The crisis in diabetes care in England

BMJ 2012; 345 doi: (Published 17 August 2012)
Cite this as: BMJ 2012;345:e5565

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Hold on Drs Rayman and Kilvert1. All is not lost here; diabetes care in England has improved over the decades and continues to work on delivering the National Service Framework for diabetes. Take comfort from the 2010 Commonwealth Fund report that of seven developed nations the NHS was ranked as the second best health care system in terms of quality and safety2.

Through what has been established as the norm now (i.e. QOF data), we can describe our current state of care. McGlynn et al first described health care’s failure to deliver reliable comprehensive care for people with long term conditions in 2003 with only 55% of people getting the care they required3. Sounds familiar.

To date we have our current state from the expansion and focus on the delivery of health care by health care professionals. Steps to a solution should embrace engaging people through patient centred care, as defined by “care delivered with the patient’s needs and preferences in mind” 2. Historically the NHS has regarded this as nice but not necessary. We as clinicians think we understand it but do we really when 54% of people feel that their doctor tells them about their treatment options and what is best suited for them2? Delivering the National Service Framework for diabetes needs this and other patient centred issues to be addressed in order to achieve the evidenced based outcomes we know help people with diabetes.

1. Rayman G, Kilvert A. The crisis in diabetes care in England. BMJ 2012;345:e5446
2. Davis K, Schoen C, Stremikis K. Mirror, mirror on the Wall How the performance of the U.S. health care system compares internationally. 2010 update. Commonwealth Fund 201 ; 23 June
3. McGlynn E, Asch S, Keesey J, Hicks J, DeCristofaro, Kerr E. The quality of health care delivered to adults in the United States. N Engl J Med 2003; 348:2635-45

Competing interests: None declared

Joanne M Watson, Consultant Diabetologist

Musgrove Park Hospital, Taunton, Department of Metabolism, Musgrove Park Hospital, Taunton, TA1 3RD

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