Audit shows sixty percent of people with diabetes in England not receiving recommended care

Sixty per cent of the 1.42 million people with diabetes in England included in the latest National Diabetes Audit do not receive all the care recommended for their condition.

The fifth national audit, carried out by The NHS Information Centre in 2007/08 and funded and commissioned by the Healthcare Quality Improvement Partnership (HQIP), also shows people with diabetes are more likely to have complications if they live in certain parts of the country or have a more socially deprived background.

People with Type 1 diabetes or Maturity Onset Diabetes of the Young (MODY) were also found to be less likely than those with Type 2 diabetes to receive any of the nine care processes recommended by the National Institute for Health and Clinical Excellence (NICE).

The audit found that in England:

  • Just over 90 per cent of people with Type 2 diabetes received a BMI, blood pressure or blood sugar (HbA1c) check, compared to just over 80 per cent of people with Type 1 diabetes and just over 70 per cent of people with MODY diabetes.
  • 80 per cent of people with Type 2 diabetes received a foot examination, compared to 60 per cent of people with Type 1 diabetes and less than 40 per cent of people with MODY diabetes.
  • More than 90 per cent of people with Type 2 diabetes received a cholesterol check, compared to just over 70 per cent of people with Type 1 diabetes and less than 50 per cent of people with MODY diabetes.

However, the increase in those who did receive all nine care processes - 40 per cent in 2007/08 – is significant compared to five years ago, when 6.5 per cent of patients received all nine care processes.

The fifth annual NDA also shows the complication rate, relating to nine specific complications sometimes had by diabetes patients, varies widely by region.

England's 10 Strategic Health Authorities (SHAs) were ranked according to prevalence for each of the nine complications, ranging from cardiac failure and stroke to amputations and angina. All but one SHA ranked in the lowest performing quarter for at least one complication, while seven ranked in the top performing quarter for at least one complication.

The audit also found wide variation in meeting care targets across England's 152 primary care trusts (PCTs). For example, glucose control and blood pressure targets are achieved for 50 per cent more people with diabetes in some PCTs compared to others.

Apart from eye disease, all complications were found to be more common with increasing social deprivation, with a two fold increase in complications between the least and most socially deprived patients.

The prevalence of stroke, for example, was 0.47 per cent in people with diabetes with the least socially deprived backgrounds, compared to 0.74 per cent for the most socially deprived.

Wales participated in the audit for the first time in 2007/08, and data is also available for the 15 per cent of General Practices across the 22 Welsh local health boards who took part.

The NHS Information Centre's clinical lead for diabetes, Dr Bob Young, said: “Diabetes affects an estimated 2.1 million people in England, not to mention the lives of friends and family of those who suffer from the condition. It also places significant pressure on the resources of the NHS.

“The National Diabetes Audit is hugely important in assessing the level of care which people who have diabetes receive. This year's results shows positive steps have been taken by care providers – with the percentage of people receiving all the care that is recommended for them up from just over six per cent to 40 per cent in just five years.

“However, that means that more than half of diabetics still do not get all of the care that is recommended they receive. There is stark contrast in the level of care depending on what type of diabetes a person has, where they live in the country, and how socially deprived they happen to be.

” Robin Burgess, Chief Executive of the Healthcare Quality Improvement Partnership (HQIP), said: “The National Diabetes Audit really highlights the need to address the shortfalls in care. Whilst the report shows an increase in the number of people receiving the right level of care, the numbers not receiving it are simply unacceptable. There is urgent need for clinicians to review practice, and for commissioners to ensure that the report recommendations are actioned immediately.”

The executive summary of the audit, including a PCT dashboard with detailed analysis of the audit results, can be accessed at www.ic.nhs.uk/nda from July 1. It is also attached to embargoed copies of this press release.

The full report for the 2007/08 paediatric National Diabetes Audit, an executive summary for which was published in February 2009, can also be accessed at www.ic.nhs.uk/nda from July 1.

Data for the 2008/09 NDA is already being collected. PCTS, hospital trusts, GP practices and specialist paediatric units can participate by visiting www.ic.nhs.uk/nda/takepart

ENDS

Notes to editors

  1. The NHS Information Centre (The NHS IC) is England's authoritative, independent source of health and social care information. It works with more than 300 health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. The NHS IC also produces more than 120 statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.
  2. The NHS IC is the largest single provider of clinical audits to the NHS and carries out a range of audits, mainly funded by the Healthcare Quality Improvement Partnership, into cancer, heart disease and diabetes.
  3. The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Their purpose is to engage clinicians across England and Wales in systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care. The programme comprises more than 20 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions, including diabetes.
  4. The nine processes of care for diabetes are recommended by the National Institute for Health and Clinical Excellence (NICE) and are; HbA1c, BMI, blood pressure, albumin, creatinine, cholesterol, eye examinations, foot examinations and smoking.
  5. The nine complications for diabetes are listed in this document within the SHA rankings (pdf 43KB).
  6. The NICE guidelines for Type 1 and Type 2 diabetes provide audit recommendations for a detailed range of clinical aspects of care for people with diabetes, for more information on these, go to http://guidance.nice.org.uk/topic/endocrine/?node=7096&wordid=77
  7. For non-media enquires about The NDA or diabetes information and services at The NHS Information Centre, contact diabetes@ic.nhs.uk
  8. For media enquires please call 0845 257 6990 or contact: