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Diabetes UK: 'False economy' as 200 frontline diabetes specialist nurses go in NHS cost-cutting

An audit[1] by the charity Diabetes UK has revealed over 200 diabetes specialist nurse (DSN) positions are unfilled2 - twice the figure reported in 2009.

The audit was based on responses from 385 trusts, foundations and PCTs, as the data is not collected centrally. 'Diabetes Watch' has been launched by the charity to ensure transparency over the levels of care and support for people affected by diabetes at a time of unprecedented change in the NHS.

Barbara Young, Diabetes UK Chief Executive, described the shortfall as "a false economy which harms patient care and will increase costs to the NHS".

"We are very concerned that at a time when numbers of people with diabetes are increasing, there is a decrease in frontline diabetes specialist nurses. This will mean longer waiting times for specialist support, more unnecessary amputations, more people losing their sight and far poorer health outcomes. This is simply not acceptable.

"DSNs are crucial in supporting independence and in helping people self manage their diabetes more effectively. They play a vital role in preventing expensive complications, in supporting people with complex needs and, critically, in providing primary care teams with specialist expertise that reduces emergency hospital care.

"Diabetes costs the NHS £9bn a year and that can only increase as a result of these short-sighted and harmful actions", said Young.

Dr Peter Carter, Chief Executive and General Secretary of the Royal College of Nursing, said: "It really is worrying that despite repeated warnings, NHS Trusts are still making short-sighted decisions which risk leaving patients high and dry. Our own survey showed that more than one in ten specialist nurses may already be at risk of redundancy - something which we know would have a serious impact on patient care. Not only does this put patients at risk of needless complications, but by doing so it wastes money. The smart solution for Trusts would be to keep investing in specialist services which can keep patients as well as possible and above all, out of hospital."

June James, audit author and a diabetes consultant nurse, said: "There is a mass of evidence proving the clinical effectiveness of DSNs and their ability to reduce medication errors, the numbers of people needing admission to hospital, and length of hospital stays.3

"Reductions in DSN staffing levels will continue to compromise the quality of care received by people with diabetes, complicated by associated health problems such as heart and kidney disease, or during pregnancy. Worryingly, even when DSNs are in post, they are being asked to cover shortfalls elsewhere. At a recent national meeting of around 100 hospital DSNs, I asked how many of those in attendance were being asked to work on general wards to help with staff shortages there, and nearly everyone put their hand up."

The National Diabetes Inpatient Audit4 found people with diabetes account for 15 per cent of inpatients. According to a previous survey5 by Diabetes UK, the average diabetes patient reported a twofold increase in their ability to manage their condition before and after seeing a specialist nurse. Another study6 at Liverpool's Aintree Hospital showed how an entirely nurse-led diabetes clinic can increase 'good' cholesterol levels as well as significantly reduce high blood pressure levels, a strong risk factor for heart disease - which accounts for around half of all deaths among people with diabetes.

Research presented at the Diabetes UK Annual Professional Conference in March 2011 shows the effectiveness and cost savings of Diabetes Specialist Nursing (DSN) input. An ongoing project run by Portsmouth Hospitals NHS Trust, enables a Diabetes Specialist Team, including Diabetic Specialist Nurses and a consultant, to provide proactive and reactive treatment to inpatients with diabetes. Data extrapolated from this project shows a reduced hospital stay of 1.4 days and the researchers calculated that in their 1,000-bed hospital, this equated to a potential cost saving of between £1.5 and £4.4 million a year, with staffing cost for this project to be around £170,000.

Poorly controlled diabetes can lead to short-term complications of low blood glucose (hypoglycaemia) and high blood glucose (hyperglycaemia), which, in extreme cases, can require urgent hospital treatment. Changing blood glucose levels over the long term can increase the risk of blindness, kidney failure, stroke, heart disease and amputation.

Diabetes UK is calling on commissioners and NHS Trusts to stop cutting or freezing DSN posts to support short sighted cost saving initiatives. The charity has written to Secretary of State for Health Andrew Lansley urging that the Department of Health questions Trusts who cut posts to ensure people with diabetes receive the highest quality care they deserve in the most cost effective way.

"From day one I struggled to find specialist care"
Elaine Clark, from Dagenham, lost her husband John, 51, in May 2008. He had Type 2 diabetes and died of heart failure related to the condition.

"John was first diagnosed with diabetes in 1990 and despite warnings about his high blood pressure and cholesterol levels, continued to smoke, drink too much, eat takeaways, and not monitor his blood glucose levels properly.

"As a result, in 2000, John lost most of his vision from diabetic retinopathy and went completely blind a year later. We then moved to Barking and Dagenham where I couldn't find any DSNs. I campaigned hard and eventually two were brought from neighbouring Havering.

"For five years until his death, John received only around half a dozen DSN visits. But I recognised the immense strain the DSNs were under and their huge caseloads. I had to chase for diabetes foot care and, despite urgent requests by a district nurse for John to see a dietician at Christmas 2007, the hospital could only offer an appointment the following August.

In July 2007 John had a stroke and spent 17 weeks in hospital. Soon after he began having severe hypos and wasn't eating so was readmitted for a further 16 weeks, in which time he lost 6st (38kg). He then moved to a nursing home where he died three weeks later.

Barking and Dagenham now have a Complex Care Clinic. It's amazing - there are five DSNs, and other specialist HCPs. But from day one I struggled to find specialist diabetes care for John. It's so worrying to hear that so many DSN posts are being left unfilled. I can't understate their importance for people living with diabetes. There needs to be better access to care for people with the condition. No one should have to go through what my family and I have."

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