The NHS is not giving enough priority to diabetes

Astonishingly, this isn't about a lack of money.

As someone who has run NHS bodies and been an NHS groupie for more years than I care to think about, I wept with joy at the tribute to our health service in Danny Boyle’s breathtaking opening ceremony for the London Olympic Games. For me, those that work tirelessly for our health services are an even greater pride to Britain than our amazing athletes.

But as brilliant as those working in the NHS undoubtedly are, the sad fact is that as an institution it is failing when it comes to diabetes healthcare. Diabetes is one of the greatest health challenges we face but its rise seems to be inexorable and the seriousness with which it is tackled simply doesn’t match the seriousness of the condition and its complications.

There are now 3.7m people with diabetes in the UK and 7m at high risk and the fact that rates of devastating diabetes complications such as kidney failure and stroke are now at record levels is one of the reasons that 24,000 people with diabetes die early every year. To put it simply, diabetes is big a big, growing and serious problem to which insufficient priority is being given. 

The astounding thing is that it is not about money. How often are these words heard? Not often. The NHS already spends 10 per cent of its annual budget on diabetes – that £10bn is more than the total amount of money spent on the London Olympics over the last seven years. For this kind of investment, you would expect Jessica Ennis-esque levels of healthcare performance but much diabetes spending is going on the wrong things.

About 80 per cent of NHS spending on diabetes goes on treating the devastating diabetes complications, such as blindness, amputations and kidney disease, the vast majority of which are basically avoidable, while not enough is being done to prevent complications from occurring in the first place. For example, less than half of the people who should have been screened for diabetes under the NHS Vascular healthcheck have been. 

Risk assessment and early diagnosis are key to giving people treatment as early as possible that can help prevent complications developing or help them avoid developing diabetes if they are at high risk. Barely half of people with diabetes are getting the basic checks they need to manage their condition. Fixing both of these things could save the NHS Olympic scale cash through fewer hospital admissions and less complex treatments. It would also ensure that those with diabetes have a better quality of life and in many cases mean the difference between life and death.

As the London Olympics comes to a close I hope one of the lasting legacies of these games will be greater participation in sport and physical activity. Not only would this lead to better health and well-being for people across the country, but could also play a crucial role in reducing risk of Type 2 diabetes.  But if the growing problem of diabetes is to be truly tackled – and the ticking time bomb at the heart of the NHS defused – then we need the NHS and Government to declare and make diabetes a priority in the way that as a nation we prioritised the effective delivery of a wonderful Games. 

Barbara Young is chief executive of Diabetes UK

 

Barbara Young is chief executive of Diabetes UK.

Photo: Getty
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The Prevent strategy needs a rethink, not a rebrand

A bad policy by any other name is still a bad policy.

Yesterday the Home Affairs Select Committee published its report on radicalization in the UK. While the focus of the coverage has been on its claim that social media companies like Facebook, Twitter and YouTube are “consciously failing” to combat the promotion of terrorism and extremism, it also reported on Prevent. The report rightly engages with criticism of Prevent, acknowledging how it has affected the Muslim community and calling for it to become more transparent:

“The concerns about Prevent amongst the communities most affected by it must be addressed. Otherwise it will continue to be viewed with suspicion by many, and by some as “toxic”… The government must be more transparent about what it is doing on the Prevent strategy, including by publicising its engagement activities, and providing updates on outcomes, through an easily accessible online portal.”

While this acknowledgement is good news, it is hard to see how real change will occur. As I have written previously, as Prevent has become more entrenched in British society, it has also become more secretive. For example, in August 2013, I lodged FOI requests to designated Prevent priority areas, asking for the most up-to-date Prevent funding information, including what projects received funding and details of any project engaging specifically with far-right extremism. I lodged almost identical requests between 2008 and 2009, all of which were successful. All but one of the 2013 requests were denied.

This denial is significant. Before the 2011 review, the Prevent strategy distributed money to help local authorities fight violent extremism and in doing so identified priority areas based solely on demographics. Any local authority with a Muslim population of at least five per cent was automatically given Prevent funding. The 2011 review pledged to end this. It further promised to expand Prevent to include far-right extremism and stop its use in community cohesion projects. Through these FOI requests I was trying to find out whether or not the 2011 pledges had been met. But with the blanket denial of information, I was left in the dark.

It is telling that the report’s concerns with Prevent are not new and have in fact been highlighted in several reports by the same Home Affairs Select Committee, as well as numerous reports by NGOs. But nothing has changed. In fact, the only change proposed by the report is to give Prevent a new name: Engage. But the problem was never the name. Prevent relies on the premise that terrorism and extremism are inherently connected with Islam, and until this is changed, it will continue to be at best counter-productive, and at worst, deeply discriminatory.

In his evidence to the committee, David Anderson, the independent ombudsman of terrorism legislation, has called for an independent review of the Prevent strategy. This would be a start. However, more is required. What is needed is a radical new approach to counter-terrorism and counter-extremism, one that targets all forms of extremism and that does not stigmatise or stereotype those affected.

Such an approach has been pioneered in the Danish town of Aarhus. Faced with increased numbers of youngsters leaving Aarhus for Syria, police officers made it clear that those who had travelled to Syria were welcome to come home, where they would receive help with going back to school, finding a place to live and whatever else was necessary for them to find their way back to Danish society.  Known as the ‘Aarhus model’, this approach focuses on inclusion, mentorship and non-criminalisation. It is the opposite of Prevent, which has from its very start framed British Muslims as a particularly deviant suspect community.

We need to change the narrative of counter-terrorism in the UK, but a narrative is not changed by a new title. Just as a rose by any other name would smell as sweet, a bad policy by any other name is still a bad policy. While the Home Affairs Select Committee concern about Prevent is welcomed, real action is needed. This will involve actually engaging with the Muslim community, listening to their concerns and not dismissing them as misunderstandings. It will require serious investigation of the damages caused by new Prevent statutory duty, something which the report does acknowledge as a concern.  Finally, real action on Prevent in particular, but extremism in general, will require developing a wide-ranging counter-extremism strategy that directly engages with far-right extremism. This has been notably absent from today’s report, even though far-right extremism is on the rise. After all, far-right extremists make up half of all counter-radicalization referrals in Yorkshire, and 30 per cent of the caseload in the east Midlands.

It will also require changing the way we think about those who are radicalized. The Aarhus model proves that such a change is possible. Radicalization is indeed a real problem, one imagines it will be even more so considering the country’s flagship counter-radicalization strategy remains problematic and ineffective. In the end, Prevent may be renamed a thousand times, but unless real effort is put in actually changing the strategy, it will remain toxic. 

Dr Maria Norris works at London School of Economics and Political Science. She tweets as @MariaWNorris.