The NHS
Baroness Manzoor Excerpts(7 years, 3 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Darzi of Denham (Lab)
My Lords, in opening this debate, I declare my interest. I am a practising surgeon in the NHS at St Mary’s Hospital, Paddington, and the Royal Marsden and am the chair of surgery at Imperial College. I proudly sit as a non-executive director of NHS Improvement. Over the past 10 months, I have led an independent review of the health and care system with the Institute for Public Policy Research.
As a surgeon and a former Health Minister, it is a great honour to speak in this place to mark the 70th anniversary of the National Health Service. The NHS is this country’s most treasured institution. It touches our lives at times of the most basic human need when care and compassion matter most. This is a time for reflection to celebrate the institution and give thanks to NHS staff for their service to our nation, and to look to the future.
The NHS is the expression of the moral principle that no one should be denied healthcare because of their means—the idea that the provision of healthcare should be based on need and not the ability to pay. Most people alive today cannot recall the time before the health service was created. With each passing year, the number of people who can recall the pre-NHS era recedes, but if we are to secure its future we must never forget what preceded it.
A friend recently told me the story of his family. His parent worked in the textile mills in Lancashire that have long since disappeared. In the simple kitchen there were two sugar bowls. One was for the sugar and the other for the doctor. It was where they would save a penny or two whenever they could so that, if any member of the family got sick, they could pay for a visit to a doctor. Fear of falling sick was a normal part of daily life in Britain. Illness was the surest path to poverty and destitution, not just for the individuals but for whole families. The founding of the NHS took that fear away for millions and it is a fear that those of us born since have never known and can only imagine.
The NHS was the greatest achievement of the post-war Labour Government. We owe an eternal debt of gratitude to Nye Bevan for his vision, passion and determination to establish the health service. He memorably described the NHS as taking the place of fear. It remains one of the most extraordinary achievements of any society anywhere in the world. It is on occasions such as the 70th anniversary that we must make and remake the case for comprehensive, universal healthcare, free at the point of need for all.
Never let anyone tell you that we cannot afford the NHS. The moral principle of universal access to healthcare is shared by all people everywhere. Those countries that have made it a reality have done so in different ways, but by far the most efficient, dignified and lowest cost is to create a universal service free at the point of need funded by taxation. Private insurance and social insurance systems are much more costly. Those who argue that we cannot afford the NHS are seriously wrong. It is a fundamental error of logic to say that something is unaffordable so we should make the move to something more expensive.
The NHS is funded by us all. It serves each of us and it reflects the best of us. The health service employs 1.5 million people across the four nations of the United Kingdom—that is 5% of all working people in our country. The NHS is its people, not only the doctors and nurses but clinicians of all kinds and the porters, cooks, cleaners and, yes, the vital managers and administrators too. Spending a day working as a porter in the NHS was one of the most illuminating moments of my career. Every member of Team NHS matters. Every one has a contribution to make and each is valuable. I pay tribute to the NHS employees of today who are my colleagues, and to the NHS staff of previous generations. On this day of thanksgiving, we owe them a lasting debt of gratitude.
I have worked in the NHS for longer than I have been a citizen of this country. In a time of great anxiety, I pay a special tribute to the citizens of other countries who have helped to build our NHS throughout its existence and remain the backbone of it today. From the Windrush generation to the European citizens and nationals of every race and creed, from every corner of the world today, they have made an immeasurable contribution. Let that never be forgotten.
NHS staff work at the frontiers of innovation because healthcare exists at the limits of science. This country is a scientific superpower with an extraordinary record of discovery and invention, yet in recent years we have fallen behind on investments in R&D. R&D is the engine of innovation yet R&D spending as a share of GDP has been falling while our competitors have invested more. We need a new commitment to be at the top quartile of advanced countries for R&D investment. The future prosperity of our country depends on it.
Many of the most important medical discoveries took place in this country, often through partnership between the NHS and the universities. No matter the challenges, we are constantly finding new ways to treat disease and soothe pain and suffering. That means that high-quality care is constantly a moving target: to stand still is to fall back. What energises NHS staff is relentlessly improving the quality of care they deliver to their patients. In my review of the NHS with the IPPR we found that, on a wide range of measures, the NHS has maintained and improved the quality of care it provides. Fewer people are harmed and more people are cured than ever before. There is a huge amount to celebrate and to be proud of, yet we should frankly acknowledge the difficulties the health service has faced. The past decade has been the most austere since the health service was founded. Waiting times have risen considerably and the system has been subject to needless destructive reforms. The NHS is not failing, but it is fragile.
A properly funded NHS is the foundation on which a fair, cohesive and inclusive society is built, so the new funding settlement announced by the Prime Minister, the Chancellor and the Secretary of State for Health is very welcome. My friend the noble Lord, Lord Prior, and I, together with the IPPR, recommended a 3.5% annual funding increase: the Government came close, with 3.4%. However, the settlement did not include public health, capital investment or education and training. Each of these is vital and the Government must now deliver on them too.
Securing the NHS is an eternal task. It is no more perfect than life itself. That is why new investment must be joined with reform. Together with the noble Lord, Lord Prior, and the IPPR, I set out a 10-point plan for a 21st-century NHS. At its heart is a new vision, what we call “neighbourhood NHS”, where services are organised around groups of patients with broadly similar needs, rather than groups of professionals with broadly similar skills. We argue that there should be a new option for single integrated care trusts, able to take responsibility for all the health and care needs of a population.
Warm words on mental health must be followed by bold actions. Parity of esteem should mean parity of service. Bringing care closer to people is a crucial principle for a modern NHS, yet for too long the NHS has said it would invest more in care closer to people yet continues to do the inverse of its stated strategy. Each year we say that resources will shift and each year they flow upwards towards hospitals rather than outwards towards communities. That is why we must lock in more spending on primary, community and mental health services each year in the decade ahead.
As we celebrate the past on this anniversary day, we must also look to the future. It is our duty to seize all the technological opportunities that this new era offers. There must be a tilt towards tech to create a digital-first health and care system. That will demand investment in digital infrastructure, improved data sharing and embracing full automation. Many people fear that automation will destroy jobs, but it is much more likely to reshape them by taking away mundane tasks that fill most of our time working in the NHS. This will release more time to care and give more space for clinical reasoning, for research and for innovation.
I have spent decades developing robotic surgery. The robots have yet to replace me, but they have helped me deliver higher-quality care to my patients. For all these improvements to happen, we need a radical simplification of the system. It has become impossibly complicated and is in desperate need of change. I therefore welcome the Prime Minister’s commitment to bring forward legislative change. Tinkering at the edges will not be enough: we need fundamental reform. Above all else, we need to confront the great social challenge of today, which is social care, as we heard earlier.
When the NHS was founded, life expectancy for men was 66 and for women it was just 71. Today, it is 79 and 83 respectively. Today, one-quarter of NHS beds are occupied by patients who are medically fit to go home, if there were good enough support for them. More than £3 billion a year of NHS money is wasted by delayed transfers or transitions of care. If Bevan were designing the health service today, it is unimaginable that he would have excluded social care. We must now extend that simple, noble, brilliant principle of care based on need rather than the ability to pay from the NHS and apply it to social care.
Social care reform has become the third rail of British politics: any politician touching it swiftly expires. Between now and 2030 the number of people over the age of 65 will increase by about one-third and the number of those over 85 will nearly double. At the same time, the working-age population will increase by just about 3%. If we do not act now, a heavy burden will fall on families to take care of their relatives. Since 2010, social care has been slashed. Despite rising demand, state social care has plummeted by 27%. That does not mean that less care has been provided. There has been a dramatic rise in informal care. Critics will argue that the older generation should contribute more of their wealth to pay for social care, particularly the wealth locked up in housing, but tying social care reform to the thorny issue of wealth inequality and taxation is wrong. If we make that hurdle for social care reform, there will be no progress at all. Surely, the level of personal wealth is a better basis for wealth taxation than the need for social care.
Better social care means that families spend less time on functional tasks and more time on relationships. If we want a less lonely and more dignified future for our ageing society, now is the time to act. There could be no better birthday present for the health service. It has been a privilege for me to open this debate, but it has been the greatest honour of my life serving the National Health Service for nearly 30 years. In 30 years from today I hope to see the NHS’s centenary. It is a great comfort to know, for me just as for all of us, that the NHS will be there to provide care and compassion when it matters most.
Baroness Manzoor (Con)
My Lords, to assist the House, I say that Back-Bench speeches are limited to four minutes so, when the clock strikes four, time is up.
Lord Mawson (CB)
My Lords, I thank the noble Lord, Lord Darzi, for introducing this important debate. My colleagues and I have been at the cutting edge of the integration agenda for 35 years now. We are today generating a national and international movement and infecting the NHS culture. This year we have welcomed leaders from 23 countries across the world to see our work. Today I am taking our experience to 10 cities and towns in the north of England, through the Well North programme, which I have been asked to lead by the CEO of Public Health England. I declare my interests.
If we are to have an NHS in 70 years’ time, we suggest the following steps, based on hard-won practical experience. First, we must return to the fundamental question raised by the Peckham experiment in 1948, “What is health?”. The NHS closed this project in 1952, saying that its services would now be delivered by the NHS. It was wrong. Some 50% of our patients today do not have a biomedical problem: they have a housing, education or employment problem, or they are lonely. I am finding similar numbers in communities in the north of England. The Bromley by Bow Centre is Peckham mark II, but this time with a business plan.
Secondly, we should stop building health centres. Today we offer a vast array of services to our local community and our 40,000 patients. They stretch from conventional healthcare for local residents to opportunities to set up your own business, from support with tackling credit card debts to help with learning to read and write and help up the career ladder. We should stop building health centres, but that is not to denigrate clinical health. On the contrary, we need to position clinical health within a broad range of services to drive well-being in communities.
The list in this debate question is far too limited. We need to create a locally blended offer, where doctors sit alongside others, including patients and local residents, to provide what people need. It is healthier for doctors. Our health centres are more like a John Lewis store, where the customer is welcomed in and a host of choices are laid before them. The people who run successful department stores know that a diverse product range makes complete sense for the customer and financial sense for the business. You can capture the customer and have an opportunity to offer myriad products and services. It is the same principle in integrated holistic centres, where health is about life and living, not just disease and illness. It is about sweating our community assets. This approach would create benefits and savings across a range of Whitehall departments, not just the Department of Health.
We are working with our partners to build two new town centres in Rotherham and Stocksbridge, just outside Sheffield. The retail sector is challenged at the moment by the internet, but there is a real opportunity to rethink what a town centre is and to put the heart back into it. We will require flexibility and imagination from the NHS and other government departments.
Thirdly, over the years we have developed many innovations that have quietly gone national. The latest is the social prescribing movement which we founded in Bromley. It is now in 20% of GP practices nationally and 80% in Tower Hamlets; there is a network of 2,000 social prescribers across the country. Social prescribing should be the norm in every practice, because it focuses on what matters to patients rather than what is the matter with them. It also ensures maximum engagement with patients in managing their own health. Let us unleash healthy communities.
Finally, there is too much focus on beds and hospitals rather than on early intervention. People believe that the NHS will solve their health problems; often it will not. We are breeding a massive dependency culture through an institution that I would suggest is far from well. Let us be honest. It is not lack of resources that is the problem, but what we have chosen to focus on. I fear more of the same. What happened to the five-year plan? It is time to be more radical. Let us drop the sentimentality about the NHS and return to the fundamental question: what is health in the modern world for our children, in a society that is increasingly atomising? I agree with the noble Lord, Lord Darzi. It is time for fundamental reform, based not on sentiment, theories or ideology but on practical innovation and experience on the ground—and it cannot be led simply by the vested interests of the medical profession.
Baroness Manzoor
My Lords, we must keep to time, otherwise noble Lords at the end of the debate will not get their full four minutes.
Lord Colwyn (Con)
My Lords, I welcome the debate of the noble Lord, Lord Darzi. I must also declare my 40 years in the NHS and that I am a fellow of the British Dental Association.
In 1948, the nation’s dental health was in a worse state than that of defeated and occupied Germany; decay and gum disease were rife and more than three-quarters of the adult population had complete dentures. The creation of the NHS meant that, for the very first time, dental care was free at the point of use and the demand was overwhelming. By late 1948, more than 80% of practising dentists had signed up to work in the NHS and, in the first nine months of its existence, NHS dentists provided over 33 million artificial teeth, performed 4.5 million extractions and put in 4.2 million fillings. By 1951, the NHS started running out of money and so charges for dentures were introduced—the first charges of any kind for NHS treatment. This controversial move caused much debate and led to the resignation of Aneurin Bevan. Charges for other types of dental treatment soon followed and, to this day, dentistry remains the only part of the NHS that is not free at the point of use.
NHS dentistry today looks very different from the way it did 70 years ago. Modern technology means that dentistry today is relatively pain free compared with the dentistry of the past. Our nation’s oral health continues to improve and most of us keep at least some of our own teeth past the age of 85. Satisfaction with NHS dentistry is at a record high. Despite an estimated 10 million adults in the UK reporting dental anxiety and 6 million experiencing dental phobia, 85% of patients rate their NHS dental experience as positive.
We cannot, however, afford to be complacent. Although oral health on average is steadily improving for the general population, there are still unacceptable variations in outcomes, depending on where you live. Almost half of five-year-old children living in places such as Pendle, Rochdale or Burnley have tooth decay, but a mere 5% are affected in Waverley or Guildford. Tooth decay remains the leading reason for hospital admissions among young children, despite being almost entirely preventable—a scandal in 21st-century Britain. Increasingly, there are also problems with access to NHS dentistry in many areas. A recent BBC investigation revealed that only 52% of dental practices were able to accept new NHS patients. Almost half of all adults in England—a total of 21 million people—have not seen an NHS dentist for over two years.
The reasons for that can be traced back to two main problems: the lack of funding and a failed dental contract. NHS dentistry has been chronically underfunded in recent years. Nominal spending on dental services per capita fell from £41 in 2013 to £36 in 2017. This drop is even greater if we take into consideration inflation and the rising cost of dental materials. At the same time, patient charges in England have increased at an unprecedented pace—a 5% rise each year for the past three years. Data shows clearly that this fee makes many people delay going to the dentist until the problem has escalated, ultimately requiring more expensive treatment.
The second reason for problems with dental access and rising inequalities in England is the way that dentistry is commissioned. The failed NHS dental contract effectively sets quotas on the number of patients a dentist is able to see on the NHS.
Baroness Manzoor
I am so sorry. We are running late and have to go to the next speaker.
Lord Colwyn
I have only one more sentence. It has led to such low morale in the workforce that 58% of dentists are looking to leave the NHS in the next five years.
Long-term Plan for the NHS
Baroness Manzoor Excerpts(7 years, 4 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Hollins
My Lords, there is much concern in this House about social care. Can the Minister confirm that the now-promised social care plan will address not only the needs of older people but the needs of all vulnerable people of all ages? It is a little-known fact that the cost of meeting the needs of people with learning disabilities will soon overtake the cost of care of the growing number of older people. It is really important to address that.
Baroness Manzoor
My Lords, we have plenty of time. It is the turn of the Lib Dem Benches.
Baroness Ludford
My Lords, further to the question from the noble Lord, Lord Davies, is it not true that the OBR forecast budget deficit is twice our net EU contribution? We will also be making continuing payments for participation in EU programmes and agencies, let alone the £39 billion divorce Bill. Is not the Brexit dividend claim on the No. 10 website—which is a government website, not a Tory Party website—a breach of the Government’s duty to ethics, truth and accuracy?
NHS: Deficit
Baroness Manzoor Excerpts(7 years, 11 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord O’Shaughnessy
As the noble Baroness pointed out, additional spending is going in. I should point out that the proportion of public spending on health has increased under this Government, so even while fiscal retrenchment has taken place, more money has been spent on health. On the idea of a cross-party convention, we talk about building a cross-party consensus on social care with the Green Paper that will come out in due course. We need to focus on action. The danger with conventions and commissions is that they just prolong the process of making decisions, whereas moving ahead with decisions on both integration in the NHS and getting consensus behind reforming social care is the way forward.
Baroness Manzoor (Con)
My Lords, does my noble friend agree that there is nothing to prevent NHS organisations, acute services and social care working together? There are no barriers and that can be done currently. Therefore, having a commission that will prolong things is not necessary. We must exclude any barriers that exist now.
Lord O’Shaughnessy
My noble friend is absolutely right: there are no barriers. Indeed, the five-year forward view, in which the NHS sets out its own future, talks about integration and moving towards accountable care systems. Some capital programmes have been announced today under what will amount to a £10 billion capital programme over five years. These are precisely to deliver the transformation which is needed by making the kind of investment to provide that level of integration.
Health: Flu
Baroness Manzoor Excerpts(8 years ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord O'Shaughnessy
That is unexpected and would be worrying if it is true. That is not the information on which we have based our policy. Our information is that, for most people—though not all—flu jabs are effective in mitigating the risk of flu in care settings.
Baroness Manzoor (Con)
My Lords, the World Health Organization recommends what strain of vaccine should be developed, nine months to a year ahead. This happened before the Australian epidemic which affected the elderly and killed many people. Will the Minister confirm that the vaccine which has been developed here in the UK is both effective and relevant and that the young and elderly people do need to access it?
Lord O'Shaughnessy
My noble friend is absolutely right. Back in September, Simon Stevens, the head of the NHS, warned about the impact of the flu epidemic in Australia and New Zealand. The feedback on that was that the particularly vulnerable groups were the over-80s and five to nine year-olds. We have talked about helping younger children through school-based immunisation. We also have the highest uptake in Europe of over-65s getting flu jabs. There is clearly more to do because around one-third of people still do not.
Adult Social Care in England
Baroness Manzoor Excerpts(8 years ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord O'Shaughnessy
The consultation is looking primarily at the funding situation but in doing so it will have to consider the shape of the market and making sure that the whole system is put on a sustainable basis for the future, which obviously will involve looking at some of the issues the noble Lord has highlighted.
Baroness Manzoor (Con)
My Lords, first, I congratulate the Government on making £2 billion available to social care. That is very welcome, but there is great variation in social care across the country which needs to be tackled, as well as the need to focus and co-ordinate services between acute and social care. Can my noble friend the Minister say exactly how NHS England will be helped to ensure that this is tackled quite urgently?
Lord O'Shaughnessy
The noble Baroness is quite right. In social care and the delayed transfers of care from hospitals, there is a huge amount of variation across the country. The additional money that was announced in the Budget comes with a variety of conditions, which has not been the case previously. One of these is to reduce the amount of variation in the quality of services available from local authority to local authority. For the first time, a set of reviews is taking place of local authorities—some of which will be facing challenges, others will not yet be—to make sure that that interface between the NHS and social care, which is one of the big problems where the system falls down, is looked at; that people are moving forward smoothly; that money is crossing those silos; and that the kind of service being provided is joined up and is actually providing for the needs of the people affected.
Brexit: Nursing Staff
Baroness Manzoor Excerpts(8 years, 4 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)
My Lords, it is the turn of the Conservative Benches.
Baroness Manzoor
My Lords, it is a fallacy to continue repeatedly to suggest that EU nurses and doctors are not welcome in this country. Quite frankly, I am fed up with it. I worked in the NHS for over 25 years, and this is damaging staff morale because people are almost being targeted to feel that way. EU nurses and doctors do tremendous good work, and they are respected, welcomed and valued, as are other nurses and doctors from across the world. We have a great opportunity to celebrate this. Does the Minister agree?
Lord O'Shaughnessy
I completely agree with my noble friend, who speaks from experience. It is important not to peddle a myth of unwelcomeness, when it is clearly the case that nobody has said that they are unwelcome. No one in government has said that they are unwelcome; nor has the BMA, the RCN, or anyone else for that matter. They are valued as highly as any other member of the medical profession.
Health: Electronic Patient Records
Baroness Manzoor Excerpts(8 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Manzoor
To ask Her Majesty’s Government what plans they have to ensure that electronic patient records are available to healthcare professionals on a national basis, with appropriate safeguards and patient consent.
Baroness Manzoor (Con)
My Lords, in asking the Question standing in my name on the Order Paper, I draw the House’s attention to my entry on the register of interests.
The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)
My Lords, the Government are committed to making patient and care records digital, real-time and interoperable by 2020. Ahead of that, summary care records, which provide essential information about a patient, such as their medication, allergies and adverse reactions, are now available in many parts of the country in key areas of the NHS, such as ambulance and A&E services. Healthcare professionals can view these, with patient consent, to inform decisions about care.
Baroness Manzoor
I thank my noble friend for that comprehensive Answer. I am rather concerned that the National Data Guardian’s third report, which was out last year, does not fully address the issue of who those electronic patient data belong to. Do they belong to the GPs? Do they belong to NHS England? Do they belong to NHS Digital? This is particularly important because some GPs are moving towards only localised electronic patient record-sharing, which will have an adverse effect on the efficiency of the NHS. Can my noble friend the Minister assure the House and me that electronic patient data records will be kept nationally and that it is the patient’s choice over who has access to those records?
Lord O'Shaughnessy
My noble friend makes an important point about the use of data. There is a balance to be struck. The first point to be made about the use of data is that patients need to be part of any decision about sharing them. In 2012, the NHS Future Forum published an independent report on this issue and used the phrase,
“No decision about me without me”,
to describe the role of patients. There is of course a need to share data among clinicians, particularly when they treat a patient themselves. There can also be wider concerns: for example, in a public health pandemic or some such incident data would need to be shared more widely. But that can be done only with patients being informed and offering their consent.
Carers over 80: Support
Baroness Manzoor Excerpts(9 years, 4 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Lord Privy Seal (Baroness Stowell of Beeston) (Con)
My Lords, I am so sorry to get up but we have not yet heard from the Conservative Benches. Although I recognise that there has been a series of Labour Peers it is the turn of the noble Lord, Lord Flight.
Lord Prior of Brampton
Yes, we are talking about not just people who are registered carers but in particular where older people are looking after each other reciprocally, whether that is within marriage or a long-term partnership. Again, you cannot monetise something like that. It is part of a loving relationship. One of the tragedies in this is that it can sometimes change that caring relationship of husband and wife to one of a carer and a cared-for person, which can have a quite difficult psychological impact on individuals.
Baroness Manzoor
My Lords, do the Government have any plans to provide respite care for carers, particularly where there are significant disabilities involved with the person being cared for?
Lord Prior of Brampton
Respite care is hugely important. I think that the better care fund provides about £130 million a year for respite care. Giving people time out is hugely important.
Local Authorities: Public Health Budget
Baroness Manzoor Excerpts(10 years, 3 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Prior of Brampton
The noble Lord may be interested to know that the McKinsey institute assessed that the cost of obesity to the British economy was some £46 billion. I am under no illusion about the importance of proper prevention.
Baroness Manzoor (LD)
My Lords, health inequalities continue the gap in access to services and equity in our health services. The gap remains the same and has not become narrower between various socioeconomic groups, 20 years on. That means the rich, poor, black and indigenous white population. Exactly what is going to be done with part of the health prevention budget to try to reduce the gap?
Lord Prior of Brampton
A condition of the grant to local authorities is that they take on the responsibilities that the Secretary of State has under the Health and Social Care Act to reduce inequalities. As statutory bodies, local authorities have a duty under the Equality Act 2010 to provide equal opportunities for people with protected characteristics.
Health: Diabetes
Baroness Manzoor Excerpts(10 years, 3 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Manzoor (LD)
I congratulate the noble Lord, Lord Harrison, on securing this debate and on his insightful and well-informed views on the issues of diabetes. Like many in your Lordships’ House, I am familiar with the effects of diabetes as, unfortunately, a family member has a history of it. I therefore declare my personal interest in the disease.
Looking at the range of speakers in today’s debate, I am sure that diabetes in the UK will be covered very well. As I have recently taken on the brief of spokesperson on international aid and development, I thought that I would take an international perspective on the disease, which I hope will not throw the Minister off his stride. It is certainly not my intention to do that.
The next big issue in diabetes internationally will be TB-diabetes co-infection. However, before I move on to that area, I want to restate that our NHS spends about £10 billion on diabetes every year, equal to 10% of its entire budget. This is an important disease to research, diagnose and treat effectively in the UK. It should also be a priority to ensure that any variations in treatment—the noble Lord, Lord Harrison, alluded to this—are minimised across the population, particularly as there are currently 3.9 million people living with diabetes in the UK.
The International Diabetes Federation estimates that, worldwide, there are 387 million people living with the disease, equal to 8.3% of the global population. It also estimates that, by 2035, an additional 205 million people will develop diabetes. The World Health Organization estimates that in 2012 diabetes was the direct cause of 1.5 million deaths and projects that diabetes will be the seventh leading cause of death by 2030. The total number of deaths from diabetes is projected to rise by more than 50% in the next 10 years globally. These figures are scary—even more so when you consider that 80% of diabetes deaths occur in low and middle-income countries, many of which may already be ravaged with disadvantage, poverty and conflict.
We in the UK should take a lead in increasing global awareness of this disease through our meetings with the UN and the EU, so that sufficient resources are made available to address this epidemic. As has been seen in the UK, diabetes care is costly and has the potential to cripple any healthcare system. According to the International Diabetes Federation, $1 in every $9 spent on healthcare is currently spent on diabetes.
It is interesting to note that type 2 diabetes used to be seen as a disease of the rich world and that, when it started to affect the better-off in poor countries, it was perceived as a sign of development. Now, three out of four people with diabetes live in low and middle-income countries. This rise in type 2 diabetes is being driven by ageing populations, rapid urbanisation and lifestyle changes. In developed countries, most people with type 2 diabetes are above the age of retirement, whereas in developing countries those most frequently affected are aged between 35 and 64. This means that in low and middle-income countries, type 2 diabetes affects many more people of working age, which has a profound effect on economic productivity.
Of course, type 2 diabetes treatment and care are not yet routinely or widely available in developing countries and, when treatment is available, it is rarely free. For individuals in developing countries, the out-of-pocket costs to treat type 2 diabetes are very high, often leading households to sell their possessions to pay for their treatment. In India, for example, treatment costs for an individual with diabetes make up, on average, 15% to 20% of household earnings and many poor people often cannot afford to get treatment or cannot access it easily.
At a national level, the type 2 diabetes epidemic threatens to overwhelm health systems and, potentially, to reverse development gains made in low-income countries—countries where we are spending a lot of money. Therefore, through DfID, more targeted investment is needed to support fragile health systems and stretched national healthcare budgets and to prevent economic progress from being undermined.
However, there is yet another threat. Low to middle-income countries now face a double burden of disease: rates of non-communicable diseases, such as type 2 diabetes, heart disease and stroke, are on the rise, but at the same time low to middle-income countries are still grappling with high burdens of infectious diseases, such as TB, HIV/AIDS and malaria.
In TB-diabetes co-infection, high blood sugar levels suppress the immune system, making individuals with latent TB—someone who does not have symptoms, is not sick and cannot spread the disease to others—more at risk of developing active TB. This is similar to how HIV undermines the immune system and makes individuals living with the virus more susceptible to developing TB. People with type 2 diabetes are three times more likely to develop TB, and type 2 diabetes is responsible for causing an estimated 15% of all TB cases. Brazil, China, Indonesia, Pakistan, India and Nigeria together account for 52% of people living with TB and 50% of all people living with diabetes. This is important for the UK, because of the strong ties that we have with these countries, and we must also not forget the fact that some parts of London have the highest incidence of TB in Europe.
What we are seeing happen now with TB-diabetes is similar to what we saw happen with TB-HIV. When HIV rates rose in the early 1990s, with the immune systems of people with HIV being weakened, that caused TB rates to skyrocket, particularly in Africa. We must make sure that history does not repeat itself by tackling TB-diabetes head on. Failing to act could lead to significant increases in avoidable disability and early death and could have disastrous consequences for health systems. There needs to be more integration between TB and diabetes programmes, similar to how it has been essential to integrate TB and HIV programmes. Perhaps the Minister could reassure us that NHS England in the UK has collaborative frameworks in place to enable this to happen. Could the Minister also reassure me that the Department of Health works collaboratively with DfID to develop policies on TB-diabetes and could he say whether those policies enable more co-ordination between programmes and countries with a high burden of TB and escalating rates of diabetes?
Finally, I know that preventing diabetes and promoting the best possible care for people with diabetes are a key priority for our Government, which is to be welcomed. However, not only does more need to be done to educate our own population about type 1 and type 2 diabetes, but we must also ensure through our aid programme that this epidemic is not forgotten. We are world leaders in providing excellent health services and we have a significant and well-developed research base. That puts us in a strong place to provide a global leadership role and we should embrace that in this key area.