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Type 1 diabetes care: Fearsome Four

If you took a step back and looked at the quality of care provided for folks with Type 1 diabetes, it’s perhaps quite easy to slip into click bait territory. It’s all the rage nowadays- irrespective of what level of media you are, it’s all about the click bait. Bad news sells- so it’s fashionable to leak stories, have faux-outrage or indeed simply to slate the level of care provided. Buried in all of that are genuine stories, which need listening to but alas, lost in hubris and the zeal of journalistic ego.

However, if one stands back and takes a calm look at the overall care, the overall average is probably a B-, with some areas providing A+ care and some downright awful. Many factors abound and this piece isn’t about hand wringing about the negatives, nor about falling back on the usual reasoning of… “if we only had more money”.

If one could crystallise down areas, which need looking at to genuinely improve care, it probably- for starters- could boil down to about 4 areas:

Listening to patient needs:

Genuine desires to listen to what patients are asking for. Access is a big issue yet in 2016, email access to patients are labelled an innovation. They are not- they are simply a part of life nowadays. Listen and try to understand what patients are saying- the present rigid model doesn’t work- it needs to be nimble, flexible and ready to adapt according to the changing times. Much lip service continues to be paid to patient needs- that needs to change or at the very least a conversation about what’s possible and what’s not in the present NHS climate


 You wouldn’t ask anyone to do gall bladder surgery- so lets try and get a similar concept to type 1 diabetes care. It isn’t easy or simple- its as difficult as doing anything you aren’t trained in. Any healthcare professional providing Type 1 diabetes care should be trained to a minimal standard. The variability of results and outcomes do boil down to levels of training or indeed support available


As specialists, the leadership and indeed the impetus for change- apart from patients- need to come from specialists. This is our job- and in the absence of genuine desire to listen to patient voices, the responsibility for that must sit with us. That involves not only championing the cause and safety of patients with type 1 diabetes but also doing what a modern healthcare needs. A Consultant’s role is to consult- that includes not only patients- but also primary care- support where needed. We cannot criticise primary care for lack of training if we are unwilling to provide the necessary support to do that.


Finally, the issue of money. Is there enough money for ideal or optimal Type 1 care? No one actually knows as its pretty impossible to factor all that in when dealing with the myriads of NHS contracting, multiple organisations etc. What I can tell you is that widget-based funding- is not applicable to a long-term condition such as type 1 diabetes. It stops the flexibility needed, it stagnates innovation and results in detrimental care. We need to get to a more simplistic way of organising budgets around patient needs- and indeed, one provider would help- rather than multiple ones who not only have their own vested interest but also lack the simple philosophy of communication for the sake of the patients

So there we are- Four obvious areas- none of which are either insurmountable or impossible. A lot sits within the grasp of the healthcare professionals – and a lot is indeed deliverable. Can we is the billion-dollar question? One would hope so- and certainly, there is the desire amongst many. We shall see. As the oft-quoted saying goes…We, indeed, are the change we have been waiting for.

Aren’t we?



Dr Partha Kar
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