Keeping people with diabetes out of hospital

Lord Rennard

Today, Lord Collins of Highbury asked a question about how the Government was responding to the rapidly growing number of people with diabetes.  I used the question to draw attention to the report that I launched today on “Keeping people with diabetes out of hospital.”

The report was drawn up through a series of meetings convened by the Primary Care Diabetes Society that I chaired in the House of Lords.  Earl Howe, the Minister for Health in the House of Lords confirmed that he would look at the report and study the evidence on which it was based.

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 more susceptible to mismanagement, complications and the subsequent reliance on costly acute care services.

Our report showed that there is some excellent practice in helping people to achieve good diabetic control – but that this best practice is not consistent.  Much more is being learned about how we can help people with diabetes maintain healthy lifestyles and avoid diabetic complications that can have these serious consequences.

I suggested to Earl Howe that greater provision of insulin pumps and more extensive use of bariatric surgery may prove to be cost effective to the NHS over a few years.  When wider considerations are taken into account in terms of people with diabetes sustaining better health in future and contributing more positively to the economy, the these procedures may reduce the costs of diabetes to the public purse rather than add to it. 

Health Minister Paul Burstow spoke at the official launch of the report in the House of Lords later this afternoon.  I was able to introduce him as a personal friend and as a good friend of the diabetic community.  He was very mindful of the consequences of failing to help people manage their diabetic control and the huge cost (about 10% of the NHS budget) of trying to deal with the problem at the moment.

It is an issue which parliamentarians present (including Adrian Sanders MP who chairs the All Party Parliamentary Group on Diabetes) undertook to keep up the pressure.

13 comments for “Keeping people with diabetes out of hospital

  1. Dave H
    01/11/2011 at 8:17 pm

    What benefits would there be from early screening? How many people are diagnosed when it’s necessary to put them straight on insulin, and how many are found while they are still in a position to manage the condition with diet and pills? I would have thought that the longer that a person can maintain a good blood sugar level without needing insulin to deal with the highs, the less organ damage they will suffer and the worst effects will be delayed or avoided.

    There does seem to be some enlightenment locally – I know someone who was diagnosed early due to a family history of diabetes and so was watching for signs. Ten years ago or so, there was no recognition of treating that stage where it was obviously going to progress but hadn’t yet reached some arbitrary threshold. Now, it seems, people in a similar state are more likely to get assistance with managing the progress of the condition. The other area in which things have improved is a greater willingness to prescribe test strips for glucometers, so that sufferers can check their blood sugar at more regular intervals and once again, better manage their condition to maintain a more consistent blood sugar level.

  2. maude elwes
    01/11/2011 at 8:29 pm

    My thought on this thread is, keeping all of those out of hospital, who simply can be looked after alternatively is the absolute best move you could make. To go into hospital in this country now, is definitely detrimental to any persons well being.

    First there is the threat from not being understood if you speak English. MRSA follows and if that doesn’t get you, you can face contamination of every kind in or around your person. Blood for a start. Not a good idea unless you donated your own, and insist on having a pint or two of that. Should you make it through that hurdle, the no food or drink served, unless relatives or friends can be kind enough to bring it in for you, is a must. Then there is that other lark of perhaps the nurse, or, whoever is attending to your needs, decides to do you in, just for the hell of it. A little overdose of this or that in the bag of a saline drip can be lethal these days.

    No, stay away from a UK hospital at all costs. Your life may depend on it.

  3. MilesJSD
    milesjsd
    02/11/2011 at 5:07 am

    A socially-deprived aging person in Plymouth has diabetes with a water-retention problem in the legs.
    She lives in a small single flat in a low-income-tenants sheltered-housing association block and depends upon an NHS carer and so forth, and can hardly walk

    but the thing which struck me as being odd was that not the NHS but the Local Social Care service provided her adjustable leg-raising bed.
    ————-
    Another older lady with diabetes had a slight problem, getting out of a bath rather than into it;
    for which the Local Social Care loaned her a £5 suction-=foot stool upon which she could stand to get out of the bath,for which the lady had to sign and promise to return in good condition when she dies.

    “Peccadillos ?”

    The curious thing is that the Social Care service in Plymouth denies any need for it to help with any Health matter.
    “Anything to do with Health you must go to your GP for”.

    Ten years ago at the end of a TV ‘scrutiny’ put to NHS leaders, the big-question was put
    “What System will work now, for the NHS ?”
    Answer: “Any system will work – provided all departments use the same one”.
    ————-
    It looks as if there is still disparity within the NHS, and between it and ‘Social Care’

    and one is also mindful that maybe Britain’s Overall Longest-Term Strategy is still being ‘farmed- out’ to individual Civil-Service Heads who jealousy like to design their own take on Strategy but under the many and various titles for ‘Policy’.

    I also see a streamer across the top of channel 275 Body in Balance, saying
    “Eat less sugar to improve your mood”;

    so what is the Somatopsychic news about Diabetes, and possibly therewith about the over 400 other so-called Degenerative Diseases, that are in truth not diseases at all but symptoms of an underlying complex disease “Lipotoxzemia” ?
    (Horne: “The New Health Revolution”).

    What other factors lie hidden ?

  4. Twm O'r Nant
    02/11/2011 at 8:35 am

    If people want to eat themselves to death with sugar that is up to them.

    I had a pal who did the same recently. Would he give up sugar?No! Did they amputate for ulcers
    and pain? Yes! Did he die from this terminal surgery?Yes!

    His comment before the events unfolded?

    “Life would not be worth living without sweetness”

    Live and learn.

    Me? I’m a dry person and I prepare most of my own food from natural ingredients, fruit and veg. I use very little sugar indeed,other than naturally occurring fructose.

    • MilesJSD
      milesjsd
      02/11/2011 at 9:48 am

      Tempting to be said, Twm:
      “So you wish others down the corruption track you yourself will not travel ?”

      Seriously, ‘though:
      “freedom” does not mean “do as you like(within which “as you like” does not necessarily mean “what is best”);

      the human-being is a social-animal – and whilst being innately blessed with the holy seven sacramental energies, is also subject to exigencies of human-civilisation some of which work against one or more of those seven sacramental-energies –

      and that is why it likewise could, and I argue should, be held that the only “private” conduct and behaviour allowed by human-civilisation is that of the compassionate, ‘terminal-bed’, kind;
      not of the “this human-being is worthy to be supported, even secretly so, as more-than-one human-being” pretence;

      and why the one-human-being taking from the Common Purse more livings than one-human-being essentially needs (i.e. the legislated ‘one’ = (say) £300 per week) to be healthy, citizenlike, and environmentally-supportive) is also morally and malfeasantly wasteful and un-sustainworthy (given that at birth the individual human is sustainworthy).
      ————
      (Do not put the above in your pipe and smoke it.)

      (Do not commit, neither by word nor deed, suicide;
      nor murder;
      nor any kind of harmful deprivation ).

    • Dave H
      02/11/2011 at 12:30 pm

      Have you seen how much sugar is in all sorts of manufactured food, even when you wouldn’t expect it? Even salsa comes with sugar-loaded ingredients, often corn syrup. Perhaps the government should look at the amount of sugar added to foodstuffs and the difficulty in finding those without. We’ve had the great salt debate, now we need a similar one on sugar. No doubt the manufacturers will claim that we’re all used to the taste and so they can’t change the ingredients.

      While I’m a great fan of home-prepared food, it’s not always possible and I’m not aware of any legal limits or pressure to reduce the sugar in food.

      After all, as we were reminded by a recent guest post on here, even the Lords now has added Sugar.

  5. 02/11/2011 at 12:42 pm

    No Chance in this day and age, as Atos stroke off diabetic people who have disabilities then they have no money and not enough food for days and an inadequate diet there is now an increase in the number of hospital admissions due to coma relapse, organ breakdown and more and unnecessary amputations. Really amazing how you take notice of ones bill and are part of it yet take notice of another part in consequence to that bill and do not see the affect and consequences. And of course that affects diabetic children as all money taken off parents is also money taken off the support and provision to children of an adequate diet or a special diet. Go change the Welfare bill then there would not be an increase in diabetics to hospital in a critical state.

  6. Gar Howell
    03/11/2011 at 1:55 am

    I discussed this subject with a n MSc health
    graduate student from Kings this afternoon sitting in the NFI foyer. I can’t quite remember the title of the Graduate course; it can’t have been “health prevention”; at least I hope not but with regard to Dia(too much)-betes(sugar) I have my doubts!

    She was a deeply thoughtful Derbyshire lass of 21, with a fine career ahead of her in health care.

  7. 06/11/2011 at 8:09 pm

    If you’ve been diagnosed with diabetes, prospects are you are thinking that you could kiss your satisfaction of food – a crucial and very important aspect of any well-rounded lifestyle – goodbye. The nice information is that along with remaining the one most significant issue you are able to do to handle your disease and consider handle of one’s health, following a diabetic weight loss plan is astonishingly basic, nutritious and (surprise!) tasty and rewarding. The 2 essential points to recollect when commencing this diet program are: 1) understand what to consume and 2) know when to eat it.

  8. lordrennard
    14/11/2011 at 2:10 pm

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

  9. 13/05/2012 at 8:51 pm

    diabetes runs in famalies like my husband he is blind through it 1/60 vision left in one eye none in the other he is deemed legally blind 4 uncles one aunt has it he is on dialysis through it found out that he has artial fribulation a heart condition

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