Diabetes prevention and care: we know what to do, so why aren't we doing it?

Imagine having such poor vision that you have to rely on your toddler to ‘tell mummy when the big red bus comes’. This patient had had diabetes for most of her life and it had damaged most of her body. I felt sad but I also felt angry. How could this have happened? Of course, diabetes care cannot prevent complications in every patient, but surely we could prevent much of the tissue damage that blights our patients’ lives. We have a huge evidence base for good diabetes care. It was with this vision that the NSF was launched in 2003. I was delighted that the Cinderella of diabetes was finally coming to the ball. It never occurred to me that one day I would be responsible for helping to deliver this NSF nationally. Throughout the country healthcare professionals have struggled for years with the rising tide of diabetes. There is great expertise. There are many champions for different aspects of diabetes care. And there are many diabetes healthcare professionals working tirelessly and unsung. The Diabetes Tsar is one of a cast of thousands and cannot deliver anything alone. I worked with a Department of Health team, and with NHS Diabetes whose priorities I set. In one sense, the challenge is simple – we know what to do, so why aren’t we doing it? In reality the challenge is immense. In 2013, the NHS had 1.364 million staff including 147,087 doctors and 371,777 qualified nursing staff.1 These staff have variable training and expertise in diabetes and care for millions of patients in thousands of healthcare settings. Healthcare resources are always under pressure.