what are you hoping people will learn from your speech at the conference?
I’ll also be discussing how much money we are actually spending on diabetes at the moment. It does look like the NHS budget is being used up significantly so we need to learn how to use the resources we have at optimised value. We are probably under-using some things, but maybe in some parts of the country we are over-using. I plan to speak about the concept of value.
How important are events like DPC2017?
When you look at the variation of care we identified in the Atlas you can see there are huge differences. People are working too much in isolation, working on their own in hospitals etc. DPC2017 brings everyone together. It’s a big community of good practice and sharing and learning about what has worked well and what hasn’t.
What has been your biggest career achievement so far?
Setting up the UK National Screening Committee, which advises ministers and the NHS about all aspects of population screening and supports implementation of screening programmes.
I also think everyone with diabetes should own their records. I’m very interested in how we use knowledge from research and knowledge from experience and how do we find out which service is doing well and spread ideas to other services.
You have written a book about exercise slowing down the ageing process – tell us more about this and how you discovered this theory
This is very much linked to the so called epidemic of diabetes. In the 21st century there’s an environmental problem – and now the three big problems are the car, the commuter and the desk job. Most people start around the age of 23 and they sit down for the next 40 years with an hour commute.
So from the age of 23, there’s a fitness gap that opens up how active you are and how active you can be and when disease strikes, the fitness gap only wides. It’s very tricky though, because working an eight-hour day, with a commute, means there’s not always much time for exercise.
We’ve been working on a walking app, which not only tracks activity levels but means everytime someone goes into to get a prescription of metformin, they are given encouragement from the pharmacist. They are asked how they are getting on and encouraged to walk more. This is already happening in some chemists, but will be launched nationally very soon.
You started your career in public health in Oxford in 1972, what are some of the most valuable lessons you’ve learnt in health and self-management?
I think there’s this issue of using knowledge. People need clean and clear knowledge. Making sure people have clear information. I started before the internet existed, when there really was no knowledge available. Since then the internet has changed everything for the better, but the health service is still about 10 years off. When people get a hospital letter or a lab report, we should be prescribing knowledge and activities, not just appointments and medication.
You have done, and continue to do, a lot of work with older people, what are the common misconceptions you have discovered throughout your work?
That everything that happens in terms of ageing from the age of 50 is not actually down to ageing at all. Ageing isn’t actually a major problem until people reach their 90s. The main problem comes from disease and adopting the wrong beliefs and attitudes.
What are some of the biggest challenges healthcare professionals are faced with when treating diabetes?
I think the problem in most people’s lives is time, but also environment. It’s very easy to tell someone to change their lifestyle, but if they are stuck behind a desk for eight hours with a commute either way, it’s not all that easy to exercise.
Do you practice what you preach?
I try to stick to a Mediterranean diet and I exercise for 10 minutes every day mainly doing strength exercises such as press ups. I also use the walking heath app from Public Health England. It’s very good as it forces you to keep an eye on your step count and how briskly you’re walking.
What does the future of diabetes care in the UK hold for us?
I think we have got to be clear about the differences between type 1 and type 2 diabetes. We also need to have a very clear definition of how many diabetes-related programmes there are. I believe we should have a map of England showing, for example, how many type 2 diabetes programmes there are and they should all be audited and put into an annual report.