Diabetes: Tailored Prevention Messaging

Debate between Jim Shannon and Jo Churchill

Thursday 24th October 2019 Westminster Hall

[Jo Churchill]

I truly will. That brings me to the hon. Member for Heywood and Middleton, who wrote to me about the meeting she mentioned. I have written back to say I would really appreciate the chance to meet her to discuss the various challenges. Having already had an obesity roundtable and a Green Paper roundtable, I know there is an awful lot of overlap in these areas. I feel we could work on that. If she will forgive me, I will get back to answering the hon. Member for Strangford.

Over 2018 and 2019, the diabetes prevention programme achieved full national roll-out, making England the first country in the world to achieve full geographic coverage, which is a great achievement. There is strong international evidence demonstrating how behavioural interventions that support people to maintain a healthy weight and be more active can significantly reduce their risk of developing the condition in the first place, which I think the hon. Member for Washington and Sunderland West referred to. The programme identifies those at high risk and refers them on to behaviour change programmes, which, as we know, is very much more likely to lead to positive results than sending someone away and telling them, “Get on with it yourself.”

The NHS long-term plan commits to doubling the capacity of the diabetes prevention programme to up to 200,000 people per year by 2023-24 to address the higher than expected demand and specifically to target inequalities. Furthermore, NHS England and NHS Improvement have enabled digital routes to access the programme, which will support individuals of working age in particular. As the hon. Member for Strangford pointed out, it is important that people can get information where it is most accessible. Those digital routes went live across nearly half the country in August 2019, and full digital coverage is expected in the next year.

The hon. Members for East Londonderry (Mr Campbell) and for Upper Bann (David Simpson) spoke about children. That is where the prevention Green Paper, “Advancing our health: prevention in the 2020s”, targeted support, tailored lifestyle advice and personalised care using new technologies will all have an effect. I take on board the point that there have been a lot of consultations and so on in this area. We received an awful lot of responses to the Green Paper and we are considering them, but I will make announcements shortly, particularly on ending the sale of energy drinks, on promotions and on one or two of the other areas the hon. Member for Strangford mentioned, so watch this space. I have been in position for only 12 weeks, but this whole area is of huge importance to the nation’s health. I hope that, if we can target children and young people through their lifetime, we can stop problems later on.

[Jim Shannon]

I am very encouraged—I think we all are—by the Minister’s response on that point. When she brings recommendations and legislation forward, I think she will find that Members across the House will be very supportive of them. I am greatly encouraged by what she says.

[Jo Churchill]

I thank the hon. Gentleman. I hope Members noticed that yesterday we launched the National Academy for Social Prescribing. I think Members across the House understand that people do not always need a tablet when they go to the doctor. The hon. Gentleman spoke about the importance of mental health support, referral to exercise classes and various other things for people with diabetes. I was lucky enough to go to Charlton Athletic yesterday and see some brilliant things being put into practice in the community, where the messaging was much better received. Twenty-six per cent less men feel able to go and talk to their doctor, so perhaps we can give them the message at their football club, their rugby club or just their workplace. That applies to women too, now they have much busier lives and many more of them work. Targeting people appropriately so we can get messages to them in the right places about how they can look after themselves better has to be the right way to go.

A dedicated Type 2 Diabetes Prevention Week campaign was launched in 2018. The campaign aims to raise awareness among healthcare staff in primary care about the causes, complications and groups at risk of type 2 diabetes, which I think was mentioned, and the services available to manage patient health. Following the success of the last two years, the campaign will be rolled out again in 2020.

The hon. Member for Strangford mentioned the importance of ensuring that messaging to support those with diabetes is tailored to relevant sectors of society. In June 2018, Language Matters was launched to encourage positive interactions with people living with diabetes, to ensure tailored messaging to relevant sectors of society and to expand routes into the prevention programme. It is a little like health checks: people have to know about it, and know how to use it, in order to access it.

In 2017-18, and again in 2018-19, an additional £5 million per year was made available for diabetes specialist nurses. There is a need to beef up support in that area. Diabetes UK, which I have already met—I happen to be lucky enough to have known its chief executive for some time, and it was at the obesity roundtable, as was Cancer Research UK—does a fantastic job in helping to spread that message and to provide information. Another message that has come out is “think pharmacy first” to empower pharmacists. The 11,500 pharmacists on our high streets are a resource that is just waiting to be used, and I hope the new pharmacy contract will be the start of that relationship.

We will do more in the future to support those with type 2 diabetes. There are a range of apps in the NHS app store to further overcome many of the issues people currently face with traditional, face-to-face structured education. NHS England and NHS Improvement are developing online self-management support tools called Healthy Living for people with type 2 diabetes. Many in the Chamber will be familiar with DAFNE and DESMOND—dose adjustment for normal eating, and diabetes education and self-management for ongoing and newly diagnosed—as well as other programmes for those living with diabetes.

Healthy Living will consist of a structured education course with additional content focused on maintaining a healthy lifestyle, including content on weight management, alcohol reduction and cognitive behavioural therapy for diabetes-related distress. Once the course has been developed, NHSE hopes to commence its roll-out from January 2020. It will have universal availability, it will be free to users and local commissioners, and it is intended as an online resource to supplement other quality assured digital coaching programmes that can be commissioned in local health economies. However, it will be in addition to face-to-face support, because everyone has a preferred method of getting information.

As the right hon. Member for Leicester East said, the risk of developing type 2 diabetes is higher in black, Asian and minority ethnic communities. I am pleased to say that NHS England and NHS Improvement are working with the Cultural Intelligence Hub to deliver an insight project to support future communications and improve engagement with those communities. The aim is to support an increase in available places on the NHS diabetes prevention programme and the take-up of those places; to raise awareness of type 2 diabetes, its risk factors and complications, and ways to prevent it; and to promote messages.

NHS England and NHS Improvement have invested £39 million in each year of transformation funding. That funding is key to improving structured education, reducing variation and helping with foot care for diabetic foot disease.

I agree that new technology is key to the management of diabetes. I hope the shortage in the supply of flash monitors will be overcome shortly, but what fantastic news it is that so many people, including many of our colleagues in this place, now have access to those monitors. I know how much difference they can make to people’s lives, and that is only to be welcomed.

I thank the hon. Member for Strangford for highlighting this issue. I look forward to meeting the all-party parliamentary group and working further with it on these messages. I hope I have demonstrated that we are working hard so people can receive the treatment and support they need to live longer but enjoy quality of life.

Community Pharmacies

Debate between Jim Shannon and Jo Churchill

Wednesday 2nd October 2019 Westminster Hall

[Jo Churchill]

On the matter of reimbursement, which was also raised by the hon. Members for York Central and for Westmorland and Lonsdale, we seek to ensure a fairer system of reimbursement for pharmacy contractors and value for money for the NHS. I am sure we would all agree that that is the challenge that we face the whole time. That is why, in July, we launched a consultation on community pharmacy drug reimbursement. We have engaged widely with pharmacy stakeholders and have had an excellent response. We will consider all those responses fully and set out plans for the fairer system in due course. I appreciate that the response will be, “But it’s needed now,” but a pharmacy is a private business, and reimbursement is not pharmacies’ only form of income. What I am talking about will take a shift. There is an acknowledgment that that shift—that transition—will need to be assisted. There is also an independent funding stream from the flu vaccine, for example. I would like to see—and have been discussing with officials—whether a broader vaccine programme could be rolled out through pharmacies as well, and reimbursed. We know we need to do better.

[Jim Shannon]

The Minister has so far given a comprehensive response to our concerns. I suggested in the debate that, when it comes to medical attention, pharmacies could do more to oversee small things such as the flu vaccination that she referred to and diabetes and glaucoma. As other hon. Members have mentioned, there are small things that pharmacists could do to take the pressure off GPs. Is that something the Government would consider—giving more responsibility to the pharmacist and taking pressure off GPs and accident and emergency?

[Jo Churchill]

If the hon. Gentleman will just bear with me for a second, he will hear me largely repeating what the right hon. Member for Rother Valley said when he so beautifully laid out the skills and expertise that lie in the pharmacy sector, and how they can be utilised better.

As I said, the deal sets out a programme of work we shall be working on. Our aim is that collaborative working across the system will deliver an integrated and accessible community health service for all. I want to name-check the hon. Member for Strangford here because, as he articulated, communication lies at the centre of this issue. One instance might be the digital expertise that the hon. Member for Washington and Sunderland West said exists in Gateshead, where people’s greater readiness to get services from pharmacists, and the fact that pharmacists can do more, is having a positive effect for patients.

First, pharmacists told us that we must utilise and unlock the potential of the highly skilled pharmacy teams that are embedded in communities throughout the country, including in the constituency of the hon. Member for Halifax, with everyone celebrating what pharmacists can deliver. That is why the settlement aims to deliver more fulfilling, patient-facing careers for community pharmacists and technicians, as highly valued members of the NHS team. Additionally, populations will be helped by much better services.

Secondly, pharmacists told us that they wanted continuity. The settlement funding over five years gives certainty, and gives community pharmacists the confidence to invest in their business. However, there is no one size fits all. Being in the centre of a town is not the same as being in a rural village. Looking at these things in the round is why we want this to be collaborative.

Maraviroc and Progressive Multifocal Leukoencephalopathy

Debate between Jim Shannon and Jo Churchill

Monday 30th September 2019 Commons Chamber

[Jo Churchill]

I thank the hon. Lady, but I return to the fact that it is a judgment for clinicians to make; it is not one for me to make at the Dispatch Box.

My colleague Baroness Blackwood rightly said this summer that we need a national conversation on rare diseases to identify the big areas on which we need to focus so that we can offer the best possible care for rare disease patients and their families, who are often affected by what their loved ones are going through. I could not agree more so, starting this autumn, we will be engaging with patients, researchers and clinicians to gather evidence and identify the major challenges faced in this field.

[Jim Shannon]

I am pleased to see the Minister in her place. I offer her congratulations; it is well deserved.

Will money be set aside at the end of the consultation to address the medicines that are needed for those rare diseases? If money is not set aside, it will not go anywhere.

[Jo Churchill]

I am not in a position to say. Although each cohort is small, the overall rare disease community is large. That is why such debates make an important contribution to the broader conversation. I am grateful for how they raise awareness of the rare disease community, which comprises some 3.5 million people in this country.

Quality in the Built Environment

Debate between Jim Shannon and Jo Churchill

Wednesday 13th December 2017 Westminster Hall

[Jo Churchill]

My hon. Friend is in an area of the country where there is large pressure on the number of houses being built. She brings a pertinent point to the debate. It is difficult to be independent when not independent of the entire system. I will come to that point.

There are four different redress providers in the system: the housing ombudsman; the property ombudsman; ombudsman services; and the property redress scheme. However, there are still gaps. A key point is that we need simplicity in any system we develop for the individual homebuyer, for them to understand how to navigate the system.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this forward. I am chair of the all-party parliamentary group for healthy homes and buildings, and therefore this is a very important issue for me. We are doing an inquiry at the moment looking at noise, acoustics, heating, windows and finish so that we have homes that are habitable for this day and age. Does she agree that being environmentally responsible and promoting social integration—the designer sometimes does not see that important issue—are key components in delivering quality in the built environment, and that planners and indeed Government need to give consideration to that?

[Jo Churchill]

I could not agree more. Many of us sit on different APPGs, and the hon. Gentleman brought up environmental issues and the fact that people’s homes should use modern-day construction methods that give them the cheapness to be able to run a home efficiently. It should not impact on the environment. We should be using what skills we have to make homes healthier for people and communities. I trust that my hon. Friend the Member for Henley (John Howell) may well come on to the importance of design within the environment. The hon. Gentleman is right. Also, building in the vernacular is extremely important in certain areas of the country, making people feel like they are rooted and have more of a sense of place.

The NHBC guarantee currently covers most builds in the sector and purports to be independent, as my hon. Friend the Member for Hornchurch and Upminster (Julia Lopez) said. However, in the main, large house builders fund the organisation, and any surplus funds are returned to the house builder at the end of the guarantee period. It is my belief that that skews the system and leaves it unable to act clearly on the side of the consumer.

Large house builders obviously seek to make a profit, and I have no issue with that, but some of our largest house builders have paid themselves tens of millions of pounds—in one case it was hundreds of millions of pounds —in dividends this year. When we have such poor outcomes on quality, I find that challenging. For an industry that has overseen a substantial rise in profitability over recent years to oversee an equal decline in customer satisfaction ratings and a fall-off in skills training, for which it sees itself as only partially responsible, is unacceptable. Just 10 companies build half of new private homes. Arguably, that does not aid competition. As the number of new homes has risen, satisfaction has fallen. The time for Government action to step into the broken market is arguably upon us.

Research indicates that investment by these companies should be targeted at skills. They build thousands of units each year—thankfully, they built somewhere in the region of 220,000 to 230,000 units last year—but they directly employ very few skilled workers and are largely reliant on subcontractors across the industry, where the whole basis is to drive down costs rather than concentrate on quality. An acute shortage of good site managers compounds the problem, yet they seem reluctant to train and to ensure quality and delivery. Worryingly, the industry estimates that to carry on building in the same way we would need to double our workforce. My question to the Minister is why we are not building construction training schools at the heart of large sites—even those sites subdivided between different house builders—so that individuals can earn while they learn and be proud of the homes in which their communities live.

It is not an industry into which young people will be encouraged to go, given the working in all weathers, the cyclical nature of the industry and the prospects it holds. The difficulty for small builders and subcontractors in accessing and providing employment for training over the course of a national vocational qualification period means that, if work dries up and they have apprentices, they potentially fail to enable them to complete their training. There is no co-ordinated thinking. If someone is on a price for a contract, they are less likely to spend time training employees—they will be looking to optimise their income.

Large house builders take much of the gain from others’ training, but do not always feed back down the supply chain, nor do they incentivise or reward the benefit they ultimately get from others. That is short-sighted, since it is those skilled craftsmen who will ensure continuity of supply in the future. Having an independent clerk of works or similar who would look at the quality of the work as the construction is going up is one solution. Currently, there are some 700 inspectors in the industry, which equates to their inspecting some 317 units each year. We know that houses are not being inspected properly.

What about the consumer? Unless there is a challenge to the system to ensure that quality standards are driven up, there is little encouragement for those house builders who produce a poor quality product to raise their game. Some large producers concentrate on quality, but that is often reflected in the price. Should quality be a question of either/or? Snagging on new house builds ranges from issues such as backfilling cavity walls with site rubbish to splicing broken roof trusses, leaky roofs, poor electrical work, insufficient insulation and the repointing of joints on walls where purposeful demolition and reconstruction should have happened. My hon. Friend the Member for Hornchurch and Upminster alluded to the problems she had.