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.