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Addressing the Postcode Lottery in NHS Healthcare: Why Where You Live Shouldn’t Determine the Care You Get

In a country that prides itself on having a National Health Service (NHS) free at the point of use, it seems contradictory — even unjust — that the quality of care one receives can still be influenced by where they live. 

This phenomenon, known as the "postcode lottery," is a growing concern across the UK. It highlights stark regional variations in access to treatments, waiting times, specialist care, and even basic services. For a health system built on equity, this inconsistency raises serious questions.

What Is the Postcode Lottery?

The term “postcode lottery” refers to the variation in public services based on geographical location. In healthcare, it means that patients in some regions may have access to life-enhancing or life-saving treatments that are unavailable just a few miles away. 

This is not due to medical need or clinical appropriateness, but because of local funding decisions, administrative inefficiencies, or staffing shortages.

Real-Life Examples of the Inequality

Cancer Treatments: Access to the latest cancer drugs can vary from one NHS Trust to another, with some areas offering cutting-edge therapies while others cite budget constraints.

Mental Health Services: Waiting times and available therapies for mental health support differ widely. A child referred for mental health services in one part of the country might be seen within weeks, while another elsewhere could wait months.

IVF Treatment: Some Clinical Commissioning Groups (CCGs) offer three rounds of IVF treatment, while others offer just one — or none at all.

GP and Dental Services: The number of GPs and NHS dentists per capita is significantly lower in some regions, leading to long waits and overstretched services.

Why Does It Happen?

Several factors contribute to this disparity:

Decentralised Decision-Making: Local Integrated Care Boards (ICBs, formerly CCGs) decide how NHS funds are spent in their areas, resulting in different priorities and service levels.

Staffing Shortages: Rural or deprived areas often struggle to attract and retain skilled medical professionals.

Socioeconomic Factors: Areas with high levels of deprivation often face higher health needs but may receive proportionally less funding.

Infrastructure and Resources: Legacy infrastructure, hospital capacities, and even transport links affect how care is delivered and accessed.

The Impact on Patients

The postcode lottery doesn’t just affect statistics; it impacts real lives. Delayed diagnoses, lack of access to innovative treatments, and long waits for referrals can worsen patient outcomes. It can also contribute to increased anxiety, financial strain (as patients may choose to go private or travel long distances), and a sense of injustice and inequality.

Addressing the Postcode Lottery

National Standards and Accountability: The NHS must implement and enforce more uniform national standards, ensuring that minimum service levels are guaranteed across all regions.

Transparent Data Sharing: Making data on regional disparities public can drive accountability and help patients and advocacy groups campaign for change.

Better Funding Allocation: Funding models should take into account local health needs and deprivation levels more fairly, ensuring that areas with greater needs receive proportional support.

Centralised Access to Treatments: High-cost treatments and specialised services should be commissioned at a national level where possible, to prevent disparities driven by local budget decisions.

Incentivising Workforce Distribution: Offering financial incentives, career development opportunities, and housing support for healthcare workers in under-served areas could help address staffing imbalances.

Digital Health and Telemedicine: Expanding remote consultations and digital health tools can bridge gaps, especially in rural or underserved areas, improving access to GPs and specialists.

Final Thoughts

The NHS is often described as the “jewel in the crown” of British society, but the postcode lottery tarnishes that reputation. A truly equitable health service must offer consistent, high-quality care regardless of geography. It is time for policy-makers, NHS leaders, and the public to demand an end to the postcode lottery and push for a system that delivers on the promise of universal care — equally and fairly for all.

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What’s the Best Time of Day to Take Insulin if You Have Type 2 Diabetes?

For those living with type 2 diabetes, managing blood sugar levels is a daily balancing act. For some, this includes taking insulin. 

But one common question that arises is: when is the best time of day to take insulin if you have type 2 diabetes? 

The answer depends on the type of insulin you're using, your lifestyle, your meals, and your individual treatment plan. Here’s a breakdown to help you understand the best timing and why it matters.

Understanding the Types of Insulin

Before discussing timing, it’s helpful to understand the main types of insulin prescribed for type 2 diabetes:

Basal (long-acting) insulin: Works steadily over about 24 hours. Examples include insulin glargine (Lantus), detemir (Levemir), and degludec (Tresiba).

Bolus (rapid- or short-acting) insulin: Taken before meals to manage blood sugar spikes. Examples include insulin lispro (Humalog), aspart (NovoRapid), and regular insulin.

Premixed insulin: A combination of long-acting and short-acting insulin in one dose.

Best Times to Take Insulin for Type 2 Diabetes

1. Long-Acting (Basal) Insulin

For those who take once-daily basal insulin, the timing is often flexible — but consistency is key.

Evening or bedtime is commonly recommended, especially if morning fasting levels are high.

Morning administration may suit those who experience low blood sugar overnight or have issues with remembering a bedtime dose.

Same time every day: Choose a time that you can consistently stick to — whether that’s after brushing your teeth in the morning or before bed.

Tip: Some insulins, like Tresiba, have more flexibility and don’t need to be taken at exactly the same time each day.

2. Mealtime (Bolus) Insulin

If you're on a basal-bolus regimen, rapid-acting insulin is usually taken:

10 to 15 minutes before a meal, or

Immediately after eating, if blood sugar was low beforehand or if meals are unpredictable.

The goal is to match the insulin peak with the post-meal rise in blood sugar.

3. Premixed Insulin

This is usually taken twice daily, around 30 minutes before breakfast and dinner. Timing is crucial, as it contains short-acting components that need to align with meals.

Things to Consider When Timing Your Insulin

Meal Patterns: Regular meal times help you plan insulin doses more effectively.

Exercise Routines: Physical activity can lower blood sugar, so timing around workouts is important.

Sleep Schedule: Avoiding overnight hypoglycaemia is key; some people need adjustments based on their sleeping patterns.

Shift Work or Irregular Schedules: May require a tailored approach with help from your diabetes care team.

Consult Your Healthcare Provider

Everyone’s diabetes journey is different. What works for one person may not suit another. Always consult your GP, diabetes nurse, or endocrinologist before making changes to your insulin routine. They may recommend adjustments based on your HbA1c results, glucose monitoring data, lifestyle, and other medications.

Final Thoughts

The best time to take your insulin depends on the type of insulin you use and your daily schedule. The key is consistency and coordination with meals and activity. Managing type 2 diabetes with insulin may seem daunting at first, but with the right support and routines, it becomes part of everyday life.

NHS Hospitals that Specialise in Treating Gastroparesis

Gastroparesis is a chronic condition in which the stomach takes too long to empty its contents, leading to symptoms such as nausea, vomiting, bloating, and malnutrition. 

While it can be a difficult condition to manage, the NHS does offer specialist treatment at selected hospitals across the UK.

In this post, we explore NHS centres that provide advanced care for gastroparesis patients, including surgical options such as gastric electrical stimulation (GES), which may help in severe cases.

Leading NHS Hospitals for Gastroparesis Treatment

University College London Hospitals (UCLH) – London

UCLH is one of the leading centres for gastrointestinal motility disorders. With a dedicated gastrointestinal physiology unit and experts such as Dr Anton Emmanuel and Mr Majid Hashemi, UCLH offers detailed diagnostic testing and both medical and surgical treatment for gastroparesis.

Visit UCLH Website https://www.uclh.nhs.uk/our-services/find-service/gastrointestinal-services-1/gastrointestinal-physiology

Broomfield Hospital – Chelmsford, Essex

Broomfield Hospital is home to one of the UK’s most experienced gastroparesis specialists, Mr Sri Kadirkamanathan. The hospital is known for performing gastric electrical stimulation (GES) procedures, helping patients with drug-resistant symptoms regain some quality of life.

Aberdeen Royal Infirmary – Scotland

With surgeons such as Mr Bruce Duff and Mr Ken Park, Aberdeen Royal Infirmary is recognised for its skill in gastrointestinal surgery. The hospital offers advanced treatments for gastroparesis, including GES implantation.

Glasgow Royal Infirmary – Scotland

Another respected Scottish centre, Glasgow Royal Infirmary provides specialist surgical care for gastroparesis under the expertise of Mr Grant Fullarton, with options like GES available for appropriate patients.

Ninewells Hospital – Dundee

Ninewells Hospital takes a multidisciplinary approach, combining surgical expertise (led by Mr Afshin Alijani) with nutrition and intestinal failure support (Dr Reynaulds). This makes it an excellent choice for patients needing holistic care.

Wishaw General Hospital – Scotland

Mr Hakim Benyounes at Wishaw General Hospital provides specialist surgical services for gastroparesis, including access to GES therapy for eligible cases.

Gastric Electrical Stimulation (GES): What You Need to Know

GES is a treatment involving a surgically implanted device that sends mild electrical pulses to the stomach muscles. It is typically reserved for patients with severe gastroparesis who haven't responded to other treatments.

However, it’s important to note that NHS England does not routinely fund GES due to limited long-term evidence of its effectiveness. Some patients may access it through private healthcare or as part of clinical trials.

NHS England Clinical Commissioning Policy on GES https://www.england.nhs.uk/wp-content/uploads/2018/07/Gastroelectrical-stimulation-for-gastroparesis.pdf

Finding a Specialist Centre

You can use the Medtronic clinic finder to locate NHS and private centres across the UK and Ireland that offer gastric electrical stimulation:

Medtronic Clinic Finder https://www.medtronic.com/uk-en/patients/treatments-therapies/neurostimulator-gastroparesis/clinic-finder.html

If you're in Wales or Northern Ireland, your GP may refer you to a specialist centre in England or Scotland.

Further Support and Resources

For more information and patient support, we recommend Guts UK – a national charity offering resources, helplines and real-life patient stories:

 Guts UK – Gastroparesis https://gutscharity.org.uk/advice-and-information/conditions/gastroparesis

Gastroparesis can be a life-altering condition, but specialist care is available within the NHS. From advanced diagnostics to surgical therapies, the right help is out there – and understanding your options is the first step towards managing your condition.

Have you been treated at one of these hospitals? Please your experience in the comments, and let others know they’re not alone.

You can help Ellie Dyson, a friend of That's Health, by donating to her appeal to raise the funds for a private GES operation for her:- https://www.gofundme.com/f/gastric-pacemaker-to-help-me-live-my-life

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