Integration can improve diabetes care and reduce costs

Health leaders and commissioners can improve the delivery of diabetes care by integrating services as recommended by a major NHS plan, according to a new Diabetes UK report.

The charity’s report called Improving the Delivery of Adult Diabetes Care Through Integration calls for routine care to be delivered in a joined up way from GP surgeries to hospitals, to ensure people get swift access to care from the right part of the healthcare system at the right time as set out in the health service’s Five Year Forward View.

Diabetes UK’s report shows how this approach can ensure that people with diabetes have quick access to specialists when they need it to identify problems. This, in turn, can help to reduce their risk of avoidable but serious complications such as blindness, amputations and stroke.

As well as being devastating for the person, these complications are costly to treat and they account for the major part of the £10 billion the NHS spends on diabetes every year. Treatment of complications also adds considerable pressure to acute hospitals in terms of beds and emergency admissions.

The report details a series of measures that commissioners and health leaders can implement to fit with the model of care in the Five Year Forward View and so help ensure that the 3.2 million people with diagnosed diabetes get the healthcare that meets their needs as well as help the NHS to save money. Examples include:

• An integrated IT system means that GPs and specialists can see the same record and ‘at risk’ patients can be identified. Evidence shows that this can help to improve the coordination of care throughout the system, as well as patient satisfaction and engagement in the care they receive.
• Effective care planning where clinicians and people with diabetes work together to agree goals and identify needs is vital for enabling people to manage the condition. But at the moment almost two thirds of people with diabetes do not have a personal care plan.
• Health leaders should overcome the rigid financial divide between primary, community and secondary care by pooling budgets and agreeing a protocol on how people with diabetes will be treated across all care settings. This means that finances are less likely to get in the way of people receiving the right care when they need it.

Diabetes UK recognises that the work of joining up health services is not easy in the current system where, for example, fragmented commissioning and financial arrangements can make integration between different services hard. The charity says this is why national policy is needed to support local action by developing ways for financial systems to support integrated working and multidisciplinary clinical networks, which can manage change and improvements across all parts of the NHS.

With the number of people with diabetes projected to rise to 5 million by 2025 and costs expected to rise sharply to £17 billion within 20 years, Diabetes UK is urging health leaders to implement their recommendations as a matter of priority.

Barbara Young, Chief Executive of Diabetes UK, said: “The commissioning and delivery of diabetes care is often fragmented between different parts of the NHS. This means that people with diabetes face delays to see specialists, undergo repeated tests, and are left not knowing which part of the system has responsibility for delivering a particular part of their care.

The commissioning and delivery of diabetes care is often fragmented between different parts of the NHS

“This has a huge impact on the care they receive and on their ability to effectively manage their condition. Ultimately, poor practices such as these are contributing to the all too frequent development of the serious but avoidable complications that are not only personally devastating for all those affected but also use up a big proportion of the NHS budget.

“This is why it is good news that Simon Stevens’ [Chief Executive of NHS England] has recognised that the current approach to diabetes care can be improved through better integrated services as set out in the Five Year Forward View. Our report uses examples of how health leaders can implement Stevens’ vision and deliver better diabetes care that meets the needs of all people with diabetes.

“It shows that by placing people with diabetes at the centre of their care, pooling services and budgets and giving people with diabetes more opportunity to have a say about how their care is delivered, we can have an effective service that provides better outcome for patients and better value for money for the taxpayer.

“We recognise that the current health system often makes it hard for commissioners to make these changes but the fact that some health providers have made great strides in the delivery of diabetes care shows that improvements can be made. With increasing numbers of people being diagnosed with diabetes and diabetes costs threatening to bankrupt the health service we need the good practice described in our report to be adopted by the rest of the health system.”