(12 years, 8 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Keith Vaz (Leicester East) (Lab)
As always, I begin by declaring my interest as someone who has type 2 diabetes, and also as vice-chairman of the all-party group on diabetes. I have known that I have this illness since a chance testing in 2004. It has given me first-hand experience of the importance of early detection and careful management of the disease. I am delighted to see the Minister of State on the Front Bench, and I am very pleased to see my hon. Friend the Member for Sedgefield (Phil Wilson), who also has type 2 diabetes.
Failure to properly identify and care for sufferers comes at a high price. The most devastating costs are human. There are 2.8 million people with diabetes in the United Kingdom. This number is set to more than double by 2032. That means that 10% of the population will be susceptible to devastating complications, which include amputation, blindness, heart problems and strokes. There are also the financial costs of the illness. Diabetes costs the NHS £9 billion per year—about £1 million an hour. With the NHS expected to make savings of £20 billion by 2015, this is an expense that we can ill afford and which is only set to increase if drastic action is not taken.
The excellent NHS atlas of variations and the national diabetes audit have shown that there are shocking regional variations in diabetes care. Some 80% of amputations due to diabetes can be prevented with the right checks. The incidence of amputations in a primary care trust is indicative of the quality of diabetes management there. In Leicester East, for example, the annual number of amputations per 1,000 adults with diabetes is 1.4, significantly below the national average of 2.7. However, a sufferer who lives in Swindon is more than twice as likely to have an amputation. The rate there is 4.0 amputations per 1,000 adults with diabetes in the population. That is significantly above the national average.
Changes under the Health and Social Care Bill will mean that more power is devolved to a local level. I am very concerned that this may worsen regional inequalities and I look forward to reassurances from the Minister. We need rigorous checks and balances in place to ensure that there is high-quality diabetes care which meets National Institute for Health and Clinical Excellence guidelines across the country.
So how can we minimise the human and financial cost of diabetes? There is no great mystery in how to treat and prevent type 2 diabetes. We do not need to spend millions searching for a cure: 80% of type 2 diabetes is preventable with the right care and management, including lifestyle and exercise. This means that with the right prevention, the NHS could save up to £720,000 per hour. The NHS health check programme is a positive step towards identifying the “missing million” who it is estimated have diabetes but simply do not know it. However, 90.48% of those eligible did not receive a health check between April and December 2011. Moreover, the health check is only for those between the ages of 40 and 70 years. The south Asian population becomes at risk much earlier, from their mid-20s. Screening must therefore be targeted.
It takes something as simple as a regular check to prevent many of diabetes’ most serious complications. An eye test can prevent blindness, a foot check can prevent amputation, and blood pressure tests can prevent a stroke and heart disease, yet diabetics are not receiving the nine health checks that NICE guidelines recommend they require. It is estimated that 1.3 million sufferers across the country are failing to receive them.
Type 2 diabetes often goes hand in hand with obesity. Some 31% of UK children are now classified as overweight. If current trends continue, 60% of men and 50% of women will be clinically obese by 2050. Over the past decade, Governments have spent £2 billion tackling obesity levels, but they have failed to fall. Urgent Government action is required, and it should consider seriously the possibility of a fat tax, which has been introduced in Denmark, and a soda tax, which is being introduced in France, and make compulsory the introduction of sugar and fat reduction measures by the food and drinks industry.
I have before the House next month a ten-minute rule Bill, calling for soft drinks companies to reduce the amount of sugar that they put into their products, and to bear some of the responsibility for the obesity and diabetes crisis by putting some of their profits back into prevention and research programmes. That is the sort of action the Government should be taking.
As we have seen today with the Government’s alcohol strategy, prevention is better than cure. The Home Affairs Committee in 2008 recommended the introduction of a minimum price per unit of alcohol—an end to the pile-it-high and sell-it-cheap drink deals. In 2011, there were 1.2 million alcohol-related hospital admissions, so I welcome what the Government announced this morning and am sorry that I could not be in the Chamber, but the Home Secretary decided to give the House 30 minutes’ notice of her statement and I had a prior engagement at Hertfordshire university. I welcome what the Government have done, however. It is an example of a Government taking action to deal with prevention.
Research has shown that investment in first-class diabetes services now will lead to huge savings in the future. Southampton university hospital’s investment in a multi-disciplinary specialist diabetes team saved it an estimated £2.2 million over 22 months, but there is not only a cost imperative to ensure that such facilities are available to all diabetics. Last year 24,000 people with the illness died earlier from causes that could have been avoided through better management of their condition. Those measures are required to save lives.
I am delighted that the European Parliament is taking strong action to tackle diabetes, and I hope that the resolution passed there last week will do much to get Europe moving on the issue. Some of the action that it calls for, such as an EU-wide diabetes strategy, will be taken up by the European Commission, but much of the responsibility, particularly for the obesity and diabetes prevention and diabetes management programmes, will fall on member states, including our own. I should be very interested to hear what the Minister has to say about what this Government are going to do as a result of that European Union resolution.
Next month in Copenhagen, for the first time in the history of the EU, the EU diabetes leadership forum will take place during the EU Council presidency of the host country. I was delighted to hear that the Minister will be speaking at that convention, sharing good practice and, I hope, encouraging others to act with Britain to halt the diabetes tsunami.
Diabetics, in order to manage their condition effectively and to prevent many of the costly and damaging complications that I have discussed, must have access to the right drugs at the right time, and I have been contacted by pharmacists, patients and many others in the industry who are extremely concerned about widespread shortages of prescription drugs. The number of prescription medicines officially listed as in shortage on the Pharmaceutical Services Negotiating Committee website is only 30, but an investigation by The Times found that pharmacists were reporting shortages of up to 350 drugs per day.
Eucreas, a diabetes drug, and Travatan, which is used to treat ocular hypertension and glaucoma, one of its complications, are just two examples of many drugs that pharmacists report as being in short supply. A survey of 400 pharmacists for the magazine Chemist and Druggist found that 67% of pharmacists have to wait for up to three days or more for an emergency stock delivery, and that 84% are very concerned about patients being adversely affected by shortages. Some 18% said that they spend over five hours a week trying to get hold of stocks of drugs. The estimated cost for pharmacies across England, according to Lloyds pharmacies, is approximately £39 million lost in staff time, which could be better spent on patient care and public health interventions. Most worryingly, nearly 60% of pharmacists think that the situation will worsen over the next year, and 45% know a patient whose health has suffered owing to shortages, sometimes so badly that they have had to be hospitalised.
The consensus is that the problem lies not with the amount of drugs being manufactured in the United Kingdom, but the fact that some of the drugs intended for the United Kingdom are being exported for profit. Medicines in countries such as Germany can fetch up to four times as much as they do in the United Kingdom. There are other reported problems in the supply chain, including inaccurate quotas and manufacturers trading only with a limited number of wholesalers.
It is imperative that the Minister ensures that there is a full and frank exchange of information between chemists, pharmaceutical companies and wholesalers. Pharmaceutical companies are making enough medicines to supply demand in the United Kingdom. We need to ensure that they reach those who need them. We need the Government to set out a clear timetable for action to show that they are tackling the issue. It is clear that the guidance published last year was not sufficient to end the shortages. I hope that it will not take the death of a patient to lead to some change.
Before concluding, I want to highlight the important work being done in the city of Leicester. I want to thank my local GP, who initially diagnosed my diabetes, as I have said, in a chance test in his diabetes awareness surgery. He now heads the clinical commissioning group for Leicester. Professor Azhar Farooqi has provided real leadership on this issue. There is also a clutch of local distinguished academics, including Professor Khamlesh Khunti and Professor Melanie Davies from the university of Leicester. There is also Professor Joan Davies from De Montfort University, which, under the dynamic leadership of Professor Dominic Shellard, the vice chancellor, has designed the first artificial pancreas, which was viewed only two weeks ago by Her Majesty the Queen. Leicester will soon have its own centre of excellence for diabetes—the first.
In recent months diabetes campaigns have achieved much success in raising awareness of the issue. I would like to commend the work of Diabetes UK, led by its chief executive, the noble Baroness Young, and particularly her Feet First campaign, in co-operation with the Society of Chiropodists and Podiatrists. The all-party group on diabetes, led ably by my friend, the hon. Member for Torbay (Mr Sanders), has done excellent work, especially on regional variations in care. I would also like to congratulate the International Diabetes Federation and its president, a Brit, Sir Michael Hurst, and vice-president, Anne-Marie Felton, on their tireless efforts to raise the profile of the illness globally and whom we have partly to thank for international successes such as the recent EU diabetes resolution.
In my constituency, I want to pay tribute to Silver Star, a registered diabetes charity that, through its mobile units—Merlin, Dorothy and Amanda—in the United Kingdom and in Goa in India, has been able to raise the awareness of diabetes among the south Asian communities. I also want to thank the Minister for the work he has done on diabetes. I think that he has done more than any other Minister in the 25 years I have been in the House in trying to raise this issue and deal with the problem. I thank him most sincerely for what he has done.
Diabetes is an epidemic that can have devastating consequences, and it is on the rise, but we are not powerless in the face of it. With the right care and proper management, diabetes can be controlled and often prevented. Complications and expense can be minimised. Having the right drugs is as important as the Government acting quickly to deal with shortages. We need investment in prevention and in specialist multi-disciplinary teams. We also need firm action to tackle the unhealthy food and drink industries. We must ensure that regional inequalities improve, not worsen, under the changes that are being made. If we do that, it will not only save the NHS billions of pounds but, much more importantly, save thousands of lives.
The Minister of State, Department of Health (Paul Burstow)
I congratulate the right hon. Member for Leicester East (Keith Vaz) on securing this debate and on making such an effective and compelling case for raising awareness of diabetes and preventing, postponing and better managing the condition. I know of his personal experience and the leadership that he has shown in his constituency and in the House on these issues over many years. The centre of excellence that he talked about is there as a testament to his determination to make this happen, and I pay tribute to him for that. He rightly paid tribute to the work of the all-party parliamentary group and, in particular, my hon. Friend the Member for Torbay (Mr Sanders), who has proved an excellent chair of the group and has done some excellent work, as the right hon. Gentleman described.
The case for action is absolutely compelling. As the right hon. Gentleman said, the number of people with diabetes is rising, with profound effects on their quality of life. As he rightly said, there are huge health inequalities, for which some of the most deprived and excluded pay the highest price. It is therefore a big responsibility for any Government to tackle these issues. The costs to our society and to the NHS are substantial.
We currently have the most accurate picture ever of the state of diabetes care in England, with the national diabetes audit, the detailed analysis by the national diabetes information service and the atlas of variation, all serving to expose an unjustifiable variation in the levels of care and treatment from one postcode to another—the classic postcode lottery. We now plan to go further in providing more information than ever before by publishing a specific themed atlas on diabetes, which will prove to be an invaluable tool for commissioners and campaigners, and patients and carers, to use to make sure that we get the very best diabetes care in every part of England.
The data show that there has been significant progress, but, as the right hon. Gentleman says, there are still shocking, inexplicable and unjustifiable variations that we have to bear down on. We know what works at three levels—population-level interventions, targeted interventions, and what can be done better to manage the condition. Let me go through what we are doing in those contexts. First, it is vital to raise awareness among the population. The right hon. Gentleman and other hon. Members, the NHS, and other organisations—including, in future, Public Health England—have an important role in raising overall awareness. Supporting healthy behaviours that improve the population’s health is absolutely key to successful prevention. We need to tackle the main risk factors that are particularly relevant to type 2 diabetes.
One of the key strands from the Government’s point of view is the work done through Change4Life, which has a clear focus on maintaining healthy weight and increasing levels of physical activity, as that is very important in addressing obesity. That also requires much more effective collaborative working between local authorities and the NHS to ensure that we exploit the full range of levers that local authorities have in making a real difference in those two areas. Our planned health and wellbeing boards will provide a new and important lever for driving improvement on the public health side.
The right hon. Gentleman talked about other interventions. We are addressing this through our public health responsibility deal. Some of these issues are not about regulation but getting the relevant industries to move further and go faster, and that has already borne fruit, not least in reducing trans-fats in products. I appreciate his welcome for the comprehensive approach that the Home Secretary outlined today with regard to reducing alcohol harm—the harm that it does to the individual and the harm that its effects can have on others on our streets—and the decision to move, after consultation on the details, towards minimum unit pricing. The right hon. Gentleman is right that that can have a profound effect, not just on liver disease, but on many of the other aspects that we are discussing.
The second area is targeted interventions. The right hon. Gentleman rightly raised the importance of NHS health check and of targeted interventions for high-risk people. We can reduce and even reverse the worst effects of diabetes if we are effective in identifying at an earlier stage those who are at risk. That is why risk assessment and diagnosis are essential to the strategy that has been in place for some time. It is important to identify more people at an earlier stage and to give them the messages and support that can enable them to mitigate the worst effects of diabetes. The national roll-out of NHS health check is a key component in that. We have signalled our determination, through the NHS operating framework, to ensure that that continues.
The proactive identification of people who are at risk of vascular diseases, including diabetes, is key. The right hon. Gentleman mentioned that that covers a population of people from 40 to 75 years of age. I can tell him that in some parts of the country, high-risk individuals are being targeted specifically—for example, those in the south Asian population, where there is a greater risk of type 2 diabetes. We know that the risk in that population is four or five times greater than that in the European population. That will be reinforced shortly by the guidance that the National Institute for Health and Clinical Excellence is finalising on the detection and prevention of diabetes in high-risk individuals.
Paul Burstow
I will gladly do that.
Accurate and timely diagnosis is key, but diabetes can be hard to spot and some of its symptoms, such as extreme tiredness and weight loss, can be attributed to other diseases. Again, NICE has produced advice on preventing adult pre-diabetes and on early detection. It is key for GPs and others to be more effective at early diagnosis. The national clinical director for diabetes, Rowan Hillson, has been supporting that work to raise professional awareness, which is critical.
The third area is long-term management and self-care. There has to be a team effort across primary and secondary care, and the patient has to be at its centre. A person with diabetes must know how to spot and report changes in their health that might result in serious complications with life-changing or even life-shortening consequences. Integrated multi-disciplinary care is crucial to delivering the best outcomes in diabetes.
I will give a couple of examples that pick up on the right hon. Gentleman’s references to the scandalous picture in respect of amputations in England. He rightly rehearsed the variations from one part of the country to another, which are inexplicable and shocking. On average, 73 amputations take place every week, but eight out of 10 of those operations are unnecessary because they could be prevented simply by following what we know works. It is critical that we get that message out and translate it into practice by clinicians. For example, we know that when a foot care team is established, which is a relatively modest investment, it can cause as much as a 50% drop in the rate of amputations. Such investments can release resources. That is why they are part of the quality, innovation, productivity and prevention work and the Nicholson challenge, which the right hon. Gentleman talked about.
There is also room for further progress in the use of insulin pumps, which are particularly relevant to type 1 diabetes. They provide for the slow release of insulin. The NICE guidance clearly recommends the use of insulin pumps for type 1 diabetes when daily injections are not working, and yet many primary care trusts are dragging their feet and not making pumps available. That is why we have established the NHS Diabetes insulin pump network and why it is oversubscribed for its first meetings, with more than 270 members. I think that it will prove an invaluable way of beginning to drive out unacceptable practices. We are also auditing the availability of insulin pumps so that we can identify where use is not adopted properly.
Paul Burstow
I am coming to that almost straight away.
I welcome the fact that there will be a type 1 diabetes parliamentary lobby by the Juvenile Diabetes Research Foundation in the next month or so to highlight some of the relevant issues.
Population levels, targeting, and management and self-care are all critical, and I want to say a bit about what we are going to make happen. First and foremost, NHS Diabetes leads on improvements, spreads best practice, supports professionals and develops professional networks of the type that I have described. The national service framework for diabetes is reaching the end of its life, and we now need to set new ambitions and new directions towards making the further progress that the debate is highlighting the need for. That will be reflected in both the new cardiovascular strategy and the long-term conditions strategy, which the Department is working on in collaboration with many other stakeholders.
We also need the system to be supported by incentives such as payment by results. That was why we rolled out new tariffs last April to recognise paediatric diabetes care as a discrete specialism, and why we will continue to develop tariffs to support best practice.
The right hon. Gentleman asked about Eucreas, which is a glucose-lowering drug. It is composed of two drugs, metformin and vildagliptin, and I understand that although there may well be supply problems with the combined drug, the industry is not aware of any supply problem with the two separate tablets. I will gladly write to him about that in further detail, but that is what I have learned about that drug so far.
More generally, the Department is working to address the issue of parallel exporting of UK medicines in conjunction with the Medicines and Healthcare products Regulatory Agency and the pharmaceutical supply chain, to ensure that medicine supplies are not compromised and we do not have the tragedies to which the right hon. Gentleman referred. I will write to him about the progress of that work.
The right hon. Gentleman also asked about Copenhagen. I look forward to the opportunity to meet colleagues to share best practice and learn about it from others.
As the right hon. Gentleman says, diabetes is a complex, lifelong, progressive condition. When it is well managed, with the right education and support, it is possible to prevent the most severe, sometimes fatal complications. We have the data to guide us and the evidence of what works, and we have the economic case. We are setting our strategy with the ambition of making even more progress. Now, we need commissioners and clinicians to act so that the best is not the exception but the norm across the national health service.
Question put and agreed to.