Health: Diabetes

Viscount Falkland Excerpts

Thursday 2nd July 2015 Lords Chamber

[Viscount Falkland (CB)]

My Lords, I thank the noble Lord, Lord Harrison, for again giving us the opportunity to discuss diabetes, and I congratulate him on the very comprehensive way in which he introduced the debate. I do not think anybody reading his opening remarks in Hansard to find out what this is all about could get anything better online.

Education, which is part of the title of this debate, is so important, and this debate is important because so many people have stressed the importance of education. I suppose that I was rather complacent, because I did not have a doctor when I was diagnosed with diabetes. I was 64 years old, in this House, and I did not think that there was anything wrong with me. I knew that I was having a little difficulty making speeches in your Lordships’ House—I used to dry and feel a little nervous. When we were talking about it, a friend in the House said, “I think you’ve got diabetes”. That was just before Easter in 1999. He said, “I think you ought to have it looked at straightaway. I’ll ring up my doctor”—a private doctor. I said, “I have no doctor, so thank you very much”. The doctor was very efficient and certainly did not say what the noble Baroness, Lady Young, said; I did not have a “touch of diabetes”. My sugar levels were almost catastrophic—no wonder I was feeling odd when talking to the House.

Noble Lords probably know that for a person whose metabolism and pancreas are working properly, the blood sugar levels will be around 5.5 or 6.0. Mine were 29. I was very fortunate in that the doctor acted quickly. He got me the last appointment before Easter—or I would not have been seen until the following week—with a diabetes specialist in a clinic the following day. The professor said, “This is a very sad situation, isn’t it?”. I said, “Yes. It sounds as though it really is”. He gave me an hour of education about my condition. He said some important things apart from explaining what the condition is—the malfunction of the beta cells of the pancreas and the whole business of metabolism. He said, “One thing that I must tell you is don’t be worried about this condition. What we’re going to do for you, and what we’re going to provide by way of education and advice, will make you able to control not just your diabetes but your life. You will be eating better and taking more exercise”. That is exactly what happened.

I have been on a learning curve since then. In eight of those intervening years I was on ordinary medication and then, because I ran out of my own insulin, I was put on synthetic insulin, which noble Lords will be familiar with. There are two lots, one of which carries me through the night. As all diabetics know, when you are asleep your liver produces sugar. I also have the insulin which I take before every meal. Every day I check myself on a wonderful machine. The technology that is available to enable one to supervise one’s condition is excellent.

I found myself an NHS doctor. I have nothing but praise for the NHS but it just does not have the time to provide the necessary education. I was approached by a member of staff of this House who knew that I had spoken previously about diabetes. He said, “My doctor has told me this week that I’ve got diabetes”. I asked what the doctor had said and was told, “He didn’t say very much and that’s why I’m asking you what it’s all about”. I replied, “You need some information. It means that you really have to alter your life”. I ran across to the nurse in the House of Commons and she was horrified to hear of the doctor’s reaction. She said, “Send him here and I’ll give him some of the leaflets that we have here, so at least he’ll know the basics”. I imagine that that experience of a member of staff here is replicated all over the country.

[Baroness Young of Old Scone]

I hope that the noble Viscount referred him to Diabetes UK as well.

[Viscount Falkland]

Diabetes UK is an excellent organisation and I congratulate the noble Baroness. The last time we had a debate on this, I think she was only just starting in her role. Having heard her excellent speech today, I would say that she has obviously been on a very successful learning curve. I was very interested in everything that she said.

I now find myself at the age of 80, which is around the age that the doctor predicted I would live to if I looked after myself, and I still feel pretty well. I still ride a motorcycle and so on. I hasten to say that I check myself with my machine before I go anywhere near a vehicle, because it is very dangerous to have diabetes and to drive a vehicle. I hope that most people who have the condition report it to the DVLA, because not to do so would be very serious.

With this complaint, education never stops. We are constantly developing treatments, machines and monitors, and we have different kinds of medication, so we have to adjust to changes the whole time. It is ongoing. I absolutely agree with the noble Baroness, Lady Young, on what we could save in the National Health Service if we got education right—she produced the figures; I could not find them. It is short-term thinking because, as she said, the upfront cost is very high. But the cost if people have heart disease, amputations or all the other dreadful things that can happen, as she outlined in her speech, is astronomical compared with what one would spend on education. Unless they have education, people will not look after their condition. I hope that the Minister can reassure us that there is movement in the right direction on this because it is a growing threat.

I am very glad that the noble Baroness, Lady Manzoor, drew our attention to what happens in the third world, or the developing world as we now call it, and how awful it is for people who do not have our fortune in having a National Health Service that gives us important parts of what we need to treat our conditions. In those countries, a high proportion of their income is spent on this disease. The worry and stress that that must cause is absolutely appalling. The noble Baroness made a very interesting contribution on that.

It is going to get more expensive. One noble Baroness—I cannot remember which one—mentioned the replica pancreas that is now being developed in the United States. That will all become very expensive. People who come here from Saudi Arabia with diabetes can, I suppose, afford it, but people here will not be able to. Important developments are going on, which is good news, but the rising cost beyond the high levels that we already have in the NHS really does mean that organised education is the only way. This is the argument I am making and I hope that the Minister will also make it. And it should not just be short-term education—people really need a course.

The nurses in my NHS practice are absolutely excellent. When they go on a course, they are marvellous. Most of them are immigrants, I might add, so noble Lords will understand that I have no sympathy with UKIP. In the National Health Service, they are marvellous. They love what they learn and they pass it on; they are an important part of the future. I hope that this debate, which I knew would be good but has been better than I expected, will result in an improvement in the NHS service and for patients.

Standardised Packaging of Tobacco Products Regulations 2015

Viscount Falkland Excerpts

Monday 16th March 2015 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I congratulate the Minister and the Department of Health on producing a high-quality and thorough set of regulations after a thorough consultation exercise. I join the noble Lord, Lord Faulkner, in adding my congratulations to the department for receiving the Luther Terry Award for Exemplary Leadership by a Government Ministry. It is measures such as these that make Britain a world leader in public health.

In our debates on this subject, I have spoken extensively about the need for these regulations and the evidence that they would make a real difference. The bare facts are these: only one in 10 smokers in the UK started after the age of 19, and two in five started before 16. We have already heard from the Minister the figures on how many people die each year from smoking-related diseases, and the number of children between the ages of 11 and 15 who take up the habit and risk their health by spending hundreds, if not thousands, of pounds a year on a toxic product.

The unconscious trigger of attractive packaging is an extremely successful marketing tool that encourages children and young people to glamorise and take up smoking. Bright colours, sleek designs and slim cigarettes—to name but a few—all make people falsely believe that such cigarettes are less harmful. I remember as an impressionable teenager the impact that some of those cigarette pack designs had on me. It made a big difference and I indeed wanted to start smoking, and did so; and I think I was influenced by some of that marketing material.

I should like briefly to turn to some of the objections that have already been advanced by opponents of these regulations in this debate. First, the tobacco industry has claimed that standardised packaging would increase the volume of illicit tobacco on the market. This is flatly contradicted by a recent HMRC assessment and an independent review by Sir Cyril Chantler, both of which indicated that there is no evidence for such a claim. Indeed, there is no evidence that standardised packs would be easier to counterfeit. Standardised packs are not “plain packaging”—that is a misnomer. They would carry the same security systems as current packs. There is no evidence that that there has been an increase in the illicit tobacco trade in Australia since the implementation of the policy. The total weight of illicit tobacco detected by Australian customs has remained roughly static since 2007-08. Indeed, a recent study shows that there was no change in the availability of illicit tobacco in Australian shops since the introduction of standardised packaging. At any rate, it seems logical that the way in which to reduce illicit trade is through more effective regulations, which these regulations clearly are.

Secondly, the tobacco industry has claimed that standardised packaging would damage small businesses because it would make it more time-consuming for shop assistants to retrieve packs, and that this delay would make tobacco less profitable for small businesses as opposed to large supermarkets. Tobacco companies based these predictions on interviews with just a handful of retailers. In contrast, peer-reviewed studies of small shops in Australia before and after the standardised-packaging policy demonstrate that there was no significant increase in serving time.

It is true that standardised packaging is likely to result in reduced tobacco sales. In fact, it is the very purpose of these measures; it is the Government’s hope and certainly mine. Every pound that consumers no longer spend on tobacco they will surely spend on other goods and it is very likely that small businesses will pick up some of this trade. After all, shops, including small shops, have adjusted to the continuous decline in the prevalence of smoking from half of the population in 1960 to roughly one-fifth now and there is no reason to suppose they will not be able to adapt further. On this point, can the Minister confirm that in the interests of reducing costs to retailers the measures will be implemented at the same time as the packaging and labelling measures in the EU tobacco products directive in May 2016? Can he also confirm that retailers will be given a full year after the implementation date to sell through existing stores of non-standardised packs? It comparison, retailers in Australia were given just eight weeks to do that.

The tobacco industry has made what I think is a very convoluted argument that standardised packaging will lower prices and thus increase tobacco consumption. In the process of conducting his review last year, Sir Cyril Chantler was told by tobacco companies that sales had increased slightly, despite the fact that the industry had told its investors the opposite. Analysis by the independent market research company Euromonitor concurred that there had been a decline in sales in Australia between 2012 and 2013.

As we have already heard, it seems to be contested—although frankly I do not know why—what the impact in Australia has been since the introduction of standardised packaging. I have looked very carefully at what the helpful leaflet Standardised Packaging for Tobacco Products, produced by very reputable organisations such as the British Heart Foundation, King’s College London, the University of Waterloo, Cancer Council Victoria and the UK Centre for Tobacco and Alcohol Studies, has said about the impact so far. It shows that there is a reduction in young people taking up smoking and an increase in the proportion of existing smokers who are trying to quit. Indeed, the National Drug Strategy Household Survey in Australia showed that the proportion of 18 to 24 year-olds who had never smoked increased from 72% in 2010 to 77% in 2013.

A 2014 study from Australia that reported in the British Medical Journal shows that the prevalence of smoking among adults fell by 15% in the second half of 2013 alone. Finally, following evidence that smokers find cigarettes in standardised packs less appealing—which of course is the very purpose of it—there is new evidence that calls to Quitline, a free smoking cessation service, have increased by 78% since the introduction of standardised packaging.

It is a credit to the very thorough and painstaking way that this measure has been developed by the Government that these are the best criticisms opponents can level. Above all, it is time to listen to the 72% of Britons and the majority of all political parties and support standardised packaging.

[Viscount Falkland (CB)]

My Lords, I am a non-smoker but having been in your Lordships’ House for some years one thing that concerns me about this measure is the unintended consequences. One is always worried in this House about them and so we should be. It seems very odd that so few people have expressed the view that tobacco is a legal product. How can you interfere with the marketing and the sales of a legal product? I think the product is undesirable and the arguments of the scientific community about its danger to health are indisputable. However, we have to think rather carefully about what may follow. If you get away with this without too much protest there are all kinds of bien pensants and vigorous politically correct people who will seek to do various things. For example, it could happen quite easily that in some local authority someone of limited life experience might suggest that, with obesity and the compulsion that people have to eat too much, it might be a good idea to prevent restaurants allowing people to eat on the pavement under an awning because that attracts people to sample the restaurant’s delicious wares. Noble Lords may think that this is a trivial, Clarksonesque point, but it bears thinking about.

I am grateful for the efforts that have been made to curb the ill effects of smoking. I am a frequent cinema goer—I have been a film buff since I was a boy. I do not think I would be talking to noble Lords today if they had not banned smoking in cinemas. I may have a husky voice, but I would probably be dead by now, I should think. These are things that have to be considered.

In the speeches so far, there has been scant respect for one thing that is very important to this country, and I hope it will be borne out in the speeches during the election campaign. This is a trading country, and trading countries require freedom in order to encourage the production of goods, to sell them and to market them correctly. If you do not like smoking, then ban it, for heaven’s sake. Do not try to pretend that this is going to deal with it—it is not going to deal with it. We have already seen the unintended consequences on the streets. In some of our best streets in the West End of London you see cigarette ends everywhere because people are smoking at lunchtime in doorways, smoking in the open air and smoking in groups; they are also smoking in their homes because it is unsatisfactory outside so that the smoke filters through badly constructed walls.

There are all kinds of aspects of this whole problem which have not been properly addressed, and I do not think that packaging is the answer. Should the noble Lord who introduced this amendment guide us towards the Lobbies, I shall follow him.

[Lord Warner (Lab)]

My Lords, I had not intended to speak in this debate, but I want to congratulate the Minister and the last speaker has provoked me to take us back to the time when I, as a Minister, was taking through this House the legislation banning smoking in public places and in the workplace. Some of the arguments which we heard from the last speaker and from the noble Lord, Lord Naseby, took me back to those times, the good old days when Parliament was challenged because it had the temerity to introduce legislation in this area to protect people’s health and, in particular, to try to protect children’s health. We heard the same old rubbish, if I may put it that way, on second-hand smoke, which was later proved scientifically to be as dangerous as direct experience of smoke. We can sit through these debates hour after hour, but the science does not change. The science is the same as it always was. It just gets better for those who want to control the consumption of tobacco. The Government are to be congratulated on taking this legislation forward, and I hope the House will support it overwhelmingly.

Before I sit down, I shall ask the noble Lord, Lord Naseby, whether he enjoyed the Eagles concert last July which he experienced as a guest of JTI Gallaher.

NHS: Diabetic Services

Viscount Falkland Excerpts

Thursday 29th November 2012 Lords Chamber

[Viscount Falkland]

My Lords, I, too, am very grateful to the noble Lord, Lord Harrison, for this debate. Particularly after the long discussions that we had about the House of Lords and its future, this debate so far has shown how it combines expertise, such as my noble friend Lord Kakkar’s expertise as a doctor, experience, such as those of us who are here as diabetics, and those like the noble Lord, Lord Roberts of Llandudno, speaking with articulate concern. It has been a wonderful debate.

A light has been shone on this subject this week. It was unfortunate for the MP for Slough, who is apparently a doctor, to imply that diabetes is a result of a poor lifestyle, and that those who indulge in a poor lifestyle and have diabetes should be deprived of the funding for their medication. That was stupid and irresponsible. What has been said so far in this debate shows that this is a complex condition that we have; I know that I have a complex condition. As I hope your Lordships can see, I am relatively well. I have had diabetes for 13 years. It was diagnosed in this House and I fully admit that I had been in denial. My wife had suggested that I might have diabetes. A good friend of mine in this House asked me to join him for lunch with his guest. After about five or 10 minutes, he noticed that I had been drinking a lot of water, which is one of the signs of a surplus amount of glucose in the bloodstream. He asked me some further questions and said, “Look, I am a diabetic and I think you are too”. He asked me whether I had a doctor. I said that I had hardly ever seen a doctor and that I belonged to a National Health Service panel. He excused himself, saying, “You wait here. I’m going to make an appointment for you this afternoon”.

My friend got me an appointment for that afternoon, which was the last appointment with that particular private doctor before Easter—I did not have a private doctor at that time. The doctor conducted a simple test and said, “You’ve certainly got diabetes and I’m going to pass you on; I don’t feel capable of dealing with it and I think you need immediate attention”. He rang a specialist diabetes clinic and I got an appointment for the following day, which, again, was the last appointment before Easter. I have been with that clinic ever since. However, I use the National Health Service and I talk to the doctor about my diabetes when we have a regular discussion about my medication. I am very thankful to the National Health Service for providing me with my medication and I am very thankful for the nurses, who have been mentioned, in my practice. They often seem to be more on top of the developments than the doctors.

Being a diabetic has been an extraordinary experience. I have had to give up certain things, and I am not talking about just Mars bars and pastry: I have had to give up playing golf; I cannot play with the same concentration that I used to because the blood sugars alter the whole time in one’s bloodstream. For six years I have been an insulin-dependent diabetic, which makes it even more difficult to do certain things, although I can drive a vehicle because I am very conscientious.

I wonder how many diabetics are conscious of the fact that they should report their condition to the DVLA. The DVLA guidelines are rather strange but basically they point in the right direction. If you are an insulin-dependent diabetic, you should check your blood sugar every time you go anywhere near a vehicle. If you are caught in an accident with a low level, you are committing an offence and will pay a penalty.

Generally speaking, my life is pretty good. When I first saw the specialist, he said, “You are in a very bad condition, aren’t you? Do you realise what your blood sugar level is?”. I will not mention the technical term for it but for the average person—for those in this Chamber even—whose pancreas is working properly, the blood sugar level would be about 5.5 or 5.7. Mine was 29 and the specialist said, “You are one Coca-Cola away from a coma”. I said, “I feel perfectly all right”. He said, “That is odd. I have people with a quarter of your level who are almost crawling in through my door”. It is curious because I have a reasonable feeling of well-being most of the time, although not all the time. I think that diabetics can feel like that.

However, I am not convinced that the NHS generally, as has been mentioned today, gives the kind of service that allows people to have the lucky break that I had when my diabetes was spotted. The number of people who are undiagnosed has been mentioned. I think that the noble Lord, Lord Rennard, mentioned the cost and ramifications of that. If you have nearly 1 million people with diabetes all wandering around the streets not feeling 100%, they are likely to have complications without having had the original diabetes diagnosed. Finally, something may bring them to realise it, but it will be a serious business and they may not have long to live. The cost of dealing with that emergency to the NHS is out of all proportion to what would have to be spent on medication on a daily basis.

I do not want to decry the NHS—I am the first person to praise it—but diabetes is an extremely odd, and serious, condition; one’s requirements change the whole time. One very important thing that the noble Lord, Lord Rennard, mentioned, and which saved my life, is the specialist diabetic nurses. It is all that they do, and they are absolutely essential; if you have any stress or worry, they talk you through it and get you to make the necessary adjustments, such as going to see your doctor or changing your medication. So it is quite extraordinary what can be done on a personal level. That is where the NHS is in trouble, because it is really not equipped to deal on a personal level with all the people who have diabetes.

There must be a better interface between the NHS and the private sector. Education and training is essential and can be provided to the NHS, if it cannot handle the problem, by the private sector, and not expensively. In any case, even if it is expensive, it is going to save a lot of money in the long run by preventing the kind of complications that cost all the money. We have already mentioned amputations and heart disease, and all the rest.

That is my first suggestion and question to the Minister. Why can we not work towards closer co-operation on these services with the NHS? When I go to my NHS people, they are sent everything from the private clinic but they do not have a compatible computer, which seems strange. That would seem to me the first step. They get the written stuff, which goes into a file. So when I go in, nobody ever knows what has happened the previous year. I have taken to having just a brief summary of what happened at my last inspection. I go regularly and have all the things that have been mentioned—a carotid examination, a foot examination, everything. I am thankful for that and for the course that my condition has taken. Whether I shall be standing here much longer in this condition, I do not know; I shall not say that I do not care about it, but I am optimistic. I think that I will probably have a pump, in the long run; they have been mentioned for type 1 diabetes but I think that in the end, most people like me, with type 2, will also have pumps. Then perhaps I will be able to go back to the golf tee and play golf again. Who knows?

How can we reduce the number of people who do not realise that they have this condition? As long as it remains at this level, we are in trouble.

Health: Diabetes

Viscount Falkland Excerpts

Thursday 4th November 2010 Lords Chamber

[Viscount Falkland]

My Lords, I, too, thank the noble Lord, Lord Harrison, for the chance to speak on what is really a very important health matter. I am a type 2 diabetic of 10 years’ standing. Like many men, I hid my head in the sand for a while, although I knew that something was wrong. Curiously enough—it was actually 11 years ago—the condition would manifest itself most strongly when I was speaking in your Lordships’ House: I could not see as well, I used to feel that my voice was failing and I would feel an enormous thirst come upon me. Eventually another Peer asked me whether I was all right. He turned out to be another diabetic—he is still with us today, alive and kicking—and, having spoken to me at lunchtime, he made an appointment for me to see his doctor at 4 o’clock that afternoon. I went to that appointment and I was in a clinic by the next day, where the principal doctor dealing with me said, “It’s a good thing you have come, because things aren’t very good and you are about one Coca-Cola away from a coma”. Diabetes is an insidious disease because generally you feel perfectly well, apart from under certain stressful conditions. I am grateful to the noble Lord for his actions, although I have not been able to repay him other than by suggesting that he might like to move to France because he was unhappy with his rubbish collections. Apparently, in France his rubbish is collected on six days out of seven. I feel that that is a poor exchange, but I was glad to be able to do something for him.

I was on ordinary medication for half the time before it became necessary for me to depend on insulin and, during that time, I was lucky enough to receive expert advice from health professionals on how to deal with my condition. I have become increasingly aware from people to whom I have spoken that diabetics are in a kind of a club. For instance, the man who collects my rubbish that will not be collected by the local council has diabetes. He is an ex-cruiserweight boxer, whom I like very much, but even though he has been a man of physical action he does not understand how the body works. His doctor has not told him why his metabolism has changed—why he cannot metabolise carbohydrates and so on—even though he is an intelligent man. Broadly, in a population in which diabetes is becoming an increasing problem, far too little information is given by the authorities on the basics of how the body works and why the body might not be working normally. It is one of the wonders of the human body that it can do all the things that we know that it has to do. With diabetes, it is rather like moving from an automatic car to having to do everything manually. The control of diabetes is extremely difficult, so people need education and training to deal with it. I know that the National Health Service does not have the time—I am a great supporter of the NHS, which is second to none in dealing with serious conditions—but, where a serious illness is some way off but it is known that a present condition could lead to such illness, I think that there are serious deficiencies in the NHS.

Happily, over the 10 years in which I have had diabetes there have been a number of developments, many of them from the United States. I know that the United States has problems with healthcare, but most of the developments in technology—pumps, monitors and so on—come from there. Much of the development is costly but it is extremely effective. For example, the pumps that are now available for children with diabetes 1 are minute, and they do not have to inject. There has been an absolutely transformation of that scene.

I have managed to keep reasonable, but not perfect, control of my diabetes. The condition can lead to issues with your feet, nerve endings, eyes and so on, but if you do not control it and you do not have regular check-ups to make sure that what is called technically your HbA1c, which is inescapable, is under control—any doctor can tell from a blood test whether it is or not—you will be in serious trouble. The problem with the National Health Service is in part due to the short-termism that exists in Britain in many other respects. I have spoken about this before. Quite naturally, the NHS is concerned about costs, but the expense of dealing with diabetes is all about cost-benefit analysis. For example, to give a pump to a person with an HbA1c in excess of 9 per cent or 10 per cent, which is very dangerous but can easily be dealt with by some of the new technologies, costs about £5,000—the price will probably fall—but for someone who is almost bound one morning to wake up with a red mist in front of his eyes, or his feet not working, or a pain in his chest that is then diagnosed as heart disease, a proper cost-benefit analysis would show that, if the NHS paid for the pump, it would save money in the long run by preventing the person from developing these serious conditions. That is the serious point that I wish to make. It is curious how you can get the serious point over quite quickly when you have nine minutes, whereas it is very difficult when you have only three.

Diabetes is generally a self-treating condition, on which you know more than your doctor—although not all doctors. I asked a question in the House as a result of a disagreement that I had had with one of the doctors in my practice. It was answered by the noble Baroness, Lady Thornton. I was very grateful to her, because she gave me the answer that I wanted to hear, which was not in accordance with what the doctor had said. He had said in sum that people’s HbA1c was generally more satisfactory when they never tested themselves, to which I had said, “That’s nonsense. You’re talking from a cost point of view, because you think the National Health Service shouldn’t pay for the strips and so on”. The answer from the noble Baroness and from NICE was in my favour. It was published, quite wisely, in the specialist diabetes press. There is a lot of difference between relying on your doctor in the normal way—doctors always do their best—and learning about the thing yourself, dealing with it, getting expert advice and going for tests at the right intervals and so on. I hope that the noble Earl will be able tell us when he replies to this debate that the Government have it in mind to approve that.

Not coming from an ethnic community, I did not realise that only 3 per cent of the general population have my condition, but I am proud that I share it with all kinds of people from the different ethnic communities in our country. I know that Indian friends of mine have it, particularly in the feet—I do not know why that should be so. Diet is a very important factor. I can assure the noble Lord opposite that chocolate—as long it is 85 per cent cocoa and he has only three or four squares—is very good for him and he can have it every day. However, he should not have a piece of white bread every day, which is much worse than a bar of chocolate. Having had to spend money on some of the new technology, I have a gadget that measures my blood sugar and shows it on a graph. One piece of toast has a dramatic effect; four squares of chocolate is negligible. One can learn from the new technologies.

I have come to the end of my time, although I could go on for ever. I hope that the noble Lord will introduce a debate on this subject again, because there is much more to say about it. More education and more awareness on the part of the Government and the National Health Service of the cost of not dealing with the disease in its early stages will have immense benefits, not just for individuals but for the state and the economy.