In January 2018, NHS England issued guidance in the form of a letter, dated 30 January 2018, to clinical commissioning groups (CCGs) concerning the provision of glucose monitoring devices. The guidance states that the treatment of diabetes and the provision of glucose monitoring devices is a service commissioned by individual CCGs. Local CCGs are responsible for deciding how they allocate resources dependant on the needs of their local population. A copy of this letter is attached.

The South East London Area Prescribing Committee, of which NHS Southwark CCG is a member, has published an updated interim position statement relating to FreeStyle Libre Flash Glucose Monitoring, which is attached. Mechanisms are currently being put in place to support delivery of a local implementation plan. It is not possible to place an exact date for completion of the local implementation plan. However, it is anticipated that eligible patients will be able to access FreeStyle Libre on the National Health Service in south east London in autumn 2018.

In January 2018, NHS England issued guidance in the form of a letter to clinical commissioning groups (CCGs) concerning the provision of glucose monitoring devices. The guidance states that the treatment of diabetes and the provision of glucose monitoring devices is a service commissioned by individual CCGs. Local CCGs are responsible for deciding how they allocate resources dependant on the needs of their local population. A copy of this guidance has been attached.

Reducing variation in the management and care of people with diabetes by 2020 is an objective in the National Health Service mandate. The NHS RightCare diabetes pathway shows the core components of an optimal diabetes service, as well as evidence of the opportunity to reduce variation. Ultimately it is for clinical commissioning groups (CCGs), who are primarily responsible for commissioning diabetes services, to meet the requirements of their population. In doing so, CCGs need to ensure that the services they provide are fit for purpose, reflect the needs of the local population, are based on the available evidence and take into account national guidelines. This includes determining whether specific technologies, such as flash glucose monitoring, form part of their service and if it is suitable for individual patients to support the ongoing management of their condition.

The Regional Medicines Optimisation Committee North has issued advice on the use of Freestyle Libre to support the CCGs in doing this, suggesting a careful start to its use and data collection to better understand the benefits for patients. The guidance Regional Medicines Optimisation Committee (RMOC) Flash Glucose Monitoring Systems Position Statement is attached.

£1.5 million is being made available by NHS England in 2018/19 and 2019/20 through the NHS Test Bed Programme to implement and evaluate digital delivery models for self-management support and education for people living with type 2 diabetes. Further, NHS England will be investing £10.5 million in 2018/19 to improve provision and uptake of structured education through the Transformation Fund bidding process. Up to 25% of these funds can be used to commission digital approaches, subject to the receipt of appropriate plans.

A new website on NHS.UK will be launched in July which is aimed at people living with type 1 diabetes. This will focus on empowering people to self-manage their condition. Individuals visiting the site will be able to access remote personalised digital education content from Diabetes UK and an on-line education programme developed by Bournemouth Diabetes Centre.

The first Diabetes Prevention Week took place from 16-22 April 2018. The campaign aimed to raise awareness of the Healthier You: NHS Diabetes Prevention Programme with the public and healthcare professionals, specifically general practitioners (GPs) and practice nurses, and of the causes, complications and at-risk groups of type 2 diabetes.

Engagement with the campaign from across the country was high – nearly 5,000 Diabetes Prevention Week toolkits were ordered in just over a month. The majority of the toolkits were sent to our target locations, GP practices, but there is also evidence that the toolkits were being used in the wider community setting with orders coming in from local councils, libraries and pharmacies. NHS England is at the early stage of planning a further Diabetes Prevention week in 2019. There were 6,694 completions of the Diabetes ‘Know Your Risk’ tool in Diabetes Prevention Week. This is up 223.69% on the previous month, and 167.55% on the previous year.

An evaluation of the impact of Diabetes Prevention week is being produced which can be made available to the devolved administrations.

Clinical commissioning groups (CCGs) are responsible for commissioning diabetes services to meet the requirements of their population. In doing so, CCGs need to ensure that the services they provide are fit for purpose, reflect the needs of the local population and are based on the available evidence and take into account national guidelines. This should include consideration of access to insulin pumps and other diabetes technologies for people with diabetes who might benefit from them.

The most recent National Diabetes Audit publication reports the number of people with diabetes who were offered a diabetes structured education programme within 12 months of diagnosis and the number who attended a programme within 12 months of diagnosis, by diabetes type.

Information showing the number of people newly diagnosed with type 1 diabetes and type 2 and other diabetes who were offered/attended a structured education programme within 12 months of diagnosis in each clinical commissioning group in the year 2015 is attached, due to the size of the data.

Data in the following table shows the total number of people newly diagnosed with type 1 diabetes and type 2 and other diabetes who were offered/attended a structured education programme within 12 months of diagnosis in England and Wales.

Type 1 diabetes

Type 2 and other diabetes

Source: National Diabetes Audit 2016-17

NHS Digital has advised that caution should be taken when using programme attendance figures, as it is believed that poor recording within primary care systems means that the apparently low rates of attendance at structured education programmes are an underestimate.

The Diabetes Transformation Fund is supporting 137 clinical commissioning groups (CCGs), in partnership with local providers, to expand the numbers of structured education places for patients with type 1 or type 2 diabetes. £10.2 million is being made available to support this in 2018/19. Evidence has also been highlighted to CCGs setting out how investment in structured education should both improve outcomes and result in re-investable savings over the medium term.

The National Diabetes Audit, carried out by NHS Digital with funding from NHS England, supports CCGs and providers to understand local levels of referral to, and attendance at type 1 structured education and how these compare to other CCGs.

The Department’s National Institute for Health Research (NIHR) welcomes funding applications for research into any aspect of human health, including diabetes; it is not usual practice to ring-fence funds for particular topics or conditions. Applications are subject to peer review and judged in open competition, with awards being made on the basis of the importance of the topic to patients and health and care services, value for money and scientific quality.

The NIHR supports research studies through its funding programmes, training and support for health researchers, and through providing world-class research facilities. The NIHR currently has £23,171,620 of funding for research into treatments for diabetes. Last year, NIHR infrastructure, through the Clinical Research Network, supported more than 100 new studies and recruited 37,857 patients to diabetes studies.

The long-term approach to diabetes involves both seeking to reduce the increase in the prevalence of diabetes and, for those with diabetes, seeking to reduce the likelihood of developing complications and improving overall levels of treatment and care.

Work to reduce the increase in future prevalence of type 2 diabetes is being delivered through the NHS Diabetes Prevention Programme. By 2020, the programme will support up to 100,000 people at high risk of type 2 diabetes each year across England. Those referred will get tailored, personalised support over at least nine months to achieve a healthy weight, improve nutrition and increase levels of physical activity in order to reduce risks of developing type 2 diabetes.

Work on reducing the likelihood of those with diabetes developing complications is through the diabetes treatment and care programme. This focuses on four key interventions:

- Increasing attendance at structured education by both those newly diagnosed with diabetes and those who have had the condition for a longer period;

- Increasing achievement of the diabetes treatment targets and reducing variation in achievement of these targets between clinical commissioning groups and between general practitioner practices;

- Reducing the levels of amputations by increasing the availability of multidisciplinary footcare teams; and

- Reducing lengths of inpatient stay for people with diabetes by increasing the availability of diabetes inpatient specialist nurses.

The flash glucose testing monitoring system known as the Freestyle Libre was approved for reimbursement on National Health Service prescription from 1 November 2017 through its listing in Part IX of the NHS England and Wales Drug Tariff.

The listing of a medical device in the Drug Tariff should not be interpreted as a recommendation to prescribe a particular product. Flash glucose testing is not suitable for everyone. The Regional Medicines Optimisation Committee has issued advice on the use of Freestyle Libre to support decisions about its use. Patients will need to discuss the ongoing management of their condition with their healthcare professional and consider whether flash glucose monitoring is suitable for them.

The Department has no plans to ask clinical commissioning groups (CCGs) to review their prescribing policies or monitor access to flash glucose monitoring.

Within its financial constraints, the NHS is committed to providing access to new drugs and medical technologies. Ultimately it is for CCGs, who are primarily responsible for commissioning diabetes services, to meet the requirements of their population. In doing so, CCGs need to ensure that the services they provide are fit for purpose, reflect the needs of the local population, are based on the available evidence and take into account national guidelines. This includes determining whether specific technologies, such as flash glucose monitoring, form part of their service and if it is suitable for individual patients to support the ongoing management of their condition.

The flash glucose testing monitoring system known as the Freestyle Libre was approved for reimbursement on National Health Service prescription from 1 November 2017 through its listing in Part IX of the NHS England and Wales Drug Tariff.

The listing of a medical device in the Drug Tariff should not be interpreted as a recommendation to prescribe a particular product. Flash glucose testing is not suitable for everyone. The Regional Medicines Optimisation Committee has issued advice on the use of Freestyle Libre to support decisions about its use. Patients will need to discuss the ongoing management of their condition with their healthcare professional and consider whether flash glucose monitoring is suitable for them.

The Department has no plans to ask clinical commissioning groups (CCGs) to review their prescribing policies or monitor access to flash glucose monitoring.

Within its financial constraints, the NHS is committed to providing access to new drugs and medical technologies. Ultimately it is for CCGs, who are primarily responsible for commissioning diabetes services, to meet the requirements of their population. In doing so, CCGs need to ensure that the services they provide are fit for purpose, reflect the needs of the local population, are based on the available evidence and take into account national guidelines. This includes determining whether specific technologies, such as flash glucose monitoring, form part of their service and if it is suitable for individual patients to support the ongoing management of their condition.

The flash glucose testing monitoring system known as the Freestyle Libre was approved for reimbursement on National Health Service prescription from 1 November 2017 through its listing in Part IX of the NHS England and Wales Drug Tariff.

The listing of a medical device in the Drug Tariff should not be interpreted as a recommendation to prescribe a particular product. Flash glucose testing is not suitable for everyone. The Regional Medicines Optimisation Committee has issued advice on the use of Freestyle Libre to support decisions about its use. Patients will need to discuss the ongoing management of their condition with their healthcare professional and consider whether flash glucose monitoring is suitable for them.

The Department has no plans to ask clinical commissioning groups (CCGs) to review their prescribing policies or monitor access to flash glucose monitoring.

Within its financial constraints, the NHS is committed to providing access to new drugs and medical technologies. Ultimately it is for CCGs, who are primarily responsible for commissioning diabetes services, to meet the requirements of their population. In doing so, CCGs need to ensure that the services they provide are fit for purpose, reflect the needs of the local population, are based on the available evidence and take into account national guidelines. This includes determining whether specific technologies, such as flash glucose monitoring, form part of their service and if it is suitable for individual patients to support the ongoing management of their condition.

The flash glucose testing monitoring system known as the Freestyle Libre was approved for reimbursement on National Health Service prescription from 1 November 2017 through its listing in Part IX of the NHS England and Wales Drug Tariff.

The listing of a medical device in the Drug Tariff should not be interpreted as a recommendation to prescribe a particular product. Flash glucose testing is not suitable for everyone. The Regional Medicines Optimisation Committee has issued advice on the use of Freestyle Libre to support decisions about its use. Patients will need to discuss the ongoing management of their condition with their healthcare professional and consider whether flash glucose monitoring is suitable for them.

The Department has no plans to ask clinical commissioning groups (CCGs) to review their prescribing policies or monitor access to flash glucose monitoring.

Within its financial constraints, the NHS is committed to providing access to new drugs and medical technologies. Ultimately it is for CCGs, who are primarily responsible for commissioning diabetes services, to meet the requirements of their population. In doing so, CCGs need to ensure that the services they provide are fit for purpose, reflect the needs of the local population, are based on the available evidence and take into account national guidelines. This includes determining whether specific technologies, such as flash glucose monitoring, form part of their service and if it is suitable for individual patients to support the ongoing management of their condition.

Freestyle Libre, the flash glucose monitoring system was included in Part IX of the England and Wales Drug Tariff from November 2017. People with diabetes insipidus or diabetes mellitus (except where treatment is by diet alone) - which includes type 1 and type 2 diabetes - are eligible for free National Health Service prescriptions if they hold a valid medical exemption certificate. However, patients will need to discuss the ongoing management of their condition with their healthcare professional and consider what is most suitable for them.

Within its financial constraints, the NHS is committed to providing access to new drugs and medical technologies. Ultimately it is for clinical commissioning groups (CCGs), who are primarily responsible for commissioning diabetes services, to meet the requirements of their population. In doing so, CCGs need to ensure that the services they provide are fit for purpose, reflect the needs of the local population and are based on the available evidence and take into account national guidelines.

Reducing variation in the management and care of people with diabetes by 2020 is an objective included in the NHS England mandate. The NHS RightCare diabetes pathway shows the core components of an optimal diabetes service, as well as evidence of the opportunity to reduce variation. People with diabetes insipidus or diabetes mellitus (except where treatment is by diet alone) - which includes type 1 and type 2 diabetes - are eligible for free NHS prescriptions if they hold a valid medical exemption certificate.

Freestyle Libre, the flash glucose monitoring system was included in Part IX of the England and Wales Drug Tariff from November 2017. People with diabetes insipidus or diabetes mellitus (except where treatment is by diet alone) - which includes type 1 and type 2 diabetes - are eligible for free National Health Service prescriptions if they hold a valid medical exemption certificate. However, patients will need to discuss the ongoing management of their condition with their healthcare professional and consider what is most suitable for them.

Within its financial constraints, the NHS is committed to providing access to new drugs and medical technologies. Ultimately it is for clinical commissioning groups (CCGs), who are primarily responsible for commissioning diabetes services, to meet the requirements of their population. In doing so, CCGs need to ensure that the services they provide are fit for purpose, reflect the needs of the local population and are based on the available evidence and take into account national guidelines.

Reducing variation in the management and care of people with diabetes by 2020 is an objective included in the NHS England mandate. The NHS RightCare diabetes pathway shows the core components of an optimal diabetes service, as well as evidence of the opportunity to reduce variation. People with diabetes insipidus or diabetes mellitus (except where treatment is by diet alone) - which includes type 1 and type 2 diabetes - are eligible for free NHS prescriptions if they hold a valid medical exemption certificate.

Freestyle Libre, the flash glucose monitoring system was included in Part IX of the England and Wales Drug Tariff from November 2017. People with diabetes insipidus or diabetes mellitus (except where treatment is by diet alone) - which includes type 1 and type 2 diabetes - are eligible for free National Health Service prescriptions if they hold a valid medical exemption certificate. However, patients will need to discuss the ongoing management of their condition with their healthcare professional and consider what is most suitable for them.

Within its financial constraints, the NHS is committed to providing access to new drugs and medical technologies. Ultimately it is for clinical commissioning groups (CCGs), who are primarily responsible for commissioning diabetes services, to meet the requirements of their population. In doing so, CCGs need to ensure that the services they provide are fit for purpose, reflect the needs of the local population and are based on the available evidence and take into account national guidelines.

Reducing variation in the management and care of people with diabetes by 2020 is an objective included in the NHS England mandate. The NHS RightCare diabetes pathway shows the core components of an optimal diabetes service, as well as evidence of the opportunity to reduce variation. People with diabetes insipidus or diabetes mellitus (except where treatment is by diet alone) - which includes type 1 and type 2 diabetes - are eligible for free NHS prescriptions if they hold a valid medical exemption certificate.

The National Institute for Health and Care Excellence (NICE) has evaluated the following glucose monitors used by people living with diabetes:

- Integrated sensor-augmented pump therapy systems for managing blood glucose levels in type 1 diabetes (the MiniMed Paradigm Veo system and the Vibe and G4 PLATINUM CGM system). NICE has evaluated these products through its diagnostics programme. The MiniMed Paradigm Veo system is recommended as an option for managing blood glucose levels in people with type 1 diabetes only if they have episodes of disabling hypoglycaemia despite optimal management with continuous subcutaneous insulin infusion.

- MiniMed 640G system with SmartGuard for managing blood glucose levels in people with type 1 diabetes. This is a NICE advice product, developed under its Medtech innovation briefings (MIBs) programme. MIBs provide a summary of the best available evidence for selected new technologies and are designed to assist National Health Service planning and decision-making. MIBs are not designed to include treatment advice but provide a critical review of the strengths and weaknesses of the relevant evidence, therefore NICE do not make any recommendations for (or against) funding the device.

- FreeStyle Libre for glucose monitoring, which measures interstitial fluid glucose levels in people with diabetes. This is also a Medtech innovation briefing therefore NICE do not make any recommendations for funding the device.

In addition, the Regional Medicines Optimisation Committee (North), one of four Committees established by NHS England to provide advice to the NHS, reviewed the use of the Freestyle Libre at its meeting on 26 October 2017. In developing its advice, the Committee took into account the MIB published by NICE. The Committee has issued guidance on the use of Freestyle Libre suggesting a careful start to its use and data collection to better understand the benefits. Freestyle Libre has been approved for reimbursement on NHS prescription from 1 November through listing in Part IX of the Drug Tariff.

NICE does not have a role in proactively monitoring the delivery of local services, so it has not made any assessment of decisions taken by some clinical commissioning groups not to fund these technologies.