The Deputy Programme Director for NHS England’s Diabetes Programme picks out the main messages from the NHS Long Term Plan:
It’s been a few weeks now since the NHS Long Term Plan was released and healthcare professionals, managers, partnership organisations, charities and the media alike are still pouring over the detail and what it means for the future of the NHS.
For diabetes, the NHS Long Term Plan sets out a range of improvements for those at risk of Type 2 diabetes and living with Type 1 and Type 2 diabetes; many of which we have already started to implement with our partners across the health system.
Why the focus on diabetes? Because it is a leading cause of premature mortality with over 22,000 additional deaths each year, doubles an individual’s risk of cardiovascular disease and costs over £10 billion every year to manage. There are also significant inequalities present as people from south Asian and black ethnic groups have up to a six-fold greater chance of developing Type 2 diabetes than people from white ethnic groups.
If you haven’t made your way through all 136 pages yet, here are the key take home messages concerning diabetes:
Type 2 diabetes prevention continues to be a priority:
Prevention is at the heart of the NHS Long Term Plan – because getting better at prevention is essential if the NHS is to be sustainable as a world leading health service. One of the key commitments is to double, to 200,000 people per year, the scale of the NHS Diabetes Prevention Programme which supports those identified at high risk of type 2 diabetes to reduce their risk.
The programme is already the largest undertaking of its kind in the world and over 100,000 people have already benefited since its introduction in 2016. In many areas demand has outstripped supply, and it has proven highly effective. More capacity means more people can receive support and delay or hopefully prevent developing Type 2 diabetes. The main observable health inequalities in diabetes relate to who develops diabetes and therefore focusing on prevention, at greater scale forms a key part of our strategy to tackling emerging inequalities.
Access to diabetes professionals is crucial for optimum treatment and care:
Over 2017-18 and 2018-19 we have invested £28.7m of transformation funding in establishing 71 new or expanded multi-disciplinary footcare teams and diabetes inpatient specialist nursing teams. For those who need secondary care support these teams deliver significant improvements to recovery and reduce lengths of stay in hospital.
The Long Term Plan takes this further, so that we ensure all hospitals provide access to these services, reducing variation and delivering significant benefits for patients.
Self-management has a key role in ‘upstream prevention’:
The NHS Long Term Plan commits to delivering better support for patients, carers and volunteers to enhance ‘supported self-management’ particularly of long-term health conditions, including diabetes. It describes improving ‘upstream prevention’ of avoidable illness and its exacerbations. So for example preventing Type 2 diabetes in those at risk – and for people newly diagnosed with diabetes providing support and education to help them manage their condition well and avoid future complications.
We’ve already invested £20.7 million over 2017-18 and 2018-19 to increase access to structured education in 133 CCGs. £2 million has also been made available to implement and evaluate digital delivery models for self-management education for people living with Type 2 diabetes so that we can further boost uptake of services.
Low calorie diets may be a potential treatment option for Type 2 diabetes:
Medical research has shown that some people with type 2 diabetes can achieve remission through adoption of low calorie diets. The DiRECT and DROPLET trials have recently published with promising results and the potential to allow some people to stop taking anti-diabetic drugs and still achieve non-diabetic range glucose levels.
Plans to test an NHS programme supporting low calorie diets for obese people with type 2 diabetes are outlined in the NHS Long Term Plan. We are currently in the early stages of planning and gathering insight from local areas and providers on approaches currently being implemented to inform our pilot approaches.
If you have an example of implementing an approach which involves low calorie diets/total diet replacement, please email us at email@example.com.
Diabetes prevention, treatment and care is going digital:
The Diabetes team has been harnessing the power of digital across its workstreams for a number of years. The Long Term Plan outlines strategies to continue this work including a new digital route of access within the NHS Diabetes Prevention Programme to widen patient choice in particular for working age populations, expanding access to HeLP Diabetes; an online self-management tool for those with type 2 diabetes which NHS England has licenced, and crucially providing patients with type 1 diabetes who meet clinical guidelines access to life changing flash glucose monitors, ending the variation in some parts of England.
In addition, by 2020-21, all pregnant women with type 1 diabetes will be offered continuous glucose monitoring, helping to improve neonatal outcomes.
With programme partners Public Health England and Diabetes UK and local health economies across England we’ve already delivered a wide range of projects. The NHS Long Term Plan commits us to much more, for the benefit of people at risk of, and living with diabetes.
- You can read the NHS Long Term Plan in full here.