NHS: Diabetic Services

Baroness Masham of Ilton Excerpts

Thursday 29th November 2012 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I thank the noble Lord, Lord Harrison, for raising the issue of the need for good managed services for people with diabetes today. I consider the noble Lord to be the expert patient for diabetes in your Lordships’ House.

The All-Party Parliamentary Group on Diabetes is very active and effective, keeping parliamentarians from both Houses up to date with the many needs of people of all ages living with diabetes. Diabetes spans several government departments—first, the NHS—but it is also a serious public health issue. With many aspects of diabetes going over to local authorities, I hope Public Health England will take diabetes as a priority. Unless primary and secondary care services work closely together, the treatment of diabetes will suffer.

I cannot stress enough the importance of the diabetic nurse and I am glad that that has already been stressed by the previous two speakers. Diabetic nurses can be the important link between primary and secondary care. They teach patients and their carers about diabetes and also community nurses. They are a vital resource for the management of diabetic services. When there are problems with insulin and patient stability, the diabetic nurse is often at the end of the telephone to give advice.

Diabetes often causes extra complications. Some years ago, a well known and well liked television presenter, Richard Whiteley, from Yorkshire, who hosted the programme “Countdown”, went into hospital for a heart operation, but sadly died due to complications because he was diabetic. More research needs to be undertaken into the causes of type 2 diabetes. I read in the press yesterday of a link between type 2 diabetes and food sweeteners:

“A sweetener used in food manufacture could be partly to blame for rising rates of type 2 diabetes … Countries that use large amounts of high fructose corn syrup (HFCS) have higher rates of the disease than those that consume little, says a new study”.

Professor Stanley Ulijaszek from Oxford University, who co-led the study, said:

“This research suggests that HFCS can increase the risk of type-2 diabetes, which is one of the most common causes of death in the world today”.

The syrup is widely used in drinks and processed foods because it acts as a sweetener, helps to keep food moist and is cheaper than regular cane sugar. Tim Lobstein, director of policy for the UK-based International Association for the Study of Obesity, has said that,

“if HFCS is a risk factor for diabetes—one of the world’s most serious chronic diseases—then we need to rewrite national dietary guidelines … and foods should carry warning labels”.

Diabetes can be a very complex condition. During this time of change in the NHS, many people are unsure of where their services will be coming from. There is dismay when people hear of the closure of A&E departments and walk-in clinics. Evenings, weekends and bank holidays mean that for long periods it is impossible to see a GP. There are real risks for people living with diabetes when things go wrong. They may have a hypo and need urgent help. Diabetes has become a ticking time bomb with increasing rates of the condition in many places around the world. When we were on holiday in Barbados some time ago, a taxi driver told us that he took the day off every Sunday in order to bicycle from one end of the island to the other. But he also said that the sugar workers used to slash the sugar cane manually, using much sweat and energy. Today they sit on tractors and everything is done mechanically. Diabetes has hugely increased in modern life.

Recently we saw an interesting presentation about the diabetic leg. We were told that the West Country is the worst region for amputations due to infections in the leg as a result of circulation problems caused by diabetes. Specialist centres in London ensure that people’s legs can be saved through expert vascular surgery. There seems to be a postcode lottery in different parts of the country.

This week, international attention is focused on HIV and AIDS. When someone has HIV/AIDS and diabetes, sometimes along with other co-infections, treatment can be very complicated, and some HIV drugs can encourage the development of diabetes. I have discussed this with Dr Jane Anderson, a marvellously dedicated HIV specialist who works at the Homerton University Hospital. She has seen co-infected patients with problems. These patients need the expertise of endocrinologists and HIV specialists to sort out their complications.

For good management, all those who are involved with those who have diabetes must be well educated about the condition. They may be teachers, medical personnel, or those involved in sports and leisure or food and drink, but it is diabetics themselves and the people closest to them who are the most important of all. The aim should be to keep fit within the community and to lead happy and healthy lives.