Covid-19: Information Sharing with Police Forces

Lord Morris of Aberavon Excerpts

Tuesday 20th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I reassure the noble Lord that no health information is shared. This is isolation information, not health information. I can tell that the noble Lord is not happy with that. I reassure him that people are asked to isolate for a number of reasons: it might be because they tested positive, or because they were close to someone who tested positive, so the fact that they have been asked to isolate has got nothing to do with the state of their health.

We are discussing this regulation on Thursday. That will give us an opportunity to go into it further, which I look forward to very much indeed. On the impact of taking the test, we have looked at public attitudes to the principle and enforcement of isolation. It enjoys an enormous amount of public support, and I think the noble Lord underestimates those in the BAME community and their response to this responsible approach to isolation.

[Lord Morris of Aberavon (Lab) [V]]

I welcome the principles set out in the memorandum of understanding on prosecutions, and Regulations 12, 13 and 14. In particular, I welcome the fact that there will be regular reviews, both locally and nationally, so that lessons can be learned. Will the reviews be published, and will the Minister confirm that there is a 12-month limit on prosecutions if evidence is available?

[Lord Bethell (Con)]

My Lords, those are two very important and clear questions. However, I will have to take them back to the department and write to the noble Lord with very clear answers.

Coronavirus Act 2020: Temporary Provisions

Lord Morris of Aberavon Excerpts

Monday 28th September 2020 Lords Chamber

[Lord Morris of Aberavon (Lab) [V]]

My Lords, I too congratulate my old friend the noble and learned Lord, Lord Clarke of Nottingham. I have enjoyed going to rugby matches with him. I also welcome my noble friend Lady Clark.

This is an important debate. I regard it as important that there should be parliamentary control over the Government’s actions in this unprecedented situation. We are steering the ship of state in uncharted waters and I fear that there is a huge amount of guesswork in the Government’s proposals, which are changing all the time and, I regret, not winning so far. In addition to their reliance on scientific evidence, I am sure that some parliamentarians can make a major contribution. If the science is constant, it should be the same evidence for each of the four nations of the United Kingdom. People are puzzled, particularly those living on the borders, about why a greater effort has not been made to have uniformity in decision-making in the United Kingdom. Why are there frequently small or marginal differences between the decisions on this matter in each of the countries? Is it stubbornness in one of the Governments or the lack of will to heed the wake-up call for Whitehall that, in health matters, there are at least four legislatures in the United Kingdom?

I know that the Prime Minister has recently discussed progress with the devolved First Ministers, but why has such a meeting taken so long? Given the situation we find ourselves in, I would have thought it imperative that frequent and regular discussions should have taken place at the highest level between each of the First Ministers.

I regret that there has been no clear guidance for universities, independent though they are, about allowing students to return to campuses only to be incarcerated. When I hear that some universities are proposing to provide only online teaching for three weeks, it is as plain as a pikestaff that this could be done in the comfort of a student’s own home. I speak as one who in the past was the chancellor of a university for 12 years.

Has a lack of decision-making been influenced by the desire of some universities to collect the fees? I am glad that this year, none of my grandchildren is incarcerated in student accommodation. If this is what is called university experience, I would prefer not to have it.

Parliament in its original meaning is a place where you talk—I paraphrase. Over the centuries, Parliament has met in two Houses. I have already expressed my concern about your Lordships’ House’s ability to govern its own procedures, including membership attendance. I have been assured that we are enabled to do so, but the reality is that the wider Executive, in the form of the usual channels, who have done a valiant job in deciding who is to speak and how many, are controlling every movement of this House. Cromwell would have smiled. There must be a limit to this. I raise only in passing my concern that this is a grey area. For the moment, what is imperative is that there should be uninhibited and repeated debates in this House and in the Commons on the way forward.

Health: Diabetes

Lord Morris of Aberavon Excerpts

Wednesday 31st October 2018 Lords Chamber

Asked by

[Lord Morris of Aberavon]

To ask Her Majesty’s Government what assessment they have made of the provision of new technologies, such as flash glucose monitoring systems, for type 1 diabetes patients throughout England and Wales.

[Lord Morris of Aberavon (Lab)]

My Lords, I have declared on more than one occasion the interest of one member of my family in the treatment of type 1 diabetes. I have taken part in many debates on diabetes and I am grateful to Diabetes UK and JDRF for the vigour of their campaigning and their advice.

The incidence of diabetes has doubled in 20 years, making it the fastest-growing health crisis. By 2025, it is estimated that 5.2 million people will be living with it. It costs the NHS £10 billion every year, largely spent on dealing with preventable conditions. Direct and indirect costs are much more. Tonight, I shall concentrate on type 1 diabetes. Although its effect has some of the characteristics of type 2 diabetes—I am not a medical man—it is largely a different problem, it is not connected to lifestyle and it strikes people of all ages, some of whom are very young.

Some years ago, I went to various research centres at universities. I went to Oxford, and I met Dr Hovorka’s team at Cambridge, my old university. I went to London, where ground-breaking research was taking place on the failure of the pancreas to produce insulin and its replacement but, so far as I know, results are limited. Over the last few decades, new technologies have transformed the way diabetes is treated and monitored and can help to reduce diabetes-related complications in the long term.

Tonight, I want to deal with the flash glucose monitoring system. Diabetes patients have to constantly monitor their blood glucose levels day and night. The flash system is a major advance over routine finger pricking. It works by inserting a small sensor into the upper arm. A reader device then scans the sensor and displays blood levels instantly, indicating whether they are going up or down. If patients can reduce their test strip use, which is presently done eight or more times a day, the expense of the flash sensor is cost-neutral or even cost-saving. Such self-management leads to lower fluctuations in glucose levels and fewer expensive complications in the future. Patients will have a reduced number of hypoglycaemic incidents, which lead to expensive ambulances and hospital admissions.

When it was announced some years ago that the Prime Minister had been diagnosed with type 1 diabetes, I wrote an encouraging note to her based on my family’s experience. I was delighted to notice that, at last year’s Lord Mayor’s Banquet, she proudly wore her sensor on her upper arm. No one would question the energy she puts into her official duties.

The heart of this debate is the countrywide variation in the availability of the sensor on the National Health Service. A few months ago, it was made available on the NHS drugs tariff in principle to NHS patients in the UK on prescription. On 5 July, the Minister stated that the NHS was committed to ensuring the principle of universal access and proudly claimed that the technology was,

“available across the country where clinicians think it is … appropriate”.—[Official Report, 5/7/18; col. 635.]

I was absolutely delighted. However, on 9 October, I had to draw attention to what was happening in practice. Only approximately 71% of the country is able to obtain the device. The hold-up is not with clinicians, who want to prescribe where appropriate, but with the clinical commissioning groups. They differ in their criteria. The noble Earl, Lord Courtown, replying very helpfully, faced up to this situation. He said:

“Many CCGs perform very well, but some do not provide this service. They are being encouraged to do so”.—[Official Report, 9/10/18; col. 10.]


I would specifically like to know three things. First, how are they being encouraged? Secondly, when can we expect universal NHS access to this important tool? Thirdly, is this situation because more than half of the areas in England and Scotland did not have training policies in place to support prescribing the device? Is it a question of resources? There has been some progress and it might be that this is now down to a third of areas not having supporting policies.

The lack of prescribed sensors is grossly out of proportion in England to Wales, Northern Ireland and Scotland. Let me tell your Lordships the grim facts. Where they are not available, patients have to pay privately around £1,200 a year. I am glad that they seem to be provided in my former industrial constituency; that amount would be out of reach for many of my former constituents. The present postcode lottery is a scandal, partly due to the differing criteria in too many CCGs. Patients in Coventry can get NHS access to sensors, but not those in Birmingham at the time the briefing was prepared. Likewise, they are available in Manchester but not in Liverpool.

I understand that the Secretary of State is deeply interested in new technologies. Diabetes UK has proposed a dedicated new national fund to support greater adoption of new diabetes technologies. This would operate over a fixed period and, coupled with the purchasing power of the NHS, would secure access to key products at fixed value for money. Diabetes UK believes that such a unified driving force would achieve considerable savings. What is the Government’s view of the proposal to set up a new fund of this kind?

Diabetes UK, working with NHS England, has developed a consensus guideline for type 1 diabetes technology. Its aim is to see a pathway in every area to ensure fair and equal access to the technology. If the Secretary of State accepts that failure to deal comprehensively with diabetes could lead to a major health crisis, there are modern technologies that could be available countrywide and substantial savings could be made. So will the Minister raise with his boss, the Secretary of State, the idea of appointing one Minister and one senior official to deal with, take charge of and monitor the whole of the field of diabetes, which will cost so much money to the NHS as a whole?

NHS: Equitable Access

Lord Morris of Aberavon Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord O’Shaughnessy]

I am more than satisfied with the independence of NICE. I am grateful to my noble friend for raising this issue, which we have talked about both in and outside the Chamber. NHS England is currently considering further evidence on the prescribing of that drug for that group of patients, after I asked it to do so.

[Lord Morris of Aberavon (Lab)]

My Lords, what progress is being made by the National Health Service on even national delivery of modern technologies, such as flash monitoring systems, for diabetic patients? I declare an interest for a member of my family.

[Lord O’Shaughnessy]

The noble Lord picks a very good example of a technology that is transforming diabetic care, as he knows. A few months ago, I was pleased to be able to approve it for prescription in the NHS; it is now available across the country where clinicians think it is the appropriate course of treatment.

NHS: Diabetes

Lord Morris of Aberavon Excerpts

Thursday 26th May 2016 Lords Chamber

[Lord Prior of Brampton]

Public Health England has clear guidelines, published under The Eatwell Guide, on what makes a healthy diet. However, I agree with my noble friend that the position is now quite confused following the report that was published earlier this week. Confusion is not something we want and I am sure that when we produce the obesity strategy later this summer, we will make it very clear what those guidelines should be.

[Lord Morris of Aberavon (Lab)]

My Lords, bearing in mind the tragic increase in types 1 and 2 diabetes each year, particularly among the young, will the Minister comment on reports of promising developments in this country and the United States in dealing with type 1 diabetes? Will he personally satisfy himself that enough funding is available for research into type 1 diabetes?

[Lord Prior of Brampton]

My Lords, I will certainly endeavour to do that. If the noble and learned Lord has a keen interest in research into type 1 diabetes, I am happy to meet with him outside and with anyone else who would like to join us.

Health: Diabetes

Lord Morris of Aberavon Excerpts

Thursday 2nd July 2015 Lords Chamber

[Lord Morris of Aberavon (Lab)]

My Lords, not for the first time, I congratulate my noble friend Lord Harrison on initiating a debate on diabetes. I am grateful to the House of Lords Library for its briefing pack. We have just heard from the noble Viscount, Lord Falkland, an exceedingly valuable speech on education, which was of service to the House. That certainly is paramount in the subject of the debate.

The background to our concerns are the words of the noble Baroness, Lady Young—we have just had the advantage of hearing her speak and it has been most helpful to have her participate in this debate—in the foreword to Diabetes UK’s State of the Nation report. She said that diabetes is,

“doubling in prevalence every 17 years, and 13 million people were already directly affected or at serious risk”.

I hope that the Government will acknowledge that this is indeed an epidemic and a national crisis, and that the sooner we learn this, and in particular look at the way that expenditure is allocated in the National Health Service, the better.

Understandably, the documentation provided concentrates on type 2 diabetes because of the sheer numbers. I have, in the past, declared a family interest in type 1. The striking comment about type 1, where the numbers are much smaller and which I shall concentrate on, is that it is one of the examples of poorer care. The report states:

“What is particularly striking is that … those with Type 1 … are receiving considerably worse routine care than other people with diabetes, and are achieving poorer outcomes”.

It was a disappointment that the department, in setting up the national commissioning service, rejected a request from clinicians and researchers that type 1 be commissioned separately or at least differently. I fear that the outcome stated in the document underlines the concern that they expressed at that time. In the absence of a disaggregation of expenditure on type 1, could I return to the issue by asking for up-to-date figures for medical research into finding the answer to the problems of type 1? There is, I fear, despite what we have heard, no simple solution.

As I have told the House previously, I have visited research centres at Cambridge—my university—at Oxford and at King’s College Hospital, London, to discuss the research into the only possible solution, which is the successful creation of an artificial pancreas. I have had its progress explained to me, for which I am most grateful, and I have maintained an interest in the great work being done at those three centres and, I am sure, at others as well.

We are told that NHS England will also have a direct commissioning role to support the new commissioning system. I would like to know from the Minister what exactly is in mind and proposed for NHS England as opposed to the commissioning boards locally.

However, in the documentation, there are repeated references to type 2 and its prevention but much fewer to the management of type 1, with its effect on an incredibly high and unexplained number of children suffering from it. My interpretation may be wrong, but it would helpful if there could be much clearer differentiation in figures, guidance and advice between type 1 and type 2.

Perhaps I may select a few figures. In 2012, fewer people with type 1 diabetes received each of the eight recommended care processes: 41% of people for type 1 compared with 62% of people for type 2. Type 1 is less likely to meet the recommended treatment targets for blood glucose and cholesterol. Similarly, and particularly important for this debate, structured education was offered to 2.4% of people with type 1 diabetes compared with 6% of those with type 2. There were similar figures for actual attendance for structural education. These figures mean something, and this is what this debate is about. They are exceedingly low and need some kind of attention. The high number of children with type 1 underlines the problems of underachievement.

Although the figure for children receiving care processes has almost doubled, it is still well below results for adults. There are considerable variations between CCGs in terms of care process completion rates and achievement of treatment targets. The key question that is asked in the Diabetes UK document, which appealed to me considerably and I repeat, is:

“Would you want to live in a place where less than 10 per cent of people with Type 1 diabetes meet all their treatment targets?”.

That is a fundamental question. My assertion would be that, where there is a responsibility and supervision nationally, there cannot be justification for this postcode lottery. I ask the Minister in his reply, or perhaps by letter, to address specifically how the postcode lottery will be dealt with.

The documentation refers to England. Regrettably I am not aware—certainly no one has recently corresponded with me—of the up-to-date figures for Wales, a devolved responsibility. Perhaps Welsh Ministers may tell me. I am sure that the noble Baroness, Lady Young, as the head of Diabetes UK, which is a UK organisation, will fill that gap in my knowledge so that I can compare my own country with England.

I could go on with the differing achievements for type 1 and type 2 in glucose levels, development of cardiovascular disease and achieving realistic targets in checking cholesterol levels. It is quite frightening to read of the emphasis on eye screening, foot checks and kidney checks and the questions posed by differing degrees of achievement. More than a quarter of children and young people have unacceptable blood glucose levels and only 12% receive all the recommended health checks. These are salutary and frightening figures. Can we allow these poor standards to continue?

We have been told, and rightly so, by many in this debate, from the noble Lord, Lord Harrison, to the noble Baroness, Lady Young, that education can equip people with skills to manage their conditions effectively, but only a handful of people attend courses. There is both an individual and an institutional health responsibility. I am sure we will be told by the Minister how it is proposed that the differing commissioning boards will be encouraged to make an increased effort to meet the need of availability and an update of education and learning opportunities. Otherwise, the cost to the National Health Service of resulting complications will be enormous in the years ahead.

Francis Report: Update and Response

Lord Morris of Aberavon Excerpts

Wednesday 11th February 2015 Lords Chamber

[Earl Howe]

We envisage that all NHS providers should be subject to whatever practical measures are agreed. We are not yet in a position to be prescriptive about what those arrangements should be. We will consult on how best to implement Sir Robert’s recommendations in the least burdensome way possible but in a way that fulfils his ambitions to the maximum extent. I totally take my noble friend’s point that junior doctors and non-clinical staff are often in the best position to judge the health and culture of an organisation. Indeed, I am aware that the CQC, when inspecting a hospital, often makes a point of convening a focus group consisting of junior doctors because it knows that there is a great deal to be learnt from that source. On community care, again, we have taken no firm decisions on how this will come about, but we wish to take the advice of those whose views we value.

[Lord Morris of Aberavon (Lab)]

My Lords, I welcome the Statement and congratulate Sir Robert once again on his most thorough analysis. I also welcome the long overdue proposed change in the law to make employers responsible if whistleblowers are harassed. Does the suggested new duty of candour mean that never again will we see gagging clauses in any NHS contractual arrangements? How long have gagging clauses been tolerated and what is the justification for them?

[Earl Howe]

I am grateful to the noble and learned Lord. NHS guidance has consistently made it clear that, where confidentiality clauses are used, they should go no further than is necessary to protect the legitimate interests of both the employer and the employee. There are circumstances when a gagging clause is appropriate, but local policies should always prohibit the inclusion of confidentiality clauses in contracts of employment and settlement agreements that seek to prevent an individual making a disclosure in the public interest, in accordance with the Public Interest Disclosure Act. Such clauses are often referred to as gagging clauses. If such clauses were to be included in a severance agreement or settlement, they would be deemed void in any event. We have made it amply clear to NHS organisations where the boundary lies between those two types of confidentiality clause.

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.

NHS: Diabetic Services

Lord Morris of Aberavon Excerpts

Thursday 29th November 2012 Lords Chamber

[Lord Morris of Aberavon]

My Lords, I am particularly grateful to my noble friend Lord Harrison for choosing to raise the subject of diabetic services. I will concentrate on type 1, in which I declare a family interest. I have had the advantage of consulting Professor Amiel of King’s College Hospital and hope to visit the research unit of Professor Johnson in Oxford in January for further discussion. I am grateful for the excellent briefing by JDRF.

The recently published report by the House Of Commons Public Accounts Committee, which has already been referred to, notes that the incidence of diabetes has doubled in the past five years. The report concentrates on type 2, which comprises the greater number, and is one of the most damning I have ever read. It states:

“There is no strong national leadership, no effective accountability arrangements for commissioners, and no appropriate performance incentives for providers. We have seen no evidence that the Department will ensure that these issues are addressed effectively in the new NHS structure”.

My simple question for the Minister is: are things going to get better after that damning report?

Type 1 diabetes is a chronic, life-threatening condition which has a lifelong impact on those diagnosed and their families. I hope that this debate will send a clear message that the cause of type 1 diabetes does not involve lifestyle factors such as obesity, poor diet or lack of exercise. There is currently no way to prevent the condition and no cure.

I have been trying for some time to get a complete breakdown of the cost of management of type 1, as opposed to type 2. I have had only modest success in the disaggregation of the figures. I firmly believe that when you have a clear idea of specific costs, you can start to prioritise and direct funds. It is estimated that the direct and indirect cost to the National Health Service of treating type 1 is nearly £2 billion a year; 400,000 people are affected, including 26,000 children; and the numbers are growing at 4% per year. The current spending for research on type 1 is inadequate and falls way behind that of other developed countries. In 2009, government spending bodies committed £51 million to fund research into diabetes. Of this, only £6 million was applicable to type 1.

When I was a young Transport Minister in 1966, just before the ark, I learnt of the methods of cost-benefit analysis. It must be painfully obvious that as 26,000 children are already affected and they are growing in number, the cost of lifetime care will be disproportionately high and merits the targeting of research funding. There is an immense issue of management to achieve a target of long-term blood glucose levels. The challenge for the family is that a child aged five faces 19,000 injections by the time he is 18, and will have pricked his finger to draw blood 50,000 times, according to the JDRF.

NICE recommends insulin pump therapy as a clinically and cost-efficient treatment option for type 1. A report by the Medical Technology Group points to significant inequality of provision of pumps across England and a lack of adherence to NICE guidelines. NICE recommends that 12% of people with type 1 should be eligible for a pump and that for children under 12 it should be 33%. The average rate of pump utilisation is 3.9%, which is still the lowest in Europe though substantially better than it was a few years ago. In the United States, provision is estimated at 33%. Mr Burstow, a Health Minister, was able to assure me on 25 April this year that we were generally in line with the United States. How he could reach that conclusion is beyond comprehension. Perhaps the Minister will be able to correct it. If the number of pumps was increased by seven percentage points to reach the 12% benchmark, additional savings on consultant visits and hospital admissions would add between £37 million and £62 million, hence my attachment to cost-benefit analysis.

I welcome the announcement of the publication of NHS scoreboards for availability, delays and access to treatment. Those PCTs not complying—a number of which have been indicated in the various reports—will have to explain themselves, I trust.

It has been emphasised to me by clinicians that providing a pump is part of a package, with structured education first. If injections do not achieve treatment targets, then there is a move on to the provision of a pump. Many achieve the required outcome without it. Evidence-based work is still evolving on how best to provide such education for children. Increasing the skilled force within the NHS to provide such structured education is not without cost. We need to raise the profile of this need if we are to achieve equity of access to such skilled healthcare professionals across the country and across the range for people with type 1 diabetes.

It would be a tragedy if the needs of those with type 1 were lost within the greater number of those with type 2. The current reorganisation of the NHS could be a great opportunity to improve the availability of treatment for those with type 1. I understand that representations were made to the Department of Health for recognition that type 1 people are a small group with a need for highly specialised support. However, the request that type 1 diabetes be commissioned separately, or at least differently, from type 2 has not been approved.

I welcome the work that is being done at King’s, Cambridge, Oxford and Sheffield on the artificial pancreas. It is vital that adequate funding is provided for what could be a welcome and major breakthrough and that, particularly in this period of change, the general issue of funding for type 1 will be addressed. I am told that there has never been a real budget for type 1 services, which have been developed on the back of academic interest and clinical recognition of need. Greater investment by the Department of Health in both the research still required to develop a viable artificial pancreas and in providing technology, as and when it becomes available, and on its role, benefits and limitations, would be very welcome to all concerned for those who suffer from type 1 diabetes. I hope that in my short remarks I have highlighted the separate needs of those with type 1 as well as type 2.