SVL0019

Written Evidence submitted by Diabetes UK

1)      Introduction

1.1)            Diabetes is the fastest growing and potentially most devastating health crisis of our time. More than 4.8 million people are currently living with diabetes in the UK. Diabetes UK is committed to creating a world where diabetes can do no harm. Our aim is to fund crucial health research, improve healthcare and treatment, and prevent yet more people developing this potentially life-threatening condition

1.2)            Diabetes UK is the UK’s leading funder of medical research for diabetes, and conducts policy and campaigns work to improve the lives and health outcomes for people living with or at risk of diabetes.

1.3)            People with diabetes are at higher risk of death from COVID-19 l. Devastatingly, a third of deaths from COVID-19 in England last year were people with diabetes, with those with type 1 diabetes having three and a half times the risk of dying, and those with type 2 at double the risk of dying compared to those without.

1.4)            Diabetes UK’s submission focuses on the measures to support people to be added to the shielding programme, and the ways in which clinically vulnerable people can be better supported.

2)      Clinically vulnerable status of diabetes

1.1)            People living with diabetes were included in the clinically vulnerable group, which does not include the support measures available to the those in the shielding programme, such as food, medicine and basic care provision, but also enhanced support and protection in the workplace.

1.2)            Due to the high level of deaths of people living with diabetes, challenges to the individualised approach (see paragraph 4) and long delays in the development of the individual risk stratification tool, together with the unprecedented rise in Covid-19 cases, hospitalisations and deaths brought by the new variant, we called for a specific group of people living with diabetes who met defined clinical criteria to be added to the shielding list. We developed this criteria of people most at risk of serious complications from Covid-19 using data from deaths from Covid-19 and our in-house expertise. This was unsuccessful and we were advised the individualised approach was the preferred mechanism for keeping these people safe, and that clinicians had been asked to review people whose individual situation and severity of condition put them at increased risk

3)      The lack of transparency in the identification of people for the shielding list

3.1)                      Diabetes UK shares the concerns raised in the National Audit Office (NAO) report regarding the lack of transparency around how the shielding list was put together. As noted in the report, “Charities we spoke to criticised government’s communication with CEV people. They noted issues with a lack of transparency on why some conditions were considered to make people CEV, which caused confusion and uncertainty.”[1]

3.2)                      We know that there are gaps in the shielding list. As one third of deaths from Covid-19 have been people living with diabetes, we know that there are a significant number of people who we believe to be clinically extremely vulnerable who were not captured by the shielding criteria. The single-condition approach to the development of the clinically extremely vulnerable group has failed to protect those whose risk is significantly heightened due to multiple factors such as age, BMI, ethnicity and deprivation level – as well as clinical markers such as HbA1c levels or a history of diabetes complications. Furthermore, there has been an overall lack of consideration of the safety of clinically vulnerable people who do not benefit from the protections brought by the shielding programme. The following paragraph looks at how the current measures are not working.

4)      The individualised approach for clinically vulnerable people who wish to be added to the shielding list is not working. 

4.1)            The Government encourages an individualised response for people who believe they should be on the shielding list but do not fit the published criteria, where GPs and other clinicians can use their clinical judgment to decide. Diabetes UK however knows from our supporters and healthcare professional contacts that there are many situations where people have been unable to be added to the shielding list despite being very high risk.

4.2)            The NAO report states that the Department for Health and Social Care is working to apply the predictive risk model to enable a more sophisticated approach to clinical risk in conversations with GPs and clinicians, and highlights that the “Timings for the model are uncertain”[2]. This has added to a climate where we are seeing many people refused their request to be added to the shielding list.

4.3)            Diabetes UK are receiving increasing feedback that in the current lockdown people with diabetes are not able to get individual shielding assessments because their clinical teams are being guided in their decisions by the current shielding list categories; or don’t have the capacity to respond to individual requests; or don’t have access to any risk tool to guide individual assessments and with which they might stratify their patient lists. The result of this is people with diabetes at greater risk of poorer outcomes are not accessing the protections of the shielded categories and for many, needing to take decisions between the health and their livelihoods. 

4.4)            The fact that some people have been successfully added to the shielding list via this route is leading to an unfair ‘two tier’ approach which is further exacerbating inequalities.  For many reasons, those at the highest risk are often least able to advocate for themselves and so not only is the current approach leading to an unequal variation in access to shielding across the UK. Furthermore, we anticipate that there is significant overlap between those group least likely to personally advocate for consideration as to whether they should be shielding and groups known to be at higher risk. As the Public Health England report ‘Beyond the data: Understanding the impact of COVID-19 on BAME groups’ showed, there is an increased risk of exposure for BAME and disadvantaged groups who are more likely to be in low paid jobs that mean they cannot simply work from home, it is likely to disproportionately impact people from BAME communities and people living in areas of highest deprivation.

4.5)            Given the continued high volume of COVID-19 deaths and hospitalisations it is imperative that urgent action is taken to swiftly mobilise this tool until all clinically vulnerable and high risk groups as afforded a good degree of protection from serious illness through vaccination. We are therefore calling for the development and deployment of a recognised, standard COVID-19 risk assessment tool to be fast-tracked, allowing the assessment of a person's individual risk based on different factors (such as age, sex, ethnicity and health conditions) to take place. This should be applicable and adoptable in all UK administrations.

4.6)            We are also calling for a robust process to be put in place to ensure that the advice a person is offered from the use of this tool will inform decisions about their own safety in the workplace.

5)      More needs to be done to protect clinically vulnerable adults at work

5.1)            As well as the implications of shielding status outlined in the NAO report such as support for food, medicines, and basic care, a significant protection offered by shielding status is the implications it has in the workplace. For example, guidance is explicit that employers may furlough their clinically extremely vulnerable staff, whereas this is not the case for clinically vulnerable people. This was a driving factor behind the urgency of our call to add the people living with diabetes at most risk of serious complications to the shielding list as it was the issue about which we have been receiving the most amount of concern from our supporters. And we know that the workplace and travelling to it is where people with diabetes are most likely to be exposed to the virus.

5.2)            We know that many people living with diabetes have no choice but to attend physical workplace settings despite high risk of complications from  Covid-19, and have received many requests for support. in one particularly concerning example we have heard from one woman, who works in a supermarket and was not supported to socially distance from customers or provided with appropriate protections when working on the till. Despite raising repeated concerns, this was ignored by store management and she felt forced to take time off due to the impact on her mental wellbeing. This is reflected in the initial results from the first 1600 responses from a recent Diabetes UK survey which found that despite being clinically vulnerable, 78% of people with diabetes who are in employment are going to work outside their homes at least once a week. Concerningly, this increases to five out of every six (84%) amongst the people who fit the criteria that Diabetes UK has highlighted as being very high risk.

5.3)            A high percentage of people who are going into a workplace feel unsafe. Diabetes UK has received a very high level of calls to our helpline from people worried about going into an unsafe workplace, a high proportion of these are from people working in schools or health care settings Our survey found that 69% of people living with diabetes who work outside the home do not feel safe from coronavirus in their workplace. Amongst the group of people who identify themselves as fitting the criteria Diabetes UK feels is most at risk of serious complications from Covid-19, the number of people feeling unsafe at work increases to 77%.

5.4)            This not only holds a potentially critical health risk should they contract Covid-19, but it is also having an impact on people’s mental health. Diabetes UK has campaigned to raise awareness of the implications of long-term conditions such as diabetes on mental health, and our survey recently showed that 39% of people living with diabetes suffered mental health issues (such as anxiety or depression) because they have not been supported to keep safe at work during the pandemic.

5.5)            As the Government looks to plan for the unlocking of the country, we expect that more of these  vulnerable people who have been missed off the shielding list will be forced to unsafely go into work. Furthermore, there must be consideration of clinically vulnerable people who are also being forced to make difficult decisions about their safety and livelihoods as they are forced into unsafe workplaces. It has never been clear what extra protection was provided for the clinically vulnerable group which people with diabetes are in. This is a complex condition with a very wide range of levels of risk and more consideration must be made in regards to their wellbeing, particularly given the high levels of deaths of people with diabetes. More must be done to help healthcare professionals protect these people.

5.6)            This is particularly relevant for those of working age where transmission is most likely, and where we have shown in paragraph 5.3 that they feel unsafe. In order to reduce risk for people living with diabetes we are calling on the government to review the measures in place for protecting clinically vulnerable working age adults. Urgent action is required to provide protections in the workplace for at least the next six-month period, until vaccine rollout has resulted in a good level of protection to the clinically vulnerable population.

February 2021