Monday, 30 March 2015

Is coming 4th out of 10 good enough for diabetes?

Late last week, NHS England published its business plan for 2015/16. It includes 10 priorities, of which ‘tackling obesity and preventing diabetes’ comes 4th, after improving, upgrading and transforming care for, respectively, cancer treatment, mental health & dementia and learning disabilities. It’s ahead, in the list of priorities, of urgent and emergency care, primary care, elective care, specialized care, whole systems care and foundations for improvement.

Of course, the list isn’t really about priorities of decreasing importance, all of these issues are of equal importance and will, we hope, receive equal attention, not to mention equal share of the some £2bn budget. Having a list of 10 makes it easier for people, including presumably NHS England staff and politicians themselves, to read and remember. It’s unarguable that all these issues need to be acted upon and also that system change is badly needed to address the early 21st century health ‘state of the art’. On that note, the business plan is to be welcomed and being 4th doesn’t mean losing out.

The targets for ‘tackling obesity and preventing diabetes', focuses on Type 2 diabetes (a detail unfortunately left out of the title) are ambitious for a year’s work. By March 2016, a prevention programme will be ‘available’ for 10,000 people at risk of Type 2 diabetes. NHS England will be working with Diabetes UK and Public Health England to develop the programme and roll it out, partly via the NHS Health Checks system. The plans are to ‘enroll’ people identified onto a lifestyle management programme to address their ‘smoking, alcohol intake, nutrition and physical activity’. The latter also applies to plans in priority 4 to also encourage these factors to be addressed by NHS staff themselves. It’s not clear if the latter will be among the 10,000 initial 'enrollees' or if there is to be a separate programme for healthcare staff.

While the forthcoming programme sounds admirable, we have a concern, based on the old saying ‘you can take a horse to water, but you cannot make it drink’. That is, it is one thing to ‘refer’ or ‘enroll’ people onto a lifestyle programme, but quite another to ensure attendance or participation. These the only things that are likely to make a difference to the health of the 10,000 souls to be identified. So, in the spirit of ‘4s’, we hope that the prevention programme in development includes this ‘top 4’ of evidence-based, vital components for success in encouraging lifestyle change:

1. ‘Invite’, ‘encourage’ or ‘welcome’ people to take part, rather than ‘refer', ‘enroll’, ‘send’ or any other paternalistic term that removes any suggestion of free choice
2. Focus on success and the future in interactive and participatory, enjoyable activities
3. Scrutinise the programme for, and remove any evidence of, judgement, tellings off, compliance-orientation, school or classroom-like environments
4. Prize autonomy, choice and personal decision-making

As we have said before, we wish this programme well and sincerely hope that this time next year, despite the election and our reservations, our blog will be trumpeting the success and ongoing delivery of type 2 diabetes prevention.

NHS England Business Plan

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