The Minister of State, Department of Health (Mr Paul Burstow)
I am grateful to the right hon. Member for Leicester East (Keith Vaz) for taking the opportunity to apply for this debate, and congratulate him on his good fortune in securing it. It follows on from the questions he asked at Health questions yesterday. I know that he has an enduring, personal interest in pursuing this cause, and I pay tribute to his work, effort and leadership in raising awareness of diabetes among the south Asian communities in his constituency. He rightly paid tribute to the work of the Silver Star organisation.
Let me first address his final point, which was on his discussions with Ministers in the previous Administration and the intentions to create a centre of excellence. I need to be honest with him. I cannot give him an undertaking tonight other than the most important one that any Minister should give at the Dispatch Box, which is that I will go away and properly consider the matter and come back to him as speedily as I can. If that means a further discussion face to face, I would be happy to do that as well.
I also look forward to the debate that I will have with the right hon. Member for Knowsley (Mr Howarth) on type 1 diabetes, and I hope that we will get the opportunity to explore some other issues on that topic. While these are not prime-time debates, they are an opportunity to air issues that affect the lives of our constituents, so I am grateful to the right hon. Member for Leicester East for raising this matter tonight. He is right to highlight the disturbing rises in the rates of diabetes in this country, because it is placing a huge strain on the NHS, and has a profound effect on people’s long-term health, with the most deprived and excluded groups often paying the highest price.
Diabetes could be described as a head-to-toe condition. Complications—many extremely serious if poorly managed—can affect every part of the body. I was particularly shocked, as I prepared for the debate, to discover that 73 lower limb amputations occur every week due to complications from diabetes. More shocking still, 80% of those amputations could have been prevented, some by lifestyle changes and others by changes in the approach of the NHS. Every preventable amputation is an appalling human tragedy, and something we need to improve on, which is why I am so pleased that we are discussing these issues tonight.
There was plenty in the right hon. Gentleman’s speech that I supported and much common ground between us. I wholeheartedly agree that we must do more to prevent diabetes across all age groups and all social backgrounds. The Government’s approach therefore has three levels. The first is the population level, and in diabetes, this is about improving general health across the population at large, recognising—as the right hon. Gentleman rightly said—that diet and lifestyle are key risk factors in diabetes. Then come targeted interventions for people at risk, which recognise that we can reduce and even reverse the worst effects of diabetes if we intervene early enough. Finally, there is the long-term management of established disease, and people with diabetes and clinicians must work together to delay, reduce or prevent complications. We need to get all three aspects right in order to secure the better results in diabetes care that all hon. Members would wish to see.
On the population level, rises in diabetes are closely linked to lifestyle and behaviour, which makes this a considerable public health challenge. Much of this is about individuals taking responsibility for their own health—for example, choosing not to have some of the sweets that the right hon. Gentleman mentioned—by changing what they eat, drink and how much exercise they take. We are clear that the Government and the NHS, while they have their parts to play, cannot and should not do everything. But what we can do is educate people about the risks, and give them the information to lead healthier lives and understand and change the influences that govern their behaviour.
I can confirm that the Change4Life programme will continue to be a focal point, as it has been successful in putting the issue on people’s radar. The Change4Life brand will continue, but we will need to change it, as it can no longer be about glossy, national advertising campaigns directed from the centre. We need Change4Life to become less an old-style, centrally directed campaign, and more a genuinely social movement, owned collectively by communities, families, voluntary organisations and industry, and driven locally. Hand in hand with this, we need a much more targeted and community-led approach to health improvement as a whole. In the White Paper, we said that local councils will be given a central leadership role on public health, and we would expect local authorities to work with the NHS and other services to develop the appropriate strategies and approaches.
Keith Vaz
Some of the key people in this are GPs. I welcome everything that the Minister has said so far, but we need to get guidance out to GPs to tell them that they need to be proactive, as my GP Dr Farouki was. When they have a patient who matches the criteria and is therefore at risk, they should perform the test, which takes only five minutes. Such guidance could be very effective.
Mr Burstow
I am grateful for that point. I will say a little about guidelines in a moment, because good news is on the way in that regard.
I was talking about the public health role of local authorities that we are developing. It will be supported by a dedicated ring-fenced budget and the implementation of a new health premium, which will allow local areas to target reductions in health inequalities, including inequalities associated with diabetes and other cardiovascular diseases. We are also committed to working with industry on a new public health responsibility deal to ensure that business takes action together with others to support the nation’s health.
On early intervention and diagnosis, the right hon. Gentleman is right to emphasise the importance of identifying pre-diabetes. There are two developments that relate to the role of GPs. First, the National Institute for Health and Clinical Excellence is developing guidance on preventing adult pre-diabetes in the first place. This will be published next year and will inform and support local public health strategies and others, as I have already described. Secondly, NICE is also preparing guidance on preventing pre-diabetes from progressing to type 2 diabetes. That will be a valuable tool in our fight against diabetes, and will help GPs and other health professionals to advise and support people at risk, hopefully to stop the disease in its tracks.
The right hon. Gentleman is right that earlier intervention and better diagnosis is crucial. NHS Health Check, which was introduced by the last Government, can prevent more than 4,000 people a year from developing diabetes, and could detect 20,000 cases earlier, so it can be, and should be, a very powerful means of detecting and supporting people at risk.
Mr George Howarth
Before the Minister moves on to the wider issues, I want to make a point about GPs and how they can be helped, which he was talking about. One of the difficulties is that often GPs are ill equipped to diagnose diabetes in the first place, and there is an argument for them to be given a series of protocols on how they should deal with certain symptoms. That would lead them towards a proper diagnosis, so I hope that he will consider something along those lines.
Mr Burstow
I will both consider it and hopefully have the opportunity to come back in next week’s debate and say a little more about it.
Mr Sanders
The right hon. Member for Knowsley (Mr Howarth) makes a very important point. There is also the role of pharmacists, who need to be aware of the symptoms that people might describe to them. There are also the opticians and chiropodists. Any number of health professional could be involved in a preventive campaign.
Mr Burstow
My hon. Friend is right, and I certainly pay tribute to him for his work as chair of the all-party group on diabetes. He has been a powerful advocate on these issues for many years. I applaud what he has done, and he is right—pharmacists and other health care professionals are part of what we need to do in order better to equip the whole service for detecting and intervening.
I was told that the right hon. Member for Leicester East was going to ask about extending the age range. That is an important point that needs to be discussed. At the moment, NHS Health Check starts at 40 and calls people every five years. The best clinical and most cost-effective case was made for doing it at that age. However, there is nothing to prevent primary care trusts from commissioning services that widen the age range. They should be considering that, particularly in areas with more susceptible populations, and clearly Leicester is one of those cases.
Keith Vaz
Last year, I wrote to the chief executive of every PCT asking how much they spent on preventing diabetes and on health checks such as the ones the Minister described. Some thought it was a freedom of information request and became very defensive. Will the Minister go back and get this information from his Department and place it in the Library of the House?
Mr Burstow
I will look into that. My view is that we need far more transparency when it comes to such issues, so that people can make comparisons of the performance of their local organisations and hold them to account over how they spend taxpayers’ money on these services.
I want to move on to long-term management. Once diagnosed, people need personalised support to manage what is a highly complex and changeable condition. A person with diabetes must know how to spot and report changes in their health, and how to get the right services to prevent more serious problems. That issue was raised by my hon. Friend the Member for Torbay (Mr Sanders) in Health questions yesterday. He was right to do so, because it is important to ensure that we have good care planning, embodying the principle of “No decision about me, without me”, which is vital in starting to transform the relationship between GPs and patients. Indeed, the diabetes year of care programme, led by Diabetes UK and the NHS, is already looking at how we can improve care plans for diabetes. Education goes hand in hand with that. I know that many NHS organisations offer patient-structured education programmes, specialist diabetes advice, care planning discussions and annual checks. We need more of that: it needs to be consistently applied and we need to ensure that good practice becomes the norm.
On treatment, it is no surprise to learn that the best results are achieved when there is a fully integrated, multidisciplinary team working across primary and secondary care, which picks up on my hon. Friend’s point. Programmes such as the excellent “Think glucose” campaign and the guidance produced by NHS Diabetes on in-patient management are already helping hospitals to discharge patients sooner and give them a better experience of care. However, there is more to do on that—as well as in other services, such as foot care and eye services—to ensure that problems are dealt with early on, and certainly long before amputations become necessary.
Meanwhile, in primary care the relationship with GPs is crucial, as the right hon. Gentleman rightly said. We need them to be alert to the signs of pre-diabetes in routine consultations and to play a key role in the ongoing management of existing conditions. How we incentivise GPs to do so is a key issue. Clearly the qualities and outcomes framework is one avenue that could be explored, but it is for the National Institute for Health and Clinical Excellence to determine what QOF indicators are ultimately introduced. My hon. Friend referred to pharmacists. I certainly agree that they provide another channel for reaching those at risk, which is precisely why they are one of the ways in which health checks can be used in various settings.
In conclusion, the right hon. Gentleman spoke about his experiences in Leicester and the important lessons that he has drawn. He is right to point to the financial climate, which is undoubtedly a constraint on what any Government can do. However, it is also correct to say that this is not just about beds and buildings; it is actually about services and where they matter most in identifying diabetes early and then providing the appropriate care. The issue is fundamentally about outlooks, attitudes and priorities in the NHS and beyond. The principles that we have set out in the White Paper—pushing power downwards, paying for quality and strengthening the voice of patients—will bring fresh impetus to improving outcomes for diabetes.
It is clear that this issue is not just for the NHS, but for all of us—for the society in which we live. We need to strengthen preventive action on diabetes. Let me conclude by saying that I share the right hon. Gentleman’s commitment and passion. I look forward to maintaining a close dialogue with him, and with my hon. Friend and the all-party group on diabetes, and to participating in next week’s debate on type 1 diabetes.
Question put and agreed to.