Tackling variation in diabetes care

The APPG for Diabetes launches today its latest report titled ‘Levelling Up: Tackling Variation in Diabetes Care’. This report is the result of a year-long inquiry into the causes and solutions to the variation in diabetes care. The report sums up the evidence collected from healthcare professionals, academics, commissioners and people with diabetes, making recommendations for how we can secure a better diabetes care for everyone. The official launch will start at 4pm today with a reception in parliament.

You can download the report here: Levelling Up: Tackling Variation in Diabetes Care

With over 4.5 million people living with diabetes in the UK, the condition is the most serious challenge facing the NHS today. Every week, diabetes leads to over 140 lower limb amputations, 450 heart attacks, 540 strokes and 460 early deaths. At the moment, we are spending more money on hospital stays, kidney complications, and performing amputations instead of helping people to avoid those complications ever occurring. There is a lot of great work going on to help people to manage their diabetes – but far too often, the quality of care someone receives, and consequently the outcomes they achieve, depends on where they live. We must focus our intentions on ensuring that everyone already living with diabetes has the necessary skills and support to manage their condition and reduce the risk of long term complications.

This report is timely as the Government and NHS England announced that all Clinical Commissioning Groups (CCGs) will have the opportunity to bid for additional national funding of approximately £40 million to promote access to evidence based interventions to improve diabetes outcomes. This will be in four key areas:

  • Improving the achievement of the NICE recommended treatment targets whilst driving down variation betweet CCGs;
  • Improving uptake of structured education courses;
  • Improving access to specialist inpatient support;
  • Improving access to a multi-disciplinary foor team for people with diabetic foot disease.

It is vital that this opportunity is grasped and used wisely to transform diabetes services and tackle the variation in diabetes care. The evidence from the report shows how it can be done. The report asks what the areas who are struggling to provide quality diabetes care and support services can learn from the areas which are doing well.

The key message is that good diabetes care is possible, the task is to make it happen everywhere.

Access to key technologies

For people with diabetes, access to the right technology is a matter of safety, control and quality of life. However, self-funding is a worryingly common theme for all people with diabetes, and muddled funding processes make accessing technology difficult even when someone satisfies the NICE criteria for it. The danger facing the NHS is that only the well-off are able to access devices that make living with diabetes easier and contribute to improved health outcomes. The report supports clearer funding pathways for diabetes technology for both patients and healthcare professionals, combined with the necessary training so people can be supported to use the devices successfully.

Support to manage their condition

For people with diabetes, self-management is a large part of their diabetes care. The NHS needs to support a comprehensive and consistent approach that includes: information and one-to-one advice, ongoing informal learning and structured diabetes education courses. CCGs need to plan a radical expansion in diabetes education, with a wider menu of options, and ensure that people with diabetes within a year of diagnosis have attended the courses. Moreover, a national standard of diabetes education for children and young people under the age of 18 is needed, which where appropriate includes training on how to use diabetes technologies such as insulin pumps and CGM.

Finally, there is the need to provide emotional and psychological support to people with diabetes.The anxiety and stress associated with the management of a long-term health condition plus the stigma associated with Type 2 diabetes has harmed people’s motivation to care for themselves.

High quality conversations with the right healthcare professionals

While information should be consistent, treatment plans benefit from being integrated and tailored by specialized professionals to an individual’s needs and lifestyles, allowing the patient to input into the decision-making process. Furthermore, as primary care deals with an ever increasing proportion of diabetes care, training for healthcare professionals should be increased to allow them to have the knowledge and skills to give accurate advice. Health Education England needs to ensure non-diabetes specialists are able to look after people with diabetes well and that there are enough specialists to support the increasing number of people with diabetes.

In terms of integration, local health economies also need to have effective local networks that share data, reduce financial barriers between organisations and undertake a regular quality improvement cycle, including integrated IT systems that allow for a patient’s information to follow them across primary and hospital care.


Every two minutes, another person is diagnosed with diabetes. The time to improve diabetes care is now. NHS England needs to work collaboratively with local health economies to support the effective use of transformation funds to address the recommendations in the report, supporting and monitoring delivery to enable high quality care. Furthermore, the Department of Health needs to ensure that the Mandate to NHS England recognises the importance of reducing the variation in diabetes care, by including a specific measurable on reducing variation in the number of people reaching the three treatment targets.

Variation is not a signal of despair – but of hope. It shows that good care can be achieved. Our task is to make it happen everywhere to tackle the diabetes crisis.

Download the report here: Levelling Up: Tackling Variation in Diabetes Care



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