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Jul 4 / Caro

Convincing Others to Pay for CGM

I’m used to speaking in public and to groups of people I don’t know. I’m used to explaining complex things in simple language and also being persuasive without coercion. These are all things I do in my job and other areas of my life.

But today, I had to do these things to a group of people holding NHS purse strings. They’re held notoriously tightly, and rightly so. The NHS simply doesn’t have limitless resources and needs to prioritise spending on things which will make a positive difference. Things for which there is sound, clinical evidence. The problem is that NHS managers can also be notoriously short sighted, looking no further than the next election. (Or, currently, no further than the abolition of PCTs). The benefits of certain interventions, medications and technology is only felt over the long term, and this is particularly so where diabetes is concerned. Saving money on the treatment of diabetes depends largely on reducing the incidence of long term complications as this is where the real money is spent. Reducing long term complications, however, means improving short term control which may involve spending money on technology such as pumps and CGMs. Here. Now. In the short term.

I’ve been down this road many times before. Sadly, even with some good clinical studies emerging proving the benefits of CGM in improving glycaemic control, and the long established evidence base showing that improved glycaemic control leads to decreased incidence of long term complications, it isn’t enough for most NHS managers. They see CGM as frivolous. Something which we did without for years. There lingers as a frustrating tendency to label patients who have poor control as non-compliant without looking at all the wider issues.

My brief for today’s hearing of the case for funding my CGM was not the most positive. It stated that I was specifically not allowed to reference “lifestyle” or “non-clinical” factors. That meant that the fact that using CGM enables me to hold down my own job in a high demand area of the NHS was irrelevant. Even my pregnancy was a grey area, as it could open the debate on whether pregnancy and having children is a “choice” rather than necessity, and the best way of avoiding issues arising in a diabetic pregnancy is to avoid the pregnancy altogether. (That’s a massive ethical debate that I don’t really want to dwell on right now!)

Despite being used to these kind of situations, I still found myself in tears on the way to the hearing. Possibly down to pregnancy hormones. But equally likely down to the sheer frustration and the disheartening possibility that they were just following procedure and tha it could all be a pointless exercise with a forgone conclusion. I felt a little bit like I would face a room full of closed minds, determined simply to identify a single reason to say “no”, rather than listening to all the arguments and making a balanced judgement.

As it turned out, it wasn’t as bad as I feared. The pane were very grateful that I’d made the effort to represent my case in person, and gave me plenty of opportunity to speak, even tolerating me slipping in those “non-clinical” factors in as discreet a way as I could. They asked sensible questions at the end, clarified a few points.

I pointed out how my hypo rate had fallen. How I’d had no hospital admissions for diabetes reasons since using CGM. How my A1c had changed and how that had allowed me to commence a currently healthy pregnancy. I also explained how my other health conditions impact my diabetes, and vice-versa, and why and how CGM helps with this. I discussed too the impact of hypoglycaemia anxiety on my life and general health. I summed up by saying:     “Finally, as someone who works within the NHS, and faces similar decisions about the provision of care for my patients on a day to day basis, I understand only too well the economic pressures on the service. I am not, however, asking for blind faith, for a treatment that “might” make a difference. This is technology that I have already been using and have made considerable sacrifices to continue using, and the numbers should speak for themselves.”

I didn’t cry on the way home. I felt relieved. I’ve done all that I can, done the very best that I can. If I haven’t convinced them now, then I guess I’ll give in.

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