| Dr Rowan Hillson |
As National Clinical Director (NCDs) for Diabetes Dr Rowan Hillson MBE represents UK’s publicly funded healthcare system, NHS in the Department of Health. As NCDs, these experts oversee the implementation of a National Service Framework (NSF) and spearhead change, by working with policy and delivery teams, clinical networks and the NHS management community to achieve joined-up action. She is scheduled to speak at the Indo-UK Diabetes Summit on January 18-19, 2013 in Chennai. Viveka Roychowdhury asks her about her experience with diabetes care, her role on the policy front, and what she feels should be the roadmap to tackle the looming diabetes epidemic in India
You have been involved with diabetes care initiatives for many years. As a clinician, what worries you most about the progression of this disease condition?
Diabetes is common, chronic, complicated and costly. Costly for the person who has it in distress, disability and premature death. Costly for the patient and the nation financially. I worry about the increasing numbers of people developing diabetes – 400 a day in England. Many people don’t know they have diabetes.
In 2003 there were 1.3 million people with diagnosed diabetes in England. In 2012 there are nearly 2.6 million. It is increasing by about one million every eight years. Diabetes is a silent killer. Most people with diabetes are recorded as dying from something else – but the diabetes is the underlying cause. In England there are 24,000 excess deaths among people with diabetes a year, compared with the general population of the same age and sex. Many of these deaths are potentially preventable.
Diabetes complications may not be noticed until they are very advanced. So people with diabetes and healthcare professionals need to ensure annual checks for risk factors and early signs of complications so they can be treated.
What have been the policy changes that you have since you were appointed as the NCD in 2008? What are the healthcare outcomes from these changes?
I believe that good national and local information about diabetes and diabetes care is vital. Information about local care allows good care to be celebrated, and poor care to be improved.
I established the National Diabetes Information Service (NDIS) and chair the partnership board. NDIS provides a comprehensive range of diabetes data, tools and information via one web portal. We published a geographical Diabetes Atlas of Variation to highlight improvement need.
NHS Diabetes, established in 2009, is our national improvement body for diabetes. With the Department of Health, I set their priorities. They provide national, regional and local support to improve care. In 2009 they worked with all stakeholders to publish integrated commissioning guidance (Diabetes Without Walls) for primary care trusts (local organisations responsible for primary care and for commissioning specialist care). They are doing the same for the new Clinical Commissioning Groups (CCGs). Built into this is the recognition of the need to tailor commissioning to local communities – for example, those with many people from South Asian backgrounds. Much work has been done on this in Leicester and Birmingham, for example.
There are 23,000 children and young people with diabetes in England. We introduced a best practice tariff for specialist paediatric diabetes units – paid if they provide all the standards of good care.
We aim to improve diabetes management in primary care. An NHS Diabetes team is working with CCGs, focussing on areas with poor NDA results. My personal campaign to increase urine albumin testing has been accompanied by an increase from 63 per cent in 2007/8 to 75 per cent of patients in 2010/11.
We are working to improve diabetes care in hospital. Inpatients with diabetes stay longer and are more often readmitted than non-diabetic patients. The National Diabetes Inpatient Audit showed that 37 per cent of diabetic inpatients had an error related to diabetes medication. The NHS Diabetes Inpatient Network has reduced this to 32 per cent in a year but much more improvement is needed. A national programme called ThinkGlucose is helping. We know that having diabetes increases the risk of dying in hospital by 10 per cent. Best practice tariffs for hospital diabetes care are being introduced. I established the safe use of insulin campaign. 92,000 healthcare professionals have now used the NHS Diabetes e-learning course. Other safety courses are receiving enthusiastic uptake.
We must reduce amputations. The NHS Diabetes Footcare network, working with Diabetes UK, are driving foot risk assessment, and prompt, appropriate referral to multi-disciplinary specialist diabetes foot teams. Some English services have reduced their amputation rate by 80 per cent. We use health economics to focus attention on diabetes. NHS Diabetes published the economic case for improving hospital care and foot care. We must improve pregnancy outcomes in women with diabetes. Competencies for diabetes midwives were published and now most hospitals have one. A national audit starts next year. NICE guidance states that 12-15 per cent of people with type 1 diabetes should have an insulin pump. About eight per cent do now – an improvement.
Our Older People’s Network with the Institute of Diabetes in Older People supports the majority of people with diabetes, including those from South Asian and other communities, and help meet their needs. Ongoing work aims to improve diabetes management in care homes. We have linked with the dementia team to improve care and diagnosis of dementia in people with diabetes, and vice versa. I chaired the expert group that published a consensus permitting diagnosis of diabetes using HbA1c in the UK (with advice about where this should not be used).
What should be the action plans of clinicians, hospital promoters and decision makers in the healthcare delivery arena in India to meet the challenges posed by diabetes care?
There is already much impressive activity to improve diabetes care in India. Delivery of diabetes care in any country should be tailored to the needs of their different populations. A benefit of integrated diabetes care is to encourage all providers – primary, community, secondary; government and private – to work together to pool their resources and expertise. All of us around the world face ever-increasing numbers of patients and need to make best use of the resources and expertise we already have for diabetes care and prevention. Individual care providers in any nation should work to national standards of diabetes care, and measure whether they are achieving these.
People describe the increasing numbers and problems of diabetes as a tsunami. But a tsunami is wall of water that comes, does damage, and goes away. Diabetes comes, does damage, and stays. Much of the damage is preventable.
*(Check out the full interview online at www.expresshealthcare.in)