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'Cuts to specialist posts damage care and raise long-term costs'

Diabetes specialist nurses help to reduce the risk of complications that are both devastating for the person involved and very expensive to treat, says Barbara Young

I must be one of the few chief executives of a health-related charity who is not calling for more money to be spent on my cause in these days of austerity.

When it comes to diabetes, no one can argue that the government is not putting its money - or, rather, our money - where its mouth is. The NHS is already spending a colossal sum on diabetes; in fact, around 10% of the entire NHS budget goes on treating the condition.

So far, so good. But the problem is that this level of expenditure is not translating into good health outcomes.

Rates of complications, such as kidney failure and stroke, are at record levels and every week about 80 diabetes-related amputations are performed that could have been prevented. We are the poorest-performing country in Europe when it comes to blood glucose control for children with diabetes.

All this is contributing to the fact that people with diabetes are dying younger than the rest of the population and many are enduring debilitating complications.

“Whether you look at it in terms of human or financial cost, this short-termism is not prudence. It is wanton recklessness that will lead to more complications and therefore huge financial and human costs”

This is bad news for the country because it means a significant chunk of public spending is being inefficiently used. But it is the 3.7 million people with diabetes who are paying the heaviest price, both in terms of reduced quality and length of life.

When looking for a reason for this, the example of the NHS approach to funding diabetes specialist nurses is a good starting point. The vital support they give people with diabetes helps reduce the risk of complications that are both devastating for the person involved and very expensive to treat.

Yet, despite everyone agreeing that diabetes specialist nurses are a vital resource, across the country we are seeing posts being cut to help balance budgets. The result is that people with diabetes have less support in managing their condition.

Whether you look at it in terms of human or financial cost, this short-termism is not prudence. It is wanton recklessness that will lead to more complications and therefore huge financial and human costs.

This lack of forward thinking is not limited to diabetes specialist nursing. Across the board, too few people get access to the checks and services they need to keep them healthy so the NHS ends up paying large sums of money to treat the complications that are the inevitable consequence of this.

I know this is something nurses feel strongly about because they are only too aware of the ongoing failure to get to grips with high rates of diabetes complications.

Fixing this does not require more money. It needs leadership. The government has publicly acknowledged that healthcare for people with diabetes is not good enough. Now it needs to back up these welcome words with strong action.

This means implementing the national plan for diabetes healthcare that has existed for 11 years but has not been brought in. Without a strong implementation plan, the lack of drive we are experiencing at the moment is likely to continue. We need to see the implementation of effective risk assessment and early diagnosis, as well as education for patients so they can play their part in managing their conditions to avoid complications. A big focus for this implementation plan should be on insisting on good standards of care across the country in line with agreed quality standards and holding commissioners and providers that do not meet these standards to account.

It is only through activating an implementation plan and strong leadership that we will stop the NHS spending so much of its budget ineffectively dealing with heartbreaking and expensive complications. This will mean people with diabetes will finally get effective diabetes care and we will see the reduction in the currently inexorable rise in diabetes and its complications.

Barbara Young is chief executive, Diabetes UK

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