Curricula for undergraduate level medical training is set by individual medical schools and are designed to develop the skills and attributes required of doctors to deal effectively with whatever is presented to them.

The training curricula for postgraduate trainee doctors is set by the relevant medical Royal College. Whilst curricula do not necessarily highlight specific conditions for doctors to be aware of, they instead emphasise the skills and approaches that a doctor must develop in order to ensure accurate and timely diagnoses and treatment plans for their patients.

The General Medical Council has the general function of promoting high standards of education and co-ordinating all stages of education to ensure that medical students and newly qualified doctors are equipped with the knowledge, skills and attitudes essential for professional practice.

The majority of health problems are encountered by doctors through routine access to primary care by general practitioners (GPs), whose training curriculum for postgraduate trainee doctors is set by the Royal College of General Practitioners (RCGP). The curriculum set by the RCGP educates GP trainees in identifying and managing those conditions most common to primary care, and includes clinical modules on promoting health and preventing disease, cardiovascular health and care of people with mental health problems.

NHS Digital was able to provide the following data that details the count of finished consultant episodes (FCE) with a primary diagnosis of diabetes and a main procedure of amputation, for the financial years between 2007-08 and 2016-17.

Due to clinical coding limitations, NHS Digital was unable to provide data for non-diabetes related limb removal procedures that took place in each of the last 10 years as it is not possible to determine if an amputation is not related to the diagnosis of diabetes in some way.

Source: Hospital Episode Statistics, NHS Digital

Note:

A FCE is a continuous period of admitted patient care under one consultant within one healthcare provider. FCEs are counted against the year in which they end. Figures do not represent the number of different patients, as a person may have more than one episode of care within the same stay in hospital or in different stays in the same year.

We do collect data centrally on each of these conditions. The Quality Outcomes Framework (QOF) reports the numbers of patients in England with a recorded diagnosis of diabetes aged over 17 years old. This is published on an annual basis in October. The QOF 2013/14 results are available at:

http://qof.hscic.gov.uk/index.asp

Also, the National Diabetes Audit (NDA) covers the proportion of patients getting the eight National Institute for Health and Care Excellence care processes for diabetes. More detail about the NDA is available at:

http://www.hscic.gov.uk/nda

The Government commissions the Adult Psychiatric Morbidity Survey as the basis of statistics on prevalence of both treated and untreated mental health conditions. The conditions covered include anxiety, depression, psychosis and personality disorder. The latest version of this survey is currently underway, and results of the previous survey, carried out in 2007 are available at:

http://www.hscic.gov.uk/catalogue/PUB02931/adul-psyc-morb-res-hou-sur-eng-2007-rep.pdf

Over £400 million is being invested in the Improving Access to Psychological Therapy (IAPT) programme over the spending review period to make a choice of psychological therapies available for those who need them in all parts of England.

We are also investing in improving provision for children and young people, older people and carers, people with long-term physical health problems and those with severe mental illness.

Since 2008 the IAPT programme has seen over 2.6 million people enter treatment, and over 1.5 million complete treatment.

In addition, over 1 million patients have reached recovery and we have seen 90,000 people move off of sick pay and benefits.

The IAPT programme has worked consistently to increase the numbers of older people accessing services, and latest figures suggest that numbers are improving.

To increase the numbers of older people the IAPT programme has supported an advertising campaign delivered through Age UK and Carers UK to ensure older people are aware that IAPT is for them. In addition, a curriculum has been developed and is being rolled out to train both existing IAPT staff and new IAPT staff to work better with older people.

Other innovative approaches to working with older people include Government support to the Alzheimer’s Society to develop online cognitive behavioural therapy for carers of people with dementia. The online resource is in place and ethical approval is being sort prior to clinical trials which started in 2014.

The Severe Mental Illness (SMI) workstream has been added to the IAPT programme to extend the benefits of improved equitable access to psychological therapies to people with SMI, including those with schizophrenia.

This workstream will work closely with secondary care mental health services, local commissioners and providers to document the benefits of access to talking therapies for people who have a SMI. They will lead the development of Patient Reported Outcome Measures for SMI and Personality Disorder who receive talking therapies, and work with professional organisations to develop more appropriate and deliverable care pathways, and determine gaps in current approaches.

NHS England is also currently carrying out a pilot aimed at improving access to psychological therapies for people with long term conditions and/or medically unexplained symptoms including diabetes, chronic obstructive pulmonary disease, stroke and other illnesses/disorders.

There is no cap on the number of IAPT sessions for each person. NHS England expects clinical commissioning groups (CCGs) and providers to have due regard to the National Institute for Health and Care Excellence guidelines and in some cases therapy may exceed 20 sessions in duration.

No estimate has been made by the Department of the proportion of adults or children with diabetes, anxiety disorder, depression, schizophrenia and personality disorder who were untreated in each of the last 10 years.

The most recent drug prevalence estimates suggest that there were 256,153 opiate users in England in 2011-12, of these 62% received treatment in the same year. The equivalent proportions for the preceding years, where there is both prevalence and treatment data, are 2006-07 – 49%; 2008-09 – 64%; 2009-10 – 63%; 2010-11 – 64%. This proportion of opiate users being treated is considered a very high rate internationally – and is a platform for significant public health gains.

No estimate has been made of the proportion of adults or children with alcohol dependency who were untreated in each of the last 10 years. However, it is estimated that 1.6 million adults show some signs of alcohol dependence; around 250,000 of whom are estimated to be moderately to severely dependent and might benefit from specialist treatment. Using this later figure, about 44% of these dependent adult drinkers were in treatment in England in 2013-14. Continued investment in alcohol treatment by local authorities is essential to make inroads into the alcohol dependent population and to help more people recover from alcohol problems.

Achieving Better Access to Mental Health Services by 2020, published October 2014, articulates our ambition and the immediate actions we will take this year and next to achieve better access and waiting times in mental health services. It includes the Improving Access to Psychological Therapies commitment of treatment within six weeks for 75% of people with 95% of people being treated within 18 weeks.

For the year 2013-14 the mean waiting time for IAPT services was 40 (days) and the median was 21 (days). Information on the number of referrals waiting more than 28, 90 and 180 days for IAPT services, for each CCG, for the year 2013-14, is attached.

No estimate has been made of the proportion of time general practitioners (GPs) spend with patients who have a mental illness.

From September 2014, over 800,000 people with the most complex health and care needs (including mental health conditions) will benefit from the Proactive Care Programme, receiving personalised, joined-up care and support, tailored to their needs. This is being delivered through an enhanced service to the GP contract.

NHS England is working with commissioners to make mental health a bigger priority, with better integration of physical and mental health care.

Improving the diagnosis of mental illness is one of four national goals for 2014-15 – where providers will be rewarded for better assessing and treating the mental and physical needs of their service users, through the Commissioning for Quality and Innovation framework.

We do not centrally hold information on the proportion of patients with a mental illness that receive drug, talking or mindfulness therapy.

The table below shows information on the number of referrals received, entering treatment and finishing a course of treatment, within IAPT services for 2013-14.

There were 53,326.6 prescription items written in the United Kingdom and dispensed in the community, in England, for medicines classified as anti-depressants in British National Formulary (BNF) section 4.3 Antidepressant drugs, for the calendar year 2013.

The Department has not estimated the proportion or number of the people estimated to experience a mental illness who are being treated by the National Health Service.

No estimate has been made by the Department of the proportion of patients with mental illness who prefer to be treated by drug therapy or talking therapies.

The Department’s 2014-15 Mandate to NHS England makes clear that ‘everyone who needs it should have timely access to evidence based services’. The Mandate sets a clear objective for NHS England to deliver the key objectives of the IAPT programme – providing access to therapies to 15% of those eligible (around 900,000 people), with a recovery rate of 50%.

The Outcomes Framework for the NHS in England clearly states that the NHS should carry on expanding access to psychological services as part of the IAPT programme.

The Government holds the NHS to account by setting objectives in the NHS England Mandate and monitoring their delivery through the NHS Outcomes Framework.

If NHS England is failing to deliver against its objectives, Ministers can ask NHS England to report on what action it has taken, or to set out a plan for improvement.

CCG commissioning plans, including for mental health, should be informed by the content of their local Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategy, which should address the needs of their local population. In addition, Health and Wellbeing Boards must include local Healthwatch as part of their core membership, Healthwatch represent the concerns and interests of local people- in their role as champions of the population.