Diabetes

Adrian Sanders Excerpts

Wednesday 9th January 2013 Westminster Hall

[Mr Adrian Sanders (Torbay) (LD)]

It is a pleasure to speak under your chairmanship, Mr Crausby.

I want to put on the record the difference between type 1 and type 2 diabetes, although the debate is about diabetes more generally. Type 1 diabetes develops when the body’s immune system attacks and destroys the cells that produce insulin. As a result, the body is unable to produce insulin, which leads to increased blood glucose levels and in turn can cause serious organ damage to all organ systems in the body. About 15% of people with diabetes in the UK are type 1s. I wish to declare my interest as someone who was diagnosed as type 1 nearly a quarter of a century ago, and I am still here. Type 2 diabetes develops when the body does not produce enough insulin to maintain a normal blood glucose level or is unable effectively to use the insulin produced. The long-term complications that challenge both type 1 and type 2 sufferers are much the same.

Diabetes remains one of the largest challenges to our health care system, with about 3.7 million sufferers in the UK; almost 1 million more are estimated to have the condition, although they do not know it. The numbers are expected to rise, which all makes for a significant challenge to the NHS, with an estimated spend of £10 billion a year on diabetes-related treatments. Much of that spend is unnecessary: people with the condition far too often suffer from late diagnosis, preventable complications and variations in care; they are often overlooked for specialist care when being treated for other conditions, particularly as in-patients; and they can be prevented from accessing treatment by the short-term financial ethos embedded in some primary care trusts.

None the less, we have made progress in recent years. I pay particular tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) and the former ministerial team for the open and constructive way in which they pursued the issue and ensured that diabetes remained a high priority during the stormy times of NHS reform. The all-party group on diabetes, which I chair, has already met the new Minister, and I am confident that the good progress will be sustained, if not surpassed. I am already heartened by the new Secretary of State’s pledge to focus more on patient outcomes and the patient experience. Let us hope that that intention manifests itself in clear instructions for managers and commissioners.

One of the priorities on which Ministers can have a direct impact is the promotion of leadership by the Department of Health. In recent years, a problem has arisen from the apparent inability to disseminate best practice around the UK and the unwillingness of some NHS organisations to implement it.

[Keith Vaz (Leicester East) (Lab)]

I pay tribute to the hon. Gentleman for all his amazing work on diabetes over his parliamentary career. As he has done, I have tabled questions to ask simply how high the spend on diabetes was in individual PCTs last year, only to be told that the information was not available and so could not be given to me. Is not that kind of information vital for an effective strategy on diabetes?

[Mr Sanders]

That would certainly be extremely helpful and would complement the atlas of care by, in a sense, putting the actuality into the story behind the figures. It is extremely unhelpful not to be able to drill down to what is really happening on the ground; we could do that if such statistics were available.

Some of the problems of disseminating information have been offset by the work of NHS Diabetes. It has been instrumental, first, in monitoring variations in care and driving the collection of more robust data, which has culminated in an extremely important publication, the national atlas of variation; and, secondly, in working tirelessly to rectify the problems it uncovers, linking national policy intention with policy implementation on the ground, including support targeted on where the greatest improvements are necessary. It is important that that work continues, as much more could be done. I hope that the Minister will reassure me that, despite the upheavals in the commissioning architecture, NHS Diabetes will retain its central role.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I, too, pay tribute to the hon. Gentleman for his fantastic work as chairman of the all-party group on diabetes. Does he agree that there need to be performance targets, like those for cancer, stroke and heart disease? At the moment, there are not the mandatory performance targets for diabetes that there are for those other diseases.

[Mr Sanders]

I am grateful to the hon. Gentleman for making that point. When one puts together speeches, they sometimes go on too long, and I had cut out that bit, so I am glad that he has raised it. The big issue is that the cause of death is sometimes recorded as stroke or heart disease when the underlying problem is diabetes. We have targets for cancer, heart disease and stroke. We really ought to look at diabetes as the root cause of other conditions for which there are targets.

The variation in care across the country is probably the largest worry for patients now, and the new implementation plan should focus on that. Failings in diabetes care cause an estimated 24,000 premature deaths each year. In 2001, the Department of Health published the national service framework for diabetes, which set out clear minimum standards for good diabetes care. Those standards include nine basic care processes that aim to end preventable complications by looking for early warning signs. Despite those targets, much of the country has seen little progress towards improving detection of type 2 diabetes and reducing the number of preventable diabetes complications. In 2009-10, results from the national diabetes audit showed wild variations in inputs and outcomes for both type 1 and type 2, including the astounding figure that the proportion of type 1s receiving the recommended nine care processes ranged from as low as 5% to 50%, with an average of 32% in England. The figures were only marginally better for type 2s. It really is not good enough.

The point about the condition is that people treat themselves 364 days a year and see a practice nurse or sometimes a general practitioner—more rarely, these days, a consultant—only once a year, although they should receive the nine care processes. The chance of developing diabetic complications can be reduced by keeping blood pressure, blood glucose levels and cholesterol levels low. Regular monitoring, backed up by periodic checks, is the key. The results from the national diabetes audit demonstrate that more needs to be done to end the postcode lottery of care for people with the condition. When as few as 5% of people with type 1 diabetes are receiving all nine care processes in some areas, there is a definite failure of care. If all health care trusts followed the national service framework, such complications as blindness and kidney disease—as well as stroke, heart and other diseases—could be prevented.

I hope that we will explore a range of best practices, but I want to highlight a couple that have scope to bring immediate improvement at very little cost. An acute issue is the provision of insulin pumps for type 1s. That is an example of where the UK should look abroad for best practice. Type 1s in other developed countries, such as France, Germany or the US, can expect to benefit from a pump if that is required for their diabetes management. Somewhere between 15% and 35% of type 1s in those countries have pumps, which enables them to lead normal lives, but in the UK the figure is less than 4%. That is clearly a failure of the commissioning structure as it is now. Will the Minister address how that is likely to improve? The Work Foundation has estimated that, if pump usage reached 12%, the NHS would save about £60 million a year.

Another example of where best practice is needed is surprisingly simple: good local leadership. Good leadership, as I have been fortunate enough to experience in my own area of Torbay, is essential to promoting effective and integrated services. Integration is key to reducing costs in the long term and, more importantly, to improving patient outcomes, which all too often get lost in the debate over health care services.

The move to clinical commissioning groups, with the potential for better scrutiny and criticism from patient groups, local authorities and health care staff could, in theory, lead something of a revolution in spurring innovation and creativity and in the striving to find best practice.

Just as educating the commissioners is crucial, so, for diabetes, is patient education, which has the happy side effect of making patients far more aware of whether they are receiving a good service and enabling them to become better advocates for their condition. I have no doubt that the great knowledge possessed by volunteers for Diabetes UK, the Juvenile Diabetes Research Foundation, INPUT and the many other groups involved in diabetes will be a considerable asset in shaping good services at a local level now that we have better scope for patient scrutiny and involvement.

In the wider sense, patient education is the core to preventing complications, which diminish the quality of life for patients and which, all too often, reduce life expectancy and increase the costs to the NHS in the long term. Good patient education programmes may require some investment, but they would pay for themselves many times over.

On a broader level, work needs to be done on detection and prevention. The number of people suffering from type 2 diabetes is set to reach a staggering 5 million by 2025. However, what many people do not know is that type 2 diabetes is a largely preventable disease. At the very least, its onset can be delayed and complications reduced.

NHS checks are vital to the detection and prevention of diabetes. In theory, such checks are available to all 40 to 74-year-olds who are seen to be at risk of developing diabetes. Shockingly, a number of primary care trusts in the UK failed to offer a single person an NHS health check last year, which demonstrates the dangerous variations in provision in the NHS. The Government can look to rectify that if they create a new national implementation plan for diabetes. Indeed they may even take up the suggestion by the hon. Member for Gillingham and Rainham (Rehman Chishti) to set targets for diabetes.

This year, the current national framework for diabetes comes to an end. It is important that we build on the successes of the framework, that we focus on reducing discrepancies in diabetes care and that the new framework emphasises the importance of health checks and prevention of the disease through simple means such as diet management. Indeed, it is essential for the Government to spell out to commissioners and to patients what services can be expected and to provide a road map to show where we want to be in a few years’ time and how to get there.

[John Pugh (Southport) (LD)]

My hon. Friend analyses the fair degree of regional variation that exists and talks about a postcode lottery. Does he think that that is primarily down to a lack of leadership at PCT level, or to the qualitative variations that we get anyway in primary care practice among GPs across the country?

[Mr Sanders]

It is a combination of both. We cannot prescribe from the centre precisely what must happen in every area. Of course local areas must reflect their own demographics and their own health picture and be able to apply priorities accordingly. However, there is something to be said for ensuring that local areas have the tools that they need, which is where NHS Diabetes did such a good job on the back of the NHS framework for diabetes.

It is equally important that health checks are used to detect diabetes in its earliest stages, as early detection and appropriate treatment can prevent the severity of the condition and the risks associated with complications such as amputations.

[Rehman Chishti]

On health checks, the hon. Gentleman must have seen the report that says that, according to Diabetes UK, nine out of 10 people do not know the four main symptoms of type 1 diabetes. Surely, therefore, the education should look at ways in which people can identify for themselves the symptoms that can lead to type 1 diabetes.

[Mr Sanders]

That is a very good point. There is the 4 Ts campaign on diabetes. If I remember correctly, the four Ts are thirst, tiredness, toilet and one other— I always remember three, but not four. Anybody who feels thirstier or more tired than usual or is visiting the toilet more often should see their GP. A simple test—it is not an invasive test—can be conducted and after an appropriate early diagnosis a patient can start to feel better very quickly. An ancient fear of great big hypodermic needles being stuck in their skin deters many people from going to a GP, but only 15% of diabetics are put on to an insulin regime on diagnosis and that is because they suffer from type 1. Most type 2 sufferers never have to take insulin via an injection device, and, in any case, those devices are subcutaneous and really nothing to fear. I speak as someone who has to inject four or more times a day, and it really is not as bad as people fear. People should see their GP. If they do not, matters will get worse, complications will set in and they will rue the day that they did not sort out the problem early on.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I know that it is unusual for a Minister to intervene at this stage, but will the hon. Gentleman help me in this matter? Is it not right that there have been huge advances in the administration of insulin? A constituent of mine showed me the pump on his stomach that gives him the right amount of insulin. He even had a device on his mobile phone that could calculate from a photograph of a particular meal the amount of insulin that should be administered to his body. He clicks on the app and the insulin is given to him at the appropriate time, before or after he has his meal. Does the hon. Gentleman agree that those are wonderful devices that should be prescribed to people as much as possible?

[Mr Sanders]

I cannot fail but to agree with every word that the Minister has said, and I am absolutely delighted that she has said that. Children in particular benefit from pumps, because they can go to school and lead normal lives alongside their school friends. It is difficult for them to find the space and time to inject, and these little devices are doing the job for them all the time. The technological advances are such that we may well reach a point in the not too distant future where there is a device that both tests a person’s blood sugar level and then injects an appropriate level of insulin, without them having to check what they are eating. The little device is like having a pancreas attached to the side of the body. That is where we are going. At the moment, however, pump usage is very low in the UK. It is about having not just the pump but the services behind the pump—the trained nurses who can train and educate the person to use the pump properly, the technological support that needs to be there to back it up and the medical expertise to understand the difference between a pump regime and any other regime. That is the detail, and I am really glad that the Minister is on the ball here.

The provision of education about diabetes seems to be somewhat of a lottery in terms of who is actually receiving information and advice. There needs to be a standardised programme of education on the condition that is accessible and effective for all.

We must not miss the opportunity to encourage healthier lifestyles as a consequence of the Olympic legacy. It is essential that funding and provision for sports facilities and physical education continue to be given priority in the coming years to capitalise on increased interest in active sport. The Olympics have given people who have perhaps never before enjoyed individual or team exercise a new drive and desire for sport, which needs to be harnessed and nurtured. Gym membership and even one-off sessions for swimming still seem to be extremely pricey, which makes those forms of exercise inaccessible for many who could perhaps benefit from them. However, I am aware that some inner-city areas have set up programmes that allow residents to use facilities at a reduced rate or even at no charge. I wonder whether that idea should be taken hold of by more UK communities, and whether the Government could assist all local authorities to find ways to subsidise it, perhaps by working in partnership with private sector organisations.

Having facilities and making them affordable is an issue, which is why I find it unbelievable that some local authorities, including my own, give permission for building on sports facilities; in Torbay, the only public grass tennis courts in the local area are about to be built on. Andy Murray won his Olympic gold medal on grass and generated more interest in the sport last year, and my area has produced some of the great British tennis players down the decades, including British men and women No. 1s in Mike Sangster and Sue Barker. That makes that act by my local authority one of unforgivable short-sightedness.

I have outlined many of the issues surrounding diabetes care, but I will concentrate now on some of the things that I hope the Minister will focus on delivering in the coming years. There needs to be a comprehensive national implementation plan, containing measures to ensure that local leadership is robust and long term in its thinking. Such a plan also requires measures to focus on detection and prevention, and it needs to ensure that best practice can be effectively disseminated. Three priorities face our NHS and other health care systems around the world: prevention; diagnosis; and care. We have a long way to go to meet the challenges of each one.

[Several hon. Members]

rose—

--- Later in debate ---

[Anna Soubry]

It could be, but I make it clear, as I said on Monday in various media interviews, that at the moment the responsibility deal is working, which is why we have some of the lowest salt levels in the world. Other countries are coming to us to find out how we have achieved that by working with industry, retailers and manufacturers to reduce salt levels. On the reduction of trans fats, under 1% of our food now has trans fats in it. Again, we have done that by working with the manufacturers and retailers.

My natural inclination is against legislation, and I say that as an old lawyer. At the moment, I am confident that the responsibility deal is delivering in the way that I want it to. I make it clear that, if there is a need to introduce legislation, we will not hesitate to do that. I am almost firing a warning shot across the bows of the retailers and food manufacturers and saying, “Unless you get your house in order and accept responsibility, we will not hesitate to introduce legislation or regulation, because we know that we in this country have an unacceptable rise in obesity, to levels that are second only to those in America.” I will therefore consider everything. I always have an open mind. I am currently content, however, that the responsibility deal is delivering, but it has a great deal more to do. I hope that those who are signed up to the calorie reduction scheme later this month will encourage more manufacturers and retailers to sign up to the responsibility deal on calories. I want to ensure that we make some real, serious and tangible progress.

Ultimately, however, as the right hon. Member for Leicester East and the hon. Member for Strangford (Jim Shannon) identified, the responsibility is ours. Nobody forces us to eat the sugar buns or whatever it may be. When we go into the Tea Room and we are faced with the choice between fruit or a piece of cake, my natural inclination might be for a piece of cake, especially since I have developed a sweeter tooth as I have got older and since I have stopped smoking. We all make the choice whether to eat a piece of cake. The ultimate responsibility lies with us as individuals and as parents, but I always have an open mind.

Diabetes is a growing problem and a major factor in premature mortality with an estimated 24,000 avoidable deaths a year—10% of deaths annually are in people with diabetes. A variation exists in the delivery of the nine care processes, with a range of 15.9% to 71.2% achievement across PCTs, which is not acceptable. However, 75% of diabetes sufferers receive eight out of the nine care processes, which is a huge improvement. In 2003-04, only 7% of sufferers received all nine care processes. In 2010-11, that figure was at 54.3%, but there is much more to be done. In the coming months, several documents will be published to guide the NHS in delivering improved diabetes care, including the response to the Public Accounts Committee report, the work undertaken on diabetes as a long-term condition and the cardiovascular disease outcome strategy.

We must ensure that people get an early diagnosis. I must commend again the work of Diabetes UK. Other hon. Members have mentioned how it is raising awareness of the early signs and symptoms of diabetes with its latest campaign on the 4 Ts, which has my full support. One in every two people diagnosed with diabetes already has complications. I thank the hon. Members for West Lancashire (Rosie Cooper) and for Blaenau Gwent (Nick Smith) for their contributions. I will not be able to answer their points specifically in my speech, but I hear what they say and will write to them if necessary to answer their questions. I am acutely aware of the complications and the devastating effects that those can have on people’s lives.

[Mr Sanders]

Can the Minister respond to the important point made by the right hon. Member for Leicester East (Keith Vaz) about pharmacists? Some private pharmacy groups offer diabetes tests, which other pharmacies should be encouraged to do. I hope that we can see the roll-out of more collaborative working between the private sector and the health service in order to identify people with diabetes, so that they start to get treated.

[Anna Soubry]

I am grateful for that intervention not only because I was coughing but, most importantly, because I was going to mention that subject only in passing. I will now expand on that a little. I absolutely agree with the points of my hon. Friend and the right hon. Member for Leicester East about the importance of pharmacies. They are important for so much of the NHS’s work, but here is a good example of where we can link them in far more with delivering the successes, outcomes and diagnoses that we need so desperately. There is absolutely a role for pharmacies, and I look forward to clinical commissioning groups, which are already thinking in new ways about how to deliver better health care at a local level and working in exciting and imaginative ways, collaborating with pharmacies far more than has been done before. It is a good point, and I hope to see more action on it.

When people get a diagnosis, we need to ensure they are managed according to the latest clinical guidelines. The quality and outcomes framework, introduced in 2003-04, has incentivised primary care to perform the nine care processes for people with diabetes, but we know that there are difficulties—I have given the figures—and not enough people are receiving all nine. The National Institute for Health and Clinical Excellence has been asked to review the quality and outcomes framework and diabetes indicators, and we await its response and findings.

Last year, the National Audit Office reviewed the management of adult diabetes services in the NHS. While that highlighted the progress made over the past 10 years, it also highlighted the unwarranted variation that exists across the NHS and the significant challenges that we face over the next 10 years. There is no excuse for poor diabetes care. No one with diabetes should lose a leg or their vision if it can be prevented. We know what needs to be done and we need to ensure that we meet the challenge head on.

The prime objective of the NHS Commissioning Board will be to drive improvement in the quality of NHS services, and we will hold it to account for that through the NHS mandate, which makes it clear that we expect to see significant improvement in the outcomes, diagnosis and treatment of diabetes. In addition, through the NHS outcomes framework, we will be able to track the overall progress of the NHS on delivering improved health and outcomes. Diabetes is relevant to all five domains in the outcomes framework, so when work programmes are developed it is important to consider diabetes and how optimising care can deliver improvements.

My hon. Friend the Member for Torbay asked specifically about NHS Diabetes and whether it will continue to play a central role. NHS Diabetes is one of six current improvement organisations that are being replaced by the new NHS improvement body in the NHS Commissioning Board. In the overall context of what I have said, I hope that he will take comfort, will believe and be sure that diabetes is something that the NHS Commissioning Board has put much higher up its list of priorities. It is aware that much more needs to be done and is the ultimate driver of all of that.

Many hon. Members have mentioned diabetes 2, which is largely, but not always, a preventable disease. I have already paid tribute to those hon. Members who have raised the issue both in their local communities and nationally.

I want to end my comments by discussing an undoubtedly serious problem in our society, which is that almost all of us eat too much. We are overweight. Some 60% of adults are either overweight or obese. As a society, we find ourselves in a situation where one third of our 11-year-olds—our year 6 pupils—are either overweight or obese when they leave primary school. Those figures should truly shock each and every one of us, and something can be done about the problem. We can all take responsibility for how we feed our children and for our own lives and diets and what we eat and drink. The Government, however, can also do things, especially at a local level. When health and wellbeing boards identify the needs of their communities, if it is not a unitary authority, they can work with borough councils.

My hon. Friend the Member for Torbay made a good point about leisure services. We are already seeing evidence in shadow form. In my constituency, GPs are issuing prescriptions for activity, and the borough council is offering real assistance. It is almost as if there are no excuses not to go along to the various leisure centres and take up a class or gentle exercise. We even have walking football in Broxtowe. The point of all this is that local authorities are beginning to knit together all the various services to ensure that we all live longer, healthier and happier lives. The ultimate responsibility is ours, but local and national Government can do so much. It is all coming down to a local level. When we see the roll-out in the spring, I am confident that we will see great progress.

Regional Pay (NHS)

Adrian Sanders Excerpts

Wednesday 7th November 2012 Westminster Hall

[Mr Bradshaw]

I am not prepared to reveal the identities of those people without their permission. I have already written to the Secretary of State and his predecessor, and I will come in a moment to the way that they responded, which was totally unsatisfactory. However, I have given the Minister the gist, and I hope that she is not challenging the veracity of my constituents’ concerns.

Another constituent wrote:

“Myself and many nurses are planning to leave or move abroad if this happens.”

Finally, another wrote:

“I have not worked a single shift without working late or missing my break. This has sent staff morale to rock bottom.”

It is clear from the testimony of my constituents—loyal NHS staff—that even before this plan is implemented, the mere discussion of it is having a devastating impact on morale. As the Minister will know, staff morale is an invaluable and extremely precious commodity in the NHS. There is a clear correlation between high morale and safe and high-quality care. Most NHS staff go the extra mile in their jobs, but they have already had two years of pay freezes, and doing unnecessary and avoidable damage to staff morale will inevitably affect the quality and safety of patient care.

[Mr Adrian Sanders (Torbay) (LD)]

Will the right hon. Gentleman congratulate the trusts in my area—the Torbay and Southern Devon Health and Care NHS Trust and the South Devon Healthcare NHS Foundation Trust—which are not joining the pay consortium for the very reason that they think that it will damage morale and productivity and inhibit their ability to recruit the best possible people to the health care service in my constituency?

[Mr Bradshaw]

Yes, indeed I do congratulate the trusts in Torbay, which have held out against the pressure to join this cartel. I hope very much that the hon. Gentleman will put his money where his mouth is and join Labour MPs in the Division Lobby later today, when we will have a main debate on this very subject in the main Chamber.

Health and Social Care Bill

Adrian Sanders Excerpts

Tuesday 13th March 2012 Commons Chamber

[Andrew George]

The summit should be as inclusive as possible—so that there is no sense of it being exclusive. The professional bodies and patient organisations in the amendment would be included as well, so I hope that the hon. Gentleman is reassured on that point.

I congratulate my colleagues in another place on what they have achieved, but underlying that is a concern about the role of the private sector. Serco in Cornwall provides an important out-of-hours service, but there are serious concerns about how the service is being run, and I have raised concerns about that over the past year. The Secretary of State has pointed out that the contract was let under Labour, but even so we can learn lessons from the previous Government’s failings on letting private sector contracts, and there are issues, which I shall take up with the Secretary of State, in that regard.

The purpose of the amendment is to ensure that the debate calms down and becomes less tribal, so that people can speak more freely and the Government can reflect on the fact that the Bill has less support than it did when it started. Support is ebbing away, and opposition to it is increasing even at this stage.

[Mr Adrian Sanders (Torbay) (LD)]

Will my hon. Friend give way?

[Andrew George]

I cannot at this stage. I am sorry about that.

I urge the Government to reflect on this debate and on the opposition in the country, to withdraw the Bill and to allow such a summit to go ahead.

--- Later in debate ---

[Andrew Selous]

I am aware of one GP in my constituency who has concerns about the reforms. The overwhelming majority of GPs are thoroughly behind them. I find it troubling that Opposition Members do not trust our nation’s GPs, with their wisdom, good sense and commitment to patients, to do the right thing by their patients. They will look at the powers in the Bill and use them for the good of their patients where it is wise and appropriate to do so.

I have to tell Opposition Members that the clinical commissioning group in Bedfordshire has already established a new team to deal with emergency calls from elderly people in care homes. That has resulted in a 40% reduction in hospital admissions and has enabled vulnerable elderly people to be treated at home. That is just one example of the sort of thing that we will see when doctors make use of the powers that they are given in the Bill.

I will cite a few areas of the NHS in which, if Opposition Members think honestly, they will recognise that there were problems when they left office. I will use three brief examples from my constituency. As we heard from the Chairman of the Health Committee and others, one of the important things that the Bill will do, under part 1, is to integrate health and social care. I am extremely grateful to the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), who has been looking at the issue of delayed transfers of care at Luton and Dunstable hospital. The new structures that will be introduced under the Bill, with the full integration of health and social care, will be helpful in that area and will deal with the serious issue of delayed transfers of care.

[Mr Sanders]

One of the problems that my constituents have is that they have experienced integrated health care in Torbay since 2003, but it is having to be dismantled because of the Bill. It is difficult to explain to my constituents why what they have taken for granted and enjoyed under existing legislation requires this big Bill.

[Andrew Selous]

All I can say to the hon. Gentleman is that in my area the current structures are not dealing adequately with that issue. The powers in the Bill are permissive and I am hopeful that they will help.

To move on to mental health and other NHS services, my biggest town, Leighton Buzzard, has a 16-bed unit for mental health patients. Many of those beds are empty at the moment and could be used for step-up, step-down care or intermediate care. By giving commissioning powers to doctors and fully integrating mental health with other NHS services, the Bill will open up the possibility of those beds being used for the people of Leighton Buzzard and the surrounding area.

If Opposition Members are serious about orthopaedics, which is a massive issue for the NHS, they will know that the standard of care varies widely and that we can do better. I have discussed this issue with the Chair of the Health Committee and my right hon. Friend the Minister of State. Professor Tim Briggs, who is the clinical director at the Royal National Orthopaedic hospital, and others have useful suggestions in this area that the Government are prepared to listen to.

I say to Opposition Members: look at the record so far. Ten thousand more people have had access to cancer drugs. There are 4,000 more doctors and 900 more midwives in the NHS. There are 15,000 fewer managers and administrators, and all the savings from that are going back to the front line, where they are needed by the hard-working staff of the NHS. Opposition Members should look at the money. The Government are committed to spending £12.5 billion more on the NHS in England, unlike in Wales where, under Labour’s stewardship, the NHS is being starved of funds.

We heard terrible stories about health inequalities from the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman), who spoke before me. I wonder whether he has looked at clauses 22 and 25 of the Bill, which for the first time put in law the duty to deal with health inequalities. My goodness, that is needed, because under the previous Government health inequalities got worse and were in a state comparable with Victorian times.

Clause 116 will prevent discrimination in favour of the private sector. We have listened to a lot of concerns about the private sector. Perhaps Opposition Members have forgotten about the private sector treatment centres, which were paid £250 million for operations that they did not perform. Clause 116 will ensure that the higher tariffs that have been paid to private sector providers cannot happen in future.

The involvement of local authorities in public health is another vital thing that did not happen under the previous Government. If Opposition Members think honestly about what local authorities can do fully to involve schools, children’s centres and care homes in the national health service, they will agree that there are real possibilities.

My plea to Opposition Members is to look at the facts, to look at what is in the Bill, and to look at the improvements that have happened already, such as the greater number of doctors and midwives and the £12.5 billion extra that is going into the NHS, under this Government.

Oral Answers to Questions

Adrian Sanders Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Lansley]

The right hon. Gentleman should know that the timing of the publication of Robert Francis’s public inquiry is a matter for the inquiry, not for me. It is pretty rich for him, who came to this Dispatch Box to disclaim all responsibility for what happened at Stafford hospital, to accuse us of being responsible for something like that. Something like that will not happen because our plans focus on quality for patients, which he failed to do.

[Mr Adrian Sanders (Torbay) (LD)]

The Secretary of State will be aware of the report today that more than 1.3 million diabetes patients have not been offered vital tests. Does that not re-emphasise the need for a plan post-2013, when the national service framework for diabetes comes to an end?

[Mr Lansley]

Yes, indeed. I share my hon. Friend’s view about the importance of this publication. For the first time, we are publishing the data so that we are absolutely transparent about performance in this and other areas. It is wrong that there are primary care trusts that are failing to meet the nine standards of care that are set out. That is why we published the atlas of variation. By focusing on that variation and through the commissioners’ responsibility to meet the standards, not least in the publication of the quality standards, we will deliver improving standards across the country.

Contaminated Blood

Adrian Sanders Excerpts

Monday 10th January 2011 Commons Chamber

[Mr Lansley]

I share the view of the hon. Gentleman. Today the people who should feel that we are expressing our support are those who have been harmed and their families. Those are the people whom we are really supporting today. I hope that they will feel that although not everything that they have hoped for is being provided, we are at least making very substantial progress and doing a great deal to show recognition of the harm that occurred to them.

At this Dispatch Box, I speak on health matters for England; I do not speak for Wales and I am not in a position to say what the decisions of the devolved Administrations are. I have set out what we are going to do in England. We are funding the measure from within allocated budgets, so no Barnett consequentials flow from it. These matters will be determined within each of the other Administrations in respect of whether they wish to share in the arrangements that I have described.

[Mr Adrian Sanders (Torbay) (LD)]

There cannot be a Member of this House who does not have at least one constituent who is affected or who knows someone who is affected by this. I am sure that every hon. Member would like to congratulate the Government on the statement. Will the Secretary of State give an assurance that the bureaucracy needed to process matters forward has been looked at, so that it is kept to a minimum?

[Mr Lansley]

Yes, we have done that. My hon. Friend is absolutely right: hon. Members will have met constituents or the families of constituents who have been harmed, or the families of those who died. I hope that hon. Members will take the opportunity to bring the terms of today’s statement to their attention, so that people can access the additional support at the earliest possible opportunity. We will seek to do what my hon. Friend mentions. What I am describing builds as far as possible on existing mechanisms and, with the exception of the new discretionary trust, will not create any additional bureaucracy.

Diabetes (Young People)

Adrian Sanders Excerpts

Wednesday 15th September 2010 Westminster Hall

[Mr Adrian Sanders (Torbay) (LD)]

I congratulate the right hon. Member for Knowsley (Mr Howarth) on securing this important and pertinent debate. It is timely, given that we have a new Government and a new Health Secretary with responsibility for the issue. This is a great opportunity for us to help him to help those with the condition. I register that I am a type 1 diabetic whose condition is controlled by injections of insulin.

Diabetes, whether type 1 or type 2, is a chronic condition for which there is as yet no cure. Type 1 diabetes is believed to be genetic, rather than a consequence of lifestyle; type 2 diabetes is firmly believed to be a consequence of lifestyle and diet, and not necessarily of genetic factors.

The treatment regimes for types 1 and 2 are slightly different. Treatment of type 2 is very much about diet, exercise and changing a sedentary lifestyle. Medicines might be introduced to induce what insulin the body still produces to work better, although injections of insulin are increasingly being prescribed for people with type 2 diabetes, particularly those who have had the condition for a long time. The type 1 diabetic is someone whose pancreas has effectively packed up and said goodbye, so in order to stay alive, they must take injections of insulin—there is no alternative. Medication is sometimes prescribed later in life to ensure that the insulin taken works a little faster or more efficiently. For those considered to be at risk of other complications that tend to come with diabetes, such as strokes or heart problems, statins and other such drugs can be prescribed.

Just under one in five people with diabetes has type 1. Most are likely to have been diagnosed before age 40; I have had the condition since my late 20s. This debate is about diabetes in young people, so I will focus on that. I am glad that I was not diagnosed with diabetes as a young person, because it has a major impact on a young person’s life, educational chances, social interactions and psychological attitude to life.

The typical treatment for somebody with type 1 diabetes is perhaps three injections a day of fairly fast-acting insulin, taken at meal times. Before going to bed, they might take a fourth injection of a slightly longer-lasting insulin to maintain their body’s balance through the night, when they are not exerting themselves and require a different type of insulin. There are dozens of types of insulin—fast-acting, slow-acting, mixed—and which insulin or insulin mix is right is a decision for the patient and their GP in light of their circumstances.

The condition changes with age. The first insulin that someone is prescribed is not necessarily the one with which they will continue later in life. New insulins come on the market all the time, promising better control and fewer complications, and from time to time the treatment regime is reviewed and the GP or consultant may recommend change. Of course, that can cause complications, as the effect of any change is specific to the person. I am sure that the right hon. Member for Knowsley will know, if his daughter has ever been asked to change her treatment regime, that a degree of adjustment must take place before the patient is comfortable with the new regime.

Many people with diabetes make contact with the health service only once a year. It is a condition that must be managed by the diabetic themselves. For 364 days of the year, they are their own consultant. They know their body better than anyone else, and they must take the decision whether to increase or decrease the dose according to how much energy they are expending or what type of food they are about to eat. Once a year, the diabetic has a medical check-up. Some good GP practices bring in people twice a year: once to see the GP, once to see a specialist nurse. Some diabetics might see a medical professional three times a year in addition to seeing their consultant in hospital, but most people who have been diagnosed and are living with the condition normally come into contact with the health service only once a year. It is vital, therefore, that at that point the health service can detect whether there is a problem, analyse what it is and make correct suggestions about any changes in treatment.

For young people of primary and secondary school age, one big problem is the stigma of diabetes. There are a lot of misconceptions out there about what the disease is, what it does and what the condition brings. A young person might be told, “I’m sorry, you’re going to have to inject yourself,” but there is a stigma to that. They need a clean, perhaps private environment in which to make that injection. Although great advances have been made in injection devices—some are disguised as pens—there is still a stigma attached to having an injection, even a small, subcutaneous one. They are not great big syringes, as they used to be in the old days, but even with those advances, there is still a stigma.

Injections are not the only part of it. A sensible diabetic will want to test their blood sugars, which means taking a blood sample and putting it through a testing machine so the reading can advise them what injection of insulin is required. A clean, discreet environment is needed, which is difficult to find for someone in school—far more difficult than for me, a Member of Parliament. That is another reason why I am glad I did not have the condition as a child.

There are three stages for a young person with diabetes. Often, in a primary school environment, they may be the only person with the condition. Kids are quick to pick up on somebody who is a little bit different or has special requirements. Often, the primary school might have difficulty coping with a child who has diabetes. Many cases are on record—Diabetes UK has done a lot of work to highlight the issue—in which primary schoolchildren have not been able to get teachers or other school staff to assist them with testing or injecting because the school insists that a parent come in to do so. Working parents simply cannot do that, so in some cases, parents have had to move children away from their desired school to a bigger school, or one that can cope with a child who has diabetes.

We then move to secondary school. Although secondary school is ever longer ago, we can perhaps remember what we were like as teenagers, and the reality is that people do not want to be different when they are at secondary school. They do not want to admit that there is something that they cannot do, particularly if they are male. The reality, however, is that, with the right treatment, there is nothing that they cannot do. However, if they cannot, for whatever reason, do what they need to do, they will have difficulties doing what they wish to do.

We then come to the third stage—higher education. Things are different again when people go up to university. They may break the link with their home-town medical support, whether it is a GP or a consultant. They suddenly come into a university environment, which is very different from the home environment. The encouragement to do all the things that a diabetic should not do, in terms of when and what to eat and how much to drink, becomes that much greater. Young students with diabetes have reported to me that whatever medical support services there are at universities lack an understanding of that pressure, so there needs to be some improvement in that area.

The right hon. Member for Knowsley rightly mentioned the NICE guidelines on insulin pumps, and it is worth realising what they say, because they are quite limiting, in terms of the number of people who can be prescribed pumps. The guidelines recommend that the therapy be used when every other treatment has failed. Someone who has not got on well with injecting insulin or medication will be put on an insulin pump as a last resort. The NICE guideline for children under 12 says that they

“can have access to insulin pump therapy if multiple daily injections are considered impractical or inappropriate.”

There are lots of incidences of young children finding that injections are impractical and inappropriate because their school cannot help them, but their cases do not always come to light.

The criteria are very narrow. In many respects, a child should be put on a pump as soon as they are diagnosed—that should be done straight away, no question. What seems to be holding us back is not simply the cost of the machine, which is about the size of an iPhone, and which is permanently attached, giving the wearer a small dose of insulin throughout the day so that they can go off and do everything they want without having to worry about syringes, needles and all the rest of the paraphernalia. What is important, however, is that pumps have proper back-up from technical and medical staff who understand them, and that is where there is a big gap. The all-party group on diabetes came across the case of a child on a pump who lives in Portsmouth, but who is supported by a hospital in Leeds.

[Claire Perry (Devizes) (Con)]

I apologise for missing the start of the debate, which is particularly topical, given that my hon. Friend the Member for Salisbury (John Glen) and I had a meeting with the JDRF this morning and discussed the very point that the hon. Member for Torbay (Mr Sanders) raises. I was struck by a number of points, which I hope that he will agree with. One is that the importance of what he has just said about managing the disease in a far more cost-effective and efficient way cannot be overstated, and we can have remote monitoring of blood sugar and dosage levels with a pump. The most shocking thing that I have heard is that although our wonderful scientists in Cambridge are developing an artificial pancreas, which is an amazing breakthrough that will mean a mechanical solution to type 1 diabetes, UK citizens will not be able to avail themselves of the technology. Pump usage is only at about 4%, including among the young group that we are discussing, but levels of pump take-up in the US and other areas are as high as 40%. It is absolutely self-evident from the point of view of cost-effectiveness and long-term treatment that the adoption of pumps should be a high priority—

--- Later in debate ---

[Mrs Linda Riordan (in the Chair)]

Order.

[Mr Sanders]

The points about take-up were also made extremely well by the right hon. Member for Knowsley. Getting in place the support systems for pumps will help those who make decisions about budgets locally to ensure that the equipment is there and in play for everybody who is prescribed one.

In a sense, the great hope for the future is a pump that also tests blood sugar, adjusts the dose accordingly and communicates, if the patient wishes, with a medical professional about what is happening to the patient’s body. When that happens, clinicians will be able to gather much more information from diabetics, rather than just hearing what they have to say. Of course, people will tell their GP, “I’m doing everything you said I should,” but the reality may be just a little different, so that new information will take things much further forward.

In conclusion, I have a couple of questions for the Minister. How much notice does his Department take of international comparisons regarding care and research? The hon. Member for Devizes (Claire Perry) mentioned the fact that take-up here is much lower than in the United States. Should that factor be taken into consideration when we discuss what are appropriate treatments and what budgets should be? What efforts are being made to co-ordinate international research into effective treatments and a cure for diabetes? A cure may be a long-term possibility, but it would be silly if several different countries, with several different groups of taxpayers, funded the same research at the same time. Some international co-ordination would be in everybody’s interest.

Once again, I thank the right hon. Member for Knowsley for securing the debate. I look forward to hearing the Minister’s response.

Several hon. Members rose—

[Mrs Linda Riordan (in the Chair)]

Order. I hope to call the Front-Bench speakers at 3.30 pm.

--- Later in debate ---

[Barbara Keeley]

Indeed, and we heard earlier that the incidence of type 1 diabetes is increasing by about 4% each year. The biggest increase is in children under five. A fivefold increase in the past 20 years, as my right hon. Friend the Member for Don Valley (Caroline Flint) said earlier, is a matter of great concern. It is important that more attention be paid to helping GPs, pharmacists, other health practitioners and teachers to identify type 1 diabetes in children and young people. As with many long-term conditions, early identification is the key, because the later the diagnosis of diabetes, the greater the impact.

My right hon. Friend the Member for Knowsley asked the Minister in an Adjournment debate on diabetes last week to introduce protocols for GPs on dealing with certain symptoms. That would ensure that GPs were better equipped to diagnose diabetes. The Minister said then that he would consider the point and would have more to say on it during today’s debate. I hope that we shall hear his answer.

As we have heard, the Government’s NHS White Paper proposes to give GPs the power to commission services, instead of primary care trusts, which will be abolished. I have raised on a number of occasions recently the fact that there is great concern that many GPs do not have the depth of knowledge required to commission specialist services for conditions such as diabetes. GPs may not have the skills, experience or desire to assess whole-population health care needs, to manage the market, to negotiate contracts and to monitor performance. That is becoming a key point of concern, because GPs did not necessarily come into medicine to do those things. Indeed, I understand that the Royal College of General Practitioners is urging the Secretary of State for Health to put back his plans for GP commissioning. The college’s report on the Government’s consultation has unearthed “major concerns”. That is in line with the responses from medical charities such as Rethink and campaigns such as the Muscular Dystrophy Campaign, which also have concerns that GPs lack the skills and experience for commissioning across such a range of conditions.

There are also concerns that in taking on such a wide role, GPs’ primary role of making diagnoses and providing patients with all the information and support that they need could be affected. Some of the statistics are already becoming a cause for concern. Surveys by Diabetes UK have found that 20% of young people feel that they rarely, if at all, discuss their goals for their diabetes care during check-ups. Further, only 26% have attended a course to help them learn about managing their diabetes. The essence of managing a long-term condition is recognising that people must become expert patients. If they are young, their family members must become expert carers. Will the Minister outline what steps the Government will take to make sure that GPs are better equipped to diagnose conditions such as type 1 diabetes and to continue, and improve, their support for people with the condition?

There is a clear need for people with diabetes to be given better information about how to manage their condition. The hon. Member for Torbay (Mr Sanders), who chairs the all-party group on diabetes, has tabled early-day motion 72, which notes that 65% of the 2 million people in the UK with diabetes are not taking their medication as prescribed, because two out of three do not understand what those medications are for or how to take them. We have heard from my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) what it is like to land at home with a host of medications, without having a real idea of what to do with them.

[Mr Sanders]

It is helpful that the hon. Lady has raised that point, because it is an important element of the issue. There are enormous savings to be made by preventing wastage, but we are not just talking about tablets—there is also medical equipment. Increasingly, people with chronic conditions depend on medical equipment. Being able properly to take and analyse a blood sugar reading is a very important aspect of a diabetic’s ability to treat themselves.

[Barbara Keeley]

Indeed. I understand that the early-day motion argues that people with diabetes have a right to expect a personalised information prescription, so that they receive clear and consistent information on diabetes, which will enable them to start to understand their condition and treatment options.

Will the Minister outline what action the Government plan to take to ensure that the NHS at a local level provides diabetes care and support in line with the standards set out in the EDM? The Minister will know that I am always concerned to ensure that we consider carers’ issues in the House, and my hon. Friend the Member for Mitcham and Morden has just touched on some of those issues. We should consider the effect that long-term conditions, such as type 1 diabetes, have on family members and carers. My hon. Friend described it as a soft issue, but carers are the backbone of support for children and young people in this situation, and there is an impact on them.

The Juvenile Diabetes Research Foundation states:

“Type 1 diabetes pervades every aspect of a person’s life.”

Of course, it also affects their family. As we have heard, everyday activities, such as eating and drinking, which are often difficult enough with children—particularly young children—involve much thought and planning on the part of carers of children and young people with type 1 diabetes.

My hon. Friend the Member for Mitcham and Morden mentioned the survey carried out by the parent group, Children with Diabetes. As she said, it found that 83% of parents said that their family life was affected by a diagnosis of type 1 diabetes—quite understandably—and 84% of parents said that the treatment that they received was affected by where they live. That should not be the case; we should not have a postcode lottery. Some 60% of parents said that their children were most worried about being seen as different—children are, of course, always worried about that—and, most worryingly, 50% reported that their children had been bullied as a result of having type 1 diabetes.

The hon. Member for Torbay talked about the stigma associated with treatment by injection. Clearly, bullying in schools can be a result of stigma and perceived difference in children. That is of great concern. Diabetes UK has found that many parents of children with diabetes are forced to give up work, for reasons outlined in today’s debate. In a recent survey, half of primary school pupils with type 1 diabetes and a third of their secondary school counterparts reported that their parents had to reduce their hours or give up work to help to administer insulin injections.

The report also revealed that two thirds of primary school pupils and four fifths of secondary school pupils questioned think that school staff do not have enough training in diabetes. That is not surprising given the findings of an earlier 2008 survey of primary schools. It found that 42% of schools that had children with diabetes did not have any policy advising staff about the supervision of blood glucose monitoring by the child, 48% did not have a policy advising staff on how to help carry that out, 41% did not have a policy advising staff on how to supervise medication of any sort, and 59% did not have a policy advising staff on how to give medication. So the load is falling directly back on to the parents, because the schools do not have a policy.

When we consider type 1 diabetes, it is important to look at the people around the child or young person with the condition and to consider the level of support, information and training that is needed. The children’s charter for diabetes states that discrimination in education should end and that children with diabetes should be treated with respect. I hope that the Minister agrees with that sentiment.

As I say, one of the major concerns among diabetes charities and groups, such as the Juvenile Diabetes Research Foundation, is the postcode lottery that they feel exists regarding the treatment of type 1 diabetes. We have talked a lot in this debate about insulin pump therapy, because that is rightly viewed as the gold standard of treatment for the condition. Insulin pump therapy reduces hypoglycaemia and long-term complications, and it can make life easier. As we have heard, the treatment involves a bleeper that delivers small amounts of insulin throughout the day.

Those pumps are a cost-effective treatment that can help reduce contact with primary care, reduce hospital out-patient and in-patient admissions and, most importantly for children and young people, deliver a better quality of life. As we have heard, less than 4% of the population with type 1 diabetes use a pump. As right hon. and hon. Members have said, that figure is far below the level of use in Europe, where it is at 15% to 20%, and the United States, where it is at 35%. In fact, given the number of children and young people who go on holiday to the States, it is likely that they will run into pump therapy when they are there. Of course, people also read about the therapies available in other countries on the internet.

It is clearly important that insulin pump therapy becomes available. As we have heard, it can be used by adults and children over 12 and, as my right hon. Friend the Member for Knowsley mentioned, NICE guidance also recommends that children under 12 with type 1 diabetes have access to insulin pump therapy if multiple daily injections are considered impractical or inappropriate.

The hon. Member for Torbay provided a vivid description of the stigma, bullying and other issues that arise in school. For example, he mentioned how hard it is to find a clean and private place in which to administer injections. I have touched on the difficulties of schools not having policies, and teachers not supervising the situation. Clearly, children of almost any age will almost always find it impractical in a school setting to administer injections. In those cases, insulin pump therapy will always be better for the child or young person.

As we have heard, it is worrying that there is considerable inequity in insulin pump provision across the country. My hon. Friend the Member for Mitcham and Morden talked about the figures released this month by the Medical Technology Group, which show that there is a postcode lottery, in terms of access to insulin pumps in the UK. We can compare the cost of insulin pumps, which are £3,000, with the cost of bariatric surgery for the morbidly obese, which is about £7,000. Both of those treatments have beneficial effects, save the NHS money and improve the quality of life for the patient. Bariatric surgery use has increased tenfold from 2000 to 2007 but, as we have heard, our levels of prescribing insulin pumps are only a quarter—or a fifth—of levels of usage in Europe. Given that GPs are to take on a commissioning role, will the Minister state what action the Government plan to take to ensure that insulin pumps become much more readily and evenly available across the UK?

I would like to thank the Juvenile Diabetes Research Foundation, the Eye Health Alliance, Diabetes UK and, of course, the Members’ Library for their excellent briefings on the subject, which have helped us all in today’s debate. I started my preparation for the debate not really understanding very much about the condition, and particularly how it affects children and young people, and I feel that I do understand it now. Given the number of people involved with the issue in every constituency and the prevalence of the condition, all hon. Members should understand it as well as I hope we will by the end of the debate; the discussion has been excellent from that point of view. I pay tribute to the children and young people who are living with this condition, and to their parents. I hope that through this debate and the questions that we are asking the Minister, we can improve the service and support that they receive from health and other services in future.

Diabetes

Adrian Sanders Excerpts

Wednesday 8th September 2010 Commons Chamber

[Keith Vaz (Leicester East) (Lab)]

I am most grateful for the opportunity to raise in this House the very important issue of the prevention of diabetes. I must first declare my interest as a sufferer of type 2 diabetes. I was diagnosed with this condition when I was asked by my local GP to open a diabetes awareness day in my constituency. I attended, I was given a test, and I was telephoned the next day by my GP to inform me that I had type 2 diabetes.

Since 1996, the number of diabetes sufferers in the United Kingdom has risen from 1.4 million to 2.6 million, and it costs the NHS £1 million an hour. I believe it is vital that we stop this epidemic. Diabetes is an incurable metabolic condition that leads to high blood sugar levels, which can have serious consequences for short-term and long-term health. The hormone insulin, which is made by the pancreas, helps glucose to leave the blood and enter the body’s cells, where it is used for energy. People with diabetes experience raised blood sugar because insulin is not being produced by the pancreas or there is insufficient insulin or insulin action for the body’s needs.

As the House will know, there are two types of diabetes: type 1 and type 2. In the UK, 90% of adults with diabetes have type 2, where the pancreas produces insufficient quantities of insulin and/or the insulin has a reduced effect on the muscle and liver cells. Type 2 diabetes can be managed through healthy eating and regular exercise, but if the disease progresses, anti-diabetes tablets, incretins or insulin injections may need to be taken. In type 1 diabetes, the body does not produce insulin at all as a result of the body’s defence system attacking its insulin-producing cells. Treatment involves daily insulin injections, in conjunction with healthy eating and regular exercise. Type 1 diabetes is usually diagnosed in children or young adults. For the purpose of this debate, I will be referring largely to type 2 diabetes, which is, in my view, preventable, as opposed to type 1, which is not.

[Mr Adrian Sanders (Torbay) (LD)]

May I pay tribute to the right hon. Gentleman for securing this debate and for his support for the all-party group on diabetes? Some studies have shown that preventive action can put off the diagnosis even of type 1 diabetes, so he is speaking for all diabetics tonight.

[Keith Vaz]

I am most grateful to the hon. Gentleman for his intervention. I pay tribute to him for the work that he has done in this House as chair of the all-party group, which has made a profound difference to Parliament’s understanding of the issue. He is quite right—the research does indicate that. It is important that we take on board the very important research that is being done in this area, as he describes, and indeed pay tribute to the work of other organisations such as Diabetes UK, which has campaigned for so many years on the issue.

Diabetes is a ticking time bomb—a time bomb that needs to be defused. It is estimated that by 2025 more than 4 million people will suffer with diabetes. That will be a shocking increase in the numbers.

--- Later in debate ---

[Mr Burstow]

I will both consider it and hopefully have the opportunity to come back in next week’s debate and say a little more about it.

[Mr Sanders]

The right hon. Member for Knowsley (Mr Howarth) makes a very important point. There is also the role of pharmacists, who need to be aware of the symptoms that people might describe to them. There are also the opticians and chiropodists. Any number of health professional could be involved in a preventive campaign.

[Mr Burstow]

My hon. Friend is right, and I certainly pay tribute to him for his work as chair of the all-party group on diabetes. He has been a powerful advocate on these issues for many years. I applaud what he has done, and he is right—pharmacists and other health care professionals are part of what we need to do in order better to equip the whole service for detecting and intervening.

I was told that the right hon. Member for Leicester East was going to ask about extending the age range. That is an important point that needs to be discussed. At the moment, NHS Health Check starts at 40 and calls people every five years. The best clinical and most cost-effective case was made for doing it at that age. However, there is nothing to prevent primary care trusts from commissioning services that widen the age range. They should be considering that, particularly in areas with more susceptible populations, and clearly Leicester is one of those cases.

Oral Answers to Questions

Adrian Sanders Excerpts

Tuesday 7th September 2010 Commons Chamber

[Mr Burstow]

The right hon. Gentleman is absolutely right to draw our attention to the rising rate of diabetes in our country. When it comes to diabetes in children, we have to bear in mind that the diagnosis for type 1 diabetes—which affects about 23,000 children in this country—is a genetically predisposed condition that cannot easily be prevented. We need to do more about type 2 diabetes, however, by tackling the obesity problems in this country. We need to deliver physical and healthy eating programmes through schools and other partners, and those things are much better done in the context of the local authorities, which will now have a new responsibility for public health that the last Government never gave them.

[Mr Adrian Sanders (Torbay) (LD)]

Information and education are also important for people with the condition of diabetes, to help them to get the maximum benefit from their prescribed course of treatment. May I urge the Minister to make an assessment of the improvements to health that education and information can contribute?

[Mr Burstow]

My hon. Friend makes a good point about the value of information in empowering patients, and about the value of education. That is why we want to do more with NHS information prescriptions, which is an important tool, and to ensure that the care planning process that delivers tailored care plans also includes structured education. There is no doubt that providing education really does make a difference to the outcomes for people with diabetes.