Supporting NHS delivery of NICE Hybrid Closed Loop (HCL) access

In the first two years of the NHS England implementation plan, the main focus has been on children and young people. By the end of 2025, 71% of CYP had been brought onto HCL technology. 

Usage of HCL in the adult population also more than doubles in the first year of the five-year plan (ie up to 2025). It is, however, still at less than 10% of the adult population. 

Although overal HCL use has increased, implementation is uneven between areas. In the CYP population by the end of 2024/25, uptake ranged from 79% in the highest-performing ICB to just 37% in those that were least advanced in creating a 'postcode lottery'—is a key issue that needs to be addressed as TA943 continues to roll out. 

No. Levels of national funding have been announced for the remaining years of the five‑year plan, and NHS England has stated that this funding is sufficient to bring 30% of eligible adults onto HCL (in addition to paediatric implementation). This assumes at least a 25% contribution from ICBs. 

ICBs will therefore need to consider how to deliver implementation funding beyond the resources provided through the five‑year plan. This may mean prioritizing spend from other budgets, based on the value of HCL both for improving the lives of people with type 1 diabetes and supporting the wider objectives of the NHS. It is worth recalling that, overall, diabetes costs the NHS £10 billion every year.

The five-year planning framework states that implementation activity should be organised around five core principles. These principles act as prioritization criteria for how local systems should plan and deliver change: 

• HCL technologies will be initially rolled out to type 1 diabetes patients where the need is greatest and to those who are likely to benefit most. 
• HCL technologies will be delivered from specialist centres with paediatric units regarded as the optimal place to start implementation. 
• Education and training is a vital component in supporting wider access to HCL technologies and will be at the heart of the rollout. 
• HCL technologies will be phased into the NHS in both an equitable and sustainable manner to avoid exacerbation of existing health inequalities. 
• NHS bodies will only purchase HCL technologies in line with the recommendation set out in the NICE technology appraisal. NHS England reserves the right to undertake further commercial activity to ensure HCL systems continue to deliver value for the NHS as new technology emerges. 
• The phased implementation of HCL will be transparent and supported by data. A robust process for monitoring and reporting uptake will be formalised through the National Diabetes Audit and National Paediatric Diabetes Audit. 

These principles are the foundation for shaping credible implementation plans though leave scope for the NHS locally to decide how to carry forward. Our access team is working closely with ICBs and trusts locally to understand how adult implementation is being phased and prioritized so that we can tailor our support to work with the grain of these priorities.