PDEL: Oh no…more acronyms. Or is it?

So, once again, it’s all change in the NHS. Amidst all the acronyms, one cannot miss the return of SHA – previously Strategic Health Authorities – which will undoubtedly raise a smile among those who have lived through previous NHS reorganisations.

Of course, the powers that be don’t want to suggest that old structures are simply returning, so we’re now talking about Special Health Authorities! Meanwhile, NHS England is still there, but not quite there, and will now be known as the ‘NHS Group’. It doesn’t quite have the same ring to it, does it?

However…

Amidst all these changes, one development should be of particular interest to the diabetes community: the introduction of PDEL (sorry another acronym), or the Preventative Departmental Expenditure Limit. This represents ring-fenced funding for preventative measures and interventions.

The crucial question is how prevention will be defined and implemented. Are we talking about primary, secondary, tertiary or even primordial prevention? There will undoubtedly be considerable debate about what qualifies for PDEL funding.

For diabetes leadership, this should represent a golden opportunity. So much of what we do in diabetes is fundamentally about prevention. Whether through lifestyle interventions, medications with demonstrated cardiovascular and renal benefits, or technology that improves HbA1c and helps prevent longer-term complications, there is a compelling case for recognising these interventions as preventative expenditure.

PDEL could therefore be far more transformational than simply protecting existing budgets. With the right arguments and evidence, it could reshape how preventative diabetes care is funded and delivered.

Take obesity, for example. Current eligibility criteria for weight-management medications hardly have a return on investment written all over them, nor are they particularly rooted in a preventative philosophy. Requiring a BMI above 40 alongside multiple comorbidities is arguably more about restricting access than preventing disease. Could this be an opportunity to revisit where obesity medications fit within a preventative strategy, including access before significant comorbidities develop?

There is also an opportunity to reopen discussions about wider access to diabetes technology. Evidence increasingly demonstrates its benefits in improving HbA1c and potentially reducing future complications. Following a recent visit to the Diabetes Technology Network meeting, there was a noticeable sense of resignation about further expansion of technology access. Yet PDEL could offer an opportunity to look beyond 2029, when existing ring-fenced funding arrangements begin to run out, and build a more sustainable case for investment.

We have spoken at length about the need to shift towards preventative spending. Local authorities and councils clearly have a vital role in addressing the underlying determinants of ill health, particularly deprivation. But there must also be recognition of the preventative value of clinical interventions, whether medications or technology, in reducing the risk of complications.

In an increasingly competitive funding environment, diabetes leadership cannot afford to focus simply on how difficult circumstances are or how challenging it might be to compete with other priorities. It needs to be ready for that contest and make the strongest possible case, supported by robust datasets and compelling evidence. That evidence already exists, both in academic literature and real-world data.

Funding cycles are always fraught with risk, and NHS restructuring inevitably creates uncertainty. But chaos also creates opportunities.

This feels like one of those moments.

Diabetes leadership needs to grasp this opportunity and make the case for securing investment over the next decade and beyond. The aim should be to move beyond simply protecting existing provision and argue for a genuinely preventative model of diabetes care.

The alternative is to start on the back foot, adopt a position of resignation and risk a gradual slide towards mediocrity.

This is not the time for despondency. It is the time to make the case.