There’s been much talk in the media of an NHS stretched to its very limits over recent weeks. Chief among the concerns is a lack of beds; inpatient admissions are rising year on year with the usual influx of extra admissions in winter.
As a result, non-urgent treatment for more than 50,000 patients has been postponed and A&E departments in dozens of hospitals are struggling to cope. On December 11, according to The Times, 18 large hospitals in 12 NHS trusts across England didn’t have a single bed available.
This is in part down to an ageing population, but it’s a problem compounded by rapidly rising incidences of Type 2 diabetes.
Secondary care for people with diabetes accounts for a disproportionately high strain on health economies through the UK. Around one of every 16 sixteen people is estimated to have diabetes in the UK, but people with diabetes occupy one in six of all hospital beds. That inpatient care amounts to £2.3-2.5 billion per year of NHS expenditure.
People with diabetes attend hospital more often and be treated for longer than the general population too. Research from Insight Health Economics suggests that of the £2.3-2.5 billion expenditure on inpatient care for people with diabetes, £573-686 million is over and above the sum spent on a population of the same age and gender without the condition.
So, how can we tackle the problem? By helping people to better manage their diabetes and head off preventable complications before they arise. Individuals and health economies alike would benefit immeasurably; the UK Prospective Diabetes Study (UKPDS) showed that a mean reduction in HbA1c reduction of just 0.7% delivers a 37% fall in microvascular complications, a 43% in amputations, a 14% reduction in heart attacks, 12% fewer strokes and a 22% reduction in deaths.
It’s important to remember that helping people to better manage Type 2 diabetes is not about developing and prescribing expensive medications. It’s a question of empowerment. Empowering people with the knowledge and the motivation to make positive, lasting changes to their lifestyles and take control of their health.
The traditional, reactionary model of patients turning up, being told off, being treated, told to “do better” and being sent home, is not working. Instead, the NHS must adopt more innovative solutions to educate people with diabetes on glycaemic control, BMI, finding the right diet and getting the most out of exercise.
New, digital solutions combine one-to-one sessions with expert behavioural change coaches and evidence-based education, giving patients the tools to transform their lifestyles by themselves. Behaviour change techniques rooted in behavioural psychology can help patients set clear, achievable goals and realistic timelines, while the ability to access digital education any time, anywhere boosts engagement levels and delivers value for money.
The investment required is minimal compared with the potential gains. If we assume the NHS budget is £100bn and a solution costs, say, £100,000 per CCG, the total NHS expenditure for all 209 CCGs would be £20.9 million – 0.02% of the total budget.
If a solution can deliver on the promised clinical outcomes, it would likely pay for itself - and in many areas, deliver significant cost-savings on top - through substantial reductions in prescribed medications, decommissioning of structured education, reductions in A&E attendance and reductions in GP consultations.
The business case for change is clear. Digital solutions offer a low-risk, high-value way of addressing a huge unmet need which, if delivered at scale, could free up vast numbers of hospital beds throughout the UK. At a time when we couldn’t need them more.
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