An article in a diabetes nursing journal last month described how a PCT was able to reduce its costs by £500,000 over 2 years by cutting back on the number of blood glucose meters offered to people with diabetes and thereby the amount of blood glucose testing strips being prescribed. This is extremely impressive and hopefully the money saved will be ploughed back directly into diabetes self management education. The article did not state whether this would be the case, but did say that blood glucose monitoring should ‘only be used as part of self management education’.
This begs the question for us ‘What parts of diabetes care should not be used as part of self management education?’ Hospital and GP practice based consultations? Diabetes specialist nurse consultations? Foot clinics? Dietitians? Retinal screening? Pharmacy prescriptions and medicines reviews? If we are going to pick and choose who should and who shouldn’t do blood glucose monitoring on the basis of self management education, perhaps we should also start limiting many of other aspects of diabetes care which very often do not promote self management? That would save as much money if not more, plus the incalculable cost of time, stress and wasted journeys.
More than once we have heard about consultations where someone is told off or given limited information to help them self manage their condition. Many times the attitude of ‘patients don’t do as they are told, they are simply non compliant’ comes through the stories of health professionals. It’s particularly hard for people with diabetes who have attended diabetes structured education and learned so much about managing their condition in all its carb counting, insulin adjusting, hypo treating, correction bolusing glory, who then visit a clinician who simply tells them off for having an HbA1c outside the recommended range and accuses them of not sticking to their diet!
Obviously if we simply applied the cost-cutting principle to all these other aspects, we may end up with fewer services all round. But what if the money saved were redirected to investment in services which were truly self management orientated? That would really be something. There are welcome suggestions of this in the current health reform aspirations, but we have yet to see which ‘babies’ are thrown out and which survive the metaphorical bathwater that is the Health Bill.
So, back to our question: why should it only be blood glucose monitoring that is offered in the context of self management education? Surely every single aspect of diabetes care should ‘only be offered’ in this aspiration? Blood glucose monitoring limitations can bring eye-catching savings in the short term, but without a proper, self management focused strategy alongside this decision, the real costs of doing so will start to become evident in the long term. We also need to bring more accountability into the ‘people’ cost of diabetes care provision, and make sure that we are investing our money to provide real self management support and services.