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Re: [IPk] Funding / Waiting

Hi Nick,

This message surprises me. Essentially, pump therapy is being handled in the
NHS like something much more invasive, specialised and complicated than it
is. If you are being treated by an endocrinologist, ie a trained diabetes
expert, it is a real surprise that his clinic is not geared up to starting
people on pumps.

Minimed have not been as quick as they might, at training up diabetes nurses
in pump initiation, and there is no doubt that doctors in the NHS are
reluctant, reasonably so in the light of a poor experience with previous
generations of pump. Even so, the benefits of pumps are fairly clear, and
most clinics find that particularly for motivated users, after a flurry of
contact around initiation, we manage with less involvement than before.

Dr Pickup is the expert who wrote the original editorial in the BMJ, to
which someone responded negatively this week. He, and Harry Keen, are
clearly very pro-pumps.

It seems you have two problems in the UK; one, to persuade professionals to
give pumps a chance, and two, to persuade the NHS to fund them.

The second may already have been done by the involvement of diabetes UK in
the National Service Framework, which will be published shortly. I will
contact Paul Streets to confirm this. The former needs further realistic
promotion to professionals, emanating from respected peers. One option is to
conduct a study, possibly a simple survey, among current pump users relating
to safety, satisfaction, and outcomes particularly HbA1cs. Something like
this would have a bigger impact on professional behaviour than any amount of
grumbling, albeit justified, from users!

Do members of the group have an interest in this? Another option worth
considering is a pump subgroup of diabetes UK, which would get space and
time at meetings, both patient and professional, to focus on pump therapy.

In targeting the profession, we need to know who our friends are. If you are
attending a positive clinic, perhaps we should give those details to John
Neale as co-ordinator of the list (or campaign manager).

We need to do very similar things here in Ireland, but we are in the happy
position that pumps are generally fully covered by health boards, and all
disposables are covered automatically now. Considering that only 18% of
diabetes expenditure goes on management of the condition, with 60% spent on
complications, there is always a good argument in favour of better glucose
control, however it can be achieved. It's time the NHS moved on that,
uniformly if possible.

Tony O'Sullivan
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