Agenda item

Susan Lloyd, LBBD Consultant in Public Health, presented the report and explained the difference between the different types of diabetes and the actions needed to identify and treat diabetes and to reduce the secondary complications and issues which it causes. 

There had been significant improvements in diabetes care in the community over the past year and the report provided details of the progress to-date and the future partnership working that would be needed to achieve the desired continued improvements.  The prevention of diabetes was becoming a significant driver to reduce pressures on care and health services and the community and to improve the wellbeing of those that are, or could become affected by the condition.  Next year a preventative programme would be started to identify and check individuals that had the risk factors for developing the disease and to encourage lifestyle changes that can reduce or remove their risk.  A mixed commissioning approach would also encourage closer working between primary and secondary health care.  The Board was advised that the levels of type 1 were quite low compared to the national average, however, type 2 had a higher than national incidence rate with around 13,300 individuals currently being treated.  In addition, there was an estimated 10,000 residents at pre-condition stage and potentially at risk of going on to develop diabetes type 2.  The Borough also had significantly higher ethnic / demographic risks than the national average.  Sue explained that £4.3m is spent on diabetes medication alone, which is 15% of the total prescription medication costs for the Borough, and there are also significant and indirect costs, e.g. social care and lost work attendance.  Susan also clarified that an average of 10% was used as it was not possible to attribute costs because many individuals had multiple conditions.  However, what was clear was that the prevention of developing diabetes and reduction of complications, such as foot amputations, would produce significant financial savings: but more importantly the life style and of individuals would be positively enhanced.

The Board noted that 27 GP Practices had been approached but so far only two had responded to the on-line services trial.  Dr Waseem Mohi, Barking and Dagenham Clinical Commissioning Group (CG) stressed that the changes undertaken in one year were considerable, and were more than had been achieved in 10 years or more in other boroughs.  A cohort of some 20,000 individuals with potentially controllable and pre-diabetes were being targeted.

The results of the changes would be seen in five to ten years, when amputations, blindness and hospital admissions and care costs were reduced. 

In response to a question from Anne Bristow as to why we were only getting half of the eight processes and what the barriers were, Dr Mohi explained that we needed incentives to push change and that was now starting to have an impact, however, it needed to be noted that GPs in the Borough have on average 1,000 more patients that national average.  There was clearly a spend to save opportunity and additional funding would enable skills enhancements in health professionals that could be used to identify and prevent early condition diabetes.

The Chair commented that the ELHCP would be strongly lobbied to ensure that it provides parity of care across its area and it was suggested that a letter should be sent on behalf of the Board.

The Chair reminded the Board that the Pharmacy consultation was in progress. Residents need to be more aware of the services that health professionals, other than GPs, can provide or that may be more appropriate for their needs.  The potential to use joint events, for example healthy cooking sessions by local health champions and weight taking by health professionals was suggested.  NELFT suggested that if certain ethnicities are more susceptible to diabetes the potential to use faith groups as a conduit could be a useful. The Chair advised that Cllr Bright would be able to help in that area, but it was important to decide what the priorities were before seeking their help, or they could be overloaded with requests.  Healthwatch suggested that they too could assist in disseminating information and in obtaining public feedback. 

The Board: 

Received the current position, costs and significant health issue and risks to the health and wellbeing of residents with diabetes and pre-diabetes and the action needed to reduce the pressures on health and social care services from the effects of diabetes and:

(i)  Diabetes prevention –
Agreed that a diabetes prevention approach, which meets the needs of residents, is supported to enable the long-term reduction in significant health costs and for the poor health reduction targets to be realised;

(ii)  Diabetes care processes –
Agreed that systems and structures that embed improved diabetes care in the Borough are supported, the details of which were set out in the report;

(iii)  Requested the Deputy Chief Executive and Strategic Director for Service Development and Integration to write on behalf of the Board to the ELHCP raising the Board’s concern over the inequality of provision for diabetes locally, in relation to other areas of the country, and asking the ELHCP to take the necessary action for the service provision to be balanced and funding provided to enable a spend-to-save opportunity that will allow future costs reductions to be realised. 

(iv)  Agreed that focus needed to continue in regard to digital solutions, consistency of messages to communities to increase health engagement, including use of Healthwatch to do this, and in educating the young and enhancing their “pester power” to effect healthy lifestyle change at home, ensuring a consistent approach to health checks and service delivery across GP practices, including through the use of commissioning.