A comprehensive new survey of all 152 PCTs undertaken and published by the Medical Technology Group (MTG), backed by national diabetes support groups INPUT, the Juvenile Diabetes Research Foundation (JDRF), clinicians and leading cross-party MPs, has exposed major inequities in care for patients with diabetes across the country. The findings show that 17% of patients with type 1 diabetes in Blackburn with Darwen PCT benefit from insulin pump therapy, compared with only 0.4% in Luton, leaving tens of thousands of patients with type 1 diabetes without access to the right treatment from the NHS.

The MTG is the UK's leading coalition of patient groups, research charities and medical device manufacturers working to improve access to cost effective medical technologies. The survey, launched as part of the MTG's 'Pump Action' campaign confirmed that overall uptake and utilisation for insulin pump therapy remains extremely low, just a third of the NICE benchmark for the therapy.

The MTG conducted the survey to facilitate better understanding of the causes of this problem, which persists despite years of government study and established guidance which recommends greater utilisation of insulin pumps. The survey found that:

- The average rate of insulin pump provision for people with type 1 diabetes is 3.9% compared to the 12% benchmark recommended by NICE[1];

- Only two PCTs gave information which suggests they are providing insulin pumps in line with the NICE benchmark;

- Only 5 out of 113 PCTs have a strategy in place to implement NICE guidance on insulin pumps in line with their statutory duty to adhere to NICE technology appraisals within 3 months of issue;

- Just over a third (35%) of PCTs do not use tools and guidance such as NICE's Commissioning Guide to help deliver adequate insulin pump therapy services;

- Current utilisation of insulin pumps for type 1 diabetes in the UK (3.9%) is extremely low in comparison to other countries, such as the US (estimated at 35%) and Sweden, France and Germany (estimated at 15-20%)[2].

The MTG is calling on the Coalition government to make positive changes to help improve the health, safety and well-being of the UK's quarter of a million diabetics - and at the same time make essential efficiency savings for the NHS.

Insulin pump therapy is a clinically and cost effective treatment option that is recommended by NICE for people with type 1 diabetes, whether adult or child, for whom multiple daily injections have failed, and for children under 12 if multiple daily injections are not deemed practical or appropriate

The principal benefits of insulin pump therapy for patients and the NHS are as follows:

- improved patient outcomes including management of blood glucose levels (HbA1c) which reduces the risk of severe hypoglycaemia (symptoms of severe hypoglycaemia include collapse and coma) and/or diabetic ketoacidosis (DKA);

- Reduced risk of complications (e.g. heart disease, stroke, blindness, kidney disease, nerve damage);

- General better health, improved treatment satisfaction, reduced anxiety and depression and improved quality of life;

- A reduction in emergency hospital admissions;

- A reduction in planned hospital admissions. Better diabetes self-management is linked to a reduction in inpatient supportive care and overall hospital stays and associated NHS costs[3].

Here is just one example of the difficult struggle that is often endured by patients who are trying to get insulin pump therapy from the NHS:

Thomas Double is 12 and has type 1 diabetes. He uses an insulin pump to manage his condition, after his mother Jacqui battled for over two years to get agreement from her PCT to fund the therapy. His brother Joseph (14) also now uses an insulin pump which gives him excellent control of his own blood insulin levels and the freedom to get on at school and enjoy time with friends.

Jacqui Double, mother of Thomas and Joseph, said:

'It's a travesty that PCTs still aren't providing insulin pumps to those eligible under NICE guidance - parents and individuals shouldn't have to battle with NHS decision-makers in order to get the services and support they're entitled to.'

Adrian Sanders MP, Chair of the All Party Group on Diabetes said:

"It is sad to see that after years of investment and promises from Government, we are still seeing glaring postcode lotteries in the health service. The lives of so many people with diabetes could be easily improved by providing pump therapy while for the taxpayer there are long term savings, not only within the NHS. The UK should be leading the world in pump therapy, not lagging behind most of Europe and the Western world."

Dr Ian Gallen, Secretary of the Association of British Clinical Diabetologists said:

"I welcome the MTG's campaign to improve patient access to insulin pumps. The introduction of pumps some two decades ago was a major advance in the management of type 1 diabetes which has transformed patients outcomes and experiences - but uptake is well below par and we need concerted action to bring the benefits of pumps to the majority of patients not just the lucky few."

The MTG urges PCTs and emerging GP consortia to access as an urgent priority the "How to Why to" Guide on Insulin Pumps, which has been produced and recently launched by the NHS Technology Adoption Centre (NTAC) following its national programme to identify and overcome the barriers associated with implementing this technology.

The new guide has been specifically designed to save commissioners time, improve patient outcomes and enhance overall productivity. The guide helps to bridge many of the gaps identified by Trusts, PCTs and other stakeholders who play a crucial role in delivering diabetes services as part of NTAC's implementation project by providing:

- Support for the development of a business case for the provision of insulin pump therapy in line with NICE guidance;

- A roadmap to implementation of a pump service including how to set up an implementation team;

- Guidance on how to effectively procure pump therapy technology and associated consumables.

NTAC's Hadleigh Stollar said:

"The "How to Why to" guide incorporates NTAC's national experience of systematically implementing insulin pump therapy to enable successful change to be achieved locally. Commissioners are at the heart of an ambitious agenda of change in today's NHS - we look to them to drive improved quality services and to meet outputs that will deliver high quality care for patients. This is a stiff challenge, but the "How to Why to" guide is specifically designed to help commissioners and all those who play an important role in delivering effective diabetes care, to understand what it takes to plan and deliver an appropriate insulin pump service that is cost effective, and improves the experiences and outcomes of patients wherever they live."

In addition the MTG makes the following recommendations to improve insulin pump uptake:

1. Diabetes patients should be given better information about their treatment options, including insulin pumps. Clinicians should routinely share high quality information with their patient, and information should also be available online and through printed materials. This will help patients to make appropriate choices about their care.

2. A comprehensive map of insulin pump services, such as specialist pump clinics, should be made available to GPs, and patients should be able to access specialist pump centres through the Choose and Book system. This will support GPs in their new commissioning role to ensure that patients can access the care they need in line with NICE guidance.

3. The new NICE quality standard on quality standard should support improved access to insulin pump therapy as one of the standard range of treatment options for people with type 1 diabetes.

4. Training and guidance on the use of insulin pumps should be readily available to both patients and clinicians to prevent unnecessary delays to provision:

Structured training modules should be made available to patients online to ensure safe and timely access to insulin pumps.

Insulin pump modules should be included within GP and secondary care training.

5. Patients' rights enshrined in the NHS Constitution to NICE-approved treatments such as insulin pumps should be made legally enforceable. Healthcare commissioners must take steps to ensure that patients in their local area have convenient access to high quality specialist insulin pump services that meet their clinical needs.

John Davis, Founder of INPUT and member of the MTG Management Committee said:

"Access to a treatment as important as insulin pumps should not be dependent on where you live. Insulin pumps have been recommended by NICE because they are an efficient use of the NHS's resources, and because they can have a dramatic impact on patients' quality of life and clinical outcomes.

"The MTG is campaigning to improve patient access to insulin pumps by ensuring that every person with type 1 diabetes who could benefit from an insulin pump - no matter where they live - receives the specialist care they need".

Notes

- Interviews may be arranged with patients and spokespeople on request.

- The MTG is a coalition of patient groups, research charities and medical device manufacturers working to improve access to cost effective medical technologies for everyone who needs them.

- INPUT is a national advocacy group working to increase access to insulin pump therapy. INPUT is a member of the MTG.

- The survey has been undertaken by the MTG, in partnership with INPUT and Adrian Sanders MP, chair of the All Party Group on Diabetes.

- All 152 PCTs in England were asked for details of insulin pump provision in their area, and the services and procedures which they have in place to care for diabetics. The research was carried out from January - May 2010.

- Less than 4% of patients with type 1 diabetes have access to an insulin pump in the UK, compared with 35% in the US

- NICE guidance states that continuous subcutaneous insulin infusion (CSII) is recommended for people with type 1 diabetes, whether adult or child, for whom multiple daily injections have failed, and for children under 12 if multiple daily injections are not deemed practical or appropriate.[4]

- NICE guide: Commissioning an Insulin Pump Therapy Service

1. NICE's commissioning guide on insulin pump therapy services states that the standard benchmark rate for the uptake of insulin pump therapy is 12% of people with Type 1 diabetes. It is 33% for children younger than 12 years old.

2. Pickup J. Insulin pump therapy: then and now. In: Pickup J. Insulin Pump Therapy and Continuous Glucose Monitoring (ed), pp 1-10. Oxford University Press, Oxford, 2009

3. NHS Technology Adoption Centre

4. NICE Technology Appraisal Guidance 151

Source:
Medical Technology Group