title: Association of British Clinical Diabetologists (ABCD) survey of secondary care services for diabetes in the UK, 2000. 1. Methods and major findings.
abstract: OBJECTIVE
  To examine the provision, and variations in, secondary care diabetes services in the UK.
  A postal survey of all 238 identified secondary care providers of diabetes services in 2000.
  
  
  RESULTS
  Following two reminders, a 77% response rate was achieved. Major deficiencies in core staffing levels were recorded, with 36% of services provided by only one consultant physician with an interest in diabetes. The provision of diabetes specialist nurses was less than recommended in 87% of responses, whereas podiatry and dietetic support was unavailable in 3% and 27% of responses, respectively. Diabetes registers were not present in 28%, and a co-ordinated retinopathy screening programme unavailable in 26% of responses. Key biochemical measurements were unavailable in 9% (microalbuminuria) to 18% (HDL-cholesterol) of responses. A 'Well-Resourced Service' score was devised taking account of levels of personnel, facilities and specialized clinical services. There was a significant geographical variation in this score (P < 0.001), with the lowest score (least well-resourced services) in the Eastern NHS Region of England, and the highest score in the North-west NHS Region of England. The 'Well-Resourced Service' score was also significantly lower (P < 0.05) where there were less than two whole-time consultant physicians providing diabetes services. In contrast to other aspects of service provision, availability of dieticians and a combined diabetes-ophthalmology service had declined since 1990. Of 245 recorded bids for resources and service improvements for diabetes care, the success rate overall was 44%, and lowest where bids were made for dietetic and podiatry support.
  
  
  CONCLUSIONS
  There is presently a major shortfall in provision of secondary care diabetes services throughout the UK, with evidence that there is significant regional variation and less facilities and resources where there are less than two consultants providing specialized diabetes services. On average bids for service improvements were only successful in < 50% of cases, most usually where the service was relatively better provided for. Considerable development and investment are required nationally to ensure equitable access to specialized diabetes services, a vital component in reducing adverse diabetes outcomes.
authors.affiliation: East and North Herts NHS Trust, Welwyn Garden City, Royal Free Hospital School of Medicine, London, UK. peter.winocour@qeii.enherts-tr.nhs.uk
authors.forename: P H
authors.initials: PH
authors.lastname: Winocour
authors.forename: A
authors.initials: A
authors.lastname: Ainsworth
authors.forename: R
authors.initials: R
authors.lastname: Williams
mesh_terms: D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000628:therapy*; D005843:Geography; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008511:Medicine; D012955:Societies, Medical; D013038:Specialization; D011795:Surveys and Questionnaires; D006113:United Kingdom