Inadequate NHS diabetes care causing harm to patients

Posted: 25/05/2012

NHS diabetes care is 'inadequate' and some patients come to further harm due to poor care in hospital, a leading specialist says. A further report warns that diabetes care in England is in a ‘state of crisis’, with fewer than half of people with the condition getting the basic minimum support.

Dr Gerry Rayman, national clinical lead for inpatient diabetes, has said that a third of hospitals have no inpatient diabetes nurse specialist, and with the increasing number of hospital patients suffering from diabetes, (now one in six) the situation is 'quite alarming'. He said it was ‘absolutely disgraceful’ that one in six people in hospital had diabetes but that, unless they had suffered a stroke, hospitals did not appoint specialist teams or consultants to look after them. He added: "Unfortunately, many people in hospital with diabetes do come to harm as a result of, I'm afraid to say, inadequate care in hospital."

Diabetes accounts for 11% of all NHS inpatient expenditure, and cost the service around £23.7bn last year, a figure projected to increase to just under £40bn by 2035.

Diabetes that is not controlled can cause many serious long-term problems:

• excess glucose (sugar) in the blood can damage the blood vessels, contributing to heart disease, strokes, kidney disease, impotence and nerve damage;
• uncontrolled diabetes is the most common cause of blindness in people of working age;
• people with diabetes are also 15% more likely to have an amputation than people without the condition.

In Type 2 diabetes, not enough insulin is produced or the insulin that is made by the body does not work properly. It tends to affect people as they get older and usually appears after the age of 40, but increasingly is seen in younger, overweight people. It accounts for 90% of all cases. Type 1 diabetes, a condition which usually means insulin cannot be produced at all, is responsible for the other 10%.

The State of the Nation 2012 report, which was published on 14 May by Diabetes UK, looked at 12,800 patients on the wards of 212 English and 18 Welsh hospitals. It found that there are some areas where just 6% of people with diabetes are getting the regular checks and services recommended by the National Institute for Health and Clinical Excellence and overall less than half of patients are receiving this basic standard. The report details how not getting these checks has helped fuel a rise in rates of diabetes-related complications. These complications account for about 80% of NHS spending on diabetes and are one of the main reasons that treating the condition costs about 10% of the NHS budget, Diabetes UK said.

The national service framework for diabetes – setting out the healthcare diabetes patients should get – has been in place for 11 years but has not become a reality, Diabetes UK warns. The charity is calling on the Government to urgently deliver a plan to implement these standards.

Care services minister Paul Burstow said: "There is still much to be done to help tackle diabetes and root out poor care. That is why we are working on a new long-term conditions strategy with diabetes as an exemplar. Our focus is on prevention and education, with more done to get earlier diagnoses and to help people manage their conditions themselves. This report and our new strategy will help local NHS services act so that diabetics get the care they need and deserve."

The Department of Health also claimed that it was trying to improve care standards, arguing: "That is why the National Diabetes Inpatient Audit (NaDIA) reviews diabetes management in hospital each year and feeds results back to individual hospitals to take appropriate action."

However, on 17 May the NaDIA showed that a third of patients with diabetes who are admitted to hospital in England and Wales are being put at risk of dangerously high or low blood glucose concentrations, with potentially fatal consequences, because of errors made in their treatment. These include medication errors, which often lead to severe hypoglycaemic episodes and the potentially fatal diabetic ketoacidosis.

A bleak picture therefore emerges of the NHS provision of treatment for this increasingly common disease.

Return to news headlines