Five areas NHS integrated care boards can improve diabetes care for people

As integrated care boards (ICBs) are established there is an opportunity to further shift the dial on diabetes prevention, treatment and care, building on improvements over the last two decades.

Preventing type 2 diabetes and supporting the delivery of high-quality care for people living with all forms of diabetes are the priorities of the NHS Diabetes Programme (NDP). The increase in prevalence, long-term risks of complications and budgetary impact of treatment make diabetes one of the most important non-communicable diseases to target.

Our aim is to improve outcomes and equity across socioeconomic deprivation, ethnicity, age, and type of diabetes. We set out five high-impact areas for ICBs to consider:

 1. Population health management

Clinical and demographic data can support planning, enabling targeted interventions to prevent ill health, improve care and address variation. Systems like Nottingham and Nottinghamshire ICB have prioritised diabetes as part of their approach. We are working with several ICBs that have built diabetes data into their dashboards and are supporting others to do the same.

We are making access to diabetes data much easier. A new Diabetes data hub on the FutureNHS platform (this platform requires a login) shows information at ICS, PCN and GP practice level. An interactive map shows how systems are performing against diabetes care processes, which are associated with reduced mortality, emergency admissions, amputations and diabetic retinopathy. Through the NHS Long Term Plan (LTP), a share of the annual diabetes implementation fund, worth over £100million across five years, is allocated to each ICB to support this and other LTP commitments.

In some areas, PCN approaches are being successfully adopted to provide new models of diabetes care across a larger footprint, as set out in the Primary Care Diabetes Service (PCDS) ‘at-a-glance’ guide. Risk stratification tools, such as those developed by NHS England, PCDS and the Association of British Clinical Diabetologists, can help care providers ensure those people at greatest risk of complications are called for review.

ICBs should have a clear plan to recover diabetes care process delivery to at least pre-pandemic (2019) levels by the end of 2022/23, to support more people to achieve NICE recommended treatment targets and reduce the risk of diabetes-related complications and deterioration. ICBs should review the available data and use risk stratification tools to inform the areas of focus.

2. Preventing Type 2 diabetes

Weight gain is putting more people at risk of Type 2 diabetes. It is vital that systems prioritise engagement with, and referral into, the National Diabetes Prevention Programme (NDPP). An independent NIHR funded evaluation has shown that the NDPP resulted in a 7% reduction in the number of new diagnoses of Type 2 diabetes in England (2018 – 2019), with programme completers on average 37% less likely to develop Type 2 diabetes, making it a life-changing experience.

The NHS LTP commits that 200,000 people a year will be supported by the NDPP. ICBs should have a clear plan to increase the number of people that are referred to the NDPP in line with their LTP trajectories.

3. Type 1 diabetes treatment and care

Access to specialist care and technology; education; and peer support are key to improving outcomes for people with Type 1 diabetes.

Better integration between primary and secondary care could improve access to specialist care. New Provider Collaboratives, partnering trusts and other providers together, could present opportunities for diabetes care. New national standards for sharing diabetes information across care settings, including self-reported data from digital tools, are also being developed.

Over 80% of people with type 1 diabetes are now using flash continuous glucose monitoring. A recent update to NICE guidance indicates that all adults with Type 1 should be offered this technology. The NHS LTP also committed that all pregnant women with Type 1 are offered continuous glucose monitoring, and we are very close to meeting this target for eligible women being offered it. NICE will soon be consulting on provision of Hybrid Closed Loop systems. ICBs should be aware of these future developments and the need consider demand profiling, workforce development and commissioning strategies to support access.

Diabetes education provision is now bolstered by new, nationally-funded, digital self-management tools like Digibete and My Type 1 diabetes for Type 1 and Healthy Living for Type 2.

ICBs should have clear commissioning policies in place on the provision of diabetes technology, in line with NICE guidance, and ensure that people with diabetes can access structured education to support diabetes management.

4. Diabetic footcare

Lower limb amputation is one of the most feared complications of diabetes, with major impacts on somebody’s quality of life and associated higher morbidity and mortality. Whilst England has some of the lowest rates of amputation internationally, we must continue to improve and address unwarranted variation.

Systems should ensure timely access to multidisciplinary footcare teams. Some ICBs have further to go to meet this commitment and can improve quality by implementing footcare recommendations in the Diabetes GIRFT Programme National Specialty Report.

5. Safety in hospitals

Up to 20% of inpatients have diabetes at any one time. People with diabetes in hospital have higher complication rates, longer lengths of stay and higher re-admission rates. Despite good progress, there is still variation in the quality and availability of inpatient diabetes services and the frequency of hospital-acquired harm.

A key LTP commitment is that all trusts have a diabetes inpatient specialist nurse service. Transformation funding over several years has helped close gaps, but ICBs should be satisfied that all hospitals have this in place.

Jonathan Valabhji

Professor Jonathan Valabhji is National Clinical Lead for Multiple Long-Term Conditions at NHS England, having been National Clinical Director for Diabetes and Obesity between 2013 and September 2023. He is Clinical Chair in Medicine at Imperial College London and Honorary Consultant Diabetologist at Chelsea and Westminster Hospital NHS Foundation Trust.

As well as a practising clinician and researcher, over the last decade he established and led the NHS England diabetes and obesity programmes, with a broad portfolio of national workstreams focusing on lifestyle interventions, clinical care, and technological support for diabetes self-management. He has led rapid translation of high-quality research into national policy and practice and has established models for evaluation to assess translational impact.

He successfully made the case for, and led implementation of, the NHS Diabetes Prevention Programme, the NHS flagship prevention programme. By 2018 England became the first country to achieve universal population coverage with an evidence-based type 2 diabetes prevention programme, with over 1.3 million people now referred in, and latest evidence suggesting reduced type 2 diabetes incidence in both programme participants and at population level associated with programme implementation.

He qualified in 1990 from St Bartholomew’s Hospital Medical College, London, and in 2019 was awarded OBE in the Queen’s New Year Honours List for services to diabetes and obesity care.

Professor Partha Kar

Professor Partha Kar is National Specialty Advisor, Diabetes with NHS England and co-author of the national Diabetes GIRFT report.

He has been a Consultant in Diabetes and Endocrinology at Portsmouth Hospitals NHS Trust since 2008- and pioneer of the Super Six Diabetes Model which is recognised as one of the good examples of integrated care.

He has helped to expand use of technology in Type 1 Diabetes- namely use of Flash Glucose in Type 1 Diabetes and CGM in Type 1Diabetes pregnancy along with online digital self-management platforms- while recently leading on real world data collection on Closed Loops for subsequent NICE review. He has worked subsequently with NICE on updating relevant guidelines in non-invasive glucose monitoring access in Type 1 and Type 2 Diabetes.

His other work has involved introduction of frailty into QoF treatment targets, Diabulimia pilot projects in the NHS; championing “Language Matters” and helping to create an overview of Diabetes care in Primary Care Networks. Recent work has focussed on transitional care models- as well as tackling inequalities in technology access based on deprivation and ethnicity.

He is one of the leading users of social media in diabetes care – and writes a monthly blog for the British Medical Journal.

He has also been:

  • Co-creator of TAD (Talking About Diabetes) – TED talks from those with T1Diabetes
  • Co- creator of Type 1 Diabetes comic (Volume 1 to 4)
  • Co-creator of DEVICES (Virtual Reality educational modules in diabetes)

Beyond diabetes, he also recently taken a role in tackling issues of racial disparity in the medical workforce as the Medical Workforce Race Equality Standard lead for NHS England. He has also been named as one of the most influential BAME individuals in healthcare in 2020,2021 and 2022.

Follow Partha on Twitter: @parthaskar