Diabetes in the UK

Diabetes treatment is a postcode lottery

Monday, 09, Jun 2008 12:00

The story of diabetes treatment in the UK is in fact many stories. Men and women in different parts of the UK experience widely different standards of care and treatment. Like so many other medical conditions in Britain, diabetes is a postcode lottery.

Where it's good, it's very good. Standards have shot up in services across the country, with the need for preventative checks, psychological counselling and educational initiatives now well understood.

But where it's bad, it can be very bad.

Many services experience inadequate staffing levels, budget cuts, low morale and heavy workloads. The health of hundreds of patients is put at risk by lack of dietary advice and psychological support is often unavailable. This is a particularly dangerous failure, because although the reasons for the development of Type 1 diabetes are less clear, Type 2 diabetes is closely associated with obesity and other lifestyle factors.

People with diabetes are 2-3 times more likely to suffer from depression, yet access to psychological support has fallen from 45 per cent to 41 per cent.

Sandra Gidley, Liberal Democrat health spokeswoman, has a particular interest in diabetes. "It is very patchy," she says. "It hasn't been helped by constant re-organisation of health services, so people are more concerned with keeping their jobs than providing new services."

A recent report by Diabetes UK gave the NHS two stars out of five for its performance.

"We are very worried about the slow progress the NHS is making towards delivering all the national service framework standards by 2013," says Douglas Smallwood, chief executive of Diabetes UK.

"It is not good enough that almost two million people with diabetes are facing an unnecessarily increased risk of life-threatening complications because of the government's failure to address the quality of diabetes services across the country."

Nowhere is the gap between services more evident than in retinal screening, a process designed to spot signs of retinopathy, a condition common to people with diabetes.

Blood vessels in the eye become blocked and leaky, getting in the way of light passing to the retina. Without treatment, it can ultimately blind the sufferer.

The thing about retinopathy is how easily it can be treated, if diagnosed early. Pain free laser treatment, where tiny beams destroy damaged parts of the retina, can prevent further loss of sight in about 80 per cent of cases. But it can't bring sight back. So diabetes charities have concentrated their efforts on preventative measures – calling on the government to ensure all over-12s with diabetes are given regular screenings with a digital camera.

The latest figures don't make for satisfying reading. Sixty per cent of primary care trusts failed to meet their targets of offering all people with diabetes the chance to be screened for retinopathy, while 762,673 people with diabetes over the age of 12 didn't receive retinal screening in the year ending March 2008.

Take David. David contacted his local hospital in June 2006 because his annual digital screening test had not arrived. He was informed the service would be transferred to the Norfolk and Norwich Hospital, a hundred-mile round trip. When he called them, the hospital told him that due to funding difficulties the service would not be up and running until next January.

David was not the sort of man to take this lying down. He wrote to his MP, who - to his credit - raised the matter several times to the Department of Health. Then he wrote to the health secretary before finally deciding to go all the way to the top and write to the new prime minister, Gordon Brown.

It didn't do any good. Two years after he was last seen, David was still waiting for his retinal screening appointment.

"I feel that despite my best efforts, I keep getting fobbed off when all I want to know is, are my eyes going to be screened and if so when?" he asked.

"I am going the extra mile in keeping a strict eye on my diet and lifestyle - the very least I would expect is support from the PCT in the very important matter of digital retinal screening."

As it stands, three quarters of a million people with diabetes in England are at risk of losing their sight because they are not being screened for diabetic retinopathy.

But the problem isn't just with service provision, it's also in how many people take up the offer.

"There's a patchiness in the number of services that offer the test," Ms Gidley says, "but there's also a lot of people who don't take the offer up.

"So we need an education programme telling people this is an important way of preventing sight loss."

Without proper education and decent, universal coverage, people with diabetes will continue to be vulnerable to the devastating side effects of their condition, as well as diabetes itself.

Groups like Diabetes UK are calling for the provision of emotional and psychological support as an integral part of a diabetes care package, and for the package to be part of an overarching policy that will put an end to the post code lottery.

Diabetes UK is holding a Diabetes Week from the 8th to the 14th of June to raise awareness of the seriousness of diabetes. To find out more about diabetes in the UK and Diabetes Week visit the website.