Hybrid closed loop technology for patients with Type 1 diabetes

It is likely it will take up to a few years for some people who are eligible to be offered hybrid closed loop technology. The ICB is following the national rollout implementation which is over a 5-year period.

We have been working with members of your clinical team to create priority grouping following the national recommendations. This means your clinical team will provide this to those in most clinical need first, starting with; those with an urgent need, children and young people, those who are pregnant or planning to become pregnant, and those already on standalone Continuous Glucose Monitoring (CGM) and insulin pumps that require an urgent upgrade to a hybrid closed loop.

We are following the national approach to guard against inequities in access.

Speak with your clinical team at your next appointment to find out about access and their timescales for rolling out the technology.

The rollout is over 5 years because of the following reasons:

• Limited funding has been allocated to the ICB each year of the implementation period, limiting the number of patients having access all at once
• People will need to be trained to use HCL systems effectively.
• Variation in access due to expertise and staff numbers in the clinical teams.
• The need to train staff to support effective use of HCL systems and reduce variation in access across the country.
• The need to address the current health inequalities related to age, socioeconomic status, ethnicity, language barriers, and access to smartphones and the internet, all of which could affect uptake of HCL systems.
• Variation in purchasing of diabetes technologies.

Due to the above reasons your healthcare teams would not be able to offer hybrid closed loop to all eligible patients straight away.

Steps have been taken to start the rollout whilst allowing time to equip the diabetes teams with skills to help people to use the technology effectively.

We would kindly ask patients to bear with their diabetes teams as they learn how to support you best with this new technology.

An unplanned rollout which does not address these inequalities of access and variation in what services can offer would have a greater risk of creating gaps in access to the technology across Norfolk and Suffolk.

Adding HCL will help to improve glycaemic management.

Each area has varying levels of pump clinician staffing, expertise and capacity. We’re working to make this more consistent so that each area can meet the needs of its local community.

Locally, we have set up a working group across Norfolk and Suffolk which your clinicians have been attending and actively contributing to. They have been supporting each other, so the eligible patients are able to access hybrid closed loop systems as soon as possible.

The ICB has been allocated limited funds to implement this technology, however we also are tackling the health inequalities for access to everyone who is eligible. We have therefore ensured that all the teams have access to the funding available.

No, the NHS has not stipulated an age limit for access to HCL. Adults who are eligible will be offer HCL within the five- year period. Your clinicians have will continue to support you and provide advice and guidance concerning your diabetes care.

Children and young people are in the priority group.

These are recommendations from the National Institute of Health and Care Excellence (NICE) based on a range of research, evidence and health economic data. We understand the frustration of those who don’t qualify. The decision would have been made with other healthcare professionals and patient representatives at a national level. Please see the NICE Technology Appraisal TA943  for more information

Please continue to follow the advice of your specialists and take good care of your diabetes.

It depends on whether you meet the access criteria. The best thing to do is to speak to your Diabetes Healthcare Team who would be advise you on whether you meet the criteria. Once the roll out plan starts, it will take five years to cover all those who are eligible.

NICE technology appraisal TA943 sets out the legal criteria that patients must meet to qualify for this technology.

NICE and NHS England have negotiated a national deal to provide cost-effective Hybrid Closed Loop systems. This process was able to identify a small number of systems that we are able to select from. As new devices come to market, technology progresses and, if prices change, the cost effectiveness point may change, therefore the range of devices will be under constant review. This means that the devices/systems available for us to offer you may change over time. We will review our selection locally based on the needs of our population and the devices made available by the above process. We will only be able to provide devices listed on the national system.

The device you are offered will also be dependent on your usage and consumables. Your device may change if it no longer suitable for your clinical needs.

You may be required to change your device at any time if it is no longer deemed clinically suitable by your clinical team

If you are planning a pregnancy, or become pregnant, you will be asked to change your device to an HCL system that is licensed for use in pregnancy.

You will be asked to change device if you are an Omnipod 5 (OP5) user and are currently required to change pods more than 3 times per week. Using OP5 pods more frequently is not cost-effective for the NHS.

Yes, you will be able to choose from the HCL systems that become available to the NHS at a cost-effective price at a national level. ICBs and clinicians will be expected to follow this.

Your specialist team will provide guidance based on your age and whether you are pregnant or considering a pregnancy.

This means that you will be offered what has been identified as the most cost-efficient and clinically effective solution for you and your individual needs. As part of the implementation plan, a national framework is being developed to identify the systems available which meet the cost-effective price set by NICE.

The framework is also being designed so that it can be adapted over time to keep up with changes in technology as systems develop and new ones are launched.

Early upgrade will depend on your clinical circumstances. Your clinical team will inform you if you are suitable for HCL before your warranty is up.

Yes. Please be reminded that you will need to have a private appointment to monitor your HCL treatment. Attending an NHS funded clinic to monitor your privately funded NHS treatment is considered co-funding.  Co-funding is currently against Department of Health policy and ICBs will not consider any funding requests of this nature.

Yes. Please be reminded that you will need to have a private appointment to monitor your HCL treatment. Attending an NHS funded clinic to monitor your privately-funded NHS treatment is considered co-funding.  Co-funding is currently against Department of Health policy and ICBs will not consider any funding requests of this nature.