Diabetes UK
Hounslow Voluntary Group
Patient Power
Use of Hounslow Council Gyms for Diabetic Patients, September 2007
Your Chair has lobbied for preferential terms to be made available for people suffering from Diabetes (and heart disease and morbid obesity) in order to encourage them to keep fit and use facilities within Hounslow Council gyms and leisure centres. As a consequence, Hounslow PCT’s Chief Executive and acting Director of Public Health have had talks with CIP (who operate the Council’s gyms and leisure centres) in order for preferential terms to be negotiated, but the response has been that we will have to wait until summer 2008 when contracts will be re negotiated for this to be considered.
Since then we understand that CIP has lost the contract to operate the Gyms but we will continue to place pressure for the new contract with the new operator to incorporate concessions.
Prevention and early detection of Type 2 diabetes
You may recall that in earlier newsletters we commented on the failings of Hounslow PCT to meet the National Service Framework requirements for the NHS to act in relation to prevention and early detection of type 2 diabetes, where Hounslow PCT has still not allocated any funding towards prevention or early detection of type 2 diabetes.
Local diabetes awareness activity is necessary in order to influence the public (particularly those in harder to reach communities) to make lifestyle changes in order to help prevent them from developing diabetes; and to perform screening to identify those who have diabetes (but do not know that they have it) for them to start controlling their blood sugars. Otherwise people will be still at risk of developing diabetes or complications that are otherwise avoidable.
The “Hounslow PCT Commissioning Intentions for 2007-08” were approved at the PCT Board Meeting on 1st February 2007, but did not show intention to commission “awareness” activity or screening. Our Chair has raised this matter with the PCT many times over the last 2 years and been told that nothing is being done whilst the PCT have a deficit as there is no funding available.
At the PCT Board Meeting in February 2007, our Chair made a formal offer of help from our Voluntary Group and its voluntary resources to undertake “Awareness” initiatives and assist in screening. This offer extended the work already being done by us at the Diabetes Information Desk at West Middlesex Hospital and the road shows through 2006. It will incorporate us supplying literature display wall units to be installed within Outpatients One at West Middlesex Hospital.
The “Hounslow PCT Commissioning Intentions for 2008-09” are yet to be presented to the Board, but whilst there is a deficit I do not think funds will be allocated towards prevention and early detection.
Throughout 2007 we continued our partnership with the PCT by carrying out Diabetes Awareness activities to promote prevention and early detection of diabetes, details of which can be found on the “Past Events” page of this website
We will continue these awareness activities throughout 2008, and expand on them. We hope to do more road shows than before, to make them more effective, to generate larger audiences, and to concentrate our efforts in reaching out to the harder to reach communities.
However we will continue to place pressure on the PCT to commission these activities from paid professionals.
Diabetic Retinopathy Screening
You may recall that in earlier newsletters we commented on the failings of Hounslow PCT to meet Government targets in relation to screening patients with diabetes for retinopathy. The PCT had not met those targets and had been misreporting to the public that that they had met targets. As a result of not being screened, people suffering from diabetes were at risk of going blind because they have not had treatment that would have stopped them going blind because of their doctors being unaware of retinopathy developing. Your Chair has raised this matter with Hounslow PCT many times. The PCT have now admitted that the screening to date, at Ashford Hospital, Moorfields (Ealing) Hospital and High Street optometrists (although better than not being screened at all) does not meet the standards laid down by the Government. This matter was raised at the Hounslow PPIF (Public Patient Information Forum) meeting on 8th March 2007.
In April 2007 we were able to report that the PCT had agreed to Commissioning a “Gold Standard” Retinal Screening Service in partnership with Ealing PCT, and one that will meet the minimum standards laid down by the Government.
Your Chair was invited to attend the Service Implementation Meetings as Diabetes UK and User Representative and attended every meeting. The Service was commissioned from a company called Medical Imaging and was based in Ealing. The Service will write to Hounslow and Ealing patients and invite them to be screened. For Hounslow PCT patients, the screening will be done at the new Heart of Hounslow Health Centre, built on the old Thelma Golding Health Centre Site on 92 Bath Road, Hounslow; at The Feltham Health Centre; and also at a health centre just inside the Ealing border. There will be 4 Screening sites to cover the Ealing PCT area. Letters started going out to all patients from May 2007 inviting them into this new service. The first screening started on 3rd September 2007 and there will be sufficient capacity to screen every patient by this Gold Standard Service over the coming year.
This is extremely good news, and is evidence of how successful lobbying can achieve results.
Click here for more information
Cholesterol reducing Statin tablets
Several patients have approached our Group because their GP has switched their prescription from Atorvastatin to Simvastatin. The reason being that Hounslow PCT Medicines Management & Prescribing Group has recently sent recommendations to GPs that Simvastatin be prescribed instead of Atorvastatin. The PCT point out that Simvastatin, is now sufficiently old to be out of license, and can be made by other manufacturers much cheaper than the newer Atorvastatin which is still under license.
The PCT state that this will save them £1million. However, according to the NW London Cardiac Network Board Minutes for their January 2007 meeting, Hounslow PCT presented a paper stating that the savings would me much less, and based on the PCT’s own numbers, the saving would only be £424,000. This assumes that all prescribing of Atorvastatin would change to Simvastatin, but this will not be the case (as the newer Atorvastatin will have to be prescribed where Simvastatin does not achieve the desired effect of reducing Cholesterol sufficiently) so the savings will be less than this.
Our Chair is obviously worried that the recent PCT instruction to GPs to switch is in contradiction to the current “PCT Guidelines for the care of People with Diabetes” which was issued in 2004. There is some debate over whether this new recommendation will have precedence over the PCT’s Guidelines. The “Guidelines” clearly state when to prescribe Simvastatin and when to prescribe Atorvastatin. Under section 9.6 Treatment Plan for Lipid Lowering. Where there is Hypercholesterolemia (Cholesterol >5 and Triglyceride <2.3) Simvastatin is the first line drug, and Atorvastatin the second line drug where Simvastatin does not work as intended. Where there is mixed Hyperlipidaemia (Cholesterol >5 and Triglyceride = 2.3 to 4.5) Atorvastatin is the first line drug.
The issue of recommending GPs to switch Statins did not come to the Hounslow PCT “Diabetes Strategy Group” on which our Chair sits, where these issues should have been addressed to avoid this confusion.
Our Chair is obviously worried that the recommendation to switch Statins to a cheaper one would not be in the interest of the patients, but merely to save money, and that patients would have to switch back to the dearer drug where the cheaper one failed to lower cholesterol properly.
Our chair is also concerned that this method of saving money would only work if there was patient compliance, and that would be difficult to achieve where patients viewed the risk of side effects of Simvastatin to be unacceptable and did not comply with taking the Simvastatin as prescribed, and have to be reinstated with Atorvastatin in order for the patient to maintain good control of their cholesterol.
There is also a lot of concern over what the level cholesterol should be. The NICE (Government) guidelines say Total Cholesterol should be under 5mmol/l and LDL cholesterol to be under 3mmol/l. But much newer research by the Joint British Societies (JBS) guidelines indicate that Total Cholesterol should be under 4mmol/l and LDL cholesterol under 2mmol/l for good control. Our Chair fully expects Nice to come into line with JBS, but it will not take effect until they publish their detailed guideline on lipid management in December 2007. In Diabetes UK literature, “Understanding Diabetes” it recommends good control to be as per the JBS guidance. To avoid confusion, please discuss your cholesterol levels with your GP. For further information please visit our Chair at The West Middlesex Hospital Information Desk on a Tuesday Morning.
London Borough of Hounslow Council - Hounslow Children and Young Peoples Plan 2007-2010
This plan sets out what the Council sees as its priorities for children and young people over the next 3 years. You may recall that in earlier newsletters we have commented on the failings with this plan. Your Chair wrote to the Council on deficiencies in the draft plan and received a response. The reply hopes that amongst other measures, developing the role of the Obesity Nurse, and monitoring children with high “Body Mass Indices” to 2010 will achieve a reduction in obesity and prevent diabetes and heart Disease. However, it does not go far enough in just identifying children that are obese.
We would like to see special attention being paid to those children that are obese, and where obesity runs in the family, and where they also run an increased risk of developing diabetes, due to it running in their family. We will continue to place pressure on the PCT and council to do more to prevent diabetes. Please contact our Chair for further details.
