Health: Diabetes

Lord Prior of Brampton Excerpts

Thursday 2nd July 2015 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, I thank the noble Lord, Lord Harrison, for introducing this very interesting debate—I have certainly learned a great deal. I will reflect on a number of themes that came out of the debate before turning to my prepared speech, and obviously I will come back to education and prevention.

First, I was struck by the contributions from noble Lords who have suffered directly from type 1 or type 2 diabetes—the concept of the expert patient is clearly very strong and important here. The noble Lord, Lord Harrison, looks very well on it: he has obviously looked after himself extremely well. Self-care will be a very important part of going forward. Secondly, we have to do better on education. The noble Baroness, Lady Young, made some interesting suggestions about how we can increase the uptake of education. The work that Diabetes UK does is terrific. It must be one of the most active charities in dealing with these terrible long-term conditions. Thirdly, on the relationship between diabetes and other long-term conditions—be it stroke, cardiovascular disease or other things—the number of people now living with multiple, very complex long-term conditions is a huge challenge for the National Health Service. That challenge was simply not there in 1948 when the NHS was set up. We have to change the way in which we deliver care very radically to address these issues.

The noble Baroness, Lady Masham, talked about the importance of diabetic specialist nurses who provide a tremendous resource to people suffering from diabetes. The noble Viscount, Lord Falkland, talked about the growing use of technology and referred to the artificial pancreas, which was also mentioned by the noble Baroness. That illustrates another huge challenge to the health service, as many of these developments will be hugely expensive. Whether a tax-funded healthcare system can afford these very expensive treatments will be a big challenge for the National Health Service as we go forward.

Over the past year I have heard many things said about the five-year forward view but never before have I heard it said that it made someone feel frisky. However, I am pleased that it made the noble Baroness, Lady Young, feel that way. The five-year forward view recognises the challenge of long-term, difficult conditions such as diabetes, and it offers a way of dealing with them. The noble and learned Lord, Lord Morris, referred to medical research, particularly into type 1 diabetes. His concern was that type 1 diabetes was getting less attention than type 2 diabetes, a point that was very made well.

Diabetes is a priority for the Government. Frankly, it would be a priority for any Government, because more than 3 million people—probably nearer 4 million people—have been diagnosed with diabetes and maybe a further 500,000 are undiagnosed. The noble Viscount, Lord Falkland, was one of those undiagnosed people. With a blood sugar of more than 29, I think he said, it is remarkable that he is still here with us. I am very pleased that he is, but that just illustrates the fact that many other people have it less catastrophically badly than the noble Viscount and are undiagnosed.

Diabetes is directly responsible for some 5,000 deaths per year and is a major contributor to causes of premature mortality, such as heart disease and stroke. The noble Baroness, Lady Masham, described her husband’s conditions as both diabetes and strokes. There are, I believe, 22,000 avoidable deaths attributable to diabetes each year. This is a very serious illness. It not only has huge and tragic consequences for many individuals, but, as we have been told by other noble Lords, is a cost to the NHS of some £10 billion a year and a much wider cost to the economy as a whole.

On prevention, the noble Lord, Lord Harrison—I thank him for giving me sight of his speech before the debate—spoke of his personal experience of living with type 1 diabetes. Although we know that type 1 diabetes is not preventable, it is estimated that some 80% of type 2 diabetes is indeed preventable.

I thank the noble Baroness, Lady Manzoor, for her contribution. I apologise to the noble Baroness, but I was not going to address the international implications of diabetes. The statistic that she gave—that some 387 million people suffer from diabetes worldwide—is indeed sobering. I know from experience that in some parts of the world, for example in the Middle East, prevalence of diabetes is particularly strong. Her points about co-infection with TB were well made. I am very happy to put the noble Baroness in touch with my opposite number in DfID if that would be helpful.

The NHS diabetes prevention programme is a joint commitment from NHS England, Public Health England and Diabetes UK to help people identified as being at high risk of developing type 2 diabetes to take personal responsibility for lowering their weight, increasing their physical activity and improving their diet. It will be the world’s first national at-scale prevention programme. It will link into the NHS health check programme—commissioned by all upper-tier local authorities—which invites adults between the ages of 40 and 74 to a check for risk awareness, assessment and management of the key risk factors leading to premature death and disability in England. These checks take place every five years and include a diabetes risk assessment and blood test for those at risk, which could enable early detection of 4,000 cases of diabetes each year. Since the programme began, more than 10.5 million NHS health checks have been offered and more than 5.2 million checks have been undertaken. The fact that that is only 50% take-up reinforces the point made by the noble Baroness, Lady Young, that we should be able to do more about marketing these schemes to ensure a higher take-up.

On patient education, the noble Lord, Lord Harrison, and other noble Lords stated that once a patient is diagnosed with diabetes, education is vital in ensuring that they can manage their condition as effectively as possible. We have heard that GPs in some cases perhaps do not give sufficient encouragement for sufferers of diabetes to do this. There has been an interesting observation that companies, through their corporate and social responsibilities, should do more to ensure that their staff and employees take up the opportunities for better education.

The NHS Five Year Forward View sets out a clear ambition to do more to support people with long-term conditions to manage their own health and care. To achieve this, NHS England has set up the Realising the Value programme, which will help strengthen the case for change, identify a set of evidence-based approaches and develop tools to support their wider implementation across the NHS and local communities.

The NICE quality standard for diabetes sets out that people with diabetes should receive a structured educational programme as this is key to ensuring that they are able to manage their condition as successfully as possible. Sixteen per cent of people newly diagnosed with diabetes were offered structured education in 2012-13, compared with 8.4% of those diagnosed in 2009, so there is improvement but from a very low base. In the same period, the number of people newly diagnosed with diabetes offered or attending structured education rose from 11% to 18.4%. I can only agree with noble Lords and the noble Baroness, Lady Young, that that is still far too low and that we must do more to increase that take-up. I agree with the noble Lord, Lord Harrison, that sharing best practice across areas is vital in increasing patient education.

To support this, we have increased transparency through the creation of Healthier Lives: Diabetes, Hypertension and NHS Health Check. This is a major online tool from Public Health England which has revealed large variation in the prevalence and treatment of diabetes. I am afraid that variation exists between hospitals as well.

The clinical commissioning group outcomes indicator set also provides clear, comparative information for CCGs, health and well-being boards and local authorities. I think that eliminating variation is the only way of addressing the postcode lottery to which the noble and learned Lord, Lord Morris, referred. I could refer him to PHE’s atlas of variation, but the more we can publish about the performance of individual CCGs and, indeed, GP practices, the more we can eliminate variation.

I turn to children’s education. The most recent national diabetes audit report noted that the take-up of patient education was particularly low among younger people who develop type 1 diabetes in childhood. To incentivise improvements, the best practice tariff for paediatric diabetes provides an annual payment for the treatment of every child and young person under the age of 19 with diabetes, providing that 13 standards of care are met. One of these standards is to ensure that each young person has received a structured education programme tailored to meet their and their family’s needs, including their carer’s needs—a number of noble Lords referred to that—both at the time of initial diagnosis and ongoing updates throughout their attendance at the paediatric diabetes clinic. The noble Lord, Lord Harrison, referred to the important role of pharmacies in this regard. Increasingly, we will see a primary care system which is not just a traditional GP practice but encompasses pharmacy and other activities, and perhaps hospital outpatient clinics.

Once again, I thank the noble Lord for highlighting this vital issue. The Government are fully committed to combating and preventing diabetes. I hope I have demonstrated that we are working hard—although we are by no means fully satisfied yet with our results—not only to ensure that those who have diabetes are empowered to manage their condition as effectively as possible, but that those who are at risk of diabetes are given the tools, knowledge and support they need to reduce their chances of developing it.

House adjourned at 6.24 pm.