"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Wednesday, 24 August 2011

Cost of diabetes

I am incubating a monumental rant over the government's policy to blame sufferers of long term conditions for the current problems with the NHS (problems which have actually been caused by this government). This rant will have to fester a little more before I will let it out. Until then let me just explain about the cost of diabetes.


There you go: simple isn't it? Complete idiots think that the cost of diabetes is in the drugs. It isn't, and it only takes a little thought to realise why. When diabetes is well controlled - whether type 1 or type 2 - the patient is a fully functioning member of society, no one will know that they have the condition. Indeed, many colleagues do not know that I have type 1 diabetes. The only visible sign of the condition is me injecting insulin before I eat and I have become adept at doing the injection surreptitiously under the table in restaurants (all you need to do is wait for the food to appear - people naturally spend a couple of minutes inspecting what's on their plate and not at you).

A well controlled diabetic is no different to a non-diabetic when it comes to contributing to GDP. The cost of diabetic drugs is fairly small. NHS Information Centre says that last year it was £725m. There are 2.5m people with diabetes (10% are type 1), so that means less than £300 per person.

I have written before that the cost of the drugs I take is small - a few quid a day. However, I only listed the insulin that I must take. I also take other medicine which are preventative: statins and two types of hypertension drugs one of which I am told protects me from kidney damage. These drugs cost pennies per day. The fact that they are preventative is very important because the real cost of diabetes is the cost of the complications from poor control. Long term high blood sugar leads to blindness, nerve damage (leading to amputations), kidney damage (needing dialysis or transplant) and cardiovascular disease. This is where the cost lies. Secondary to this cost of treatment is the monitoring once you show signs of a complication to determine when intervention is needed.

For example I have retinopathy where the blood vessels on my retina are weak and liable to burst. Since this was diagnosed 20 years ago I have had retina clinic appointments every 6 months. I have also had many tens of thousands of laser burns on my retinas to try and prevent vessels growing too big and when one did, and burst, I had an operation where the gel in my eye was removed, my retina cleaned of the bleed and the vessel sealed. That operation lead to me getting a cataract, so I have had cataract operations too. These interventions cost many tens of thousands of pounds: as I said, it is the complications that cost.

Incidentally, for the last 5 years I have been subject to "patient choice". Every six months my GP and my local optician send me a letter telling me that I need to have my retinas screened. Every six months I politely phone them up and tell they to take me off their marketing lists because I am seen every six months by a consultant at the hospital retina clinic. (I don't want to upset GPs or opticians, but honestly, do you really think you know more about my retinas than the specialist at the hospital?) Neither the GP, nor the optician, have shown any sign of removing me from their marketing list. Beware, AQP will open the floodgates to far more companies touting for business like this.

Today the NHS Information Centre published figures of the cost of diabetic drugs. Inevitably these figures have been misreported.

Diabetes prescriptions now account for 8.4 per cent of the entire NHS net bill for primary care drugs in England.
These drugs - if used correctly - will prevent a large range of complications and hence reduce demand on the NHS in the future. We should not focus on the cost of these drugs now, and instead we should focus on the cost of diabetes if we didn't spend this money.


  1. Please help me for Christ sake

  2. Had rep at meeting yesterday re drugs for painful diabetic peripheral neuropathy. Said to him that his drugs should actually save money. Much PDPN keeps pt awake at night. Lack of/poor sleep upsets metabolism (and is shown to increase sensetivity to pain anyway). Lack of sleep = poorer diabetic control and all that entails.
    Yet, we are constantly writing to GPs asking them to help the pt with their pain! Is it the increased cost of another drug? What about the whole picture? Perhaps there is no longer a whole picture with everyone seemingly working for a different company/enterprise/trust - just lots of individualistic and competing interests?

  3. Your article has made clear to me why I receive a 'demand' that I attend for diabetic retinal screening every year, when I have told them this is done in hospital.
    Like the flu jab I assume this reminder comes because someone is getting a fee for referring/carrying out procedure. Had six calls last year re flu jab, until I lost my temper and shouted that I had told them repeatedly I was on a cancer drug and jab was not advised.

    Local hospital has outsourced its retinal screening to a company. It used to be Sally (excellent nurse) who did this; as I have an ulcer in my eye she would administer an anaesthetic drop (cost around 50p) before putting in die. Now that it is a company that does this, they haven't costed in for the anaesthetic, so doesn't have it available.

    So now hospital arranges for me to be screened by my Consultant (cost £60+?. Total waste of a highly-paid professional's time.

    As you say, the NHS is losing money in a ridiculous way. It needs to get its act together before it goes totally bankrupt.

  4. A healthcare market will cost more than the single-provider NHS. It is very simple. To have a market there has to be excess capacity in the multiple providers to allow patients to switch and the providers have to do marketing to get patients to choose them.

    Of course, if we have a single provider then we have the problem of ensuring that quality is kept high and patients are treated with respect (and yes, choice: of clinician and appointment time). It is not impossible to ensure these things happen in the NHS, but the government is ignoring these issues because they think "the market" will solve them. It won't.

  5. Richard, surely there wont be a market in the new 'NHS'.
    When the supermarket with garage opens on the outskirts of town it can afford to make no profit on its fuel, using the parent business (the food store) to keep it afloat until all the indepepndent garages are out of business.

    Is this not like the health subsiduaries of the big transnationals? Surely when they tender for contracts they will undercut the NHS and 3rd sector providers??

    This is not the neoliberal ideal as the market entry criteria are not equal. Everything is weighted in favour of the big companies. Those who think this marketisation of health services will bring improvement are either muppets or puppets

  6. "Is this not like the health subsiduaries of the big transnationals? Surely when they tender for contracts they will undercut the NHS and 3rd sector providers??"

    Cameron and Lansley assured us that there will be no competitive tendering, and every provider is supposed to be paid the same rate. However, since half of hospital care is not on tariff, and neither is most primary care and community services, there is still a lot of scope for competitive tendering. Currently the East of England SHA is outsourcing £300m of services to the private sector through competitive tendering.

    Even so, I do not believe that the private sector can undercut the NHS unless they deliberately take a loss. Circle, for example, is paid up to 20% more than the NHS for the same work and does not have to supply emergency services (they can even use NHS staff) and yet they make a loss (IIRC £23m on a turnover of £62m). Their fancy hospital in Bath makes a loss of between £6m and £7m every year.

    If the private sector cannot match the NHS cost-effectiveness, this raises the question of why do they want to be involved? The policies that are being push will eventually lead to co-pay and insurance. In that situation the more expensive private providers will be able to charge the patient extra - and that is where the market will arise.

  7. "However, since half of hospital care is not on tariff, and neither is most primary care and community services, there is still a lot of scope for competitive tendering."

    So do you think social enterprise trusts (formally provider arms of PCTs) will be in a weak position when the time comes to compete in a few years time? (I am not referring to small SEs with one type of provision by the way)

  8. Look forward to reading your 'monumental rant'. Could the NHS think a little, and realise it's own 'clinic' system is adding to costs?
    When a doctor has ten minutes in which to speak to a patient whom they have probably never seen before, but give them a check-up when they have a long-term condition - of course the doctor sees that there are no visible signs of deteriation, then ticks the box to "come back in six months". When actually an investigation might uncover an underlying condition, which if treated in time would be sorted. But waiting six months could turn this into a crisis - ergo costing more.