Care for leading causes of ill health

The data on waiting times tell a clear story of rising pressure: NHS staff have worked hard to treat more patients within target times, but demand has grown more quickly than supply and hospitals have struggled to meet their targets. Although there are limited data on waiting times beyond the ambulance service and acute hospitals, the situation is equally challenging elsewhere in the health system. General practice is under increasing pressure linked to increased workload, for example, and more patients report difficulty making an appointment.

But what happens once patients are through the door of a service, with a diagnosis of a particular condition? This and the next section look at six leading causes of ill health in England where we could find data that allow for comparison across time. We cover longer term illnesses primarily managed through general practice and other NHS services based in the community (diabetes and common mental health conditions), and sudden or life-threatening illnesses that need high quality care from the ambulance service and acute hospitals (stroke, heart attack, and breast and bowel cancer).

Care for patients with diabetes

NICE recommends eight care processes for people living with diabetes, including tests for blood pressure, cholesterol, blood sugar and kidney function. The NHS has made substantial improvements in diabetes care, but still has a long way to go: only 36.7% of patients received all of the recommended care processes in 2007 compared with 52.6% in 2016. This represents a reduction from 60.6% in 2010, although participation in the National Diabetes Audit, which measures the effectiveness of diabetes care against NICE guidelines in England and Wales, has increased and the total number of patients who received all care processes in 2016 was nearly as high as it was in 2010.

The NHS has also made progress in achieving all three NICE-recommended treatment goals for people with diabetes – controlling blood sugar levels, and reducing blood pressure and cholesterol – to avoid complications such as heart attack, kidney failure and damage to eyesight. In 2016, all three goals were met for 18.1% of people with type 1 diabetes (up from 16.5% in 2011). 40.2% of people with type 2 diabetes met the treatment goals (up from 35.1% in 2011) in 2016, but this was a reduction from a peak of 41.4% in 2014. The greatest improvement has been observed in achieving the blood pressure goal, but progress has leveled off since 2014.

A 2014 study comparing 30 European countries ranked the UK fourth for the quality of diabetes care, behind only Sweden, the Netherlands and Denmark. Figure 6 also shows that the UK was better than the average for OECD countries in 2013, both in terms of hospital admissions for people with diabetes (though this may simply reflect differences in how care is delivered) and for rates of amputations due to complications.

Figure 6: Diabetes care, age-standardised rates per 100,000 population, OCED average vs UK, 2013

Source: OECD, 2015

The number of people developing type 2 diabetes has grown and the percentage of people in hospital who have diabetes increased from 15% in 2011 to 17% in 2016. Regardless of the reason for admission to hospital, people with diabetes need high levels of care. The need for more hospital staff who specialise in diabetes has consistently been highlighted as an issue for the past six years, with fewer than one in 10 patients under a diabetes consultant while in hospital and more than a quarter of sites with no diabetic specialist inpatient nurses.

Despite an increasing workload, there have still been improvements in care, but nearly two in five inpatients admitted with diabetes experienced medication errors (38% in 2016, 32.4% in 2009/10), from either an incorrect prescription or incorrect management of medicine. In 2016, around one in 25 people with type 1 diabetes developed in-hospital diabetic ketoacidosis due to under-treatment with insulin.

Psychological therapy for common mental health conditions

One in four adults in the UK experiences a mental health problem in any given year, at an estimated cost to the economy of £105 billion per year. But mental health services have often received lower funding relative to need, struggled to offer sufficient access to services and tended to focus on containment rather than recovery. Despite improvements, these issues remain – particularly for people with severe mental illness, and for children and young people with mental health conditions. (We will be publishing further analysis on mental health services separately.)

In this briefing, we focus on access to psychological therapies for people with common mental health conditions, including depression and anxiety, which affect up to 15% of the population at any one time. Medication remains an appropriate and effective option for treating these conditions: 61 million antidepressant drugs were prescribed and dispensed in England in 2015, more than double the number in 2005. But many people prefer psychological interventions and the Improving Access to Psychological Therapies (IAPT) programme, launched in 2008, aims to improve access to a range of evidence-based psychological therapies.

Figure 7: Numbers of people referred to IAPT services, finishing a course of treatment and recovery rate, 2011/12 to 2016/17

Source: NHS Digital, 2017

The NHS has consistently met its target of at least 75% of people starting psychological therapy within six weeks of referral to IAPT services, with at least 95% starting within 18 weeks. But these targets have been criticised for allowing people to wait months too long.

Figure 7 shows that the number of people being referred to IAPT services and the number of people completing treatment has increased over time. Over a million people were referred to IAPT services in the first nine months of 2016/17, an increase of nearly 400,000 from the same period five years ago. The number of people completing treatment has also increased substantially with nearly 430,000 people completing a course of therapy in the first nine months of 2016/17, almost double the number in the same period five years ago.

As well as increasing access to psychological therapies, the quality of IAPT services has also improved. The percentage of people who completed a course of treatment and were assessed as no longer being above the clinical threshold for anxiety and depression has increased over time, and early data suggest the 50% target for recovery rates was met for the first time in January 2017. There is still a long way to go: the NHS estimates that three in four people needing help get no support at all.

Previous Next