The management of adult diabetes services in the NHS

Document type
Corporate author(s)
Great Britain. Parliament. House of Commons. Committee of Public Accounts
Date of publication
5 November 2012
House of Commons papers. Session 2012/13; HC 289
Health Services
Social welfare
Material type

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In 2009-10, there were 2.3 million adults diagnosed with diabetes in England and a further 800,000 people suffering from diabetes who remained undiagnosed. The percentage of the population diagnosed with diabetes doubled between 1994 and 2009 and is continuing to increase. The Department of Health (the Department) projects that the number of people with diabetes (diagnosed and undiagnosed) will rise from 3.1 million to 3.8 million by 2020. The NAO estimates that, in 2009-10, NHS spending on diabetes services in England was at least £3.9 billion, although this figure is likely to be an underestimate. The projected increase in the diabetic population could have a significant impact on NHS resources. Too many people with diabetes are developing complications because they are not receiving the straightforward care and support they need, either through access to high quality care from appropriately trained NHS professionals or through effective training and support for patients so that they manage their condition. Most alarmingly, the Department estimates that 24,000 people with diabetes die prematurely each year because their diabetes has not been managed effectively. An estimated 80% of the costs of diabetes in the NHS are attributable to the treatment and management of avoidable diabetic complications. Unless diabetes care improves significantly the NHS will continue to incur ever-increasing costs as the number of people with the disease rises and individuals will continue to die prematurely.

Although there is consensus about what needs to be done for people with diabetes, progress in delivering the recommended standards of care and in achieving treatment targets has been depressingly poor. There is no strong national leadership, no effective accountability arrangements for commissioners, and no appropriate performance incentives for providers. We have seen no evidence that the Department will ensure that these issues are addressed effectively in the new NHS structure. Failure by it to do so will lead to higher costs to the NHS as well as less than adequate support for people with diabetes.

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