HEALTHCARE DELIVERY
90% of adults with type 2 diabetes are overweight or obese.
It is estimated that in 2010-11 the cost
of direct patient care, such as treatment, intervention and complications, for those living with type 2 diabetes in the UK was £8.8 billion and the indirect costs, such as productivity loss due to increased death and illness and the need for informal care, were approximately £13 billion. Prescribing for diabetes accounted for 9.3% of the total cost of prescribing in England in 2012-2013. Modelled projections seem to indicate that NHS and the wider costs to society associated with the population being overweight, obesity and type 2 diabetes will rise dramatically in the next few decades. Data from the latest Health at a Glance shows that 24.7% of
Europe report2
British adults are obese, compared with an average of 16.7% in the rest of Europe. Commenting on these figures, Simon Stevens, the chief executive of NHS England, said: “The NHS is going to be funding a new national programme, proven to work, that will offer people at risk of diabetes proper support to get healthier, eat better and exercise more. We know that for people at risk, losing just 5-7% of their weight can cut the chance of diabetes by nearly 60%. If this was a pill we’d be popping it – instead it is a well designed programme of exercise, eating well and making smart health choices, and we are going to start making it available free on the NHS.”
Setting levels of ambition As part of its ambition to reduce premature mortality, NHS England is also developing a resource to support commissioners in setting levels of ambition. The NHS planning guidance, Everyone Counts: Planning for Patients 2014/15 to 2018/19, asked commissioners to agree and set levels of ambition in their two and five year plans. This resource has been developed to support NHS commissioners in setting a level of ambition on reducing potential years of life lost (PYLL) from causes amenable to healthcare as part of local service development plans. The WHO has set a 25% reduction target for mortality for cardiovascular
disease (CVD) and chronic respiratory diseases. The UK has already seen a 40% reduction in mortality rates between 2001 and 2010 for people under the age of 75. Over the same period the difference in mortality rates in this sector of the population, between the most and least deprived areas in England, also narrowed. Despite these improvements, CVD is one of the largest causes of death and disability in the UK. Comparisons with other countries show that England could still do better in improving CVD mortality rates and with an ageing population and the current levels of obesity and diabetes, unless there are improvements in prevention, past gains may not be sustained. High impact interventions identified by NHS England to improve CVD mortality rates include the NHS Health Check programme which, according to NHS England, has considerable potential to prevent or delay CVD through earlier identification and management of behavioural and physiological risk factors. The programme also has potential to support clinical commissioning groups (CCGs) in their priority role for earlier detection of disease. However, implementation and take up rates of the programme are not consistent across England and follow-up
management, whether
The WHO report states that premature NCD deaths can be significantly reduced through government policies to reduce tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity, and delivering universal healthcare.
APRIL 2015
through medical interventions, or interventions to improve people’s lifestyles, needs to improve in many areas. For example, CPR is currently attempted in only 20% to 30% of cases following an out of hospital heart attack, despite evidence which suggests that where CPR is attempted, survival rates are doubled. NHS England suggests that NHS provider staff who work with patients are taught CPR – including healthcare and physiotherapy assistants. Chronic Obstructive Pulmonary Disease (COPD) kills approximately 25,000 people a year in England and is the fifth biggest killer disease in the UK. Premature mortality from COPD in the UK was almost twice as high as the European average in 2008 and premature mortality for asthma was over 1.5 times higher. Although, deaths from asthma have plateaued at between 1000 and 1200 deaths a year since 2000, it is estimated that 90% of deaths are associated with preventable factors and almost 40% of these deaths are in the under 75 year age group.
Reducing premature mortality A number of specific interventions have been identified as having the potential to reduce premature mortality in people with COPD. Each of these has an evidence base, has consensus support from the clinical community and is
recommended in NICE guidance and the Outcomes Strategy for COPD and Asthma. Improvement in COPD mortality figures will only be achieved through the cumulative impact of evidence-based care across the COPD pathway both in long-term treatment and during acute episodes
THE CLINICAL SERVICES JOURNAL 61
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