Sugar-coated health care
James Gubb, 23 October 2008
‘The number of people who will die as a result of diabetes is forecast to rise from one in ten to one in seven in less than 20 years unless obesity rates can be reduced significantly. Costs to the NHS of treating the disease are expected to rise by a third by 2025 as the number of people suffering from diabetes reaches a record level. The figure is forecast to rise to £12 billion, before inflation, by 2025,’ says Diabetes UK. All true; it fact, if the NHS’ current productivity trends are to continue, it will probably be worse….unless, of course, we start working in a completely different way.
People who suffer from diabetes need a health service tailored to the needs of a someone suffering from diabetes, not your run-of-the-mill person with no health problems. There are examples of good practice in the NHS, but not enough. Bolton PCT now provides a local managed diabetes network. Ninety per cent of the PCT’s 57 general practices have structured diabetes care and the Bolton Diabetes Centre seeing patients with complex needs or in transition. Care aims to be patient, and not organisation or target, centred; the vision is that care should be delivered in the appropriate place at the appropriate time by the appropriately trained professional. A similar goal is held by Luton PCT. It has begun a pioneering diabetes service, which aims to help patients effectively self-manage their condition, through education, support groups and regular real-time screening.
But unfortunately, these are isolated examples. Only 57 per cent of PCTs have any sort of programme in place to raise awareness or pick up risk factors. And what about personalised medical services for those that do have the disease? There are now devices that act as continuous glucose sensors, real-time wireless transmitters, and real-time insulin pumps. These are not widely available, but could be life and cost-savers.
Is this the limitation of our system? It decides what you can have, but why should it? Where is the innovation and spread of new ideas? The Harvard Professor of Business Management, Regina Herzlinger, has one idea, expressed at an event hosted by Circle and the Harvard Business School last night: consumer-driven healthcare. Why have the postcode lottery of which PCT you happen to live in as to whether you have a decent diabetic service, when, with choice of insurer (for everyone) and a liberalised supply side driving competition through the system, you could possibly select a plan and integrated service specific to your needs?