‘Postcode lottery’ revealed in NHS care

Differences in quality of treatment for patients with dementia, diabetes and learning disabilities revealed in NHS England figures

Patients with dementia, diabetes and learning disabilities are being let down by their local health services in many parts of England, new figures show.

A postcode lottery of care across the country has been highlighted as new performance data shows that while some health bodies are performing well, neighbouring organisations are falling short.

More than half (57%) of local health bodies in England are not performing well enough on dementia, 71% are classed as “needs improvement” for diabetes care and 92% need to improve care for people with learning disabilities, the figures show.

The figures, released by NHS England, show that many clinical commissioning groups (CCGs) have been classed as needing improvement in the different aspects of care.

They have been released as part of a package of measures announced by the health secretary, Jeremy Hunt, to improve IT and digital services in the NHS.

Hunt said patients would be able to compare how well their local health service performed against others for key areas including cancer, dementia, diabetes, mental health, learning disabilities and maternity care.

Information on how well each local trust performs on dementia, diabetes and learning disability services was published on the MyNHS website, with more information on other services to be added in the autumn.

On dementia care, CCGs are rated on the number of patients are receiving a formal diagnosis and whether people with dementia are receiving annual reviews of their care plan in primary care.

Of England’s 209 CCGs, 120 need to improve their performance for these aspects of care.

Jeremy Hughes, the chief executive of the Alzheimer’s Society, said: “Over the last few years, our health system has made strides to improve dementia diagnosis rates, but with 45% of CCGs still lagging behind the national ambition, there is a significant way to go.

“People with dementia in York should be getting the same support as those in Bradford – but with diagnosis rates varying by as much as 46.1% across the country, too many people remain in the dark, unable to access the vital information, treatments and non-medical support a diagnosis can bring.

“Given the progressive nature of dementia, which means a person’s needs become more severe over time, the focus on care plan reviews is essential. However, a care plan review must be matched with support on the ground and measures should develop to assess how meaningful these plans are.”

Prof Alistair Burns, NHS England’s national clinical director for dementia, said: “Awareness of dementia is at its highest and we believe that timely diagnosis of dementia allows people to access the emotional, practical and financial support that brings. We have increased the diagnosis rate across the country so now more than 440,000 people have a formal diagnosis of dementia and can benefit from post-diagnostic support.

“NHS England today launched a support package for local areas if they feel they need extra help following the publication of the Improvement and Assessment Framework.”

Meanwhile, 149 of 209 CCGs were rated as needing to improve their care for diabetes patients based on the number of people affected who get the recommended checks each year and the proportion of patients who attend an education course about their disease.

Prof Jonathan Valabhji, NHS England’s national clinical director for obesity and diabetes, said: “People with diabetes, type 1 and type 2, have the best care and outcomes when they receive structured education early following diagnosis and go on to regularly receive and achieve all of the Nice [National Institute for Healthand Care Excellence]-recommended checks and targets.

“This is part of our wider programme to improve care for everyone with diabetes including support to improve achievements of the Nice recommendations, attendance at structured education and a reduction in amputations and improve specialist diabetes support during inpatient stays.”

Care for people with learning disabilities was rated on the proportion of patients receiving annual check-ups and their ability to keep patients out of hospital. No CCG was given the highest rating of “top performing” and 193 out of 209 were deemed to “need improvement”.

An NHS spokeswoman said: “We have seen significant increases in the numbers of people both being discharged from hospital and having their care and treatment reviewed in the last year, but it’s no secret that significant improvement needs to be made across England.

“The real difference will be made over the coming months and years as local councils and NHS bodies implement their response to Building the right support, the three-year, cross-system plan to ensure people with a learning disability and/or autism have greater say in the care and support they receive.”

A Department of Health spokeswoman said: “Work is well under way to help services around the country make progress in key areas, backed with funding to help prevent diabetes, find a cure for dementia and provide suitable supported accommodation for people with learning disabilities.

“All this is shaped by world-leading transparency, focusing efforts where improvements are needed and helping us learn from the best services.”

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