Poor diabetes care in England leading to preventable deaths

Poor diabetes care in England is leading to preventable deaths, record rates of complications and huge costs to the NHS.

Poor diabetes care in England leading to preventable deathsDiabetes UK says the disease is the fastest growing health threat of our times and current care models are not working to get on top of the problem.

The NHS spends a tenth of its annual budget on diabetes- but most of the money goes on managing complications not preventing them.

Health Direct notes that Diabetes is currently estimated to cost the UK £23.7 billion and with diabetes becoming more common, this figure is set to rise to £40 billion by 2035-36.

Diabetes is a chronic condition and, if poorly managed, can lead to devastating complications, including blindness, amputations, kidney failure, stroke and early death.

Best-practice guidelines say patients should get regular checks to ensure they are controlling their condition well enough to avoid future complications. But official audits of NHS care in England show many patients do not receive these checks.

Diabetes UK’s own annual snapshot says there has been very little overall improvement in diabetes provision in the past year and that some aspects of care have got worse – such as fewer people with type 1 diabetes receiving an annual check-up.

It says just 41% of people with type 1 diabetes – which must be treated with insulin – receive all the annual checks recommended by the National Institute for Health and Care Excellence, and only 16% meet the three recommended treatment targets for blood sugar, cholesterol and blood pressure.

Young diabetes patients receive fewer vital checks than older patients. There is also wide variation depending on where you live in England.

People with diabetes living in some areas receive better care and treatment than people living in other areas, says the charity.

Barbara Young, Diabetes UK chief executive, said: “This is not a question of spending more money. In fact, better ongoing standards of care will save money and reduce pressure on NHS resources.”

“It’s about people getting the checks they need at their GP surgery and giving people the support and education they need to be able to manage their own condition. Doing this, together with improving diabetes care in hospital, would give people with diabetes a better chance of a long and healthy life, and save the NHS a significant amount of money. We want to work with local authorities to be able to help them put good practice into place.”

NHS plans for earlier cancer diagnosis to save lives

Patients are to be given the option to refer themselves for cancer tests, as part of an NHS England bid to diagnose an extra 10% of people early.

NHS plans for earlier cancer diagnosis to save lives

The NHS said it would start testing new ways of speeding up diagnosis, including offering patients the option to book appointments directly with a hospital or testing unit ahead of seeing a GP.

The body will also fund further trials of a pioneering form of radiotherapy.

Currently, around 25% of cancer diagnoses are made too late to save the patients.

The plans are part of a drive to improve cancer survival rates in England, which are below the European average, especially for people over 75.

NHS England says diagnosing 60%, rather than 50%, of people early would mean 8,000 more patients would be alive five years after diagnosis.

This would also result in a fall in the number of cancer diagnoses which have to be made in A&E.

NHS England said it would test the following initiatives:

  • Enabling patients to book their own appointments directly with a hospital diagnostic service or testing unit instead of going to see their GP first
  • Offering patients different types of cancer tests in the same place, on the same day
  • Using community pharmacists to fast-track patients when recurring cancer symptoms are suspected
  • GPs sending patients directly for specific tests, without having to refer to a specialist
  • Better treatments
  • A potentially less damaging and more precise type of radiotherapy, called stereotactic ablative radiotherapy (SABR), has been shown to be effective when used to treat certain kinds of lung cancer.

Now NHS England wants to test how well SABR works on other types of cancer, by enrolling 750 patients a year in four new studies.

An NHS cancer taskforce, made up of cancer doctors, patient groups and charity leaders, has also been asked to draw up a five-year action plan for cancer services to make this happen.

Recent figures show that more than one in three people in the UK develop cancer, and half of those will now live for at least 10 years. Forty years ago, the average survival of cancer patients was just one year.

NHS hospitals are gridlocked

Hospitals like the Cheltenham General Hospital are being closed to new patients and routine operations- but why?

NHS hospitals are gridlocked

Primarily hospitals are all about flow- as new patients arrive, others must move on through the system and, eventually, leave. But what has happened in the past month is that the system has stalled.

Last year more than 14 million patients arrived at A&E – effectively the front door of the hospital.

Most of those are dealt with by the doctors and nurses in A&E. But one in four need more complicated care than can be given so are admitted into the hospital. These tend to be the frailest and most vulnerable patients.

Once the decision has been made to admit them, those patients need to be found a bed. When that has happened, they can receive their treatment and, once they are ready, leave the hospital.

With A&E units full, ambulances have found it difficult to drop off patients. When they turn up at hospital, it is only meant to take 15 minutes to handover a patients.

But over the last four weeks there were over 37,000 occasions when ambulances were left waiting for over 30 minutes. That is more than double the number the year before.

Once inside A&E the delays have continued – as we know from the extensive coverage given to how the NHS has been struggling to meet its four-hour target.

A growing number of those that are then admitted into hospital are facing long waits (over four hours) for a bed to be found. These are sometimes known as trolley waits. During the last four weeks the number of these has trebled from last year to over 47,000.

But it doesn’t end there- when patients are ready to be discharged, delays are once again being experienced.

The frailest and most vulnerable patients need care to be in place in the community either via council-run social care teams or local NHS services before they can be released.

If it isn’t available, they have to stay in hospital. The NHS measures this as bed days lost due to delayed discharge. There were over 62,000 of these over the past four weeks – up by nearly a third.

This creates a scarcity of beds. The effect of this is two-fold. Firstly, hospitals are forced to put emergency patients in whichever ward they can find a bed, which means patients do not always end up in the place that is most appropriate for them.

This is not good for patients or for the effective running of the hospital. Doctors and nurses waste time going on what are known as “safari rounds” looking for their patients that can be spread across many different areas. In short, the hospital stops running smoothly.

The problems also have an impact on the non-emergency side of the system. One step that is taken is that routine operations, such as knee and hip replacements, are cancelled.

It is this catalogue of problems that prompts hospitals to raise the alarm. In recent weeks a number of trusts have even been forced to declare major incidents – like the Cheltenham General Hospital- which should be something normally reserved for major accidents, like train crashes.

The most common reason put forward for the problems has been the rise in attendances. But what seems remarkable when you look at the figures is that the increase in those seems extremely small by comparison.

They have only risen by 7% on last winter. But that is significant because it equates to more than 100,000 patients.

And in the case of the Cheltenham hospital it is compounded because the local health trust want to close the A&E department completely- to save money and move all emergencies to just one hospital in Gloucestershire- which is currently loss making.