In 2001 the National Service Framework for Diabetes set standards for diabetes care in England, with a delivery strategy designed to achieve a world class diabetes service by 2013.1 However, a series of recent reports from various sources show just how far we are from delivering the standards by the 2013 deadline. A “state of the nation” report from Diabetes UK declares that diabetes care is “in a state of crisis,” and a damning National Audit Office (NAO) report accuses the Department of Health of failing to hold NHS commissioners to account for poor performance and of failure to deliver the recommended standards of care.2 3 Both reports are based on the department’s own commissioned audits.

The National Diabetes Audit reported that in 2010-11 only half of people with diabetes received all of the recommended nine care processes, with fewer than one in five achieving the recommended treatment targets.4 An estimated 24 000 diabetes related deaths each year may have been preventable, and death in young women (aged 15-34 years) with type 1 diabetes has increased ninefold since the 2007-08 audit.5 The National Diabetes Inpatient Audit 2011 found that 15% of hospital inpatients have diabetes.6 Errors in management and prescribing, iatrogenic hypoglycaemia, poor glycaemic control, and hospital acquired foot ulceration commonly compromise their care. The Atlas of Variation 2010-11 shows wide variations in outcomes for complications of diabetes.7 England, unlike the United States and many European countries, has failed to reduce amputation rates, and …