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Report reveals diabetes 'lottery'

Treatment for diabetic patients is a postcode lottery with a massive variation in quality of care from one region to another, a report has revealed.

In some regions, only 6% of sufferers received the recommended levels of care compared to 69% in the highest-achieving primary care trusts (PCTs), a National Audit Office (NAO) report found. But not a single PCT delivered the nine basic care processes which reduce the risk of diabetes-related complications such as blindness, amputation or kidney disease.

The worst offenders were Mid Essex and Swindon PCTs where less than 9% of patients were given the nine basic tests which are recommended by the Department of Health (DH). The report said that the DH is not holding poorly performing PCTs to account.

The authors say: "The department holds information to assess performance but there is a lack of accountability for PCTs who fail to ensure that the recommended standards of care are met."

It also claims that the NHS does not "clearly understand" the costs of diabetes at a local level and is therefore finding it difficult to deliver diabetes services in the most effective way. Across England only half of people with diabetes received the recommended standards of care in 2009 to 2010.

The report says: "People with diabetes require regular review of clinical indicators of disease progression. Despite the DH setting clear standards for good diabetes care, analysis from general practice records in the 2009-10 National Diabetes Audit found that under half (49%) of people with diabetes received all the care processes recommended for the monitoring of risk factors for tissue damage.

"Without regular monitoring and treatment, this damage can lead to complications such as blindness, amputation and kidney disease."

The review into the management of adult diabetes services in the NHS in England states that up to 24,000 people die each year from avoidable causes relating to diabetes. It said that there is poor performance in expected levels of care, low achievement of treatment standards and high numbers of avoidable deaths.

Care Services Minister Paul Burstow said: "There is no excuse for delivering anything but the best diabetes care. Nice (National Institute for Health and Clinical Excellence) guidance and Quality Standards set out what good care looks like. By exposing poor practice and shining a light on best practice, we are determined to drive up standards for everyone."

Barbara Young, chief executive of Diabetes UK, said it was a "national disgrace" that only half of people with diabetes received the recommended standards of care in 2009/10.

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