Chris Rennard writes… How to keep people with diabetes out of hospital

On Tuesday, I helped to launch a report ‘Keeping People with Diabetes out of Hospital‘. As a person with diabetes, I know only too well the pressure that our diabetes care services are under.

Whether I’m speaking to my Diabetes Specialist Nurse, to my consultant, or to my colleagues in Westminster, it is clear that the ‘diabetes epidemic’ is increasingly being recognised as of major concern. Of the 2.9 million people in the UK living with diabetes, a worrying proportion will suffer additional complications and will require hospital care. In the last year alone, another 130,000 people have been diagnosed with diabetes, and it is likely that they were already experiencing diabetes-related complications at the time of diagnosis.

The Primary Care Diabetes Society (PDCS) (with support from healthcare company Sanofi) recently carried out an extensive piece of research looking specifically at why people with diabetes end up in hospital and how it can be avoided.

I had the pleasure of chairing the working group of clinical experts behind the report, and I was both concerned and impressed in equal measure. My concern came when the extent of the challenge we face became even clearer — yet I was singularly impressed by the innovation and creativity demonstrated by the diabetes clinical community in tackling this problem head on.

Baroness (Barbara) Young, Chief Executive of Diabetes UK, spoke just last week on the alarming rise in the prevalence of diabetes, issuing this warning: “the time for action is now. We must reverse this trend if more people are not going to suffer unnecessarily and if diabetes is not going to bankrupt the NHS”.

She is of course, absolutely right. The human cost and the cost to the NHS of diabetes and its related complications is indeed staggering -– with some reports suggesting that it now accounts for 10% of the NHS budget.

Diabetes, by its very nature, is a complex condition and treatment spans the entire NHS care pathway. As such there are many costs attributed to it, particularly when you take into consideration the multiple complications that it can cause, including blindness, amputation, kidney failure, heart attack and stroke. More often than not these additional complications will result in a person being admitted into hospital — a medical intervention that places strain on the patient, and on the public purse.

In our assessment of current clinical practices, it became clear that, across the continuum of care, there are many gaps through which a patient can fall — managing their diabetes poorly and suffering complications, or having their condition diagnosed too late.

The socio-economic circumstances of a person with diabetes can also have a considerable impact on their access to care and the way in which they manage, or mismanage, their condition. The Black Asian and Minority Ethnic (BAME) community, older people, children and young people, and those from deprived socio-economic backgrounds are all susceptible to mismanagement, complications and the subsequent reliance on costly acute care services.

As with many organisational challenges, much of this comes down to communication and access to information.

The working group expressed their frustration at the way in which patient information is shared, or indeed not shared. To ensure that a patient has access to the appropriate treatment and specialist care it is vital that their doctors and nurses are fully informed as to their condition and medication. Whilst the general patient population may expect it, it is unfortunately not always the case. Dialogue between health care professionals across the entire NHS therefore must be multidirectional, open and fluid as standard.

Most importantly, this research shines a light on the value of sharing good practice.

There is a plethora of initiatives taking place across the NHS that are looking to keep people with diabetes in control and out of hospital. This can be as simple as putting a patient on an ‘at-risk’ register, to re-writing the entire care pathway. I hope that those on the frontline continue to innovate, to continue to share their best practice, and most of all continue to strive to attain excellence in diabetes care.

For my part, I will continue to work with other parliamentarians on behalf of the 2.9million people with diabetes, and the millions more who will be diagnosed with the condition in the years ahead for their right to the right care, at the right time.

* Lord (Chris) Rennard is a Lib Dem peer and former chief executive of the party.

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12 Comments

  • Why no mention of obesity, which is a major contributor to preventable diabetes?

    Lansley’s laughable policy of self-regulation and voluntary measures for the food industry needs to be seriously reconsidered if you want to reduce the burden on the NHS of preventable disease.,

  • How did his lordship vote on NHS bill

  • philip wren 4th Nov '11 - 9:13am

    To Richard Blogger. Agree with everything you say. I would add, why did we get non-reusable needles? Because when the govt decided that they had to issue fresh needles to those with HIV to stop the illness being spread by the sharing of needles, they could no longer deny diabetics the same rights.

    Chris might like to pick up another issue. My diabetic specialist belives I should not work and be on ESA. Having gone through the appeals process i am back at part-time work because a tribunal judged I was fit to work. My kidney’s are 80% functional, I have stents, I have retinopathy (though no laser treatement as yet), I have some damage to the nerves in my feet and I have just developed a frozen shoulder which is linked to vascular damage.

    While I was on ESA I didn’t have to be taken to accidnet and emergency because I had collapsed due to low blood sugars. How many times had I been admitted to A&E in the past 2 years because I had collapsed? Well, because I wasn’t working and was able to spend a great deal of time managing my diabetes, none.

    Why had I been medically retired? Because while working I was unable to give the proper amount of time to managing my diabetes.

    Thus the doctor on the panel, not a diabetic specialist as far as I could tell, said I was fit to work having decided that my diabetic specialist didn’t know what he was talking about. Not said, but her decision implies that to be the case.

    To be fair, around the same time as my appeal was heard, my GP did think I could do up to 16 hours a week, though he also admitted he was under pressure not to issue sick notes.

    I lost £92 per fortnight in benefits. The £2400 per annum saving would be wiped out by a couple of hospital admissions or extra attendance at my clinics.

    So far I am coping, but I wonder how many diabetics moved off ESA and forced to return to work will end up in A&E or in a hospital bed because going back to work has rendered them unstable?

    The government announces to the Daily Mail. We have got all these people off benefits. Back patting all around. In the mean time the NHS quietly picks up the bills and then the Dail Mail protests that we cannot afford the NHS.

    Wonderful isn’ it.

  • @g – Just like to say – I agree with you 100%
    First time for everything…

  • Margaret A. Rutter 4th Nov '11 - 1:43pm

    I to suffer with this condition. I am type 1. Due to a low sugar incident I was taken to my local A&E where a drip was given to bring my sugar level up. The sugar level was brought up so high that I had to be admitted and put on a slideing scale. My first morning in hospital I was given my night insulin instead of morning insulin. When I told the nurse she said she had to give it to me and did. This of course sent my control out of control. When the sliding scale alarm went off no nurse came to sort it so I had to learn how to turn it off to stop it distrubing the rest of the ward. All this due to ?

    To see my Nurse or GP is a fight to get an appointment due to them having to many people on their books. Remember they get so much a week per person and more if they see them.

    No one knows you better than yourself.So now I do the best I can to look after myself without medics, all I allow my medical staff do is sign my perscription and that is a problem since renewal dates have now been added. I only order what I need but oftern find I do not get an item I need because of the renewal date. So I never know what I am going get until I pick it up. Why can’t some one phone me and tell me when I am being denied a item I need so I have a chance to explain why I need it?

  • I’d be really interested to read the report but am having trouble finding it. Does anyone have a link to it at all? Ta.

  • Chris Rennard 4th Nov '11 - 11:37pm

    @ anna If anyone sends me their e-mail, i will send them a copynof the report until we get it online. chris

  • Can I recommend any type 2 diabetic patients to read the book and website ‘Blood Sugar 101 ‘. Which is turning conventional diet wisdom on its head using the shared wisdom of many thousand type 2 people , collaborating on the web.
    It would seem that it may be better to control blood sugar by controlling carbohydrate intake, rather than taking more carbs than you need and then overworking your pancreas to cope with it.

    @g. With you on how the food industry controls the diet policy of govt. I think our bodies were never designed to cope with the staggering amount of carbohydrate in all processed foods.

  • I am always complaining that there should be more things manufactured in the UK so I was pleased to see my autopen was made in England, less pleased to have diabetes of course.
    The autopen is very user friendly so I can painlessly inject insulin twice aday.
    My blood glucose level has returned to almost normal.
    Now I eat mostly vegetables and plenty of onions.
    Millions have diabetes in Thailand.There is sugar in all the food and of course the bottles of green tea have 8%
    sugar in them.I avoided sweets and desserts for years to no avail.

  • Chris Rennard 6th Nov '11 - 12:36pm

    also a very good article on the subject from Sarah Ludford here:

    http://www.publicserviceeurope.com/article/1053/europe-ignoring-diabetes-ticking-time-bomb

  • Chris Rennard 14th Nov '11 - 2:08pm

    The report is now available online at:
    http://pcdsociety.org/statements.php

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