NHS: Diabetic Services

Lord Collins of Highbury Excerpts

Thursday 29th November 2012 Lords Chamber

[Lord Collins of Highbury]

My Lords, I, too, thank my noble friend Lord Harrison for initiating this very timely debate. Five years ago I stopped smoking and subsequently put on weight. I stress that this was not through drink; I had a weakness for sweets. I thank my noble friend for reminding me of that. I had an eye infection and had taken on a very stressful job. My infection got worse and, after using all the available creams from the local chemist, I was finally persuaded to drop into the walk-in centre in Victoria Street, which unfortunately, as we heard recently in a debate, has since closed. The centre nurses helped me with my eye and also gave me a quick check-up that covered blood pressure and heart rate. The result was an urgent referral to my GP for very high blood pressure. The GP undertook a series of tests that led to an early diagnosis of diabetes type 2. I am therefore acutely aware of the need to raise awareness of diabetes, not only to help prevent the condition but to promote early diagnosis.

My early diagnosis and the excellent response of the NHS have meant that I have a chance of avoiding the worst consequences of diabetes. Early preventive action saves not only lives but money. As my noble friend Lord Harrison was right to point out, there is a worrying tendency to put the onus on the individual—it was the Tory Back-Bench MP for Bracknell, not Slough, I must add to the noble Viscount, Lord Falkland. Instead, as other noble Lords have indicated, we should focus more on the food industry that since the war has pumped out high-salt, high-fat and high-sugar products without any proper warnings.

However, as we have heard in today’s debate, there is a genuine fear that, at a time when the priority of diabetes should be enhanced, the new NHS arrangements seem to be removing diabetes-specific leadership, dedicated staff and specific plans. Many noble Lords have referred to the National Audit Office investigation into diabetes care, which found that:

“Diabetes care in the NHS is poor, with low achievement of treatment standards, high numbers of avoidable deaths and annual spending reaching an estimated £3.9 billion”.

In its response, the Public Accounts Committee highlighted how barely half of people with diabetes get the nine basic checks they need to manage their condition, and fewer than one in five has the recommended levels of blood glucose, blood pressure and cholesterol, leaving an unacceptably high number at risk of developing complications, being admitted to hospital and costing the NHS more money. As we have heard from the noble Lord, Lord Kakkar, the Public Accounts Committee also criticised NHS accountability structures for failing to hold commissioners of diabetes services to account for poor performance. He expressed optimism about the future, but I wonder how the new structures will stand up to the challenge of diabetes.

As the noble Lord, Lord Rennard, said, both type 1 and type 2 diabetes can lead to costly and life-shattering complications, including kidney failure, blindness and amputations, which my noble friend Lady Thornton focused on. Amputation is not only devastating, it is expensive. In England between £500 million and £600 million is spent each year on foot ulcers and amputations. I am lucky to see a podiatrist at regular six-monthly intervals. Speaking to my podiatrist, I discovered that as a consequence of the service being moved from the PCT to the local hospital trust, recruitment was frozen. His concern, as he was looking at my feet, was that without sufficient staff regular check-ups would not be carried out, so that instead of preventive treatment, he would be dealing with an increasing number of ulcers and other serious infections.

My noble and learned friend Lord Morris also pointed out that although the major rise is in type 2 diabetes, type 1 is also rising. As was referenced in a Question I put down, the first ever report into mortality from the national diabetes audit was published just under 12 months ago. It found that up to 24,000 people with diabetes are dying in England each year from causes that could be avoided through better management of their condition. About three-quarters of those are aged 65 and over. However, the gap in the death rate between those who have and those who do not have diabetes becomes more extreme when comparing those who are younger. It was truly shocking to learn that so many young people are dying from diabetes. Type 1 is a particularly difficult condition to live with, as my noble friend pointed out, and we need to raise awareness in schools and workplaces. At the end of the day, we need a huge public awareness campaign to help both to prevent and to detect diabetes.

The focus of today’s debate has been on the need for action. As I said at the beginning of my contribution, early diagnosis is key to both saving lives and saving money. We have heard about the NHS Health Check programme, which can help to detect and prevent the onset of type 2 diabetes. As my noble friend Lord Harrison said, implementation of the programme has been poor, and patchy at best. A number of PCTs failed to offer a single person an NHS health check last year, and so far this year the poor performance has continued, with two PCTs having offered no health checks to date. There is considerable variation in the way that PCTs have delivered the programme, and overall its implementation has been poor.

As the noble Baroness, Lady Masham, said, in April next year the responsibility for commissioning the NHS Health Check programme will shift to local authorities as part of their new public health duties. She is right to be concerned about the impact of this transfer on the future sustainability of the programme and the potential for further variation in its implementation.

This morning, I said in my Oral Question on HIV services that supporting self-management is critical. This approach helps people to gain the confidence, skills and knowledge to manage their own health, with resulting improvements in quality of life and even independence. My personal experience of the DESMOND programme has taught me how important this resource can be. Proper care planning, structured education and access to psychological and emotional support are essential if we are to deal with the challenge of diabetes.

In conclusion, I have a number of specific points, many of which have been raised by noble Lords today, but there is one that I want to focus on in particular. Will the Minister ensure that diabetes is given sufficient priority? There is an absolute need for a clinical lead in, and function for, diabetes within the national Commissioning Board. As we have heard, multidisciplinary networks working across all aspects of diabetes care are vital, and local commissioning work is going well for diabetes care.

My final point concerns the health checks. Will the Minister ensure that there is national delivery and national promotion of this vital work to prevent people developing diabetes? Unless there is urgent action on diabetes, thousands more people a year will be condemned to debilitating complications and early death. The time for action is now.