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Peter Bower, Matt Sutton and Sarah Cotterill
Long-term conditions are a major challenge facing the NHS, and diabetes is a particular problem. It is common among people in England, costs the NHS billions of pounds to manage, and is linked to very serious complications for patients and their families.
There is general agreement that improving healthy behaviour among the population is critical to prevent diabetes, improve health and help the NHS stay on a sustainable footing.
There is a lot known about how to change behaviour, and the sort of help and support that individuals need to make those changes and maintain them over time.
Less evidence is available on how to deliver health behaviour change ‘at scale’ – that is, to deliver it nationally, in all the different localities that people live, and reaching those in greatest need.
The NHS Diabetes Prevention Programme (NHS DPP) is an attempt to do just that. Designed by NHS England and Public Health England, working alongside Diabetes UK, this is an ambitious and world-leading attempt to bring about behaviour change, through a standardised intervention delivered by four different providers, implemented across England to people at risk of developing diabetes. People at risk are identified and referred to a group programme which helps them understand the repercussions of diabetes and make changes to their lives to reduce their risk of getting it in the future.
Initial indications are that aspects of the NHS DPP are very successful. A recent paper from the NHS DPP team described the early operation of the programme . Over 40,000 people were referred in a 10 month period, and nearly half took up their initial assessment. Although there had been concerns that groups in need of support would not attend, initial findings suggest that some of these groups (ethnic minorities, and those living in deprived areas) were showing good engagement. Early findings suggest that those enrolled have lost weight during the programme. Ongoing analyses of patients as they complete the programme will assess whether people lose weight and reduce their risk of diabetes.
These positive results from the NHS DPP programme are certainly encouraging. However, they are just early findings and do not tell us what would have happened if the programme had not been introduced, or whether it is a good investment compared to other alternatives. Programmes such as this tend to produce positive results at the outset but these may not be sustained. They also tend to focus initially on more enthusiastic volunteers.
Due to the importance placed on the NHS DPP and the lessons that may be learnt for other large scale health programmes, we have been commissioned by the National Institute for Health Research to conduct an independent evaluation, called DIPLOMA . Although we will draw on some of the same data used by analysts at the NHS DPP, we will cast our net wider, to provide a more comprehensive evaluation than that possible using NHS DPP data alone. This will include:
- A detailed look at the degree to which people accessing the NHS DPP are truly representative of those at risk of diabetes in the population
- Exploring how referrals to the NHS DPP are made, and how patients and professionals make decisions about who should attend
- Examining the content of the NHS DPP programme and observing its delivery in practice, to check that it has the best chance of bringing about behaviour change
- Using a variety of advanced statistical techniques to compare the outcomes of those participating in the NHS DPP to what would have happened if they had not attended. Only these sorts of comparative analyses can really give us an accurate view as to what the programme has achieved
- Finally, we will compare the costs of creating and delivering the programme with its long-term benefits, to see whether it is worth prioritising over other uses of NHS resources.
- An accessible summary of our work is available in this video. Also, an overview of the different work packages as well as frequently asked questions is available at the webinar slides presented to the NHS DPP regions
The NHS DPP has the potential to be a world leading example of how to deliver behaviour change at scale to make a real difference to the health of the population. The independent DIPLOMA programme will provide the very best evidence to help us understand whether that potential has been fulfilled.
 Barron E, Clark R, Hewings R, Smith J, Valabhji J: Progress of the Healthier You: NHS Diabetes Prevention Programme: referrals, uptake and participant characteristics. Diabetic Medicine 2017, 35(4):513-518.
About the authors: Peter Bower is Professor of Health Services Research and Lead at the Centre for Primary Care at The University of Manchester. Matt Sutton is Professor of Health Economics and is the Centre Lead for the Manchester Centre for Health Economics at The University of Manchester. Sarah Cotterill is a Research Fellow in the Centre for Biostatistics at The University of Manchester and an academic within NIHR CLAHRC Greater Manchester.
Disclaimer: DIPLOMA represents independent research funded by the National Institute for Health Research (Health Services and Delivery Research, 16/48/07 – Evaluating the NHS Diabetes Prevention Programme (NHS DPP): the DIPLOMA research programme (Diabetes Prevention – Long Term Multimethod Assessment)). The views and opinions expressed in this presentation are those of the authors and do not necessarily reflect those of the NHS, the National Institute for Health Research or the Department of Health and Social Care.