Interview: Make diabetes a top NHS priority, says Baroness Young

As an outspoken critic of the coalition government's health reforms, Baroness Barbara Young doesn't hold back when asked about the future of the NHS. 'I am concerned about integration,' she says.

Baroness Barbara Young: fact that fewer than 20% of people with diabetes receive structured education 'outrageous' (Photo: Jason Heath Lancy)
Baroness Barbara Young: fact that fewer than 20% of people with diabetes receive structured education 'outrageous' (Photo: Jason Heath Lancy)

'OK, so PCTs were not wonderful. On the other hand, they were buggered around so often by restructuring that you could understand.'

As chief executive of Diabetes UK, she is particularly worried about how the NHS will cope with steadily rising cases of the disease: 'If we don't do something it's going to absolutely clobber us.'

Baroness Young feels that political support for diabetes is going through a rough patch. It is the fastest-growing condition in the UK, but other diseases are hogging the spotlight. The prime minister now personally champions dementia, while cancer has its own drugs fund.

Fragmentation

Baroness Young, who fought to amend the Health Bill, believes fragmentation caused by a market economy in the new-look NHS is going to be difficult to deal with. 'The fundamental thing for a good diabetes service is an integrated pathway, underpinned by some effective multidisciplinary professional networks.

'If you've got any qualified provider, or a much more diverse market, somebody somewhere has got to make sure that happens in an integrated way.' This, she says, will depend largely on how well the regulator, Monitor, functions.

She adds: 'If we'd wanted to invent a more complicated system, we couldn't have done much better.'

Diabetic foot checks came under the spotlight in March with Diabetes UK's Putting Feet First campaign (see box). Around 80% of the 6,000 diabetes-related amputations each year are avoidable, the charity says.

IMPROVING FOOT CHECKS
Diabetes UK launched its Putting Feet First campaign for better diabetic foot care in March, with eight key points for GPs to follow when conducting the annual check:
  • Test foot sensations using 10g monofilament or vibration
  • Palpate foot pulses
  • Inspect for any deformity
  • Inspect for significant callus
  • Check for signs of ulceration
  • Ask about any previous ulceration
  • Inspect footwear
  • Ask about any pain

Baroness Young says: 'We always say to patients that a foot check isn't a foot check if you've still got your shoes and socks on.'

Baroness Young says GPs' performance on foot checks is patchy, with good use of multidisciplinary teams 'probably the exception rather than the rule'.

Practices must ensure that checks are done annually and make full use of specialist services if complications are suspected, she says.

'I mean, the life expectancy figures beyond amputation are grim: virtually nobody survives five years, about half are dead within two years. It's not good.'

She concedes: 'It is a tough ask for GPs, they've got a lot on their plate. But that's where simple protocols (come in).'

Similarly, NHS health checks to pick up cases of vascular disease and diabetes are subject to a postcode lottery too, as highlighted by a GP investigation which found that millions of patients may miss out on checks because PCTs are failing to invest.

Baroness Young says the checks are more than just vague risk assessments: the education that results is 'fundamental' to patients understanding how to modify their lifestyle, including the seven million at high risk of diabetes.

Local authorities take on responsibility for the checks in April 2013. Baroness Young says compulsory targets to deliver them should be introduced.

'In the past, you said to managers: "Deliver that or you're out." and my God, they delivered it. We saw that on waiting times, on four hours in A&E, on 18 weeks.'

For diabetes, future care must focus on patient education and self-management.

'The fact that fewer than 20% of people with diabetes get any form of structured education is just outrageous,' she says. 'How can someone be at the centre of their own care if they've not been given the tools to be able to understand it?'

The benefits to the NHS of better diabetes management could be huge, while failure to do anything would be disastrous. Diabetes UK is investigating how the NHS can make savings from the £10 billion annual cost of diabetes; not in five or 10 years, but this year.

Delivering the '15 healthcare essentials' – basic checks all diabetes patients should receive – and spotting people with diabetes 'the minute they get through the door of the hospital' are key to this.

She says: 'I just don't understand why, when we're spending £10 billion, and I reckon you can take £1 billion out of it by just doing it properly, the Treasury isn't taking more interest.' Baroness Young quips: 'There can't be many people who stroll past and offer you a billion quid.'

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