The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I should start by saying that, as a Spurs season ticket holder, I shall dwell on the kind words of the right hon. Member for Leicester East (Keith Vaz) about my time in office and ignore his cruel jibes about what can only be described as a disappointing night last night.
I thank the right hon. Gentleman for bringing this important issue to the House for another debate. He has rightly issued a number of challenges to me and the Government, and it is vital that we keep up the drumbeat of debate, which is key to making sure that we keep this serious and increasingly prevalent disease on the agenda.
Fantastic work has been done by the right hon. Gentleman and other members of the all-party group, by the right hon. Member for Knowsley (Mr Howarth), who is also in the Chamber, by the Silver Star charity and by so many others. There is very high awareness of the issue in Parliament, and I will come back to what more we might be able to do to mobilise Members even more on this important subject.
As the House will be aware, tackling diabetes is of great concern to the Government. The Department of Health is committed to preventing type 2 diabetes and to tackling the variation the right hon. Member for Leicester East highlighted in the delivery of care, because we, too, want the best possible care for those with diabetes.
There were encouraging signs from the latest national diabetes audit that progress is being made in some important areas of management and care. For example, there are clear trends of improvement in blood pressure control for people with type 1 and type 2 diabetes and in glucose control for type 1 diabetes. It is also reported that a far greater number of people are being offered structured education within a year of diagnosis. However, I will come back to structured education, because it is uptake, not offer, that I am interested in.
The report again highlighted a concerning and continuing issue of variation in care process completion and treatment target achievement for people with diabetes. I am particularly troubled by the statistics on younger people and those with type 1. The audit found that in 2014-15 just 39% of people with type 1 diabetes received all eight care processes compared with 59% of those with type 2. There is an even greater contrast with regard to age range.
Mr George Howarth
As the Minister will be aware, because I have discussed it with her before, there is a specific group of young type 1 diabetics who manipulate their insulin intake to achieve rapid weight loss. Will she give some thought as to how that group, which is relatively small, can be supported to get out of that problem, which is life-threatening?
Jane Ellison
I will certainly take that issue away and reflect on it, and we will speak about it again.
For people under 40, only 27% with type 1 diabetes and 41% with type 2 received all care processes, compared with 58% and 65% respectively for those aged between 65 and 79. I have some sense of why that is, but it does highlight the challenge we face. Encouragingly, 77% of those newly diagnosed with type 2 diabetes were offered structured education, but again the percentage was lower for type 1. That is clearly unacceptable, because everyone with diabetes should receive the best possible care regardless of age, postcode or the type they have been diagnosed with. That is why, in our 2016-17 refresh of the mandate to NHS England, we have made tackling variation in the management and care of people with diabetes a key priority over the lifetime of this Parliament.
Alex Chalk (Cheltenham) (Con)
Does the Minister agree that we need consistently early diagnosis? Early intervention is particularly important in diabetes care, as it saves the NHS from unnecessary expenditure in the long run, and, just as importantly, saves patients from unnecessary suffering.
Jane Ellison
That is absolutely right. I am going to talk about the national diabetes prevention programme, which goes to the heart of the problem. When I spoke to the all-party group, I mentioned the conveyer belt that can start with weight in childhood developing into type 2 and go through to the serious complications that have been alluded to. At all points along that continuum, there are things we can do, and must be doing, to make life better for people with diabetes.
Because of the mandate, diabetes is now right at the heart of NHS England’s agenda. We want it to lead a step change in preventing ill health and supporting people to live healthier lives. Our 2020 goal is for a measurable reduction in variation in the management and care of people with diabetes. However, there is some way to go, so this debate is an opportunity to update the House on some of the areas where we are going to make progress.
We have increased transparency through the creation of the Healthier Lives website, which is a major online tool from Public Health England. I encourage Members who have not looked at it to do so. It highlights variation in the prevalence and treatment of diabetes, allowing clinical commissioning groups and GP practices to compare how well they deliver diabetes care and so drive improvements and iron out variation. I will come on to the support that we are offering them as well.
The CCG outcomes indicator set provides clear comparative information. As was said, it will soon be replaced by the improvement and assessment framework, which will have two diabetes indicators aimed at reducing variation in the achievement of the NICE treatment targets and the referral and take-up of structured education. Consultation on the framework has just closed, and we expect it be published in the summer. It goes to the heart of tackling variation and the cohesive approach that was spoken about.
The NHS Right Care programme is a very practical approach to tackling variation that uses the “Atlas of Variation”. In the case of diabetes, NHS experts help CCGs and other local health system partners to make the step change they need in some areas to improve care, because transparency alone is not enough if we do not offer people support and hands-on advice. In Slough, for example, huge improvements have been made through a clinical mentorship programme that has upskilled healthcare professionals in general practices. That has resulted in an increase in patients who have had their blood glucose, blood pressure and cholesterol controlled. The Right Care programme will be rolled out across CCGs nationally by 2018.
I urge the all-party group on diabetes and the right hon. Member for Leicester East to continue to engage colleagues. It is absolutely right that Ministers are brought to the House and scrutinised about what we can do, but the very nature of our health system and the variation under discussion are also highly susceptible to pressure at local level from well-informed Members and senior councillors. I encourage him to continue to engage Members in asking the right questions at a local level.
Keith Vaz
I will be brief, because I know that the Minister has a lot to tell us. When Members of Parliament write to local health and wellbeing boards, it would help enormously if they were able to tell us how much they spend on diabetes awareness. They cannot do that at present.
Jane Ellison
Part of the challenge is because much of the effort that is put in relates to the preventive agenda and the contributory factors. That is one of the challenges in teasing such figures apart. However, I will reflect on whether we can do more in terms of health and wellbeing boards.
To incentivise improvements in the treatment and care of children and young people with diabetes, the best practice tariff for paediatric diabetes provides an annual payment for every child and young person under the age of 19 with the condition, providing that 13 standards of care are met. One of those standards relates to structured education. As the right hon. Members for Leicester East and for Knowsley know, I am passionate about making changes to the way in which we do structured education. We know that it works and that it is very good when people do it, but we also know that a lot of people are not accessing it. I am looking really hard at how we could take a new and radical approach, including whether there are any tech solutions, and I look forward to reporting back on that.
Our ambitions extend further than creating a level playing field. We want the management of and care for diabetes to be driven up right across the board in order to improve outcomes. The NHS is working with a number of other organisations to help to promote services that are integrated around patients’ needs across all settings. It is implementing a customer service platform to empower patients with diabetes to self-manage by booking their own appointments, managing their prescriptions, monitoring the care they have received and viewing their personal health records.
I fear that time will not allow me to touch on prevention in as much detail as I would have liked, but I want to emphasise just how seriously we take it. The right hon. Member for Leicester East has outlined the reasons why it is important, including the escalating figures and how much the rising tide of type 2 diabetes associated with lifestyle will cost the NHS in the future. The factors can be modified, and one of the most powerful weapons in our armoury is the NHS diabetes prevention programme, which is the first national type 2 diabetes prevention programme to be delivered at scale. Its aim is to help people identified as at the highest risk of developing type 2 diabetes to lower their weight, increase physical activity and improve their diet through intensive lifestyle intervention programmes. I am pleased to inform the House that the first providers will be announced by the NHS shortly, and the programme will move ahead.
The programme will also link to the NHS health check programme. Almost 3 million NHS health check offers were made in 2014-15 and almost 1.5 million appointments taken up. That is vital for first awareness and my constituency knows how important early diagnosis can be as a result of the checks carried out by Silver Star when it visited us.
The right hon. Gentleman talked about other important referral routes, including engagement with pharmacists, and I will pass on his concerns to the Minister for Community and Social Care, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who has responsibility for community pharmacies.
The right hon. Gentleman criticised the responsibility deal, but I think it has achieved a lot. We have made some important gains working in voluntary partnership with industry, such as the voluntary front-of-pack nutritional labelling scheme, which has greatly empowered consumers to know what is in their food. That accounts for about two thirds of the market for pre-packed food and drinks, but I accept that the challenge is to go further.
We will announce more about our childhood obesity strategy this summer. We will also monitor the impact of NHS England’s proposal for the introduction of a sugar tax on the NHS estate. It will be interesting to see the results of that consultation. The Sugar Smart app has empowered 1.6 million consumers to date to know more about what is in their food.
I thank the right hon. Gentleman again for bringing these important issues to the House. I am absolutely sure that we will discuss them again, because this vital agenda is right at the heart of the Government’s health programme.