The co-founder of the NHS Innovation Accelerator looks at moves to tackle Type 2 diabetes:
Three million people have Type 2 diabetes in England.
It is nearly four times as common as all types of cancer combined, and is regarded by some as the 21st century’s primary public health concern. It accounts for around £9 billion of NHS spending annually, and is responsible for over 20,000 early deaths each year.
The need for robust diabetes prevention has never been greater.
In current literature, it is well established that Type 2 diabetes can be prevented or delayed in high-risk adults. At least five major randomised controlled trials, conducted in China, Finland, USA, Japan and India have documented 30 to 60 percent reductions in Type 2 diabetes incidence through intensive lifestyle change programmes.
The US-based Diabetes Prevention Program (DPP) Research Group, for example, published a randomised controlled trial in 2002 of 3,234 participants showing that an intensive lifestyle intervention reduced the incidence of Type 2 diabetes by 58 percent, compared with 31 percent by the drug metformin, over a follow-up of around three years. The intervention was beneficial across all examined ethnic groups and both sexes. Its cost-effectiveness and safety were subsequently demonstrated.
Put simply, the Diabetes Prevention Programme could be regarded a tried and tested innovation, with patient-benefit and strong economic rationale.
Despite evidence existing for over a decade, and the clear demand for such an intervention, the DPP has thus far not been widely adopted or scaled across England, or for that matter, internationally, with few exceptions.
This, unfortunately, is not an isolated issue. Healthcare more broadly, is regarded as a challenging landscape for innovation. This is attributed to a number of factors such as the delayed impact and return on preventative strategies, difficulties in policy alignment, tricky system navigation, cultural barriers, technological heterogeneity across health systems, complex regulatory frameworks and, at times, unwieldy payment models. These are factors that apply to health systems in most industrialised countries.
Recent policy developments in England, however, have potentially altered the status quo.
The Five Year Forward View, published last October, presented a consensus and vision of what the future of the NHS could look like given resources available. More than this however, it provided a step-wise development in English policy alignment, sparking a social movement between patient groups, front-line staff, wider stakeholders and NHS leadership; a unique shift in NHS thought and ambition. This has since served, conceptually, as a platform for rapid change, implementation, and innovation.
In the context of curbing demand and driving prevention, this platform has enabled the development of a National Diabetes Prevention Programme at scale, the first of its kind worldwide, with the aligned delivery of NHS England, Public Health England and Diabetes UK.
The National Diabetes Prevention Programme was launched in March, with the identification of seven demonstrator sites across England: Birmingham South and Central clinical commissioning group (CCG); Bradford City CCG; Durham County Council; Herefordshire CCG and Local Authority (LA); Medway CCG and LA; Salford CCG and LA and Southwark and Lambeth Councils and Southwark CCG.
The collective population across these sites amounts to almost 1.8 million people, with recorded obesity rates varying from 8.2 percent to 13.56 percent. These locations are set to deliver the DPP in 2015/16, targeting up to 10,000 people at high risk of developing Type 2 diabetes – potential adoption at scale, into practice.
Demonstrator sites will test innovative ways of identifying those at risk, for example using the NHS Health Check. The intervention will comprise a combination of physical activity and diet-focused behavioural modification. The feasibility of nationally procuring a lifestyle modification service, or establishing a national framework contract for such services is also under exploration.
While aspirations are bold, the National Diabetes Prevention Programme, its feasibility, cost-effectiveness and impact will each need to be tightly evaluated and determined. Its expeditious design and development, built on the platform for change and policy alignment provided by the Five Year Forward View, demonstrate how a tried and tested innovation can potentially be adopted and scaled at pace, given appropriate health-system architecture and ambition.
This blog was first published in the HSJ.