Type 2 diabetes is a lifelong, progressive disease, which if not identified and treated early, can lead to serious complications, including blindness, lower limb amputations, strokes and renal disease. The number of people diagnosed with diabetes in Northern Ireland has increased by 71 per cent from 51,500 in 2004-05 to 88,300 in 2015-16 (5.7 per cent of the adult population). Approximately 90 per cent of these are Type 2 cases. Current estimates suggest that the local healthcare system spends £400 million annually on treating diabetes. This represents 10 per cent of the total health budget, which is potentially forecast to rise to 17 per cent by 2035.
This report highlights that:
Progress in implementing a strategic framework for Type 2 diabetes care in Northern Ireland has been very slow. - In 2003, a review by a joint CREST / Diabetes UK Taskforce identified scope for significant improvement in several key aspects of Type 2 diabetes care, including: prevention and early detection; increased availability of patient self-management education; the need to address significant workforce shortfalls; and the lack of a patient care database linking primary and secondary care. However, no formal arrangements were established for implementing the report’s recommendations.
Whilst the Taskforce had recommended that an updated review of care standards be undertaken in 2008, the Department did not complete this until 2014. This confirmed that, whilst some “building blocks” had been put in place following the 2003 review, almost all the areas highlighted still required improvement.
In late 2016, the Department published a Diabetes Strategic Framework. Many of the Framework’s proposed improvement measures closely mirror the Taskforce’s findings and recommendations. The report questions why the introduction of the strategy was so prolonged.
The Department faces several key challenges in implementing the current strategy: - The total costs of implementing the Framework’s proposed measures have not yet been established. Whilst significant expenditure may be required to fund these measures, current funding restraints mean that this might not be available. Several specific areas will also require careful management:
- as policy initiatives to encourage healthy lifestyles have, at best, only slowed the increases in obesity and Type 2 diabetes, the report highlights the need for new thinking in the area of prevention;
- a significant number and proportion of people with Type 2 diabetes have not yet been offered access to patient self-management education;
- available evidence suggests that workforce levels are still significantly below recommended levels, with the numbers of some clinical specialisms having actually reduced since 2003;
- an integrated patient care database which would help enhance care standards has still not been introduced. This also means that Northern Ireland cannot fully participate in the National Diabetes Audit which measures care standards in England and Wales, to help identify best practice and areas requiring improvement.