Lack of prevention in diabetes could cost £600m

I recommend listening to a File On 4 programme about diabetes where they explore the cost of the lack of preventative care in diabetes and how it leads to higher costs in the long term. The programme speaks for itself but it is worth excerpting a couple of parts from the pdf transcript.

Julian O‟Halloran, the File On 4 reporter is talking to Professor Mike Edmonds.

O‟HALLORAN: What do you think the cost of this particular complication – foot and lower leg complication – is?

EDMONDS: It‟s about £600 million, the cost to the NHS. And of that £600 million, £252 million are spent on amputations. And it needn’t be like this. Of those eighty amputations that I mentioned, probably 70% to 80% are preventable.

O‟HALLORAN: Are you seeing some of your patients far too late?

EDMONDS: Yes, we are seeing patients late, where they have developed extensive destruction of tissues related to infection…

The programme goes on to look at the incentive payments that GP practices get for doing a certain number of tests on diabetes patients and they found that you don’t need to test many patients to get a high payout. O’Halloran talks to Dr Henry Featherstone who wrote a report for the Policy Exchange think tank.

FEATHERSTONE: For the year that we looked at, which was 2008/2009, we found that GPs were hitting 98.4% of their indicators and therefore payments for providing clinical care to patients with diabetes.

O‟HALLORAN: So the GP surgeries were earning the maximum amount of money they could pretty well on the diabetes measures?

FEATHERSTONE: Yes, so on the performance and quality measures they were pretty much hitting their top targets. If you were to look only at the payment system, I think the assumption would be, with GPs getting 98% of their targets, that the care was absolutely fantastic. However, if you were to look at the independent National Diabetes Audit, that tells a very different story, with only 50% of patients receiving all the care processes.

A little while later is Dr David Simmons, a consultant physician at Addenbrooke‟s Hospital, Cambridge.

O‟HALLORAN: And how much does it cost a GP practice to refer a patient?

SIMMONS: A new patient appointment for diabetes is around £250 and a follow up is around £89. The perverse incentive really comes from a tariff-based system for something where the cost and the outcomes and the difficulties may be ten or fifteen years away. If you approach health from an annual budgetary cycle approach, when in diabetes the payment for it from the person with diabetes is often in fifteen years from a heart attack, from other complexities, the kidney disease, the eye disease, then an annual cycle of payments every year is not really going to have sufficient incentive, and they‟ll say, “Let’s put this off for a year, let‟s put off dealing with diabetes for a year,” when this is something which is an epidemic, it‟s an enormous cost on the country and we need to deal with it now, without the perverse incentives of saying, “Oh look, £89 for a visit, do away with that this time and we‟ll save that money and we can spend it on something else.”

So 24,000 diabetes patients are dying every year because they are not getting early enough treatment to prevent infections, gangrene and other complications. And the system is probably incentivising GPs not to refer those patients to hospital due to the way the payments are set up.

The real irony being that better, earlier treatment could save the NHS £252 million on amputations and perhaps £600 million on preventable diabetes complications in total.

So better care for the patient is cheaper. So why don’t we just do that?

Do listen to the programme in full it is an ear-opening listen.





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