Health: Diabetes

Baroness Wheeler Excerpts

Thursday 2nd July 2015 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I, too, congratulate my noble friend on securing this debate and on focusing on the key issue of how people with diabetes can be helped and supported to manage their condition. My noble friend has done a great service campaigning for improved diabetes care over a number of years and ensuring that this important issue remains an ongoing focus and priority for this House. As well as playing a significant role in the development of the strategy for diabetes care, he speaks from his personal experience as a diabetic and his contribution therefore is all the more valued and powerful for that.

This has been an excellent, authoritative debate and, at this stage, the stark facts relating to diabetes have been comprehensively covered by previous speakers. The 3.5 million sufferers could rise to 5 million by 2025 unless we are able to make substantial progress on achieving wider access and take-up of the education and management programmes we are discussing today. The most alarming statistics of all are that an estimated 24,000 people are dying each year when better management and care could have prevented their deaths; and that 10 million people are at risk of developing type 2 diabetes.

Like other noble Lords, I commend the excellent APPG report, Taking Control, which shows the way forward for addressing problems of access, availability and quality of diabetes education. I also pay tribute to the work of the diabetes think tank which, as we have heard, brings together key stakeholders and policymakers from the diabetes community. I was not able to attend its meeting this week but I read its pre-meeting documentation underlining the importance of the future plan for diabetes properly addressing the needs of people already living with the condition. That is really what today’s debate is about. Getting a better balance between this and action to prevent people getting diabetes is crucial and there is a wide recognition that in the past this balance has not been achieved. It stresses, for example, that repeatedly linking diabetes with obesity risks stigmatising people with type 2 diabetes and ignoring the needs of people with type 1 diabetes whose condition is not preventable.

The APPG report also underlines the importance of focusing on ensuring that everyone living with diabetes, whether type 2 or type 1, has the necessary skills and support to manage their own health and reduce the risk of devastating consequences and long-term complications. My noble friend Lord Harrison and other noble Lords have outlined the powerful case on the cost effectiveness of diabetes education and the importance of ensuring that the NICE guidelines and technical appraisal programmes on the provisions of education are adhered to. Patient education programmes help people with diabetes to understand more about their condition and to develop the skills needed to effectively self-manage their diabetes, as we have heard from noble Lords across the House.

Recent economic analysis undertaken by the York Health Economics Consortium, for example, showed that the DAFNE course for people with type 1 diabetes will pay for itself within four to five years due to the reduced complication rate expected from improved management of an individual’s diabetes. Patients with type 1 diabetes are monitoring and adjusting their treatments several times a day, making clinically significant decisions, so the absence of attending structured and ongoing education for these patients is particularly serious in terms of reducing the risk of serious complications resulting from poor management.

Noble Lords might have seen a recent feature article in the Health Service Journal which starkly brings this point home. It told of the experience of a 19 year-old student, who after a shock diagnosis of type 1 diabetes, was sent home from hospital with an injecting kit and practically no educational back-up. The result a week later was her first hypo. She said:

“The hospital wanted to see me inject myself before I went home to make sure I could do it. I was given a blood glucose monitor and a strips box, but broke it. I really felt I was on my own and I didn’t know what I was doing”.

It was not until three years later, when she moved to London, that she was offered her first structured education course.

For both type 1 and type 2 diabetes, the APPG report refers worryingly to the mountain of evidence it received from experts—including clinical staff, academics, academic health science networks and strategic clinical networks—calling for what it refers to as,

“the ongoing deadlock in the provision and uptake of diabetes education”.

GPs and hospital staff must be the advocates and champions of structured education programmes, but the APPG makes it clear that a significant culture shift in the attitudes of some GPs and other staff as to the importance and efficacy of the courses needs to take place.

These are key workforce development issues. Many doctors report concerns that aspects of training and development in the delivery of diabetes care beyond the hospital have not caught up with how diabetes care needs to be delivered today and in the future through different care models, and in settings away from hospitals and GP surgeries with multidisciplinary team involvement. For example, the APPG cites advice on identifying and using new diabetes technologies as “patchy at best”. Are the Government confident that Health Education England’s training and development strategies are able to address these key issues? Noble Lords have referred to the APPG’s concerns on the lack of emotional and psychological support and mental health issues, such as anxiety and depression, which are often experienced by people with diabetes. I look forward to the Minister’s response.

The noble Baroness, Lady Manzoor, spoke about the international perspective and particularly the key link between TB and stroke. Like her, I should like to talk briefly about diabetes and stroke in this country. Diabetes is a major risk factor for stroke and one-fifth of hospital admissions are for people with stroke, heart failure or heart attack. Having type 1 or type 2 diabetes almost doubles your risk of stroke and is a contributing factor to 20% of strokes in England, Wales and Northern Ireland. Good management of blood glucose, blood pressure and cholesterol is essential. The Cardiovascular Disease Outcomes Strategy acknowledges the common risk factors and the interlinking nature of cardiovascular disease—including coronary heart disease, stroke, hypertension and diabetes—and the fact that people with more than one CVD condition can often receive care from multiple and different teams in a disjointed way. Managing the diabetes condition in these circumstances can be particularly challenging.

I understand that NHS England is now reviewing the programme of work on CVD, but it is far from clear how they propose to take the Cardiovascular Disease Outcomes Strategy forward. How is the strategy to be implemented and how it will relate to NHS England’s prevention plans, including the National Diabetes Prevention Programme?

Support from carers, families and health professionals is key to successful self-management. People without carers or family support have especially to rely on a consistent and active two-way relationship with the health team members involved in their care. Caregivers play a key role in their family member’s diabetes management. They help the person they care for to make healthcare decisions and to stick to a care management plan. Helping carers to better understand the condition is vital. The access problems and postcode lottery situation in the local availability of education courses affects carers and family members as well as the cared for, so family-focused education is important, as are localised peer support programmes.

When researching for this debate, I saw another article about a young carer. It shows just what family members face in helping to support their loved ones. I am a carer and a trustee for our local carer support group in Elmbridge. The local community magazine reported a very moving interview with a 16 year-old carer who looks after her mother who has diabetes. She said:

“I’ve helped her from a young age, testing her blood sugar level and getting sugary snacks when she needs them. When the disease took its toll on mum’s sight, I also started shopping, cooking, collecting prescriptions. And I support her when she feels down … I love helping mum … but caring comes with responsibility and I often miss out on seeing friends. Plus if mum needs help and I have homework to do, the homework has to wait”.

The five-year forward review promises significant investment by NHS England in self-management and educational courses for people with specific conditions. I look forward to hearing from the Minister how this pledge is to be translated into addressing the challenges and problems for people with diabetes, their carers and families, as raised by the all-party group and noble Lords today.