Health: Diabetes

Lord Harrison Excerpts

Thursday 2nd July 2015 Lords Chamber

Asked by

[Lord Harrison]

To ask Her Majesty’s Government what steps they are taking to assist those with type 1 and type 2 diabetes to educate themselves about the management of the disease.

[Lord Harrison (Lab)]

My Lords, I welcome the noble Lord, Lord Prior, to the fight to beat diabetes. He is a doughty warrior, as are all my other colleagues who join me today to focus on educating all diabetics—types 1 and 2—to manage their condition better through structured education and training.

Believe you me, managing diabetes is a pain in the neck. For someone with type 1 diabetes, it means constantly estimating how many carbohydrates you have eaten and figuring out the right amount of insulin to inject while taking into account the amount of physical activity you have taken. For someone with type 2 diabetes, it means learning how to treat the condition with diet and exercise, and possibly also coming to grips with having to take medication and insulin. For everyone living with diabetes, it means being aware of potential complications that can develop. It means not only keeping a careful watch over your blood glucose levels but having your cholesterol and blood pressure checked, looking out for your eyes and examining your feet. Everyone with diabetes needs to understand what the condition means for them in relation to holidays, employment, driving, maintaining a balanced diet and being physically active.

There are currently 3.9 million people living with diabetes in this country. If this trend continues, that will rise to 5 million by 2025. The NHS already spends 10% of its budget on diabetes but the majority of that is spent on treating complications that are largely preventable through good care. But when people do not have the necessary skills and knowledge to manage their condition, their risk of developing nasty complications such as heart disease or kidney failure shoots up. Such complications are not only expensive to treat; they are devastating for the individual and often lead to early death. For example, diabetes is responsible for more than 135 amputations every week, but diabetes-related amputations are avoidable. We can do more to help people reduce the risk of developing complications that result in amputation by offering the opportunity to attend diabetes self-management education.

When I was diagnosed in 1969, I was never offered any form of diabetic education. Like many people living with type 1 diabetes, I learned over many years of private trial and error how to adjust the insulin to what I was eating. Diabetes self-management education now has an opportunity to make a marked difference to diabetes care. It enables diabetics to take charge of their own care, reduces the risk of developing complications, improves individuals’ well-being and has the potential to save the NHS money and allow valuable resources to be deployed elsewhere. Despite these clear benefits, according to the latest data published by the National Diabetes Audit, fewer than one in six people newly diagnosed with diabetes has been offered access to a diabetes self-management course. This number is lower still for all people who are currently living with diabetes.

The All-Party Group for Diabetes recently did a year-long inquiry into the low take-up of diabetes education. We found that many diabetics had never been offered an opportunity to attend self-management education. We discovered that too few such courses were commissioned across the land. In my own Cheshire and Merseyside Strategic Clinical Network, only three in 10 diabetes patients said they had ever been offered access to a programme.

Even when diabetes education is commissioned, barriers arise. Too many GPs are lukewarm in encouraging patients to attend these education courses. Information about participating in them is too scarce, so patients do not always understand the benefits. Another barrier is that even where there is diabetes education, there are simply too few courses offered, so the newly diagnosed diabetic does not get on to the course in the first place, and thereby benefit. Other barriers include having the wrong places to meet for such courses or long periods of time off work. Could the Minister look into whether more corporate social responsibility might be taken, to the advantage of the firms involved, to encourage diabetics to take these courses as time off work to improve not only opportunities for themselves but the contribution they make to the firms they are involved in?

However, there is substantial evidence that these barriers can be overcome and uptake rates can be increased. The Health Foundation’s work on person-centred care and diabetes has demonstrated that in helping people help themselves, we can improve the monitoring of diabetics so that they self-monitor blood glucose levels, take appropriate medication and go for regular eye examinations. Its Co-creating Health programme showed how self-management support programmes have helped to improve the knowledge, skills and confidence—collectively known as patient activation—of people in managing their own condition. Diabetes UK has also outlined a series of strategies that are being used across the United Kingdom to dramatically improve the number of people attending. How does the Minister respond to what Diabetes UK has done?

Access to diabetes education is a real problem for everyone, but particularly children. We have programmes such as DAFNE for type 1 diabetics and DESMOND and X-PERT for type 2, but they are not tailor-made for children. Can the Minister say a little more about that and the carers involved? If a mother needs to inject a baby or a child, that produces potential psychological problems. We should be running education courses for carers as well, in my view.

We would also advocate education for healthcare professionals, who too often do not fully understand the opportunities that arise, especially when new technologies appear. Again, will the Minister address that in his reply? Is there also a role for pharmacies? I have found that one of the most useful places to get information on treating my diabetes is from the very helpful Morrisons pharmacy in Chester. Can we take opportunities such as that?

A big worry I have, which I hope the noble Lord might address, is that I do not know whether the very useful Patient Experience of Diabetes Services survey will persist. I understand that Jane Ellison, the Public Health Minister, is looking at it, along with the national clinical audit. Someone wrote to me recently following the diabetes think tank to say:

“At a time when we know the resources are tight, it is a crime not to capitalise, through patient education, on the biggest resource we have—the patients themselves”.

I wonder whether the Minister might reply to that.

I conclude by saying that we need to improve the outcomes for all people with diabetes and to reduce the cost to the healthcare system. Will the Minister explain how NHS England plans to deliver on its promise, made in the five-year forward view, to support people in managing their own health and to invest in self-management education courses? Will he commit to setting up the necessary infrastructure and governance arrangements to do that?

It was a great loss when Adrian Sanders, the former chair of the All Party Group for Diabetes, lost his seat at the last election. He told us that he had two constituencies: the one he lost at the election, and all the diabetics throughout the country. He served them well, and the Minister can do the same.