Childhood Obesity and Diabetes

Debate between Adrian Sanders and John Pugh

Wednesday 24th April 2013 Westminster Hall

[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.

Diabetes

Debate between Adrian Sanders and John Pugh

Wednesday 9th January 2013 Westminster Hall

[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.