NHS: Diabetic Services

Lord Brooke of Alverthorpe Excerpts

Thursday 29th November 2012 Lords Chamber

[Lord Brooke of Alverthorpe]

My Lords, I thank my noble friend Lord Harrison for putting this debate before us. I suspect that I come under the category that was just described as “articulate concern”. I am certainly concerned; whether I am articulate remains to be seen.

I was drawn to the report by the Public Accounts Committee. In particular, I want to address the recommendation where it talked about the projected increase in the diabetic population having a significant impact on NHS resources. It said:

“The Department and Public Health England should set out the steps they will take to minimise the growth in numbers through well-resourced public health campaigns and action on the risk factors for diabetes, such as the link with obesity, and the complications they can cause”.

It is to those that I wish to address my remarks. Before doing so, I offer the Minister, at the end of rather a hard day for him, with quite a battering, some words of encouragement and thanks. I thank the Government for announcing yesterday in a Written Statement that they will consult on the proposal to introduce a 45p minimum unit price for alcohol. That is a brave step forward, on which they are to be congratulated. The figure is different from that in Scotland, but that is the lesser of the issues. I hope that all will come together, including the BMA and the rest of the medical profession, and work with the Government to move forward on this front.

This process will not be easy. It has taken time to get to the consultation stage and plenty of people will try to prevent this new policy being put in place. I have recently spent some time with the drinks and retail industry looking at the Government’s strategic policy on alcohol, and have encountered little enthusiasm for this change. Indeed, we have already seen one legal challenge against the Scottish proposal. I understand that the Bulgarians have a great interest in this matter and will raise question marks and seek a legal challenge. I suspect that there will also be a legal challenge against the Government’s proposal.

As I say, the Government’s action is a step in the right direction. In the past, the important link between alcohol consumption and diabetes has in many respects not been addressed to the extent that I would have hoped. I shall speak primarily about type 2 diabetes, and alcohol consumption causes difficulties in that respect as well as the consumption of high-fat and sugary foods. Drinks, particularly alcoholic drinks, contain a significant amount of sugar, of which nobody who consumes them is aware. Although food and fizzy drink labels show fat and calorific content, alcoholic drinks are totally exempt from any requirement to show energy or calorific factors. This means that people who drink excessively are not only harming themselves in other areas but are particularly at risk of raising their sugar levels, which may lead to type 2 diabetes.

The Minister seemed surprised to hear about what has been going on at the other end of the Corridor, but Dr Phillip Lee MP has said this week that, as a doctor, he believes that type 2 diabetes is self-inflicted in many respects and that, due to cost factors, the department should stop providing free prescriptions for people with this type of diabetes. Like my noble friend Lord Harrison, I hope that the Minister will state very clearly this afternoon where the Government stand on this issue and will refute Dr Lee’s proposition. That is not to say that there may not be some fundamental issues behind Dr Lee’s comments regarding costs in the NHS that we need to address, and I will come to that.

I see a link between drinking, obesity, diabetes and alcohol abuse. I hope that the Government will be prepared to stick to their objectives on that front and resist any challenges that may arise in Europe. I have taken soundings, as that is what we can do in this amazing Chamber, from some of my learned counsel friends who tell me that, if we are challenged in Europe, there is an opportunity for us to fight that very vigorously indeed on the basis of our having a margin of appreciation—that is, because of the scale of the problem with diabetes in the UK, we should have the freedom to act differently on this issue from other countries in Europe, even though the Commission may initially oppose such action.

Similarly, with regard to alcohol labelling, which the Minister knows I have raised previously, I have been encouraged to wait until the Commission comes back to this issue in 2014 because we cannot move unilaterally. Again, noble counsel here tells me that we could use the exemption that I referred to as a means to press the industry to move quickly and require it to move forward and introduce labelling on alcohol products that would show the number of calories in them. We should also think about the energy side of that.

Opportunities are there for us to keep pressing ahead on this front. This links to where we stand on public education, on which I will spend a few moments. Last night I had the good fortune to go to a celebration that was held in the River Room by the Terrence Higgins Trust to celebrate its 30 years of existence and the work that it has done. We were addressed by the noble Lord, Lord Fowler. He is a former Health Secretary who is remembered particularly—this was discussed at some length last night—for the very effective and world-leading public campaign on HIV that he raised in the 1980s and 1990s, and which had such a great impact on public health in this country.

After seeing reference to the emergence of a strategy on obesity, I look to see what the Government will do on that front, too. There have been plenty of other campaigns in addition to the one on HIV. There were campaigns on alcohol and drinking and driving and a range of campaigns on smoking, and they have been very effective. However, we await a national programme to highlight the problems that arise from eating and drinking too much. When can we anticipate something moving on this front? Given the evidence that we face with obesity and type 2 diabetes, such a campaign should be on the kind of scale that we had in the past. In particular, I look to see a Government that will address some of these issues in relation to children. A phenomenal number of young children are now classed as obese, and a growing number in turn will be likely to fall into the group of the 7 million possible candidates for type 2 diabetes.

We must be honest and straightforward in such a campaign. We must recognise that not only must the food and drinks industry be socially responsible but we must seek to persuade people in all the ways we can to accept responsibility for their own health. That means letting people—particularly young people—see that if they do not care for their health in the way that is best for them, there is a distinct possibility that their lives will be shortened, their health diminished and their opportunities greatly reduced. We need to highlight some of the topics that we have been talking about today, such as the risks of amputation, blindness and so on. We should not run away from presenting them to the public at large in a wide-scale programme of action. I hope that the Minister will tell us when we can expect a campaign of major proportions to come forward.