The financial problems facing the NHS have been well documented especially at a time of rising demand from an ageing population with multiple comorbidities including diabetes, the epidemiology of which is well known. The national diabetes and care programme, linked to the sustainability and transformation plans seeks to direct funding towards elements of diabetes care which will improve outcomes. Bids from CCGs or groups of CCGs are invited for funding to develop a number of work streams. Specifically, improving the uptake of structured education by the newly diagnosed. Uptake for this is only 5.7% and, given the evidence to support its effectiveness in promoting glycaemic control there is potential that cost savings will offset the increased availability. Improving the achievement of the NICE recommended targets for HbA1c, cholesterol and BP and driving down variation across different CCGs is another area to be funded. Clearly the impact of improving these parameters on long term complications has a powerful evidence base but the national diabetes audit does show a significant degree of variation across the country not just explained by differences between the populations. Reducing amputations by improving the timeliness of referrals from primary care to a multi-disciplinary foot team will also be funded. Given the significant morbidity and mortality associated with this implication, reducing frequency and severity of ulceration will reduce hospital admissions and the long term costs of amputations. Cost savings will significantly exceed the cost of putting multidisciplinary foot care teams in place. The fourth funding stream is to increase the provision of diabetes in patient specialist nurses. This revolves around the evidence for DSNs reducing the length of stay for in patients with diabetes, again the cost of putting them in place being exceeded by savings.
As expected, the funding available does come with caveats including the link between bids and STPs and that it is available for 2017/18 and provisionally for 2018/19. There is also a complex framework to follow during the process. Whilst any extra funding for diabetes is welcome, there is the potential to fragment services further depending on the success of these bids.
Dr Mark Freeman