We must end the postcode lottery for non-invasive diabetes treatments on the NHS
Jenny Hirst, MBE, Co-chair
| InDependent Diabetes Trust
All those with diabetes deserve a painless, non-invasive way of glucose testing on the NHS, says Jenny Hirst MBE, Co-chair of the InDependent Diabetes Trust.
The National Institute for Health and Care Excellence (NICE) approved the Freestyle Libre System for prescribing on the NHS from November 1st 2017 for people with Type 1 and Type 2 diabetes who are treated with insulin and self-managing their diabetes. It is intended to be used as an alternative to routine blood glucose monitoring for people aged 4 or over, although finger-prick testing is still needed under certain circumstances. This is a huge leap forward for management of insulin treated diabetes and in the quality of life for those living with the condition.
Insulin has to be used for Type 1 diabetes which is an autoimmune condition where the pancreas stops producing insulin and therefore insulin has to be administered by injections or by a subcutaneous insulin pump. People with Type 2 diabetes also have to administer insulin when treatment with tablets ceases to control blood glucose levels. In both conditions, the aim of treatment is to keep the blood glucose levels as near normal as possible to avoid the damaging, long-term complications of diabetes. Part of achieving this level of glucose control is by frequent glucose testing.
Until the introduction of the FreeStyle system, described as flash glucose monitoring, blood glucose levels have been measured by obtaining blood from the fingers using a lancet and checking this in a meter. People using insulin, especially those with Type 1 diabetes, use finger-prick tests at least four times a day but many people carry out six to fifteen tests per day, especially at times of illness, pregnancy, sporting activities or because of their lifestyle or occupation, such as driving for long periods of time. This is invasive, can be painful and over years, damages the skin on the finger tips.
The FreeStyle Libre system is the first non-invasive way for people to test their blood glucose levels and it is like the answer to a prayer for people with diabetes. This system checks interstitial glucose levels with a reader which scans a sensor worn on the back of the arm. It indicates whether glucose levels are going up or down and provides glucose level trends over time. It can also be used as many times in a day as required, so people know what is happening to their glucose levels at any given time and enabling them to take any necessary remedial action.
However, while NICE gave national approval for the device to be prescribed on the NHS, it also added that this was subject to local health authority approval by Clinical Commissioning Groups (CCGs). As could be expected, this has resulted in a postcode lottery of availability, with people in some areas having it prescribed on the NHS but in other areas, people are refused. This leaves their only option to purchase it privately at the retail cost of around £50.00 every two weeks for sensors - if they can afford it. This is despite evidence that flash glucose monitoring can improve glucose levels, reduce time spent in hypo- and hyperglycaemia (low or high glucose levels) and enable people to reduce their long-term blood glucose levels and therefore it has the potential to reduce complications and hospital admissions. As managing complications accounts for 80% of diabetes spending, any reduction in the rate of complications would be beneficial in reducing costs to the NHS. And let’s not forget the improvement to people’s quality of life!
On July 26th, BBC Breakfast had an excellent piece about the device, demonstrating how easy it is to use and also how unfair it is that some people receive it free while others don’t. They interviewed the parents of a one-year old little boy with Type 1 diabetes who are having to pay about £100 a month for the sensors. They said the FreeStyle Libre is a lot less painful and upsetting than finger prick testing for their son’s little fingers, but his CCG area refuse to pay.
Dr Graham Jackson from the NHS Commissioners was also interviewed and he refused to accept that this amounted to a postcode lottery but that “it was a reflection of local need”. People with diabetes who have to inject insulin live in all parts of the country, there is no specific ‘local need’!
Figures show that while everyone with Type 1 diabetes in Wales and Northern Ireland can have the FreeStyle Libre prescribed on the NHS, only around 43% in Scotland and 44% in England of CCGs allow it to be prescribed. If 44% of the CCGs see the device as a need, then surely the remaining 56% should?
Our organisation has said many times that splitting the NHS into CCGs and prescribing ‘according to local need’ simply does not work for long-term conditions like Type 1 and Type 2 diabetes. Treatment should be to an approved standard and should not vary according to where people live.
Whether it is a one-year old little boy or people who have been pricking their fingers umpteen times a day for over 30 years, they all deserve a painless, non-invasive way of glucose testing on the NHS.
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