Diabetes

Wednesday 9th January 2019 Westminster Hall

09:30

[Sir John Hayes (South Holland and The Deepings) (Con)]

I beg to move,

That this House has considered diabetes.

What a delight it is to serve under your chairmanship, Mr Robertson. C. S. Lewis, the great Christian writer, said:

“Courage is not simply one of the virtues, but the form of every virtue at the testing point.”

Every day, our constituents—people across Britain—are tested by the challenges that are the effects of diabetes, which is the fastest growing health crisis of our time. There is barely a family in Britain that has not been touched by it. As so many elderly ladies do, my late mother contracted type 2 diabetes when she reached her 70s. I spoke to colleagues from across the House in preparation for this debate, and many of them, including one this morning, said that they had a family member who had been affected by the disease.

In the last 20 years, the number of people in the UK living with diabetes has doubled, reaching 4.6 million. Every day, 700,000 people are dealing with the worst effects, and 700 people are newly diagnosed as suffering from some kind of diabetes. Amazingly, that is one person every two minutes, so this debate is not only necessary and apposite; rather, I would go one further and say that it is essential.

[Nick Thomas-Symonds (Torfaen) (Lab)]

Will the right hon. Gentleman give way?

[Sir John Hayes]

I shall just finish the next exciting sentence and then I will happily give way. By 2025, there could be as many as 5 million people living with diabetes in the UK.

[Nick Thomas-Symonds]

I thank the right hon. Gentleman for giving way and congratulate him on securing this debate. The statistic for Wales is that one person in 14 is affected. Does he agree that, going forward, we must look at prevention—seeing the warning signs and looking at lifestyle changes—as well as having excellent treatment for those who are formally diagnosed?

[Sir John Hayes]

Absolutely. I will deal with that during my speech. Information that leads to a better understanding of risk, which in turn leads to prevention, is critical, particularly with respect to type 2 diabetes, which is the type that I mentioned earlier when I referred to my late mother.

I spoke of hundreds of thousands of people who suffer from type 1 diabetes—about 500,000 at the moment, but that could easily rise to 700,000—but of course 90% of sufferers are type 2 diabetics, and prevention is particularly critical in their case.

[John Howell (Henley) (Con)]

My right hon. Friend is making a very strong case. Is he aware of the new research into the treatment of type 2 diabetes, which suggests that a change of diet can eradicate it, giving the person a clean bill of health?

[Sir John Hayes]

I was going to refer to the achievements of the deputy leader of the Labour party, the hon. Member for West Bromwich East (Tom Watson), later in my speech, but my hon. Friend obliges me to highlight them earlier than I had planned. He is a model example of someone who, having contracted type 2 diabetes, adjusted their lifestyle and diet, lost large amounts of weight, and fought back against—indeed, fought off—type 2 diabetes, exactly as my hon. Friend suggests. Many other hon. Members, including some in the Chamber today, are living with diabetes. Remarkably, our Prime Minister not only manages to hold down her job with immense dedication and determination, but manages type 1 diabetes simultaneously. I spoke about every family and every constituency, but many Members of this House have personal experience of dealing with both type 1 and type 2 diabetes.

During the debate, I will focus on three areas in which we can make real progress: the human and financial cost of diabetes; how education and technology can enable self-management and improve outcomes for both type 1 and type 2; and how, in the case of type 2 diabetes, intervention on societal and individual levels can prevent the onset and mitigate the effects of such a serious problem.

To prevent just a fraction of the complications arising from diabetes would have a big impact on the national health service, generating significant savings as well as fundamentally reducing pain and distress for individuals. Every week in England, over 160 lower-limb amputations result directly from the effects of diabetes, so the ability to provide high-quality diabetic foot care is of particular concern. The recently published NHS long-term plan makes a renewed commitment to the diabetes transformation fund, and I know that that will be welcomed by the whole diabetes community.

I hope that the Minister will set out what steps the Government are taking to encourage the use of education and technology to better support people in self-managing their diabetes, as that will reduce the burden of diabetes both on the individual and on the NHS. A few years ago, a family came to my constituency surgery, with a tiny, wonderful little girl. She was just about to start school. She had already been diagnosed as a type 1 diabetic. That little girl, Faith Robinson, was wearing technology that allowed her glucose to be monitored and insulin to be administered to her—that was absolutely necessary because she was so young. The family came to me with a request, which I will pass on to the Minister so that he can work with colleagues across Government to ensure that this happens routinely for all constituents who need it. They asked that Faith receive one-to-one support at school to manage that technology. The little girl was under five, and needed people at the school she was about to attend to understand the condition and how to deal with the challenges that she faced.

I estimate that there are constituents across the country in similar circumstances, with very young sufferers who need that kind of care and support. I invite the Minister not necessarily to comment today—I do not want to catch him out; that is not my intention—but to reflect on that and to say more about what can be done for that little girl, who I was able to help in that circumstance, and for many others like her.

[Mr Philip Dunne (Ludlow) (Con)]

I not only congratulate my right hon. Friend on securing the debate but thank him for allowing me to intervene on that point. My second daughter was two and a half when she was diagnosed as an insulin-dependent type 1 diabetic. I very much empathise with the story that he has just told us about his constituent. My daughter was barely able to describe her feelings because she was only just talking at the time, which was really quite challenging for the clinicians treating her, as she was unable to describe the impact of treatment and how she felt.

I agree with my right hon. Friend that the introduction of technology—both a result and part of the significant research efforts in this country by charities and the Medical Research Council—is leading to opportunities in treatment provision, in particular the flash glucose monitoring device, which I know the Government will introduce across the country in a more even way than in the past. That is very welcome, but it remains subject to clinical guidance. I urge the Minister to look at that guidance and the attributes required for people to have access to those devices, because they remain quite restricted.

[Sir John Hayes]

With the insight and acumen that characterised my right hon. Friend’s ministerial career, he has identified a point that I was going to make later. With his permission, I will amplify that in my speech. I was aware of his personal circumstances and of his expertise as a result of having a daughter with diabetes. He will recognise that the average sufferer spends about three hours a year with a healthcare professional. Self-management is therefore critical and, in turn, technology is essential to such self-management. We cannot expect a healthcare professional to be on call every time someone needs support or the kind of treatment that is routine for someone such as my right hon. Friend’s young daughter. I entirely endorse his remarks. The Minister will have heard them and will respond accordingly.

In essence, I want a world in which all people with diabetes have access to the right information, advice and training, not just at the point of diagnosis but throughout their lives. People will say, “Well, of course, we all want the very best, and we all want the ideal,” but if we do not aim for the very best, we will get something very much less than that, so I make no apologies for being definitive in my determination to aim for that ideal. It is critical that we as parliamentarians should look to more distant horizons than sometimes the prevailing powers in Government—as I know from my long experience of that—would encourage us to do. Such debates as this allow us to do that in a cross-party way, for this is not about party political knockabout but about something much more fundamental.

Only if we can achieve the ideal will people be well placed to gain confidence and to cope as the Prime Minister does—as I have described—and as the deputy leader of the Labour party does. They can manage their condition and do not have their lives inhibited by it, and so believe that their opportunities are unaffected by the condition.

To ensure the early uptake of education, it must be provided in a useful format: digitally and through every kind of agency, whether that is schools working with health professionals, or local authorities, which have a responsibility for public health following the Health and Social Care Act 2012, stepping up to the mark too. I shall say a little more about the co-ordination of that, although the Minister is already aware of my concerns. It is about ensuring that our public health effort on diabetes is co-ordinated, consistent and collaborative. That is vital, for reasons already mentioned by colleagues in interventions.

I welcome the commitment in the NHS long-term plan, as I said, to expand the support on offer for people with type 1 and type 2 diabetes, including through the provision of structured education.

[Sue Hayman (Workington) (Lab)]

The right hon. Gentleman is making incredibly important points. He mentioned the deputy leader of the Labour party, who turned his life around through diet and exercise—nutrition. That is an incredibly important issue in my constituency. Throughout west Cumbria, we have serious levels of diabetes, health deprivation and obesity. I thank the right hon. Gentleman for making what is an incredibly important point about bringing together health education at a very young age, and I encourage the Government to invest in that.

[Sir John Hayes]

I hope that the Minister, in respect of that excellent intervention and my earlier remarks, will say how he will ensure that that kind of vital education is provided in a format and at a point that works for everyone. This is about getting to people by a means and at a place that will penetrate, have effect and be comprehensible. The objectives in the long-term plan are right, but how we deliver those objectives has become the vital next step.

We have already spoken in this debate about technology. A flexible approach to the provision of technology, as well as education and support, is critical. Once equipped with information and skills, people must have access to, and the choice from, a range of technologies to help them to manage their condition in everyday life, as my right hon. Friend the Member for Ludlow (Mr Dunne) mentioned a few minutes ago. For people with type 2 diabetes, that is about ensuring access to the required number of glucose test strips. In the rapidly developing world of type 1 technology, insulin pumps and continuous glucose monitors can radically transform lives.

Decisions on which technologies are available should be made with reference to advice from clinicians, patients and, perhaps most importantly, health economists, who will help to determine value to the NHS.

[Mr Edward Vaizey (Wantage) (Con)]

Will my right hon. Friend give way?

[Sir John Hayes]

I will give way, but I want to make my point before I do so, and it might well inform and inspire my right hon. Friend’s intervention: it concerns me that, in contrast to medicines, medical devices and now digital solutions do not have clear processes for appraisal and subsequent funding once approved.

[Mr Vaizey]

My right hon. Friend has indeed inspired me. I do not have diabetes, but I tried a FreeStyle Libre sensor because a constituent of mine is involved in the company. Given my right hon. Friend’s remarks, he seems to agree with me that a robust process of cost-benefit analysis would show that the more people who were issued with that device, the more the health service would save in the long term from people being able to avoid catastrophic incidents because they could monitor their glucose levels much more effectively.

[Sir John Hayes]

I agree entirely with my right hon. Friend. In the modern idiom, we need to be technology-neutral about that, because the field is changing rapidly. As new technology comes on stream and improves, we need to be sufficiently responsive to and flexible about those changes to ensure that people get the very best, latest technology available to them, for the reasons he gave.

The limits on self-management by the restrictions on technology inhibit people’s wellbeing, confidence and, thereby, opportunities. I want to ensure that the provision of technology is consistent throughout the country. There are suggestions that such provision is patchy, that some places are better than others and that some of our constituencies are not getting all that they deserve. The Minister will not want that, because he is an extremely diligent and resourceful Minister—I know that from previous experience—and I want him to tell us how he will ensure that the technology is appraised properly, is delivered consistently and, accordingly, will change lives beneficially.

[Mr Dunne]

My right hon. Friend is being generous with his time. May I elaborate a little more on that specific point to give an indication to the Minister of the specifics that might cause difficulty between different clinical commissioning group areas? In my experience, those who are allowed to have clinical access to a glucose monitoring device already need to have their blood sugar levels under control—in single digits, below nine. For many people, however, the monitoring device is the one thing that gives them the ability to get better control of their blood sugar glucose levels. Therefore, if they do not get access to it until they are under control, it does not have the immediate benefit to their lifestyles that it would if the regime were slightly more permissive in the allocation of the devices.

[Sir John Hayes]

My right hon. Friend makes a very shrewd point about cause and effect. In Scotland, for example, both the processes leading to allocation and the actual allocation of technology are much more routine, as he suggests should be the case. I hope the Minister will tell us today or subsequently how he will ensure that that becomes true for the whole of our kingdom—that the very principles set out by my right hon. Friend become embedded in the way in which we approach technology, ensuring that it is allocated according to need.

We all agree that the resources should be targeted to secure optimal outcomes for the 4.6 million people who have been diagnosed with the condition. In addition to those diagnosed, however, one in three adults in the UK has pre-diabetes and might be at risk of developing type 2 diabetes if they do not change their lifestyle—a point made by a number of Members in interventions. About three in five cases of type 2 diabetes can be prevented or delayed. A focus on preventing the onset of diabetes should be of paramount importance. G. K. Chesterton said:

“It isn’t that they can’t see the solution. It is that they can’t see the problem.”

By seeing the problem, the solution will be implicit, because many more people will never develop type 2 diabetes if they make those adjustments to their lifestyle.

There is a dilemma, though: is it better that 50,000 people get a perfect solution and are prevented from having diabetes, or that 5 million people reduce their risk marginally? Let me set that out more clearly. Is it better that a small number of people achieve what the deputy leader of the Labour party, the hon. Member for West Bromwich East, has done—losing immense amounts of weight, changing their lifestyle and completely revising their diet? Or is it better that a very much larger number of people make a smaller change, lose less weight and change their lifestyle more marginally, but by so doing significantly reduce their risk of developing type 2 diabetes?

That is a challenge in health education; it affects many aspects of the health service’s work. It probably means that, rather than seeing this issue purely from a clinical perspective, we have to democratise the diabetes debate, spread the word much more widely and get many more people to lose a couple of inches off their waist, to lose a stone or half a stone. That effect would be immense in reducing the risk of diabetes, not for tens of thousands but for millions of people.

If the figures I have brought forward are so—I have cited them only because I have learnt them from Diabetes UK and others who have helped me to prepare for this debate—we would change the lives of very large numbers of constituents in a way they would be able to manage, understand, comprehend and act upon reasonably quickly. I want the Minister to reflect on the dilemma I have described; it may not be quite so much of an either/or as I have painted it, but we need a democratic debate about that, which is part of the reason I have brought this debate to the House. Certainly we need an open and grown-up conversation about some of those measures and how we go about tackling what I have described as a crisis.

I do not want to speak forever, Mr Robertson—I know you and others in the Chamber will be disappointed to hear me say that. That will cause disappointment and even alarm among some, but I want others to contribute the debate. However, I have a couple of other points to make so I will move on—having taken a number of interventions already, I hope colleagues will bear with me.

I have been fascinated to read about research funded by Diabetes UK that proves that remission is possible. I would like to take the time to congratulate the hon. Member for West Bromwich East once again and to say that I hope many more people will recognise that remission is a real possibility for them by making changes in what they do.

Part of the issue is how lives more generally have changed. My father cycled five miles to work and five miles home every day, but now most people do not do that. Once many more people worked in manual jobs—my father had a physique like Charles Atlas, but the nearest I have come to Charles Atlas is reading an atlas. Part of the problem is the way we live now; far fewer people exercise implicitly in the way he did, and it seems that junk food is more appealing to many people than eating fresh, healthy produce—indeed, that has been recognised by successive Governments as significant for health outcomes.

Evidence shows the best way to reduce the risk of diabetes is through a healthy diet, being physically active and reducing weight. That can be facilitated through societal approaches and targeted individual interventions. Technology, including digital services to support lifestyle changes, is increasingly critical in diabetes prevention. To be sustainable, methods to prevent type 2 diabetes should focus on individual behaviour change, not just short-term activity levels.

We recently learned that, by their 10th birthday, the average child in the UK has consumed 18 years’ worth of sugar. That means they consume 2,800 more sugar cubes per year than recommended levels. The current food chain has become badly distorted. Basic knowledge that my parents’ generation took for granted about how to buy, cook, prepare and store food has steadily but alarming declined.

We have allowed soulless supermarkets to drive needless overconsumption of packaged, processed, passive, perturbing products, and it is time that the greed and carelessness of corporate multinational food retailers gave way to a better model. It is not a coincidence, it is something considerably more than that; as local food retailers have declined—people knew from whom they were buying, understood what they were buying and where it came from—the consumption of processed, packaged ready meals has grown. We need to rebalance the food chain in favour of locally produced, healthy produce and to re-educate people about how to buy, cook, eat and enjoy it.

[Luke Graham (Ochil and South Perthshire) (Con)]

I will certainly give no lectures on buying and cooking food, but will my right hon. Friend join me in supporting Diabetes UK’s Food Upfront campaign, which calls for a front-of-pack traffic light system to ensure that the content and nutritional value of processed foods are much clearer for people who are suffering from diabetes, and for a whole other range of dietary and nutritional needs?

[Sir John Hayes]

Entirely; in fact, I call on the Minister to do just that: will he introduce a mandatory front-of-pack traffic light labelling system, which is supported not only by my hon. Friend but by 83% of the population when asked whether that should happen? The Minister will be in tune with popular opinion; he will become something of a popular hero by responding to my hon. Friend’s request, which I amplify.

[Mr Vaizey]

We have Belisha beacons—could this not be the moment for Brine indicators?

[Sir John Hayes]

It could indeed. Not only that—I wonder whether we might consider a watershed on the advertising of junk food. Wherever children go, they face adverts suggesting that they eat all kinds of foods. As children, we never ate those things, did we? We were not exposed to the same kind of seductive, alluring advertising suggesting that children should consume that kind of food. There is an argument for cracking down, and Government have a role to play. Again, that kind of watershed on junk food advertising is supported by 76% of the population. The Minister would be a double hero if he did that.

Fitness matters, too. There must be a focus on exercise, given that studies illustrate that regular exercise pays dividends in respect of health and wellbeing, including diabetes. That is why we should not build on playing fields, close down sports halls and concrete over green spaces where people walk, play, run and enjoy all the opportunities to get healthy.

There is a link between poverty and ill health, as Members in the Chamber know very well. Although 6.6% of Britons have diabetes, that percentage falls markedly in wealthy areas. In Richmond upon Thames, 3.6% of residents have diabetes; in Bradford, the number rises to 10.4%. In south Lincolnshire, where my constituency is located, 7.3% of people have been diagnosed as diabetic. Such health inequalities must be addressed. It is with that in mind that I have campaigned so hard for the protection and maintenance of our parks and green spaces, which are often the only places that communities in less advantaged areas have to exercise, play sport and get healthy. In the case of diabetes prevention, do we perhaps take too puritanical an approach by rigidly pursuing individual outcomes? As I said, contrast that with what I described as the democratisation of the debate and the wider view that I have begun to outline today.

I commend, finally, the work of Government and the NHS on moving towards a fresh approach to diabetes in the NHS long-term plan, with a commitment to double the number of diabetes prevention programmes to 200,000 places. None the less, hon. Members will agree that that is a fraction of the 12.9 million people who are at high risk. Will my hon. Friend the Minister say how he plans to take a measured approach and appraise the evidence for all available solutions that might reach the wider population, beyond those targeted special programmes for that relatively small number—well, 200,000 is not a tiny number, but it is a relatively small proportion of the total number of people at risk of contracting diabetes?

Much commendable progress has been made, but it is now time for the Government to do several things. First, they must intensify their public information campaign and encourage everyone to speak about their own type 2 diabetes with their healthcare professional. Secondly, they should ensure that healthcare professionals offer a range of proven solutions, be that education or technology to enable self-management, or the resource to facilitate prevention at scale. Thirdly, they should continually review a rapidly changing environment and update the House on the tough political decisions being made to tackle this crisis of immense proportions. Politicians can no longer afford to abnegate their responsibility to a so-called expert class driven by bureaucracy. Too much is at stake. I know that the Minister will not be able to respond now to all my points, but I invite him to meet me and other concerned colleagues once he has had a chance to reflect on some of the issues, so that we can take the debate forward.

I began with C. S. Lewis, and I will end with him as well:

“We all want progress…If you are on the wrong road progress means doing an about-turn and walking back to the right road and in that case the man who turns back soonest is the most progressive man.”

I do not think we are entirely on the wrong road, but we must be honest about what more we can do. That is not for our own interests or sake, and it is not even for the Minister’s heroic reputation, which I championed earlier. It is for all those who are suffering, or who might suffer, from the crippling illness that is diabetes.

10:01

[Mr George Howarth (Knowsley) (Lab)]

I congratulate the right hon. Member for South Holland and The Deepings (Sir John Hayes) on giving us the opportunity to debate this subject, and on the comprehensive way he introduced it. He rightly spoke about the potential of technology—I will say more about that in a moment—and about the distinction between those who deal with type 1 diabetes and those with type 2 diabetes. It is important always to make that distinction, because type 1 diabetes is an autoimmune condition over which the person involved has no control. It is not a lifestyle-related problem; someone is born with a predisposition to diabetes and something—we do not really understand what—will trigger it at some point in their life, often at a young age. There is also increasing incidence of people developing type 1 diabetes at an older age, which is a relatively new phenomenon. I will confine my remarks to type 1 diabetes and consider what can be done to help people better to manage their condition.

The Juvenile Diabetes Research Foundation is working with Cambridge University to develop an artificial pancreas. The problem with type 1 diabetes is that the pancreas does not work to produce the required levels of insulin—indeed, in most cases it produces no insulin at all. Currently, a person can have a device for continuous blood glucose monitoring, and if it is judged that the condition is not being managed satisfactorily, they can also have an insulin pump. Those are two separate devices; the beauty of the artificial pancreas is that through an algorithm the two are linked, so while the person receives continuous blood glucose level monitoring, the algorithm also enables the insulin pump to respond to a requirement for additional insulin, depending on the blood glucose level. The potential is enormous, and I commend the Juvenile Diabetes Research Foundation for its work. The technology the right hon. Gentleman referred to is now close to being so good that type 1 diabetes will become much easier to manage, which is important.

Before Christmas, I secured an Adjournment debate on the development of the artificial pancreas in which I mentioned the fact that people are now devising their own artificial pancreases. It seems mostly to involve young people who, in some cases, are technologically savvy enough to devise their own algorithms and link a blood glucose monitoring device to a pump. They are devising those devices in their bedrooms or other normal settings. Someone who is a bit older contacted me after the debate and said, “I didn’t devise this in my bedroom. I’m an engineer and I did it on the kitchen table.” The point is that people are capable of doing such things. I am not saying that that is the way forward, because although many of those devices work and people are pleased with the results of the things they have devised, it cannot be right that they are being left to create such devices on their own without them being quality assured and tested by people who are competent to do so. It shows, however, the potential of what people can do for themselves.

We should not fool ourselves into believing that technology will resolve all the problems, because the situation is difficult, particularly for some young people. Think about when we were teenagers: no matter how well disciplined or well behaved people are, the lifestyle of a teenager does not easily lend itself to monitoring a diabetic condition. Going out with a group of friends for a meal or drink and having to adjust one’s insulin level with an injection can be awkward. Young people also face challenges with the way their condition is perceived by their peer group. In some instances, people confuse type 1 and type 2 diabetes and young people in school get bullied on the basis that they have brought their diabetes on themselves because they eat too much sugar. I have seen examples of that. An autoimmune condition is not triggered by one’s lifestyle at all, yet people get bullied on that basis and it is important that they receive the necessary support.

One of my worries—I hope the Minister will try to address this when he responds to the debate—is that there is often a need for psychological, or even in some cases psychiatric, support because the challenges of being a young diabetic are such that people need other support. Schools, by the way, need better training in supporting pupils with diabetes. There have been examples of young people becoming hypoglycaemic and, when they have tried to raise their need to deal with it with the teacher, being told off and humiliated because they happen to have that condition at that time.

[Luke Graham]

The right hon. Gentleman makes a valid point. I have friends and family members with diabetes, and there are tell-tale signs. At the moment there is a great schools initiative to encourage teachers and students to do CPR and first aid; perhaps spotting the tell-tale signs of a hypo could be included in that package, and promoted in schools. Will he join me in supporting that?

[Mr Howarth]

Yes. I will not labour the point, but the hon. Gentleman is right. I would add that quite often teachers are left with such responsibilities, although they have enough challenges in their working life, but there is a need for someone in the school to have the expertise and to be trained to deal with young people with type 1 diabetes.

I know that I assured you, Mr Robertson, that I would try to be briefer than I have been, but I am coming to the end of my remarks, and the matter is important. I join the right hon. Member for South Holland and The Deepings in saying that it would be useful to have a meeting with the Minister to discuss the matter in more depth and get his thoughts on how to move forward. There is much that we can do to make people’s lives better. I hope that the debate will inform that process, and that we will be able to move forward on the basis of consensus across the House. The Minister faces challenges, and Members of this House will want to share the burden of them.

[Mr Laurence Robertson (in the Chair)]

I am looking to call the Scottish National party spokesman at 10.28, and we have two more hon. Members wanting to speak, so please bear that in mind.

10:11

[Andrew Selous (South West Bedfordshire) (Con)]

It is a pleasure to speak in this important debate, because diabetes is so significant in the UK. There are 4.6 million people with diabetes and on current projections we are on track to have more than 5 million people suffering from it by 2025. Ninety per cent. of people with diabetes have type 2, and being overweight or obese accounts for 80% to 85% of a person’s risk of developing the condition, so I shall focus my remarks on what is causing the hugely unwelcome surge in diabetes across the UK and, more importantly, what we need to do about it.

The shocking fact is that a quarter of children go into primary school reception overweight or obese. By the time that they leave, one third are overweight or obese. They are being educated, but overall they are becoming less healthy, which has worrying implications for their future life chances. In the UK at the moment, 30% of all children and 60% of adults are overweight or obese. The worry is that that has become almost normalised. People do not notice it and do not think it is a problem. To me, that is a huge social justice issue. Obesity rates are twice as high in the most deprived communities as in the least deprived. My right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) made that point eloquently in his opening remarks.

I was particularly impressed by the remarks of our wonderful chief medical officer, Dame Sally Davies, just before Christmas. She hit hard at a number of targets and came out with some important truths. She had the food industry in her sights—she said that it benefits from selling unhealthy food, that it does not pay for the harm it does, and that it clearly has not done enough. She raised the fact there is added sugar in baby milk and baby foods, for goodness’ sake. What is the justification for that, other than to put babies and very young children towards a life of sugar addiction? That is scandalous and we should call it out. Frankly, the Government should ban it as soon as they are able, and if we have to leave the European Union to do so it should be an early priority at the beginning of April.

I did not come into public life just to ban things. The corollary, of course, is that we need to make the healthy choice the easy choice, and to be all about promoting wonderful, healthy, delicious, nutritious—often British—food. My right hon. Friend the Member for South Holland and The Deepings made that point well, too. Dame Sally Davies discussed whether there might be a need for price subsidies for fruit and vegetables. Let us make fruit and vegetables—good food that will not cause obesity and diabetes—more accessible, available and affordable to our constituents. That could be done through the taxation system. Dame Sally also called for sugary milk drinks to come within the soft drinks industry levy, which is entirely sensible.

It is worth looking at some of the foods currently on supermarket shelves. Taking children’s breakfast cereals as an example, 37 grams out of 100 grams of Kellogg’s Frosties are sugar. The figure for Kellogg’s Crunchy Nut cornflakes is 35.3 grams per 100 grams. For Kellogg’s Coco Pops it has come down a little bit, but there are still 30.9 grams of sugar per 100 grams. Those are pretty appalling figures, when we think how much sugar that is.

In 2017, some own brands were not much better. Lidl Golden Balls had 36 grams of sugar per 100 grams. Aldi Sugar Frosted Flakes had 35 grams per 100 grams. Tesco Frosted Flakes had 34.9 grams. Those are Public Health England figures and some relate to August 2017, while some, such as the Kellogg’s ones, are current. We need to call that out. Not enough progress is being made, and unless healthier food is available for our constituents we shall not turn the supertanker around. We know from Public Health England that chocolate confectionery and biscuits between them account for more than 300,000 tonnes of sugar going into our diet every year. That is more than from all the other food categories put together.

My first plea is that we should do more with food manufacturers. They need to get with the programme and to know that many of us in the House have them in our sights. I am a Conservative and believe in the free market. I do not want the state to produce our food. However, there is a serious challenge, because we all pay for the NHS through our taxes and the food industry is causing a large part of the problem. Dr Chris Marshall, one of my best local GPs, had to defend the diabetes prevalence in his area and what was happening about it, but it is not fair to blame GPs when so much is stacked against them because of the food industry, among other things. The food industry needs to raise its game. It has been getting away with too much for too long and the Government need to play hard ball with it.

Active travel is another area I want to consider. I came to the House of Commons on a bicycle this morning, because I could. For our children, when we design new housing estates, let us make sure they can bicycle or walk to school. Let us get more cycling and walking in cities. That is a design and planning issue. Officials and a Minister from the Department of Health and Social Care are here for the debate. We need a cross-Government strategy to build in active and healthy travel for children and adults to help the situation.

Calorie information is also relevant. Public Health England tells us that women should eat up to 2,000 calories a day and that men should eat up to 2,500. I wonder whether anyone here knows how many calories they had for breakfast, or how many they will have for lunch or supper. What is the point of giving us that daily total if none of us has a clue how much we eat? Here is a suggestion. For people who are waiting 10 minutes to see the doctor, why not have on the surgery wall examples of the different meals that the British public mainly eat, with a rough idea of how many calories there are in them? Would not that be a start to education? It would be free, easy, and a good use of the surgery wall in a public space where we all sit and wait. Why do not we try to get some of that public information out there so that we can do something and know what we are doing?

We have talked about schools. I do not blame teachers, who have more than enough to do trying to teach children, but they have a public education role. Given that we have gone from one quarter of children to one third being overweight or obese, there should be much more emphasis on providing proper education to children on food when they are taught to cook.

We must also look to Parliament. There has rightly been a move, which I am sure you approve of, Mr Robertson, to make this a more plastic-free Parliament. I approve of that and it is right, but the information in our catering outlets about their offerings is not as good. Let us set an example on our own doorstep.

10:20

[James Duddridge (Rochford and Southend East) (Con)]

I too congratulate my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) on this excellent debate. The contributions have shown that we could have spoken at much greater length, given the breadth of issues faced.

I will talk from a personal perspective. Two years ago I received a phone call from my doctor’s receptionist, who said that the doctor would see me at 4 o’clock. Not catching on, I thought that was somewhat strange as I had not requested an appointment. I explained that I was in the House of Commons and very busy. She said, “Well, how about 9 o’clock tomorrow morning?” I agreed to go along on Friday, thinking that perhaps there was some issue that was going to be raised with me as a Member of Parliament.

I had forgotten entirely that I had had a regular blood test following quite a serious illness. A few years ago, I was in hospital for the best part of a year, in and out, and at one point none of my internal organs, including my pancreas, was working. I was obviously on quite a lot of painkillers. One of the many things the doctor had evidently said was that I could be diagnosed as diabetic in the future but, to be honest, during that period of my life I was pretty much out of it on painkillers, so I did not listen particularly.

I was completely aghast when I turned up at the doctor’s and he said, “You’re diabetic, and at the end of this meeting I will probably have to inject you with some insulin and you may be on insulin for the rest of your life, but there are other options.” In the end, he decided that he would try to manage it through other drugs initially and I never went on to an injection regime, but it was quite scary.

It was also, I thought, quite embarrassing. I felt rather guilty and perhaps stupid for having been obese. Ironically, because of my illness, I was quite thin having come out of hospital. I had lost about five stone in total, so I was not a typical case, but I had eaten too much and not exercised enough. I am now getting back on track and staying on track, but when, as Members of Parliament, something happens to us, we have an insight into what our constituents are suffering from and their experiences.

There was a call in the debate for the best possible solutions. I would argue that we need a lot more diversity and that there is no one-size-fits-all solution. Diabetes is complex. A distinction has rightly been made between type 1, type 2 and juvenile diabetes, and while I have not spent the time on it that others have, there is a medical case for making further divisions in diabetes, particularly within type 2, for reasons that I suspect we do not fully understand.

On prevention, if I could have talked to my younger self and continued to exercise through my late 20s and 30s as I had as a child, I would perhaps not have the problems I have now. My diabetes is very much under control, and I praise the work of diabetes nurses around the UK, who have a little more time than the doctors and can coach people and point them in the right direction. For example, they mentioned a book to me, “Carbs & Cals”, which has pictures of typical meals and typical sizes and goes through the grams of carbs and the calorie intake—exactly like the type of poster that my hon. Friend the Member for South West Bedfordshire (Andrew Selous) wanted to see in doctors’ surgeries.

We should have diversity because some things have worked for me and some things have not. The shock of being diagnosed as diabetic made me change my ways. For months I would not touch chocolate and I would have no carbohydrates whatsoever. I went on a course about diet for diabetics that took a slightly different approach, which I went on to adopt, counting carbs and managing things precisely. Personally, that did not work for me and abstinence from sugar or carbohydrates worked better, but maybe for others it is different.

Exercise, for me, has worked well. I am hoping to run the London marathon, but whenever I do something such as that I question it. If I speak to anyone who has run a marathon, they talk about the big meal beforehand and say, “Make sure you have plenty of carbs the night before—lots of pasta and so forth that will release slowly.” One of the benefits I find in doing that is that I understand a little more about how carbohydrates are broken down, not just theoretically, but personally, and how my body reacts to carbohydrates and sugar.

When I left the doctor’s surgery I had the prick test for glucose. I ended up having three different machines, one of which eventually linked up to my iPhone. I do not now need to do a prick test on a regular basis, but I find it useful as a way of understanding my short-term glucose as well as the six-monthly blood test that I do. Personally, as a type 2 diabetic, while I do not need to monitor my glucose on an hour-by-hour basis, I would find it useful to have something on me for a week so that I could see the effect of having a tiny bit of cereal this morning, or the difference in my glucose if I have had two glasses of wine the night before. What is the difference between running five miles and 10 miles? How many carbohydrates should I have to compensate? We need a lot more diversity in provision over time.

Having outed myself as a diabetic—as I said, one should not feel shame about it, but I did for quite a while—and spoken about it in the House of Commons, I hope that I, like a number of hon. Members, can be an advocate for diabetics across the country, understand not only my condition but those of others, and help to improve the situation over time. I thank my right hon. Friend the Member for South Holland and The Deepings for raising this incredibly important issue in the House.

10:27

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the right hon. Member for South Holland and The Deepings (Sir John Hayes) for securing the debate, for his very knowledgeable introduction and for the consensual nature of the debate that has taken place.

We have had a number of contributions; I will just touch briefly on the main speakers. The right hon. Member for Knowsley (Mr Howarth) reminded us of the importance of recognising the two different types of diabetes, which cannot be emphasised enough. I was also interested in his comments on the artificial pancreas. The hon. Member for South West Bedfordshire (Andrew Selous) raised the risk of diabetes being normalised and the impact of obesity, and the food industry’s contribution to exacerbating the problem. The figures he quoted on sugar intakes were genuinely frightening and should be a lesson to us all. The hon. Member for Rochford and Southend East (James Duddridge) gave his personal experience of his diabetes being under control. The very interesting thought of what we would say to our younger selves is one that we need to take out to our constituents in order to make an impact on the problem.

Health, of course, is a devolved matter. Consequently, it seldom features in my casework as a Member of this Parliament. That said, many of my friends have diabetes, either type 1 or type 2. It is the fastest growing health threat of our time and a critical public health matter. Diabetes is increasing rapidly, and one person in 20 in Scotland is now diagnosed with the condition—I stress diagnosed, because there will be many others who are undiagnosed. The latest figures published by Diabetes UK show that more than 3.5 million people in the UK were living with a diagnosis of diabetes in 2016-17, with just less than 290,000 of them in Scotland. Diabetes UK also reported that if nothing changes, more than 5 million people in the UK will have it by 2025. That is a figure that a number of people have used, and it is worth repeating to emphasise the impact of this health crisis.

In the Forth Valley area, which covers part of my constituency, more than 14,500 people are living with diabetes and there are more than 9,000 people with diabetes in West Lothian, which covers the other part. That helps to put the issue into perspective across a number of constituencies.

It is estimated that more than one person in 16 across the UK has diabetes, either diagnosed or undiagnosed, and it is worth remembering that around 80% of diabetes complications are preventable. I believe that in Scotland around 10% of NHS spending goes on diabetes—I think the English figure is fairly similar. If 80% of that is preventable, think how much we could save by tackling this problem, in addition to the benefit to people’s lifestyles that could be achieved. Many of those complications are preventable or can at least be significantly delayed through early detection, good care and access to appropriate self-management tools and resources, of which access to diabetes technologies is a fundamental part.

When I last spoke about diabetes, a couple of years ago, we talked about technologies. I confess that at that time I had not really witnessed much of them first hand, so I was pleased over the festive break when I saw one of my friends, Paul Kingsley, who has lived with diabetes for some time. He has a Libre patch sensor and an insulin pump. He showed me how that worked, which was interesting to see. It has made a real change to his life. I can remember when he had to do the prick tests and take his needles with him everywhere he went. Technology is making a big difference to people’s lives.

With the challenge of the increasing numbers of people with diabetes, access to the technology to help those living with the disease becomes ever more important. There are 19,000 new cases of diabetes diagnosed every year in Scotland and numbers are set to increase year on year, particularly with rising levels of obesity. Early results from ongoing research, led by Mike Lean at the University of Glasgow and Roy Taylor at Newcastle University, showed that it is possible for some people to put their type 2 diabetes into remission using a low-calorie, diet-based, weight management programme, delivered by their GP. I believe that, as a result of those promising results, NHS England has committed to piloting a remission programme for 5,000 people with type 2 diabetes in 2019, and the Scottish Government, through their “A Healthier Future” plan, pledged £42 million to the prevention, early detection and early intervention of type 2 diabetes. There is a lot we can learn from each other from these processes and as the results of these tests come out.

NHS boards in Scotland will be able use that funding to deliver programmes to prevent type 2 diabetes and to put it into remission. One such programme that receives funding from NHS Forth Valley is the Braveheart Association, a Scottish charitable incorporated organisation based at Falkirk Community Hospital. The Braveheart programmes have been designed to provide resources to support and improve the health and wellbeing of Falkirk communities. They create community-led activities and outreach health services to improve the health of local people. One of the initiatives is Braveheart Plus peer support groups, which focus on those living with type 2 diabetes and coronary heart disease. One beneficiary of Braveheart’s walking project is a lad called Ali, a sufferer of heart disease and diabetes, who was initially reluctant to take part. Through participation, he now leads his own bi-weekly group, enjoys meeting new people and is able to manage his health conditions much better.

There is little doubt that eating a poor diet and being overweight or obese cause serious health problems, such as type 2 diabetes, cancer and heart disease, and it is clear that we must take decisive action. The SNP has an ambition to halve childhood obesity in Scotland by 2030, which is one reason the Scottish Government are consulting with the public, and food and retail industries on restricting in-store marketing and promotion of foods high in fat, sugar or salt, with little or no nutritional benefit. That is very important; I think we have all been tempted.

[Andrew Selous]

On that point, does the hon. Gentleman agree that it would be good to hear from the Minister about when we will get the consultation on the 9 pm watershed and on promotions? Both are promised, but we do not yet have a date for them.

[Martyn Day]

I fully agree; that would be very useful to have.

I think we have all been guilty of impulse purchases when out shopping. It is always worse if we shop when hungry and there is a temptation to get fast food and a quick fix. We are all more than capable of cooking good quality meals, but convenience and lifestyle often get in the way of that. There is a lot we could do if there was a better marketing regime. The consultation in Scotland is part of the diet and healthy weight delivery plan, which will inform an assessment of impact and possible legislation.

No debate these days can be complete without some reference to Brexit, and why should this one be any exception?

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

We were so close.

[Martyn Day]

Yes, but it had to come in, given the requirement to stockpile insulin. Diabetes charities have warned that lives could be put at risk without reliable supplies of insulin, as the UK imports the vast majority of its stocks of the medicines. In response, stockpiles have been increased, which is good. Dan Howarth, the head of care at Diabetes UK, said in September:

“Insulin and other diabetes medication aren’t optional extras for the millions of people in the UK who rely on them. It’s incredibly important that the companies involved in their production and distribution, and those involved in guaranteeing their entry into the UK, work together so that supply continues uninterrupted.”

I would be grateful for reassurances from the Minister that that will indeed happen and about how long our supplies will last should we face the worst-case scenario.

10:35

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship this morning, Mr Robertson.

I thank the right hon. Member for South Holland and The Deepings (Sir John Hayes) for securing this important debate, especially after the excesses of Christmas—in which I am sure we all indulged, which is relevant to the topic we are discussing—and for his characteristically informative, entertaining and articulate opening speech. I also thank all right hon. and hon. Members who have taken part: my right hon. Friend the Member for Knowsley (Mr Howarth), the hon. Member for South West Bedfordshire (Andrew Selous), who is co-chair of all-party parliamentary group on obesity and does excellent work in this area, and the hon. Members for Rochford and Southend East (James Duddridge) and for Linlithgow and East Falkirk (Martyn Day). They made excellent contributions.

As we have heard—I will repeat these facts because they are worth saying again—there are 4.6 million people living with diabetes. Over the last 20 years, the number of people diagnosed has more than doubled. Every day, around 700 people—one person every two minutes—are diagnosed with diabetes, which is really quite shocking. Diabetes UK estimates that if nothing changes, more than 5 million people will have diabetes in the UK by 2025. That is why this debate is so important, and I am pleased to be here to discuss treatment, remission and prevention.

I start with treatment and care. Once a patient has been diagnosed, it is crucial that they get the right treatment and care for them. Technology can play a role in that, particularly for people with type 1 diabetes. New technologies mean that patients can be treated and monitored, which can help to reduce diabetes-related complications in the long term. However, access to those technologies is subject to a postcode lottery, as are many other things. I have heard of huge variation of availability and use across the country. I was pleased to see the Government commit to making life-changing flash glucose monitors available for patients with type 1 diabetes by April 2019. Will the Minster please also ensure that basic technologies, such as test strips and meters, are available to all patients who clinically need them across the country? We cannot just say that everyone with type 2 diabetes would clinically need them—although I have bought myself one and they are good for monitoring—but if people need them clinically, they should be available, not subject to a postcode lottery.

Such technology can be redundant if patients do not know how to use it, or do not know enough about their condition and how to manage it. That is why educational courses, such as the one that the hon. Member for Rochford and Southend East said he attended after his diagnosis, should be widely available, to give patients the knowledge, skills, support and independence to look after their own health. I was pleased to see that get a mention in the long-term plan earlier this week. Can the Minister please elaborate on when he expects the

“structured education and digital self-management tools”

to be expanded?

It is crucial that patients know about their diabetes and the health risks associated with it. According to Diabetes UK, there are over 160 lower-limb amputations every week in England that are a direct result of diabetes. As someone with type 2 diabetes, I find that really scary. Four out of five of those cases could have been prevented. Local foot care teams help to prevent thousands of amputations each year, but diabetes-related amputation is now at an all-time high. Does the Minister have any strategy to reverse that trend?

Finally on treatment and care, one person in six occupying a hospital bed has diabetes; at some sites it is as many as one in four. The majority of patients with diabetes are admitted for treatment of a different condition, but while in hospital their diabetes should not be in ignored. When diabetes is not adequately cared for in hospitals, harm can result from the in-patient stay. Acute or long-term conditions can develop further, adding further costs to the NHS and complications for the patients.

The long-term plan includes a welcome commitment to introducing diabetes in-patient specialist nursing teams to improve recovery and to reduce lengths of stay and readmission rates. Will the Minister indicate when he expects that to begin? Will he also assure us that those teams will be available in all hospitals across the country?

On remission, as we have heard, my hon. Friend the Member for West Bromwich East (Tom Watson) has been very vocal about his own transformation—it has been huge—and the remission of his diabetes owing to exercise and changes in his diet. He has done a fantastic job, as we have all acknowledged, and I wish him all the best. Diet changes, when I stick to them, have also helped me in my management of my diabetes. When I have totally cut out sugar and reduced all carbs, as the hon. Member for Rochford and Southend East said helped him, that has made a massive difference. While there is currently no evidence that diabetes can be completely cured, even by changes to diet and lifestyle—I am told that once someone is diabetic they always will be—people can take steps to control, reduce or even reverse symptoms of diabetes, and to put their diabetes into remission.

As we heard from the hon. Member for Linlithgow and East Falkirk, research and trials by Professor Roy Taylor of Newcastle University—I am very proud that a north-east university is leading the way on this—have found that a low-calorie diet of 800 calories a day, which is low but manageable, can actually reverse diabetes, which was recently listed by MadeAtUni as one of the UK’s 100 best breakthroughs in health. That is certainly an area that needs to be explored further. However, not everyone can make those changes on their own, and patients must have access to medical support and dietary advice if they wish to try. The NHS has confirmed that it will pilot diabetes remission services in England and Scotland. Some places are already rolling out the service informally. For example, I know that some GPs in Tyneside are piloting this model. Will the Minister please tell us when expects those pilots to begin?

On prevention, 12.3 million people are now at an increased risk of developing type 2 diabetes. Of course, not all of those will go on to develop diabetes, but such a high number of people at risk is deeply concerning. Type 2 diabetes has several risk factors, but as the hon. Member for South West Bedfordshire highlighted, being overweight or obese accounts for as much as 80% to 85% of someone’s overall risk of developing the condition.

Almost two in every three people in the UK are either overweight or obese. I am obviously one of the two at the moment. I strive and hope to be like the hon. Member for Rochford and Southend East, who said he is now the one out of those three. I congratulate him on that. I am back on a diet and cutting out sugar and carbs again and trying my best. However, if it was easy, nobody would be overweight. It is hard, and Christmas is not the best time to try to diet. This is why the nudge theories introduced by Public Health England are very welcome, along with proper traffic light food labelling and the “Eatwell plate”, for example.

However, we have to acknowledge that our society has become increasingly obesogenic and sedentary, and we have to address that as soon as possible, starting with the next generation in particular. In that regard, the Government launched the second childhood obesity plan last year, which I hope will help to tackle this problem if they implement all the policies within it and do not only consult on them. Clear calorie labelling and introducing a 9 pm watershed for adverts for food and drink that are high in fat, salt and sugar are two steps that the Opposition would introduce if in government, to help to reduce the high level of obesity in this country.

However, it is not all about diet, as Baroness Tanni Grey-Thompson is always telling me, but about exercise, too. Inactive children become inactive adults, which increases their risk of long-term conditions. According to ukactive, only 50% of seven-year-olds meet recommended physical activity guidelines. We therefore need to make sure that children have the space and resources to participate in sports, activities and play, which will benefit them in a host of ways, not just their health.

Nor should we forget the over-55s—or anybody, actually. According to ukactive, a total of £80.5 million could be achieved in NHS and healthcare savings on diabetes if one third of inactive over-55s were supported to be active over the next 10 years. The Secretary of State says that prevention is better than cure, and I think that that figure alone shows that it is.

The long-term plan committed

“to fund a doubling of the NHS Diabetes Prevention Programme over the next five years, including a new digital option to widen patient choice and target inequality.”

That must target people from black, Asian and minority ethnic groups, who are six times more likely to develop type 2 diabetes. We must ensure that any prevention programme reaches those communities as a matter of urgency.

To conclude, people with diabetes are sadly at greater risk of serious but largely preventable complications. For example, they are twice as likely to have a heart attack or a stroke. For those of us here who suffer from diabetes, that is a sobering fact. We must ensure that their diabetes is properly managed and cared for, so as to avoid those serious complications. What the Government do next as part of the long-term plan will be beneficial to those with diabetes, and I know that patients, campaigners and all of us here will keep a close eye on developments.

10:47

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

It is nice to see you in the Chair, Mr Robertson. I thank all Members for their contributions and my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) for securing the debate. He introduced it with his usual flourish, and I know that people watching will have been interested in what he said and the issues that he raised.

We have to keep these issues high on the agenda. They affect a lot of people and we talk about them a lot in Parliament; I cannot think of a Health oral questions that I have been involved in as a Minister when diabetes has not come up. There is a reason for that: because it affects so many of us and our constituents. We must keep raising it.

This is a timely debate. We published the long-term plan for the NHS on Monday. Diabetes features prominently in the plan, which is no accident. We would expect it to, and if it did not, we would have a debate on why not. However, more than that, the plan has a strong focus on prevention and on building a health service for the needs of the 21st century that supports people to manage their own health—not only for diabetes but across the piece—and wellbeing.

We really support that agenda in this Department and with this Secretary of State. That matters for patients—our constituents—with diabetes and others. Chris Askew is a very good man and chief executive of Diabetes UK, and his welcome for the long-term plan and the diabetes sections within it greatly attests to that.

We have heard some excellent contributions. I very much enjoyed listening to the intervention from my right hon. Friend the Member for Wantage (Mr Vaizey) and his suggestion about Brine labelling; my right hon. Friend the Member for Ludlow (Mr Dunne), who gave us insights about his two-year-old daughter; and my hon. Friend the Member for South West Bedfordshire (Andrew Selous), who talked about the food industry and child obesity. We also heard speeches from the right hon. Member for Knowsley (Mr Howarth), who talked about an artificial pancreas, which was very interesting, and from the hon. Member for Workington (Sue Hayman). I should be able to cover all those items. If I do not cover everyone’s points, I will of course write to them, as is my usual practice.

I have to say that I particularly enjoyed the contribution from my hon. Friend the Member for Rochford and Southend East (James Duddridge). It was a very powerful and insightful speech, as it always is from him, and it was delivered from the heart. He made the very good point that we are all different. That is one of the challenges not just for diabetes care, but for healthcare generally. Healthcare is not an exact science. I say that not as a doctor, but as someone who spends a lot of time with doctors.

My hon. Friend also made a point about the complexity of diabetes. In reality, it is a spectrum. We have heard a lot of talk this morning about type 1 diabetes—from the right hon. Member for Knowsley, for instance—and about type 2 diabetes from many others. But increasingly we hear about—it is not a new term—type 1.5 diabetes, otherwise known as LADA, or latent autoimmune diabetes in adults. As I understand it, that is not a clinical definition, but is generally used to describe a slow-onset form of type 1 diabetes that is often mistaken for type 2 diabetes. There are many support services for that condition, and people are increasingly talking to their doctors about it. There is lots of clinical debate around it, but the topic has been around since the 1970s. That goes to the heart of my hon. Friend’s point. Diabetes is a complex condition. There is a spectrum for diabetes, as there is for many other conditions.

I, too, pay tribute to the NHS staff, to the diabetes nurses and the doctors, but also to the support groups. My constituency has the Winchester and Eastleigh diabetes support group, which I spoke to recently. We will all have those groups in our constituencies. As MPs, we are very used to having in front of us people who are far more expert on the subject that they have come to talk to us about than we are—every single one of my constituency surgeries is an example of that—but never is that more true than when we talk to people with diabetes, who have a great and expert knowledge of their condition and the management of it. If they do not, we need to help them to have better, expert knowledge of their condition, because that is as much in our interest as it is in theirs.

There are a couple of points to touch on. My right hon. Friend the Member for South Holland and The Deepings, in introducing the debate, and my hon. Friend the Member for South West Bedfordshire touched on the food and drink industry and healthier eating. It is important that we build on the world-leading action set out in both chapters of our childhood obesity plan. We have already seen real success. More than half of all drinks in the scope of the soft drinks industry levy are being reformulated. That is equivalent to removing some 45 million kg of sugar every year, as a result of the so-called sugar tax. And some products in the sugar reduction programme are exceeding their first-year targets. For example, a 6% reduction is being achieved for yoghurts.

We will consider further use of the tax system to promote healthy food—the challenge that my hon. Friend put to me. He mentioned sugary milky drinks. The Treasury was very clear, when former Chancellor of the Exchequer George Osborne launched the sugar tax, that in 2020—next year—we would review the sugar levy and whether to extend it to milky drinks. As the Minister, I for one will certainly be welcoming that.

As part of chapter 2, we have already held consultations on ending the sale of energy drinks to children and on calorie labelling in restaurants. We are reviewing the feedback and will formally respond in due course. We will very shortly be launching consultations on restricting promotions of fatty and sugary products by location and price, and we will be consulting on further restrictions, including a 9 pm watershed, at the earliest opportunity, with the aim of limiting children’s exposure to sugary and fatty food advertising and driving further reformulation. What I will say, in answer to the challenge that I have been given on those products, is that not everyone agrees that we should do this. Let us be honest: there are people in our party who do not. I challenge them to look at the challenge that we have in our country with obesity and what it is costing our country and our health service. If we believe in a publicly funded health service, we believe in a public health system that challenges these kinds of condition, so I say to my hon. Friends: keep raising the issue in the House. Next Tuesday they will have an opportunity to do so.

Alongside that, we are committed to exploring what can be done on food labelling when we leave the European Union. My hon. Friend the Member for Ochil and South Perthshire (Luke Graham), who is no longer in his place, raised traffic light labelling. We cannot do that as a member state, but we will soon be free. Some companies have decided to take it on themselves. Kellogg’s, the cereal manufacturer, which has been mentioned this morning, announced just before Christmas that it intends to do that. I welcome that and give credit to Kellogg’s for doing it.

Wherever possible, the aim is of course to prevent type 2 diabetes from developing in the first place, which is emphasised in the NHS long-term plan. I am very pleased that NHS England and Public Health England, for which I have responsibility, and Diabetes UK, working hand in glove, have had great success in working on what is the first diabetes prevention programme to be delivered at scale nationwide anywhere in the world.

[Andrew Selous]

Will the Minister give way?

[Steve Brine]

Very briefly—be quick.

[Andrew Selous]

I, too, am very pleased that Kellogg’s has brought in traffic light labelling, but does the Minister agree that, with Kellogg’s Frosties at 37 grams of sugar per 100 grams, there is much more to do as far as Kellogg’s is concerned?

[Steve Brine]

Not only do I agree with my hon. Friend, but the company would agree with him. It is very aware of how much pressure that I and the Government are putting on it to change its products. I would say that it is top of my Christmas card list. Many other manufacturers have not yet made it on to my list, and I ask them to step up and raise their game to the level of the best. I am sure that they can.

In 2018-19, the diabetes prevention programme achieved full national roll-out, making England the first country in the world to achieve full geographical coverage. That is a great achievement, and the figures are good. As set out in the long-term plan, NHS England intends to double the capacity of the programme up to 200,000 people per annum by 2023-24. As my right hon. Friend the Member for South Holland and The Deepings said, it is a modest number in context, but it is also a big number. This is still the largest diabetes prevention programme of its kind. He asked whether we keep these things under constant review and whether we have the ambition to go further. You bet we do, and I think we need to.

There has been much talk this morning about technology. We are also developing an online, self-management support tool called HeLP, comprising a structured education course that has content focused on maintaining a healthy lifestyle for people with type 2 diabetes. That includes content on weight management and alcohol reduction—that can of course help with many health challenges—and cognitive behavioural therapy related to diabetes-related distress. NHSE hopes, once the tool has been developed, to roll it out in the summer of this year.

[Sir John Hayes]

In my opening remarks, I called for a new system for appraising technology and ensuring that it is allocated according to need and consistently across the country. On education, it does seem to me that there is a littered landscape. We have Public Health England, the NHS and local authorities. That littered landscape could easily lead to complication, confusion and even, possibly, contradiction, so will the Minister look at that, too?

[Steve Brine]

Of course I will look at it. I talk to Public Health England regularly about all these matters, and I take my right hon. Friend’s challenge on board. In the time that we have, I cannot respond in any more detail, but I totally take his challenge on board.

There are public health campaigns such as One You, the behavioural change campaign aimed at people in the 40-to-60 age bracket—sadly, that now includes me—and designed to motivate people to take steps to improve their health through action on the main risk factors, such as smoking, inactivity, obesity and alcohol, which will help to reduce the risk of developing type 2 diabetes.

I would like to say so much more, but as ever in the House of Commons there is no time to do so. What I will say is this. We have great ambition in the long-term plan. The long-term plan is a living document, a document that we will build on—we have ambitions to go even further—but I hope that the Government and I, as the Public Health Minister, have shown our commitment to improving outcomes for people with diabetes and living with it through treatment, but also to helping to prevent people from developing it in the first place. Our constituents demand that from us, and our health service, if we believe in it as a publicly funded, free at the point of use health service, which we do, needs us to deliver on that, and we will.

10:58

[Sir John Hayes]

I think that this has been, as the Minister generously said, a useful debate, but I hope that it is also the start of a process, rather than the end of a story. That process should involve, exactly as the right hon. Member for Knowsley (Mr Howarth) recommended, a continuing dialogue with Government. I hope that the Minister will agree to the meeting that I suggested with a small delegation of colleagues, so that we can explore further the matters raised briefly today. There are real issues in relation to prevention and education, as I hinted a moment ago, but also with regard to treatment, as the Minister has acknowledged. The long-term plan puts the strategy in place. We now need to ensure that that strategy is delivered in a way that brings relief from need for constituents across this country. That need is illustrated by the commitment of all those who have contributed to this debate. I am immensely grateful for your stewardship of it, Mr Robertson, for all the contributions and for the Minister’s typically robust but sensitive response to the remarks made this morning.

Question put and agreed to.

Resolved,

That this House has considered diabetes.