Oral Answers to Questions

Adrian Sanders Excerpts

Tuesday 24th February 2015 Commons Chamber

[Dr Poulter]

I am sure that the hon. Lady would like to support the plans we have put in place to ensure that we increase the number of GPs by 2020, and to ensure that 50% of doctors leaving foundation training go into careers in general practice.

[Mr Adrian Sanders (Torbay) (LD)]

In order to combat fraud, the previous Government quite rightly introduced five-year prescription charge exemption certificates. Now that the certificates are coming up for renewal, people are finding that they have to pay for their medicines once their certificate has expired, and they have even been fined. Unlike for a TV licence, there is no renewal reminder. Will the Government look at how to ensure that people are told they need to renew their prescription exemption certificates?

[Dr Poulter]

As my hon. Friend will be aware, 90% of patients receive free prescriptions either because they are older—over the age of 60—or because of long-standing or other factors. If his constituents are running into difficulties and have problems with renewing their certificate, I am very happy to look into that and to meet him to discuss it further.

Child and Adolescent Mental Health Services

Adrian Sanders Excerpts

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

May I first pay tribute to the hon. Lady for her inspiring work on suicide? Not many people in the House focus on issues that are talked about so seldom, so I pay tribute to her for the brilliant leadership she has shown. The all-party group’s report provides some really interesting and important questions of the sort that she has put to me today. These are questions that we need to ask. We have not yet established that link, but I think that it enables us to start asking local areas those questions. The Deputy Prime Minister has talked about the ambition of avoiding every suicide. We can improve services across the board by focusing much more on preventing conditions deteriorating to the point where someone becomes so desperate that they choose to take their own life.

[Mr Adrian Sanders (Torbay) (LD)]

I welcome the Government’s announcement of an extra £7 million, although I do not know whether it will be enough. I am very pleased, on behalf of constituents in Devon and Cornwall, that we have a new facility opening in Torquay—it is not yet fully open—and hope that the Minister can visit it. I also welcome the fact that he is reviewing the place of safety designation, although I question whether that actually requires legislation. The case that occurred in my constituency raised something that he has not yet mentioned: the problem that a person trying to find an appropriate place has no central register to look at. If we want a hotel room, we can go online and find a vacancy, but finding a vacancy in an appropriate setting seems to take an enormous amount of time.

[Norman Lamb]

The case in my hon. Friend’s constituency highlighted an incredibly important issue. The lessons that are being learned as a result of that incident will result in improved co-ordination and reducing the risk of that sort of thing happening. It was completely intolerable that that young girl ended up in a police cell for that length of time, and we should all be completely clear about that. The crisis care concordat makes the objective clear. We asked every area to sign up—and every area did so by December—to committing to implement the standards in the concordat, one of which is to end the practice of under-18s going into police cells. I think we need to go further and ban it in law.

NHS (Five Year Forward View)

Adrian Sanders Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

What I will confirm to the right hon. Gentleman is that the rules on the contracting out of services are the rules that we inherited from the Labour Government, although he personally might not have introduced them had he remained Health Secretary throughout those 13 years.

[Mr Adrian Sanders (Torbay) (LD)]

May I focus for a moment on a constituency case? Last Thursday, a 16-year-old was placed in the custody centre at Torquay police station. What is of concern is that there is nothing new about that. In Devon and Cornwall alone, there have been 700 cases of people with mental health problems being placed in police cells. The problem for this young woman was that, at that point, not a single facility could be found anywhere in England to meet her needs. It really is outrageous that that could happen to a 16-year-old girl in this day and age. Where does the statement mention the fourth-tier funding to provide facilities that are clearly needed, and have been needed for years?

[Mr Hunt]

The hon. Gentleman is absolutely right. It is totally unacceptable for someone with severe mental health problems to be placed in a police cell. We are making very good progress in reducing the use of police cells for that purpose, with the active support of the care services Minister, my right hon. Friend the Member for North Norfolk (Norman Lamb). In the specific case to which the hon. Gentleman has referred, a bed was available but there was poor communication on the ground, which is why we were not able to solve the problem as quickly as we would have liked. As soon as NHS England was informed of the problem, it was able to find a bed within, I think, about three hours. However, as he says, this is a problem that we must eliminate.

Oral Answers to Questions

Adrian Sanders Excerpts

Tuesday 25th November 2014 Commons Chamber

[George Freeman]

I am not aware of the veracity of the £30 billion figure, but I will happily look at it, and I happily undertake to look at the progress of the report and the work that the hon. Lady raised.

[Mr Adrian Sanders (Torbay) (LD)]

20. It is a well-established fact that type 1 diabetics who have insulin pumps are much more able to control their condition than those who do not, yet the take-up of insulin pumps in the UK compared with Europe and America is pitiful. What is the Department doing to increase the commissioning of insulin pumps? In the long run, the costs go down with better control.

[George Freeman]

My hon. Friend raises a important example of an innovation that, despite costing a little extra at the beginning, saves substantially downstream. One of the challenges in our national health service is tackling a series of ways in which the system is not well geared to incentivising such innovations. NHS England recently set out its five-year forward view, which has, for the first time, a strong commitment to tackling such issues, and we are working with it to see what we can do to remove barriers and promote incentives for earlier adoption.

Care Home Top-up Fees

Adrian Sanders Excerpts

Tuesday 22nd July 2014 Westminster Hall

[Mr Sheerman]

May I intervene very quickly just on that point, because it is very important?

[Mr Adrian Sanders (in the Chair)]

Order. It is for the Member who secured the debate to give way.

[Paul Burstow]

I will give way, but I need to stress to the hon. Gentleman that this is a half-hour debate and I need to make quite a few points myself.

Melbourne Declaration on Diabetes

Adrian Sanders Excerpts

Wednesday 18th June 2014 Westminster Hall

[Mr Adrian Sanders (Torbay) (LD)]

It is a pleasure to speak under your chairmanship, Dr McCrea, for what I think is the first time.

Diabetes is the fastest-growing health threat in the UK, the EU and across the globe. I will first talk a little about what diabetes is. It is a condition in which there is too much glucose in the blood because the body cannot use it properly. That happens because the pancreas does not produce any insulin, or does not produce enough, or because the insulin it produces is unable to work properly. That is a problem because insulin is the key that unlocks the door to the body’s cells so that glucose can enter them. Diabetes means that the body is unable to use glucose as fuel; instead, it builds up in the blood.

There are two main types of diabetes, type 1 and type 2. They are different conditions with different causes; the treatments can be different as well. Both types are serious, lifelong conditions that can lead to devastating complications if they are not managed well, but with the right treatment and support people with diabetes can reduce their risk of developing such complications.

People with type 1 diabetes cannot produce insulin. About 10% of people with diabetes have type 1; I myself have had type 1 diabetes for nearly a quarter of a century, and I am still here. No one knows exactly what causes it, but it is not to do with being overweight and it is not currently preventable. It usually affects children and young adults, starting suddenly and getting worse quickly.

People with type 2 diabetes do not produce enough insulin or else the insulin they produce does not work properly. About 85% to 90% of people with diabetes have type 2. They might get it because their family history, age or ethnic background put them at increased risk. People are also more likely to get type 2 if they are overweight. It starts gradually, usually later in life, and it can be years before people realise they have it.

There are of course exceptions with both types: there are people who have got type 1 quite late in life and there are quite young people, including children, who have type 2, which is not always the consequence of the weight a person is carrying at the time of diagnosis. As with all things, the exceptions mean it is difficult to make a comprehensive diagnosis of what is happening, precisely why it is happening and how it can be prevented.

In the UK, around 3.2 million people have diabetes, and the condition costs the NHS over £10 billion a year. Within the EU as a whole, one in 12 adults have diabetes, and one in three people with the condition apparently do not know that they have it. In this country we have done a lot of work on trying to find what was referred to as the missing million—the people who have diabetes but had not been diagnosed. I believe the figure is now around 750,000, so around 250,000 people have been diagnosed as a result of greater awareness. I will be referring to that a little later.

According to the International Diabetes Federation, globally there are 382 million people with diabetes, a figure that is expected to rise to 592 million by 2035. The number of people with type 2 diabetes is increasing in every country in the world, and 80% of people with the condition live in low and middle-income countries. The greatest number of people with diabetes are between 40 and 59 years of age, and diabetes caused 5.1 million deaths in 2013. A really frightening statistic is that every six seconds a person dies from diabetes somewhere in the world. It is a global problem—a global pandemic—and requires a global response.

That is really what the Melbourne declaration on diabetes was all about. Parliamentarians representing 50 different countries came together to talk about what was happening in their countries and what the problems were, and to discuss how we could co-operate better. We recognised that many bodies work transnationally: patient bodies, medical professionals and pharmaceutical companies all meet regularly on a transnational basis. One group that does not is parliamentarians, yet it is the parliamentarians who can initiate debates, vote on budgets, raise awareness and put pressure on Governments in a way that other bodies cannot. In a sense, the parliamentarians are the missing link.

The aim was to bring those parliamentarians together to work together to commit themselves to be advocates in the fight against diabetes and to recognise the global challenge. Those who attended committed themselves to raising the profile and working for the benefit of people with diabetes wherever they live in the world. Since the declaration was signed, over 100 parliamentarians have signed up as members and many more have declared themselves supporters. Two newsletters have been published and are hosted on the International Diabetes Federation website, a Twitter account is now active, and debates have occurred in Russia, Bolivia, Malta, Kenya, Scotland and now here today in the Parliament of the United Kingdom.

There are so many issues to address. One is prevention. Far more needs to be done on that. We may have reduced the number who are missing their diagnosis, but there are still 750,000 people out there with diabetes whose condition will develop and whose cost to the health service will increase the longer they go undiagnosed. Health education is vital, to make people aware of the risks involved. We also need information out there to combat people’s fears that if they are diabetic they will have to inject themselves with needles all their lives. Only 10% of people with diabetes are type 1 and have to take insulin subcutaneously by injection—believe me, when someone is confronted with the fact that they have to inject themselves with a needle or they are going to die, they no longer worry about injecting themselves with a needle—so 90% of people with diabetes do not have to worry about that. They can be treated by diet and tablet, and different regimes.

There is still a stigma. There are Members of this place who have diabetes but do not want other people to know about it, although it is good that increasingly Members are prepared to come forward. The situation is the same in other professions. One great thing the all-party group on diabetes achieved was a change of policy in the police, the ambulance service and the fire service: people who admitted that they had diabetes were being retired immediately, but now instead they are given individual annual medical assessments to see what they can and cannot do. Sacking people simply because of a condition seems such an obvious injustice, especially as many of them can control that condition and hold down their job as well as any other person so long as they are monitored and have that medical assessment.

Prevention will save millions. There is no doubt that the bulk of the cost of diabetes to health care systems is at the point when the complications come in and a person with diabetes has to be hospitalised. It is an interesting phenomenon that people with diabetes stay longer in hospital beds than people without it. That includes people who have been admitted to hospital for something that has absolutely nothing to do with their diabetes, or who have come in for elective surgery. The change of environment on going into hospital disables them in terms of being able to control their condition. Increasingly now, many hospitals are saying that, as people with diabetes basically self-medicate 365 days of the year, if they go into hospital, they may as well carry on self-medicating, because they know their body better than the health service is likely to.

The savings to the health service from prevention are quite phenomenal. Early diagnosis is also important, as it reduces complications, so we need to encourage people to come forward and be tested. That is linked to the need for education and information so that people do not fear being tested or being diagnosed with the condition.

Sadly, many people with the condition are not getting the checks that they are supposed to get from our health service. Diabetes UK has taken that up and argues that everyone should be entitled to 15 checks whenever they go to their GP for an annual check-up. The fact that they are not getting all 15 checks suggests that something is not working correctly in the system. Some GP practices are excellent, but others are not so good and we must ensure that everyone gets the minimum 15 checks.

The pump device for those who are insulin-dependent is a small device about the size of a pager. It is attached to the patient and provides insulin doses, almost mimicking the pancreas. It is a very good regime, particularly for children who do not want the paraphernalia of injection pens and so on. They can enjoy a life in which other children do not recognise that the diabetic is different. They must still check their blood sugar, but we are looking and hoping for the development of a single device that both tests blood and injects insulin, completely mimicking the pancreas. It is out there, but it is not yet widely available. The cost must come down and more testing is needed, but that is the future. People must live with diabetes now and the level of pump prescribing here is well below that in other EU countries. Any child who is diagnosed with diabetes should be automatically put on a pump unless there is an objection. It is the obvious way to get a child to control their condition early and to enable them to enjoy their life along with other children of the same age.

The treatment of people in care with diabetes leaves a lot to be desired, and a lot more needs to be done in the various care inspection regimes to ensure that people with diabetes who go into residential or nursing care are properly looked after.

There are questions about research. Are we spending enough on research on a cure? Are we researching better conditions and finding the best treatment regimes for people with type 1 or type 2 diabetes?

Children with diabetes must be supported in school and I hope that the Children and Families Act 2014 will go some way to helping parents with some of the problems. Some schools have refused to deal with a child with diabetes or to help them to test their blood sugar levels and take their insulin. Some schools insist that a parent must be in attendance at the school, which often means taking someone out of a job to be a full-time carer of their child with diabetes in school. Surely that is not desirable.

There are complications with transition when children move from primary school to secondary school, and then to university. They often have to deal with three health care regimes: paediatrics, adult care and student care services. Problems often arise as a consequence of those transitions.

I mentioned discrimination in the workplace in relation to blue light services. We were able to campaign against that to help to tackle it. That discrimination is still out there. People must have the courage to come forward in cases where there has been discrimination on the grounds that they have diabetes. There is probably much better understanding now in the workplace about diabetes, but there are still pockets of ignorance that need to be tackled.

All that occurs in the UK, with its well-developed health care service, many aspects of which are the envy of other countries. The Commonwealth study that has come out this week shows that the UK health service is at No. 1. That is testament to everyone who works in the health care service. They deserve our congratulations on delivering such a fantastic service cost-effectively for the majority of people who need to access services. I may list a whole load of issues and problems, but it would be wrong to be all doom and gloom and to think that we are lagging behind. We are way ahead, but we want to be even further ahead and to bring other countries up to our level. We must and can do more.

Internationally, the 66th World Health Assembly adopted a global target to halt the rise of diabetes and obesity by 2025. Every nation needs a national strategy and action plan to prevent and manage the diabetes pandemic. It is unfortunate that we no longer have a national service framework for diabetes in this country. The Government should think again about that because without a national plan and national strategy, it is difficult to determine whether we are achieving what we want to achieve in terms of reducing the number of people with diabetes, diagnosing those who have the condition and ensuring that treatment is as good as the best anywhere in the UK.

The Parliamentarians for Diabetes Global Network, which was set up through the Melbourne declaration, can help to facilitate the objective that the World Health Organisation has laid down for health care systems around the world. The network’s priority in its early years will be to build a coalition of advocates for action to prevent the pandemic at local, regional, national and transnational levels, with the focus on raising the matter in Parliaments and Assemblies across the globe to spread better understanding and awareness of diabetes and the urgency with which it needs to be addressed.

Following the declaration and events in Parliaments around the world, the ExPAND Policy Toolkit for Diabetes has gone live and will greatly assist the aims of the declaration. It is a practical guide to help diabetes advocates to challenge national Governments and to raise the profile of diabetes. It is the first comprehensive resource aimed specifically at helping MPs and other policy makers to shape and influence national policy to ensure that we prepare our health care systems for the challenges of the 21st century. With input from parliamentarians for parliamentarians, it provides a one-stop resource covering the economic case for investment, evidence of what works and best practice from across Europe, as well as practical steps for leading and developing new policies on diabetes that are fit for purpose. Key topics include prevention, self-management, innovation and person-centred care. There are also dedicated chapters on the care and treatment of children and older people. It is hosted on the International Diabetes Federation’s website and is available for any parliamentarians who want to avail themselves of its usefulness. The toolkit was the result of more than a year’s work by a network of parliamentarians, patient representatives and other opinion formers from across Europe.

The Melbourne declaration is a clarion call for action across the world and the ExPAND Policy Toolkit for Diabetes is a resource to turn words into action, but we also need momentum to reach that tipping point where no one questions why the global pandemic of diabetes receives priority attention for resources to prevent, to diagnose and to treat the condition.

--- Later in debate ---

[Jim Shannon]

I thank my hon. Friend and colleague for that comment. He is absolutely right, and I will come on to some issues that I feel the Government need to address early on. He is correct to say that vast savings will be made if there is early detection. The need for early detection was mentioned by the hon. Member for Torbay, and other Members will make the same comment.

Although it is great that money is available to treat this illness, we must not merely chase after it, putting a plaster on it after it has inflicted damage. That is clear. We need to ensure that money is spent not only on treating it, but on prevention methods—which makes me wonder whether my hon. Friend the Member for East Londonderry (Mr Campbell) was looking over my shoulder at my notes, because he made the next point that I was coming to. We cannot allow ourselves to accept the fact that 3.2 million people in the UK have been diagnosed with diabetes. Again, that is the magnitude of the problem. We must look to the causes and stamp them out at the root.

One thing that we can address is the preventive measures that need to be taken. We have talked many times in the House about the sugar content in food. The right hon. Member for Leicester East (Keith Vaz), who is not here today, introduced a measure, which I was happy to put my name to, addressing the issues of sugar in manufactured products that we eat. We need to take that issue forward, and in the future, I hope we will be in a position to take legislation on that subject through the House with the support of food manufacturers, so that we can address the issue of the food we eat. We do not need all the sugar or salt that is in food. There is a way of addressing issues outside the Chamber—issues that are outside Government control—but something needs to be done at a manufacturing level.

Our annual intake of sugar is 33.7 kg per capita. To put that in perspective, it is equivalent to eating nearly 34 average-sized bags of sugar each year. Imagine if the sugar was piled up on the table here; it would block my hon. Friend the Member for East Londonderry from sight completely. That is how much sugar we are all eating every year, and some people even eat more. Surely when discussing the Melbourne declaration on diabetes, the Government need to take another look at sugar levels in our food. What steps are the Government taking on diabetes prevention to ensure that the next generation is not blighted by diabetes in the way that this one is? Projections show that if current trends continue, in 2025, 5 million people in the UK will have diabetes. Again, the magnitude of the issue is clear, so what are the Government doing to ensure that that does not happen? What preventive measures are they putting in place to decrease that number?

The correlation between weight and diabetes has been made clear: 80% of people with type 2 diabetes are overweight or obese. The Government need to do more to increase education on the danger of being overweight or obese and tighten controls on how much sugar goes into our food. Those are all issues that I feel we need to take on board.

What is so frustrating is that up to 80% of type 2 diabetes could be delayed or prevented. I am not saying that in any judgmental way, because many in the Chamber will be aware that I am a type 2 diabetic, as I declared at the beginning of my speech. The truth of the matter is that I have to blame myself and my lifestyle choices for the onset of the disease. It was the Chinese carry-out five nights a week, with two bottles of Coke—not a good diet for anybody. That is the reason why I was almost 18 stone and had to lose weight very quickly. Aside from that, it was also a lifestyle with high levels of stress. When the two are combined, diabetes will knock on the door of nearly everybody, as most of us know.

While I am on the subject, many people can be diabetic even though they are not necessarily overweight. It can happen through them having a stressful lifestyle. How many others living the same lifestyle are not aware of the damage that they are doing to their bodies in the long term, and how can we do better in highlighting that? I have to take two Metformin tablets in the morning and two at night. That dosage could have to be increased; a doctor could come along, as he often does, and say “By the way, you just need a wee blood pressure tablet now to keep you right as well.” People wonder just how many tablets they will have to take before they reach the age of 65 and retire, if they are spared until that age.

What are the Government doing to diagnose diabetes early and treat it effectively, preventing or delaying the complications that cause so much human suffering, require costly treatment, and reduce life expectancy? Only one in 10 people who are newly diagnosed with diabetes are offered education on how to manage their condition, despite strong evidence that education is a cost-effective way of giving people the knowledge that they need to manage their condition. On managing diabetes, after someone is diagnosed as diabetic, what help is given to them to ensure that they manage that in a sensible way? I accept that the person also needs to acknowledge that they have to manage the condition. I remember Dr Mageean, my doctor, telling me when I was first diagnosed, “Jim, it is up to you what you do.” He was very clear and said, “You must manage this yourself,” but at the same time, I think we need a wee bit of help, perhaps from Government and from the health service in particular, just to ensure that we know what that all means for everyone involved.

It is estimated that in my small Province of Northern Ireland, 80,000 people have diabetes. That awful statistic worries me very much.

[Mr Sanders]

The point about education is interesting. According to the National Audit Office, the estimated amount that the NHS could save annually through people better understanding and managing diabetes is £170 million. That is just from improved awareness and education.

[Jim Shannon]

I thank the hon. Gentleman for his intervention. That reinforces the point made by my hon. Friend the Member for East Londonderry and by me: prevention saves money for the NHS. I accept that the Minister’s budget is restricted, and that we cannot spend outside of that, but if there are ways and means of reducing the money that is spent and ensuring that we can still deliver the NHS that we are all very proud of, we should try to do that as well.

On 12 February 2014, I asked the Minister what discussions had been had with the Health Minister in Northern Ireland on UK-wide strategies for diabetes, obesity, heart disease and rare diseases. The Minister said that there had been no discussions with the Northern Ireland Executive on those issues. I am asking that question again, as she is here. I respect her greatly—she knows that—and I value the work that she carries out in this place, but I honestly believe that a UK-wide strategy is needed. We had one until 2013, but then it was not carried on. I believe that it would be to the benefit of all the regions of the United Kingdom of Great Britain and Northern Ireland if that UK-wide strategy was started again, so I ask the question again.

There is cross-House approval of and support for the Melbourne declaration on diabetes, which pushed for an international effort in the fight against diabetes, and that is what this is all about. Are the Government willing to work with the devolved Administrations of Northern Ireland, Scotland and Wales to use resources wisely and create a UK-wide strategy against diabetes? They have done it before; let us do it again, and do it even better this time.

The director of Diabetes UK Northern Ireland, Iain Foster, has said:

“We are in the middle of a diabetes epidemic…With the numbers rapidly increasing it is now more important than ever that everything is done to prevent serious complications which cost the NHS millions”—

as the hon. Member for Torbay said—

“and are absolutely devastating for the individuals and families involved.”

Let us never forget that it is not just those with diabetes but the families around them who are affected by the debilitating effects of diabetes on the individual.

Will the Government commit to implementing fully the NHS health check, which should be offered to everyone aged 40 to 74, to help identify people at high risk of type 2 diabetes? I say with respect that that programme has been patchily introduced so far, so there could be a lot of improvement. The Government need to do more to ensure that those at high risk benefit from lifestyle interventions to help to prevent the disease. The National Institute for Health and Care Excellence has recommended increasing the proportion of people with diabetes who get the nine annual checks. That should happen as a matter of course when people are in their GP surgery, or in hospital for whatever reason.

Those checks help people to manage their condition and to identify any signs of complications early. However, there is a large geographical variation in the proportion of people getting them. Again, if we had a UK-wide strategy, we could ensure that there were no differences geographically in who gets the nine annual checks and who does not. Will the Government commit to increasing the number of people who receive the checks? That is a positive way forward. It is another way of doing the preventive work that we need, and will ultimately lead to the savings that we need.

In 1922, insulin was discovered by John Macleod, Dr Banting and Charles Best, yet 92 years later, in 2014, we are still fighting against the dreadful disease of diabetes. In the UK this year, 59,000 people will die unnecessarily from diabetes. I strongly urge the Government, in the wake of the Melbourne declaration on diabetes, to take serious strides in the UK in preventing and controlling diabetes.

--- Later in debate ---

[Jane Ellison]

I think that the shadow Minister has slightly misunderstood what I said. Those are the tests and that is exactly the standard to which we want everyone to work. What I am saying is that there is no top-down guarantee. We cannot sit in Whitehall and say, “It must be done like this and that is the end of it.” We have said that that is the standard, and NHS England has set a range of other standards, but to deliver that and to drive that consistency of excellence throughout the country requires a range of tools. We must acknowledge that. That is not to say that we accept patchy service—far from it—but we cannot do it with top-down diktat only; we must drive change at all levels of the system and drive towards excellence.

[Mr Sanders]

On that point, there is a difference between a treatment, which must be down to the clinician and what is right for the patient, and tests, which should be the same for everyone. They are just tests that would then dictate the right treatment regime, if additional interventions are required. There ought to be a mechanism to ensure that the tests are consistent for every patient with diabetes in the country, otherwise what is the point of having them?

[Jane Ellison]

I agree. The Government, NHS England and Public Health England are all looking at how we drive that consistency. How do we drive consistent excellence? What tools can we use to do that?

Perhaps it would be helpful if I gave an example. Public Health England is developing a tool to drive improvements in diabetes care and iron out variation. It will be launched later this year, and although I am not able to give much detail now, I am sure that my hon. Friend the Member for Torbay will be interested when it is launched. It will provide a clear picture of how diabetes care and outcomes vary across the country and among practices, which will support decisions on how to make improvements.

The Government have made transparency of data a real priority, and being very transparent about what is being delivered and identifying variation is one of the ways in which we can drive the rest to be as good as the best. I suppose I am trying to explain that, although I could send out a memo tomorrow outlining my national diktat on diabetes, that is not how we drive change. It is crunchy, it is detailed and it is about getting to that local variation and ensuring that we drive up standards in every way possible. That is one of the tools we are developing, but there are others as well.

--- Later in debate ---

[Mr Sanders]

When the Minister came to the all-party group, I do not think anyone recognised that it was her first meeting because she carried it off with distinction and quickly won over a lot of friends in the group. She has been a consistent friend throughout the period.

One of the challenges of a bottom-up approach, as has been highlighted in this debate, is getting people to use the information that is out there to drive up standards. People need to be aware of where the information is and how they can best use it, which is a challenge not only for diabetes but across the health service. I thank all hon. Members for their contributions.

Type 1 Diabetes (Young People)

Adrian Sanders Excerpts

Wednesday 30th April 2014 Westminster Hall

[Mr Adrian Sanders (Torbay) (LD)]

I congratulate the right hon. Member for Knowsley (Mr Howarth) on securing this important debate and on his comprehensive introduction to the problem. As has been said, the UK has the fifth highest rate of diabetes in the world and the fifth highest rate of diabetes among children aged up to 14 in Europe. It is important for us to do the best we can to help people with the condition.

I cannot emphasise enough the importance of getting across the difference between type 1 and type 2 diabetes. They are both chronic conditions, but type 1 is known to be genetic while type 2 is a consequence of lifestyle and diet, and is not necessarily related to genetics. Consequently, the treatments for type 1 and type 2 are varied. People with type 2 can be treated mostly with a change in diet and exercise, and some medication. Increasingly, however, insulin injections are being prescribed for people with type 2. People with type 1 are those whose pancreas has basically stopped producing insulin, and they have to take insulin via subcutaneous injections. There is no alternative to that treatment for people with type 1. Additional medication can be added to the insulin regime to reduce the risks of common complications that can affect all people with diabetes, such as stroke, heart disease, sight loss and limb amputations.

Only one in five people with diabetes is type 1, and most are diagnosed before the age of 40. I was fortunate to have been diagnosed after I had finished full-time education, because type 1 diabetes can have a major impact on a young person’s life and health in many ways—educationally, socially and psychologically. One of the major problems for children is how they treat themselves for their condition at school. There are three stages through which a young person has to go. There can be problems at primary school, which have been referred to, where teachers may refuse to help the child medicate. Some schools will not admit a child because they have diabetes. Others will admit the child but will insist that the parents come in to do the blood test and help the child deliver the insulin. That is not fair to the parents, and it increases the overall cost of the condition to the taxpayer.

In secondary school, there is the problem of the young people themselves, which has been mentioned. There are psychological difficulties inherent in having to set themselves apart from the rest of the school because they have a condition that requires them, from time to time, to test their blood sugars—that means a simple finger prick to take blood out of their finger and put it on to a test strip—and find somewhere healthy and clean to use their pen, which looks like a normal pen but is in fact an injection device, to make an injection.

The next stage is higher education, where the young person will move from their GP setting to a student health service. Transition is a major issue, and every young person with diabetes should experience a smooth transition to adult diabetes services at a stage and time right for them. Adolescents with diabetes have unique health requirements. They must cope with the biological, psychological and social transitions to becoming an adult while managing a chronic condition. Many people experience deterioration in their control of their diabetes in adolescence, and they are particularly vulnerable as their care is transferred from child to adult services.

Adolescence is also a time when lifelong health behaviours are laid down, so transition must be carefully instigated at a time when the young person has sufficient clinical understanding of managing their condition to get the most out of the adult diabetes service. If that does not happen and young people are simply transferred to adult services, they will often disengage with the service, leading to poor control and an increased risk of long-term complications.

The importance of getting transition right for young people with diabetes is increasingly acknowledged across the international health care arena. That is reflected in the best practice tariff, which includes the criteria that provider units must have a clear policy for the transition to adult services. Will the Minister explain why the best practice tariff cannot be extended—as was asked for earlier—to include all young people up to the age of 25?

The other big issue is the regional disparity of care. The problem is not just about access to medical equipment such as insulin pumps, although really that should not be an issue at all. All children diagnosed with type 1 diabetes should be offered pump treatment on diagnosis, and I would like to ask the Minister a second question: why is that not so? Parents who have engaged with the paediatric diabetes peer review have expressed to me their concern at the plan to discontinue the programme this September.

As we have heard, there is huge regional discrepancy in the provision of care for children with diabetes, in terms of both patient experience and outcomes, with the number of children achieving target HbA1cs falling woefully short in some areas and compared with other countries. Parents have been very impressed by the work of the networks to try to address variation and achieve considerable improvement. However, there is still a long way to go, and the audit can provide only benchmarks and goals, not strategies for achieving higher standards.

The peer review programme, on the other hand, has been meticulously and carefully designed to address the causes of discrepancies in care standards. The programme managers and lead clinicians in each network have worked hard to design a set of measures that enable teams to understand more fully how to provide the highest standard of care for the children who attend their clinics. It seems that the peer review programme has the power to drive change and raise standards across the country, ensuring that children with diabetes can lead healthy and productive lives.

My third question to the Minister, therefore, is why is the paediatric diabetes peer review programme being discontinued? The lifetime cost to the UK economy of everyone living with type 1 today will be more than £55 billion. With the incidence rising, that figure will only increase, and remember that only one in five people with diabetes is type 1. The three priorities for type 1 or type 2 diabetes, whatever a person’s age, must therefore be prevention, early diagnosis and the best treatment to avoid expensive complications. Where young people are concerned, whether children or young adults, we can and must do better.

Oral Answers to Questions

Adrian Sanders Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Jeremy Hunt]

We are strengthening protection for whistleblowers and are going much further by creating a culture of openness and transparency in the NHS, where people are not bullied if they speak out about poor care.

[Mr Adrian Sanders (Torbay) (LD)]

Torbay is often held up as a model for an integrated care service, but two important services are not fully integrated—mental health care and children’s services. Will the Government encourage the incorporation of all services into a fully integrated health care system?

[Mr Hunt]

My hon. Friend makes an important point and the heart of what he says is that integrated, joined-up care is most important for those who are regular users of the NHS. Children with complex needs or people with mental health conditions that can improve but not necessarily be cured can really benefit from an integrated approach. I salute what Torbay has done in blazing a trail. We are learning from that and hope that such a process will be rolled out in every part of the country as soon as possible.

Childhood Obesity and Diabetes

Adrian Sanders Excerpts

Wednesday 24th April 2013 Westminster Hall

[Mr Adrian Sanders (Torbay) (LD)]

It is a pleasure to serve under your chairmanship, Mr Davies, for the first time. I congratulate the right hon. Member for Leicester East (Keith Vaz) on securing this important debate.

I would like to highlight the clear distinction between type 1 and type 2 diabetes. The vast majority of children with diabetes have type 1, which is not preventable and needs daily treatment with insulin. That is not to say that diet is not important; some believe that one can put off presenting with type 1 by adopting a very sensible diet and exercise regime, but that is not proven. The fact is that there is not a lot that most people can do to stop it happening, myself—a type 1 diabetic—included. It is going to happen; it is a question of when.

The vast majority of people with diabetes have type 2, which is explicitly linked to lifestyle. Other risk factors include ethnicity and family history. Type 2 usually manifests later in life, but lifestyle in a person’s early years has a considerable bearing on later risk. Just to confuse the situation, rather worryingly, we now see cases of children developing type 2 diabetes, with about 500 cases diagnosed in the UK to date. It is therefore extremely worrying to hear that a quarter of children entering reception classes are overweight or obese—the proportion rising to one third at age 11.

How significant a public health disaster obesity is likely to become cannot be overstated. On current trends, it is estimated that direct costs to the NHS will be £10 billion a year by 2050 and the wider social costs will be many times that once issues such as early incapacity, lack of productivity and so on are factored in. An obese man is five times more likely to develop diabetes than a healthy man. Obese women are 13 times more likely to develop it than their healthy counterparts. Diabetes is one of the more costly long-term conditions for the NHS to deal with, so higher levels of obesity will clearly lead to greater problems for the NHS, and I am not sure anyone has yet figured out how to address the human and financial costs.

I am happy to welcome the work that the Government have undertaken so far on diabetes and wider public health issues. We have made significant progress in identifying where the problems are and what is causing them, and the national diabetes audits have been a great help in that regard. For all its controversies, the Health and Social Care Act 2012 should allow health care professionals to integrate what they do with local authorities, public health services, schools and so on—whether it happens in practice has yet to be seen.

The overarching problems are clear: a more sedentary lifestyle, and, in childhood, the attraction of TV and video games; the lack of structured sport and exercise—especially in schools—and an increased perception among parents of the heightened dangers of playing outside. Coupled with those is an increasingly unhealthy diet, exacerbated by excessively sugary, salty and fatty foods. A difficulty arises when we consider how to tackle what is at root a cultural problem. France, for example, experiences the same commercial challenges, with the availability of unhealthy food and the growth of electronic entertainment, but has only half the UK’s rate of childhood obesity. A lot of voices call for quick, and sometimes superficial, Government interventions, such as banning or regulating sugary cereals, a tax on particularly unhealthy products and so on. Such policies might have some value as part of a wider strategy, but on their own they will not effect the cultural shift we need.

We need to improve the ability of consumers, especially parents, to make informed decisions about what food to buy and prepare. To me, that implies a two-pronged approach, with better food labelling at the point of sale—whether at a supermarket, restaurant or even fast-food outlet—and better education, particularly in schools, both playing a role. We need to look at promoting alternatives to sugar, especially in soft drinks, which contribute a great deal to childhood obesity.

I spoke at a diabetes conference yesterday. A concern that came up, which has been coming up for years, is that previous strategies to improve outcomes have often failed due to silo working or a lack of integration between services. In Torbay at least, the health care system has recognised the serious problems that causes and has integrated primary and social care services, which gives it a head start when tackling public health issues. We now need that principle extended to the policies and services that impact on child health, specifically obesity. In Whitehall, there has always been a chasm between the Department of Health and the Department for Education, and it needs bridging at national and local levels. We would do well to recognise that prevention works best the earlier it starts.

Statistics show that children are already in trouble before they get to school, so there is a role for early- years services as well. Whether we like it or not, public services are driven by financial imperatives and we will need to address the problems at the funding level, by giving schools, GPs and all the other interested parties a shared duty to tackle public health issues and rewarding those that show innovation in their curriculums. Change4Life is a good start. It rightly highlights that strategies and solutions are best designed and delivered at a local level.

I conclude by praising the right hon. Member for Leicester East for securing the debate and for the work he does. I also thank the other hon. Members here today who are tireless campaigners in the field, and the Minister for her fresh approach to the subject. Any strategy we use must bring local stakeholders together. Whatever we do, it needs to be more ambitious than what we are doing.

--- Later in debate ---

[John Pugh]

There are benefits to the approach I outlined, although the people who are most acutely aware of the calorific content and the quality of their food are those who are already halfway to solving the problem. However, many people do not get even to that first base, and that is where public health messages have an impact.

[Mr Sanders]

Does my hon. Friend not think there would be an enormous benefit in having a simple traffic-light system so that parents buying children food understand that red means danger? Similarly, people queuing up at a fast-food restaurant will know which items on the menu contain the most sugar.

[John Pugh]

I hope hon. Members do not misunderstand me. I am not saying that the bits of the jigsaw cannot be put together and cannot ultimately constitute a perfectly satisfactory solution. I am saying that every one of the solutions so far advocated must come with a caveat, because it is not likely to be the magic bullet that will transform things. There is no magic bullet, and I will return to that theme when I conclude.

On sport, it is unquestionably the case that one reason why children acquire the extra pounds is that they move around far less than they ever did. When I was at school, the dinners were intensely fattening, but children moved far more, so the obesity problem was not that marked. One issue, however, is that if the problem starts early, as my hon. Friend the Member for Torbay (Mr Sanders) suggested, and the child is already overweight, he or she will be more reluctant to engage in sport and likely to look for excuses to avoid sport, so offering them a wider menu of sporting opportunities, by itself, will not help.

Pressure on producers and the responsibility deal were mentioned, and a lot can be achieved through such measures. The Minister will confirm that we have, almost without noticing, reduced the amount of salt in our food by agreement with the producers, and nobody has really minded. Clearly, similar results can be achieved by agreement with sugar producers, and there is no reason why that should not happen. Again, however, people tend to deceive themselves. We are all familiar with the phenomenon of people who sit there with a beefburger and chips, but who have a diet coke by their side. The assumption is that if they drink the diet coke, the effect of the chips and the beefburger will somehow be negligible.

The right hon. Member for Leicester East mentioned the issue of access. Access to fast food is one of the principal reasons why society has the difficulties it does. When we go to railway stations or other places where we are in a hurry to buy things to take on our journey, it is noticeable that we are presented with larger snacks than we would want, such as grab bags and extra-large chocolate bars. There is no explanation for that, other than that the producers are being blatantly irresponsible and trying to shift more of their product.

I must make a confession that may shock many Members present. As a student, I once worked as an ice cream salesman, driving an ice cream van. Our strategy was always to turn up at schools around lunch time, although my ice cream was of such low grade that the children would walk past my van. Instead, they would go to the Mr Whippy van, even if it got there later, so our strategy did not entirely work. However, Members can see that having food near lots of ravenous children is attractive to commercial interests, even if it is irresponsible of them to pursue such a strategy.

All those solutions have merit, but most of them have limitations. It is tempting simply to say there are a lot of issues—I have said as much myself—and that we have to press all the buttons to get the effect we want. I am quite happy to go along with that, I would like us to concentrate on what works and on what there is clear evidence to support; that is what I think needs to happen. One serious problem that concerns me, and which has been mentioned, is tokenism. I have seen tokenism in action; I have seen schools go through the motions of telling the children a bit about food and sticking up the appropriate pictures, but nothing really changes, so the phenomenon persists because it has not been properly addressed. There is irrevocably an element of personal and family responsibility. We cannot take that out of the equation. However, the most successful methods of making it easier for people to make the right choices must be evidenced, supported, endorsed and spread. We should not put into practice a mechanism that might or might not work.

A concern that results indirectly from concentration on the problem in question is the increasing incidence among children of not diabetes but eating disorders. However we pursue the agenda, we must do so in a way that makes it less likely that increasing numbers of children will, because of a legitimate concentration on their health and weight, become obsessed with their body shape and develop problems with eating behaviour that they would not have if they grew up naturally and in a satisfactory way.

Oral Answers to Questions

Adrian Sanders Excerpts

Tuesday 26th February 2013 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

The truth is that the Government inherited a completely fragmented NHS; we had managed institutionally to separate health care from social care, mental health from physical health and primary care from secondary care. At the heart of the legislation we have already passed and the proposed social care legislation, which we hope to introduce very soon, is the principle of integrated care. I am determined that that should be central in every area of the country so that we deliver proper care and avoid crises, keeping people out of hospital.

[Mr Adrian Sanders (Torbay) (LD)]

T5. The South Devon and Torbay clinical commissioning group is building on the integrated health and social care system for which many have praised the area. Will the Minister help complete the integration by assisting with the inclusion of mental health care services within the regime?

[Norman Lamb]

I thank my hon. Friend for that question and applaud the brilliant work that has been done in Torbay. There has been a reduction in hospital admissions because they care for people better. As I said in my last answer, it is essential that we integrate mental health in the system as well as physical health so that we give people proper care.