Health: Diabetes

Lord Morris of Aberavon Excerpts

Tuesday 19th March 2013 Grand Committee

Asked By

[Lord Morris of Aberavon]

To ask Her Majesty’s Government what is their assessment of the cost to the United Kingdom of type 1 diabetes; and what plans they have to improve treatment of that disease.

[Lord Morris of Aberavon]

My Lords, the question for this debate on diabetes follows on from the debate on diabetes initiated by my noble friend Lord Harrison on 29 November, when the House had a caring, helpful and painstaking reply from the Minister—who of course is responsible for health only in England. However, since the preponderance of contributions then were on type 2, it was not surprising that the Minister’s reply on diabetes type 1 could be measured in half a column of Hansard.

I shall particularise again on type 1, about which I have already declared a family interest. In sheer numbers, the lion’s share of the diabetes problem is type 2, where some individual action can be taken by those who suffer. Not a great deal can be done for type 1 except a great effort to mitigate the problem by management of the disease, including the use of insulin pump therapy where appropriate. I make three points. First, 400,000 people are currently affected by type 1, of which 29,000 are children, and incidence is growing at 4% a year. Secondly, lifestyle intervention will not prevent the increase in the number: obesity is not the problem. Thirdly, only research will find a cure for type 1. It is at present incurable and can strike at an early age. My aim in raising the subject is to seek once again to disaggregate the cost of diabetes type 1 from type 2, both in the cost of treatment and the provision of funds for research to find a cure. I have so far failed. The Department of Health does not currently calculate the cost in the way I would hope. Why can it not do so in future? That is my first question. Specifically, what are the obstacles?

We have estimates. The direct and indirect cost of treating type 1 is said to be of the order of £1.9 billion. With the projected increase of sufferers, the cost will be even more astronomical. Until the department is able to tell us what, in its view, is the order of expenditure, we cannot hope to make good decisions as to what expenditure is appropriate. We now have the opportunity of the shortly-to-be-born National Health Service Commissioning Board to look afresh at the two different types of disease. Aggregation of expenditure under the general figure of diabetes will not help the boards, as the Minister said, to,

“guide local commissioners to improve outcomes for people with the condition”.—[Official Report, 29/11/12; col. 333.]

I rely on those words. I am advised that representations were made to the Department of Health that type 1 sufferers are a small group—though not so small at 400,000 people—with the need for highly specialised support. However, the request that type 1 sufferers be commissioned separately or at least differently has not been approved. How is that decision justified? That is my second question. Since this is the second time that I have raised this matter in debate, perhaps the Minister could expand his reply tonight by writing to me with the department’s detailed reasoning. I would like that.

It can be of enormous material help to type 1 sufferers to provide insulin pump therapy and its monitoring as an option. There is immense international variation in the provision of pumps. In this country, as with the management of diabetes type 1 care there was a postcode lottery in the past. I was encouraged by the Minister’s reply that 8% now had pumps here in this country. He went on that,

“we still need to go further to achieve the 12% to 15% advised by NICE”.—[Official Report, 29/11/12; col. 336.]

I welcome what he said.

Specifically, what are the obstacles to enable this and why have we been so slow? It is estimated that the savings to the National Health Service that could be achieved by reaching the NICE benchmark would be £30 million and £60 million a year. We are talking about big sums of money. I am told that in the United States, probably 40% use the subcutaneous infusion. Norway, Austria, Germany and Sweden have higher figures of use than us, while of course other countries have lower ones. I have already questioned why the then health Minister, Mr Paul Burstow, was able to write to me on 25 April last year saying, “that we were generally in line with the United States”. That was a significant reply which took a great deal of wind out of my sails as I had relied on anecdotal accounts of disparity. It was a crucial response. How could the department have advised him to write as he did? Given the evidence that has emerged, that is now my third specific question for the Minister.

I come now to research. In addition to government funding, a great deal of work is done by charities, and I welcome the work of the Juvenile Diabetes Research Fund. I understand that the Wellcome Trust is also active in Cambridge, Oxford, UCL, Leeds and Hanover in Germany. Since the last debate, I have been to Oxford to discuss with Professor Paul RV Johnson, the director of the Oxford pancreatic islet transplantation team, its work on an artificial pancreas. JDRF believes that research into closed loop glucose control stands on the cusp of a breakthrough that will represent the first step towards improving the lives of millions of people with type 1 diabetes. They will be provided with an artificial pancreas. This is where we are and that is what they believe.

Progress can be achieved by a partnership between experts in various disciplines and industry for development, along with the regulatory agencies to ensure safe management. The need for disaggregation is exemplified by the fact that in 2009 the government spending bodies committed £51 million to fund research into diabetes, but of this only £6 million was applied to type 1 diabetes. I was encouraged by the progress being made at Oxford and the successes achieved with adults so far. I am sure I shall be further encouraged when I visit Cambridge and discuss the matter with the team led by Dr Roman Hovorka. While both the Government and the charities have to exercise care in the funding of projects, I hope that the Minister will himself examine whether there are any bureaucratic problems over the supervision of the spending of research funds, both public and private. It would be a pity if researchers had to spend an undue amount of time meeting overprescriptive requirements regarding the minutiae of how money is spent.

I made this point in the last debate, but I shall repeat it. There has never been a real budget for type 1 diabetes services. They have been developed on the back of academic interest and the clinical recognition of need. What has been done so far is a great tribute to the professionals. I earnestly hope that the commissioning boards will not miss the opportunity properly to recognise that type 1 diabetes is a disease with many different causes and characteristics from those of type 2 diabetes. We should ensure that the good research work now in hand is encouraged and adequately funded so that fresh hope is brought to the 400,000 sufferers of type 1 diabetes—and their number is growing each year.