Service review of diabetes

Diabetes is a life threatening, long term condition which affects more than 1.9 million people in England. Diabetes shortens people’s lives and affects their quality of life because of the long term complications. Not only is there a human cost to the person with diabetes, but the financial cost to the NHS of caring for people with diabetes is estimated to be around £9 billion every year.

‘Self care’ is a cornerstone of the Diabetes national service framework and of the Department of Health’s approach to caring for people with long term conditions. ‘Self care’ or caring for yourself is fundamental to daily living. For people with diabetes, it is about dealing with the impact of diabetes on their daily life. A growing body of evidence demonstrates that supporting people with long term conditions to care for themselves means that they do better, both in clinical terms and in their quality of life. It also can contain increases in healthcare costs.

We carried out a service review to assess the quality of healthcare for adults (aged 17 and over) with diabetes in England. The purpose is to improve the services commissioned by primary care trusts (PCTs) that ensure that adults with diabetes are offered the support that they require to look after themselves. We assessed PCTs against one another by asking:

1. Are adults with diabetes looking after their condition?

2. Do adults with diabetes feel supported to ‘self care’ through care planning, information and education?

3. Do adults with diabetes have key tests and measurements carried out?

National findings

We found that most people with diabetes: have regular check-ups; reported that they know enough about taking their medication; reported having the key tests carried out that are easily recognisable; and, where necessary, were offered advice about stopping smoking.

However, the review demonstrated that some aspects of the support offered in many PCTs are in great need of improvement:

1. Better partnerships between people with diabetes and their healthcare professionals when planning and agreeing care

2. Increasing the number of people with diabetes attending education courses and improving their knowledge of diabetes

3. Working more closely with all organisations providing and commissioning diabetes services

4. Increasing the number of people with diabetes having long term blood glucose levels of 7.4 or a lower, safe level

5. Reducing variation in general practices’ achievements

The report makes a number of recommendations to improve the services offered to help people with diabetes care for themselves. The full list is given in the main body of the report.

Read the full report: Managing diabetes: Improving services for people with diabetes (pdf 2392kb) (opens new window)

Read the press release (18th July 2007)

Read the information for people with diabetes and their carers (pdf 43kb) (opens new window)

Read the paper on the statistical methods used for the national survey of people with diabetes (report reference 34) (pdf 155kb) (opens new window)

Read our framework of assessment (report reference 36) (pdf 186kb) (opens new window)

Read our framework of assessment spreadsheet (xls 334kb) (opens new window)

Read our technical guidance on analysis and scoring (report reference 37) (pdf 138kb) (opens new window)

Results of the review

Explore the detailed results for the review below.

Access the full detailed results of the review, including underlying data (opens new window)

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Results of the review for all primary care trusts in England in alphabetical order (pdf 124kb) (opens new window)

Results of the review for all primary care trusts in the Healthcare Commission's London and South East region in alphabetical order (pdf 48kb) (opens new window)

Results of the review for all primary care trusts in the Healthcare Commission's Central region in alphabetical order (pdf 49kb) (opens new window)

Results of the review for all primary care trusts in the Healthcare Commission's North region in alphabetical order (pdf 56kb) (opens new window)

Results of the review for all primary care trusts in the Healthcare Commission's South West region in alphabetical order (pdf 38kb) (opens new window)

Follow up and ongoing monitoring

We are currently working with the 18 weakest-performing primary care trusts. These trusts fall into two categories. Either we found that their services were ‘weak’, or we could not make an assessment because we had too little information from them about the views of the people with diabetes in their area. We are monitoring the progress of these trusts with strategic health authorities.

The Healthcare Commission intends to monitor the performance of primary care trusts in future years by using a small number of indicators selected from the framework of assessment for this review.

Background to the review

We assessed the services provided for people with diabetes using a range of existing data. The main source of data was our national survey of people with diabetes, which looked at whether people with diabetes are receiving the care, treatment and information they need to manage their diabetes and reduce the risk of complications. We also used data from the the Health and Social Care Information Centre’s Quality and Outcomes Framework for 2005/2006 and Hospital Episode Statistics. PCTs were not required to collect or submit any data.

Find out more about the national survey of people with diabetes

Find out more about QOF (opens new window)

Find out more about HES (opens new window)