The government has published an interim report on its Major Conditions Strategy for England this week, setting out the “case for change and strategic framework”. And while we are pleased to see the links recognised between diabetes and mental health, we believe there are missed opportunities to further highlight the need to improve the care for people living with diabetes.
We have previously welcomed the promise to address diabetes in this Strategy - which sets out the government's approach to tackling certain groups of health conditions in England - and with the publication of this interim report we are pleased to see the government reiterate the intention to seek closer alignment and integration between mental health and physical health.
We have led the call for this, along with other charities advocating on behalf of people living with long-term conditions.
The government says it plans to outline how to implement more mental health support across physical health pathways, and we hope to see greater mental wellbeing support become available for people living with diabetes.
We also welcome the intention to rebalance the health system towards prevention of ill health, to shape services around the lives of people and to better join up care.
Missing opportunities on diabetes care
We are concerned though that so far the Strategy is missing the opportunity to highlight the need to improve the care of people living with diabetes to reduce their risk of the devastating complications it can lead to.
Diabetes care needs to be positioned a lot more prominently in the “secondary prevention” set out here, recognising it as such a significant underlying factor for so much harm including heart disease and stroke.
Improving speed of type 2 diabetes diagnoses
It is also a surprise that there is no reference to the need for local health systems to improve timely diagnosis of type 2 diabetes.
Recent evidence suggests that there were an estimated 50,000 missed or delayed diagnoses during the pandemic and that those who were diagnosed in the last two years had significantly higher average HbA1c and BMI than the previous four-year trends, suggesting a delayed diagnosis and delay in receiving care.
Recovery from the pandemic
We know that when people with diabetes receive the recommended routine care to expect, their risk of emergency admissions, heart failure, amputations, renal replacement therapy, sight loss and early death are all significantly reduced.
Delivery of these routine care processes has still not recovered to pre-pandemic levels and recovery has been hampered by the various pressures on primary care and diabetes teams.
Most recently this is being impacted by the shortages of some type 2 medications, which is leading to some people not being optimally managed and staff time being spent on reviewing people affected by the shortages.
We are also concerned that recovery has not been evenly spread and we know that those living in poorer areas are less likely to have received the care recommended. The interim report is also generally quite light on plans to tackle inequalities in health despite the promise that this strategy would replace in part the planned “health disparities” strategy.
Moving forward
Earlier in the year we submitted a response to the government’s call for evidence for the Strategy and we look forward to continuing to work with them to build on this interim report.
We will continue to highlight the ways in which it can work better for people living with, and at risk of, diabetes.
