New NICE guidance recommends ‘stepped’ risk assessments for type 2 diabetes and early intervention in cases of high risk.

Risk assessments are recommended for adults aged over 40; adults aged over 25 in certain ethnic groups; and adults with conditions that increase the risk of diabetes.

Individuals at high risk should be offered a blood test and treated through an intensive lifestyle change programme that may include medication.

Diabetes affects an estimated three million people in the UK – predicted to rise to five million by 2025 – and type 2 diabetes accounts for 90% of the total.

NICE observes that individual risk of developing type 2 diabetes can be reduced by 60% through lifestyle changes including diet and exercise.

The new guidance recommends that risk assessments be offered to people (except pregnant women) in the following groups:

• adults aged 40 or over

• adults aged 25 or over who are of South Asian, Chinese, African-Caribbean or Black African origin

• adults with conditions that increase the risk of type 2 diabetes, including obesity, hypertension and mental illness.

Individuals considered at high risk should be offered a blood test (fasting glucose or HbA1c) at least once a year, and the correct level of intervention decided accordingly.

NICE recommends preventative measures such as diet and exercise regimes. Medications such as metformin (to improve insulin uptake) and orlistat (to assist weight loss) may be used to treat ‘pre-diabetes’.

As well as helping to prevent type 2 diabetes, these measures will help to diagnose the condition – it is estimated that 850,000 people in the UK have undiagnosed diabetes.

“We are not just seeing an epidemic of type 2 diabetes, it is a tsunami,” said Professor Kamlesh Khunti, chair of the NICE guidance development group.

Thousands of deaths in acute hospitals in England could be prevented each year, new analysis has found.

Evidence found that up to 12,000 deaths were caused by poor clinical monitoring, diagnostic errors and poor drug or fluid management.

Despite the number of preventable deaths, the figure is much lower than previous estimates which suggested that between 60,000 and 255,000 fatalities were as a result of poor NHS treatment.

Researchers based finding on case records of 1,000 deaths at 10 randomly selected acute hospitals across England in 2009.

A focus was placed on potential acts of omission or acts of commission which were judged to consider whether deaths may have been prevented.

In total, 131 individuals were considered to have experienced problems with the care they received which led to their death. Also, fifty two patients had a 50% or greater chance of not having died had they not received certain aspect of NHS treatment.

“While the spectre of preventable hospital deaths may prove helpful in raising interest in patient safety and a commitment to improvement, overestimating the size of the problem and the risk to patients may induce unjustified levels of anxiety and fear among the public,” researchers said.

“In addition, confirmation of the relatively small proportion of deaths that appear to be preventable provides further evidence that overall hospital mortality rates are a poor indicator of quality of care.”

The Department of Health has questioned finances and mortality rates at Hull and East Yorkshire Hospital Trust as it gears towards foundation trust status.

A letter from Matthew Kershaw, Director of Provider Delivery, DH, to trust Chief Executive Phil Morley highlighted a number of issues which had “triggered the first stage” of an escalation process.

It followed an earlier discussion between the two when mortality rates at the trust were found to be higher than the national average and how the trust’s income did not match its activity.

The letter – sent after a meeting between the two in February – reported that the trust had been “red rated” for three consecutive months. Issues such as board capacity and performance measures had been addressed since then, however concerns over liquidity issues were also noted.

The Trust will now work with its SHA to establish Tripartite Formal Agreement and an Accountability Agreement to “bring back” to the DH “for our consideration”, the letter said.

Public Health England (PHE), the new DH-appointed agency, has outlined the leadership structure it will have in place by April 2013.

A senior leadership team and executive board will provide public health, professional and strategic leadership to help local authorities in their new role of managing public health.

Like the NHS Commissioning Board, PHE seeks to combine “a national voice and local action”: it is a national executive agency seeking to guide and co-ordinate local initiatives to reduce health risks.

In My vision for Public Health England, designated Chief Executive Duncan Selbie describes the structure and ambitions of the new agency.

PHE’s senior leadership team will include three public health leaders – a Director for Health Protection, a Director for Health Improvement and Population Health, and a Chief Knowledge Officer; and three professional leaders – a Chief Operating Officer, a Director of Finance and Corporate Services, and a Director of Human Resources.

Two further leaders will support delivery: a Director of Strategy “holding the ring on our internal discussions and with our stakeholders” to determine PHE’s strategic direction, and a Director of Programmes working with NHS and local government organisations to translate the strategy into national priorities.

The senior team will be complemented by an executive board providing “senior scientific and professional expertise” and a predominantly non-executive board with a publicly appointed chair.

According to Selbie, PHE’s ambition is to “lead nationally and enable locally a transformation in the health expectations and, in time, outcomes of all people in England”. He promises “leadership without hierarchy” and a focus on “transformation rather than transition”.

In order to have PHE in operation by April 2013, he says, it is essential to focus on shifting staff into the new agency, maintaining service continuity and frequent communication.

As the slicing and dicing of Foundation Trusts and their services intensifies, Maxine Vaccine takes a look at the commercial future of the NHS brand.

This week, the NHS news has been dominated by the struggles of NHS trusts to achieve Foundation Trust status.

Firstly, the shutdowns. South London Healthcare NHS Trust went into administration after running up deficits of more than £150m. Mid Yorkshire Hospitals NHS Trust said it was considering service closure options after seeing its deficit soar from £19.2m to £44.2m in a year. NHS North of England declared it would delete inpatient surgery and A&E services from Trafford General Hospital, the ‘birthplace of the NHS’.

Secondly, the bailouts. Andrew Lansley told Parliament that the £19m owed by NHS North Yorkshire and York would be written off to enable the new CCGs to commence doing business without legacy debts. A National Audit Office report revealed that NHS trusts have received bailouts totalling more than £1bn over the past six years. In 2010–11, the DH paid out £76m to help ailing trusts manage their deficits. In 2011–2, the figure rose to £253m. The NAO predicts that next year it will reach half a billion.

On the one hand, the Government is willing to shut down services in order to ensure that hospitals behave more like businesses. On the other hand, it’s willing to prop them up with public money if that helps them to creep through the Foundation Trust gates. The priority is neither saving money nor maintaining services: the priority is making sure that NHS Trusts disappear from the landscape.

Another clue to what is taking place can be found in the recent statement by Health Education England that it will allow commissioners to create flexible workforces that meet their own local needs. This followed an earlier statement that it would put healthcare employers “in the driving seat” to create a “demand-led workforce”. Don’t be misled by the word ‘flexible’. Of course clinicians need to be flexible – that’s not the issue. What HEE is promising is that terms and conditions, job definitions and professional grades will be flexible depending on the local employer. In other words, the NHS will no longer have a national employment framework.

What these changes are all about is grooming the NHS for private sector takeovers at a local level – the kind illustrated by this week’s announcement that Virgin Care will be running children’s health and social care in Devon for the next three years. Branson’s company declared its one-year experience of working with charity Kids’ Company means it is fully equipped to provide core NHS services to the young.

National agreements, like legacy debts, would be off-putting to potential franchisers. What they want is lucrative services, straightforward tenders, no headaches. That’s exactly what the Government is making sure they find when they come to the NHS. But what will drive the takeovers? As the Devon contract illustrates, it’s not that NHS providers cannot offer the same services. It’s the power of healthcare corporations like Virgin Care, Circle and Serco to achieve economies of scale and to drive down costs by imposing the terms and conditions of private sector employment.

And no, Andrew Lansley wasn’t lying when he said the Government wasn’t planning to sell the NHS. At the local level, the level of CCGs and Foundation Trusts, the NHS is selling itself. All the Government did was slice it up, wrap it in plastic and put it on the shelf. If companies then come along and buy it, that’s purely a local decision.

Key account managers in the pharma industry need to find out everything about the private health providers who are bidding for segments of the NHS brand. The future of UK healthcare belongs to them.

Maxine’s views are not necessarily those of Pharmaceutical Field.