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Why do people with Type 1 diabetes face a postcode lottery?


By Léa Legraien
Reporter
18 May 2018

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Diabetes UK recently found that thousands of adults and children with Type 1 diabetes are facing a postcode lottery in accessing Freestyle Libre flash glucose monitoring (flash), a sensor that continuously records blood sugar levels.

Research by the charity showed that flash is not prescribed in 52 areas in England while 38 Clinical Commissioning Groups (CCGs) are yet to decide whether to prescribe it. 

Hover over the graphic below to find out which areas in the UK prescribe flash

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What is flash?

Flash is a small sensor that sits underneath the skin and continuously stores blood sugar levels. The levels can be read with a reader that scans the sensor.

Compared to the common finger-prick blood test, flash helps people test more frequently, gives them much more information and support them to better manage their diabetes, according to Diabetes UK.

‘This can then reduce the risk of serious diabetes complications, such as amputation, sight loss and stroke, as well as improving quality of life, and saving the NHS much-needed funds’, it says.

The Regional Medicines Optimisation Committee (RMOC) recommends that flash should only be used for people with Type 1 diabetes aged four and over using multiple daily injections or insulin pump therapy.

The device can be obtained with a GP prescription under certain criteria.

What does NHS England say?

An NHS England spokesperson tells Healthcare Leader: ‘Earlier this year, we wrote to CCGs reminding them of their responsibilities and of the guidance that exists when it comes to flash and other treatments for people with Type 1 diabetes.

‘Ultimately, it’s the responsibility of local GP groups to take these into account, as they make these decisions.’

The letter, which came after a Diabetes UK survey suggested people with diabetes had restricted access to test strips in some areas, pointed out the ‘importance of reducing variation in the management and care of people with diabetes’, a ‘key objective’ for the NHS.

The letter reads: ‘We’re therefore keen to ensure that technology is made available to those that guidelines suggest might benefit.

‘Indications are that, taking into account the overall impact on healthcare costs from improved control of diabetes, the overall costs from the use of Flash can be less than those that arise from self-monitoring.

‘However, the cost / benefit analysis only holds true provided that the device is used to treat particular cohorts of patients.

‘It is therefore important that CCGs give careful consideration to the available evidence in developing their policies on funding FreeStyle Libre.’

So why isn’t flash available everywhere?

Although the Department of Health and Social Care (DHSC) made flash available within the NHS in November 2017, it is down to local authorities to decide whether it should be prescribed in their areas.

Birmingham and Solihull CCG decided to not routinely commission flash, as it has concluded that investment in flash is ‘neither affordable, nor best value for money at this time’, says CCG chief medical officer Dr Richard Mendelsohn.

He continues: ‘The CCG will only fund this treatment if an Individual Funding Request (IFR) application proves a patient’s exceptional clinical need and this is supported by the CCG.

‘We understand that patients will be disappointed with this decision. The CCG has considered information from a wide variety of sources in order to assess the clinical benefits against the costs of the products.

‘The decision has been thoroughly considered by the CCG and will be reviewed on a regular basis.’

According to the South West Yorkshire area prescribing committee, the expected cost of Flash to the NHS is over £900 per patient per year of continuous use compared with £360 – £650 for finger pricking, based on between four and eight testing a day.

The committee believes that flash is currently ‘unaffordable and unsustainable to make it available for all people with diabetes’.

Some CCGs have also expressed concern about the ‘limited evidence base to demonstrate the cost-effectiveness of the product’, says Crawley CCG clinical chair and clinical lead for medicines management Dr Laura Hill.

She continues: ‘Patient experience and quality of life improvements experienced by patients using the product were noted.

‘After careful consideration the CCG committees concluded that, given the financial position of the CCG, flash is unaffordable at this current time.

‘This decision was made on the basis of no current evidence of value for money above that of the currently available meters and because of limited data on proven clinical benefit.’

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