Diabetes

Andrew Selous Excerpts

Wednesday 9th January 2019 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

It is a pleasure to speak in this important debate, because diabetes is so significant in the UK. There are 4.6 million people with diabetes and on current projections we are on track to have more than 5 million people suffering from it by 2025. Ninety per cent. of people with diabetes have type 2, and being overweight or obese accounts for 80% to 85% of a person’s risk of developing the condition, so I shall focus my remarks on what is causing the hugely unwelcome surge in diabetes across the UK and, more importantly, what we need to do about it.

The shocking fact is that a quarter of children go into primary school reception overweight or obese. By the time that they leave, one third are overweight or obese. They are being educated, but overall they are becoming less healthy, which has worrying implications for their future life chances. In the UK at the moment, 30% of all children and 60% of adults are overweight or obese. The worry is that that has become almost normalised. People do not notice it and do not think it is a problem. To me, that is a huge social justice issue. Obesity rates are twice as high in the most deprived communities as in the least deprived. My right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) made that point eloquently in his opening remarks.

I was particularly impressed by the remarks of our wonderful chief medical officer, Dame Sally Davies, just before Christmas. She hit hard at a number of targets and came out with some important truths. She had the food industry in her sights—she said that it benefits from selling unhealthy food, that it does not pay for the harm it does, and that it clearly has not done enough. She raised the fact there is added sugar in baby milk and baby foods, for goodness’ sake. What is the justification for that, other than to put babies and very young children towards a life of sugar addiction? That is scandalous and we should call it out. Frankly, the Government should ban it as soon as they are able, and if we have to leave the European Union to do so it should be an early priority at the beginning of April.

I did not come into public life just to ban things. The corollary, of course, is that we need to make the healthy choice the easy choice, and to be all about promoting wonderful, healthy, delicious, nutritious—often British—food. My right hon. Friend the Member for South Holland and The Deepings made that point well, too. Dame Sally Davies discussed whether there might be a need for price subsidies for fruit and vegetables. Let us make fruit and vegetables—good food that will not cause obesity and diabetes—more accessible, available and affordable to our constituents. That could be done through the taxation system. Dame Sally also called for sugary milk drinks to come within the soft drinks industry levy, which is entirely sensible.

It is worth looking at some of the foods currently on supermarket shelves. Taking children’s breakfast cereals as an example, 37 grams out of 100 grams of Kellogg’s Frosties are sugar. The figure for Kellogg’s Crunchy Nut cornflakes is 35.3 grams per 100 grams. For Kellogg’s Coco Pops it has come down a little bit, but there are still 30.9 grams of sugar per 100 grams. Those are pretty appalling figures, when we think how much sugar that is.

In 2017, some own brands were not much better. Lidl Golden Balls had 36 grams of sugar per 100 grams. Aldi Sugar Frosted Flakes had 35 grams per 100 grams. Tesco Frosted Flakes had 34.9 grams. Those are Public Health England figures and some relate to August 2017, while some, such as the Kellogg’s ones, are current. We need to call that out. Not enough progress is being made, and unless healthier food is available for our constituents we shall not turn the supertanker around. We know from Public Health England that chocolate confectionery and biscuits between them account for more than 300,000 tonnes of sugar going into our diet every year. That is more than from all the other food categories put together.

My first plea is that we should do more with food manufacturers. They need to get with the programme and to know that many of us in the House have them in our sights. I am a Conservative and believe in the free market. I do not want the state to produce our food. However, there is a serious challenge, because we all pay for the NHS through our taxes and the food industry is causing a large part of the problem. Dr Chris Marshall, one of my best local GPs, had to defend the diabetes prevalence in his area and what was happening about it, but it is not fair to blame GPs when so much is stacked against them because of the food industry, among other things. The food industry needs to raise its game. It has been getting away with too much for too long and the Government need to play hard ball with it.

Active travel is another area I want to consider. I came to the House of Commons on a bicycle this morning, because I could. For our children, when we design new housing estates, let us make sure they can bicycle or walk to school. Let us get more cycling and walking in cities. That is a design and planning issue. Officials and a Minister from the Department of Health and Social Care are here for the debate. We need a cross-Government strategy to build in active and healthy travel for children and adults to help the situation.

Calorie information is also relevant. Public Health England tells us that women should eat up to 2,000 calories a day and that men should eat up to 2,500. I wonder whether anyone here knows how many calories they had for breakfast, or how many they will have for lunch or supper. What is the point of giving us that daily total if none of us has a clue how much we eat? Here is a suggestion. For people who are waiting 10 minutes to see the doctor, why not have on the surgery wall examples of the different meals that the British public mainly eat, with a rough idea of how many calories there are in them? Would not that be a start to education? It would be free, easy, and a good use of the surgery wall in a public space where we all sit and wait. Why do not we try to get some of that public information out there so that we can do something and know what we are doing?

We have talked about schools. I do not blame teachers, who have more than enough to do trying to teach children, but they have a public education role. Given that we have gone from one quarter of children to one third being overweight or obese, there should be much more emphasis on providing proper education to children on food when they are taught to cook.

We must also look to Parliament. There has rightly been a move, which I am sure you approve of, Mr Robertson, to make this a more plastic-free Parliament. I approve of that and it is right, but the information in our catering outlets about their offerings is not as good. Let us set an example on our own doorstep.

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[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the right hon. Member for South Holland and The Deepings (Sir John Hayes) for securing the debate, for his very knowledgeable introduction and for the consensual nature of the debate that has taken place.

We have had a number of contributions; I will just touch briefly on the main speakers. The right hon. Member for Knowsley (Mr Howarth) reminded us of the importance of recognising the two different types of diabetes, which cannot be emphasised enough. I was also interested in his comments on the artificial pancreas. The hon. Member for South West Bedfordshire (Andrew Selous) raised the risk of diabetes being normalised and the impact of obesity, and the food industry’s contribution to exacerbating the problem. The figures he quoted on sugar intakes were genuinely frightening and should be a lesson to us all. The hon. Member for Rochford and Southend East (James Duddridge) gave his personal experience of his diabetes being under control. The very interesting thought of what we would say to our younger selves is one that we need to take out to our constituents in order to make an impact on the problem.

Health, of course, is a devolved matter. Consequently, it seldom features in my casework as a Member of this Parliament. That said, many of my friends have diabetes, either type 1 or type 2. It is the fastest growing health threat of our time and a critical public health matter. Diabetes is increasing rapidly, and one person in 20 in Scotland is now diagnosed with the condition—I stress diagnosed, because there will be many others who are undiagnosed. The latest figures published by Diabetes UK show that more than 3.5 million people in the UK were living with a diagnosis of diabetes in 2016-17, with just less than 290,000 of them in Scotland. Diabetes UK also reported that if nothing changes, more than 5 million people in the UK will have it by 2025. That is a figure that a number of people have used, and it is worth repeating to emphasise the impact of this health crisis.

In the Forth Valley area, which covers part of my constituency, more than 14,500 people are living with diabetes and there are more than 9,000 people with diabetes in West Lothian, which covers the other part. That helps to put the issue into perspective across a number of constituencies.

It is estimated that more than one person in 16 across the UK has diabetes, either diagnosed or undiagnosed, and it is worth remembering that around 80% of diabetes complications are preventable. I believe that in Scotland around 10% of NHS spending goes on diabetes—I think the English figure is fairly similar. If 80% of that is preventable, think how much we could save by tackling this problem, in addition to the benefit to people’s lifestyles that could be achieved. Many of those complications are preventable or can at least be significantly delayed through early detection, good care and access to appropriate self-management tools and resources, of which access to diabetes technologies is a fundamental part.

When I last spoke about diabetes, a couple of years ago, we talked about technologies. I confess that at that time I had not really witnessed much of them first hand, so I was pleased over the festive break when I saw one of my friends, Paul Kingsley, who has lived with diabetes for some time. He has a Libre patch sensor and an insulin pump. He showed me how that worked, which was interesting to see. It has made a real change to his life. I can remember when he had to do the prick tests and take his needles with him everywhere he went. Technology is making a big difference to people’s lives.

With the challenge of the increasing numbers of people with diabetes, access to the technology to help those living with the disease becomes ever more important. There are 19,000 new cases of diabetes diagnosed every year in Scotland and numbers are set to increase year on year, particularly with rising levels of obesity. Early results from ongoing research, led by Mike Lean at the University of Glasgow and Roy Taylor at Newcastle University, showed that it is possible for some people to put their type 2 diabetes into remission using a low-calorie, diet-based, weight management programme, delivered by their GP. I believe that, as a result of those promising results, NHS England has committed to piloting a remission programme for 5,000 people with type 2 diabetes in 2019, and the Scottish Government, through their “A Healthier Future” plan, pledged £42 million to the prevention, early detection and early intervention of type 2 diabetes. There is a lot we can learn from each other from these processes and as the results of these tests come out.

NHS boards in Scotland will be able use that funding to deliver programmes to prevent type 2 diabetes and to put it into remission. One such programme that receives funding from NHS Forth Valley is the Braveheart Association, a Scottish charitable incorporated organisation based at Falkirk Community Hospital. The Braveheart programmes have been designed to provide resources to support and improve the health and wellbeing of Falkirk communities. They create community-led activities and outreach health services to improve the health of local people. One of the initiatives is Braveheart Plus peer support groups, which focus on those living with type 2 diabetes and coronary heart disease. One beneficiary of Braveheart’s walking project is a lad called Ali, a sufferer of heart disease and diabetes, who was initially reluctant to take part. Through participation, he now leads his own bi-weekly group, enjoys meeting new people and is able to manage his health conditions much better.

There is little doubt that eating a poor diet and being overweight or obese cause serious health problems, such as type 2 diabetes, cancer and heart disease, and it is clear that we must take decisive action. The SNP has an ambition to halve childhood obesity in Scotland by 2030, which is one reason the Scottish Government are consulting with the public, and food and retail industries on restricting in-store marketing and promotion of foods high in fat, sugar or salt, with little or no nutritional benefit. That is very important; I think we have all been tempted.

[Andrew Selous]

On that point, does the hon. Gentleman agree that it would be good to hear from the Minister about when we will get the consultation on the 9 pm watershed and on promotions? Both are promised, but we do not yet have a date for them.

[Martyn Day]

I fully agree; that would be very useful to have.

I think we have all been guilty of impulse purchases when out shopping. It is always worse if we shop when hungry and there is a temptation to get fast food and a quick fix. We are all more than capable of cooking good quality meals, but convenience and lifestyle often get in the way of that. There is a lot we could do if there was a better marketing regime. The consultation in Scotland is part of the diet and healthy weight delivery plan, which will inform an assessment of impact and possible legislation.

No debate these days can be complete without some reference to Brexit, and why should this one be any exception?

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[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

It is nice to see you in the Chair, Mr Robertson. I thank all Members for their contributions and my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) for securing the debate. He introduced it with his usual flourish, and I know that people watching will have been interested in what he said and the issues that he raised.

We have to keep these issues high on the agenda. They affect a lot of people and we talk about them a lot in Parliament; I cannot think of a Health oral questions that I have been involved in as a Minister when diabetes has not come up. There is a reason for that: because it affects so many of us and our constituents. We must keep raising it.

This is a timely debate. We published the long-term plan for the NHS on Monday. Diabetes features prominently in the plan, which is no accident. We would expect it to, and if it did not, we would have a debate on why not. However, more than that, the plan has a strong focus on prevention and on building a health service for the needs of the 21st century that supports people to manage their own health—not only for diabetes but across the piece—and wellbeing.

We really support that agenda in this Department and with this Secretary of State. That matters for patients—our constituents—with diabetes and others. Chris Askew is a very good man and chief executive of Diabetes UK, and his welcome for the long-term plan and the diabetes sections within it greatly attests to that.

We have heard some excellent contributions. I very much enjoyed listening to the intervention from my right hon. Friend the Member for Wantage (Mr Vaizey) and his suggestion about Brine labelling; my right hon. Friend the Member for Ludlow (Mr Dunne), who gave us insights about his two-year-old daughter; and my hon. Friend the Member for South West Bedfordshire (Andrew Selous), who talked about the food industry and child obesity. We also heard speeches from the right hon. Member for Knowsley (Mr Howarth), who talked about an artificial pancreas, which was very interesting, and from the hon. Member for Workington (Sue Hayman). I should be able to cover all those items. If I do not cover everyone’s points, I will of course write to them, as is my usual practice.

I have to say that I particularly enjoyed the contribution from my hon. Friend the Member for Rochford and Southend East (James Duddridge). It was a very powerful and insightful speech, as it always is from him, and it was delivered from the heart. He made the very good point that we are all different. That is one of the challenges not just for diabetes care, but for healthcare generally. Healthcare is not an exact science. I say that not as a doctor, but as someone who spends a lot of time with doctors.

My hon. Friend also made a point about the complexity of diabetes. In reality, it is a spectrum. We have heard a lot of talk this morning about type 1 diabetes—from the right hon. Member for Knowsley, for instance—and about type 2 diabetes from many others. But increasingly we hear about—it is not a new term—type 1.5 diabetes, otherwise known as LADA, or latent autoimmune diabetes in adults. As I understand it, that is not a clinical definition, but is generally used to describe a slow-onset form of type 1 diabetes that is often mistaken for type 2 diabetes. There are many support services for that condition, and people are increasingly talking to their doctors about it. There is lots of clinical debate around it, but the topic has been around since the 1970s. That goes to the heart of my hon. Friend’s point. Diabetes is a complex condition. There is a spectrum for diabetes, as there is for many other conditions.

I, too, pay tribute to the NHS staff, to the diabetes nurses and the doctors, but also to the support groups. My constituency has the Winchester and Eastleigh diabetes support group, which I spoke to recently. We will all have those groups in our constituencies. As MPs, we are very used to having in front of us people who are far more expert on the subject that they have come to talk to us about than we are—every single one of my constituency surgeries is an example of that—but never is that more true than when we talk to people with diabetes, who have a great and expert knowledge of their condition and the management of it. If they do not, we need to help them to have better, expert knowledge of their condition, because that is as much in our interest as it is in theirs.

There are a couple of points to touch on. My right hon. Friend the Member for South Holland and The Deepings, in introducing the debate, and my hon. Friend the Member for South West Bedfordshire touched on the food and drink industry and healthier eating. It is important that we build on the world-leading action set out in both chapters of our childhood obesity plan. We have already seen real success. More than half of all drinks in the scope of the soft drinks industry levy are being reformulated. That is equivalent to removing some 45 million kg of sugar every year, as a result of the so-called sugar tax. And some products in the sugar reduction programme are exceeding their first-year targets. For example, a 6% reduction is being achieved for yoghurts.

We will consider further use of the tax system to promote healthy food—the challenge that my hon. Friend put to me. He mentioned sugary milky drinks. The Treasury was very clear, when former Chancellor of the Exchequer George Osborne launched the sugar tax, that in 2020—next year—we would review the sugar levy and whether to extend it to milky drinks. As the Minister, I for one will certainly be welcoming that.

As part of chapter 2, we have already held consultations on ending the sale of energy drinks to children and on calorie labelling in restaurants. We are reviewing the feedback and will formally respond in due course. We will very shortly be launching consultations on restricting promotions of fatty and sugary products by location and price, and we will be consulting on further restrictions, including a 9 pm watershed, at the earliest opportunity, with the aim of limiting children’s exposure to sugary and fatty food advertising and driving further reformulation. What I will say, in answer to the challenge that I have been given on those products, is that not everyone agrees that we should do this. Let us be honest: there are people in our party who do not. I challenge them to look at the challenge that we have in our country with obesity and what it is costing our country and our health service. If we believe in a publicly funded health service, we believe in a public health system that challenges these kinds of condition, so I say to my hon. Friends: keep raising the issue in the House. Next Tuesday they will have an opportunity to do so.

Alongside that, we are committed to exploring what can be done on food labelling when we leave the European Union. My hon. Friend the Member for Ochil and South Perthshire (Luke Graham), who is no longer in his place, raised traffic light labelling. We cannot do that as a member state, but we will soon be free. Some companies have decided to take it on themselves. Kellogg’s, the cereal manufacturer, which has been mentioned this morning, announced just before Christmas that it intends to do that. I welcome that and give credit to Kellogg’s for doing it.

Wherever possible, the aim is of course to prevent type 2 diabetes from developing in the first place, which is emphasised in the NHS long-term plan. I am very pleased that NHS England and Public Health England, for which I have responsibility, and Diabetes UK, working hand in glove, have had great success in working on what is the first diabetes prevention programme to be delivered at scale nationwide anywhere in the world.

[Andrew Selous]

Will the Minister give way?

[Steve Brine]

Very briefly—be quick.

[Andrew Selous]

I, too, am very pleased that Kellogg’s has brought in traffic light labelling, but does the Minister agree that, with Kellogg’s Frosties at 37 grams of sugar per 100 grams, there is much more to do as far as Kellogg’s is concerned?

[Steve Brine]

Not only do I agree with my hon. Friend, but the company would agree with him. It is very aware of how much pressure that I and the Government are putting on it to change its products. I would say that it is top of my Christmas card list. Many other manufacturers have not yet made it on to my list, and I ask them to step up and raise their game to the level of the best. I am sure that they can.

In 2018-19, the diabetes prevention programme achieved full national roll-out, making England the first country in the world to achieve full geographical coverage. That is a great achievement, and the figures are good. As set out in the long-term plan, NHS England intends to double the capacity of the programme up to 200,000 people per annum by 2023-24. As my right hon. Friend the Member for South Holland and The Deepings said, it is a modest number in context, but it is also a big number. This is still the largest diabetes prevention programme of its kind. He asked whether we keep these things under constant review and whether we have the ambition to go further. You bet we do, and I think we need to.

There has been much talk this morning about technology. We are also developing an online, self-management support tool called HeLP, comprising a structured education course that has content focused on maintaining a healthy lifestyle for people with type 2 diabetes. That includes content on weight management and alcohol reduction—that can of course help with many health challenges—and cognitive behavioural therapy related to diabetes-related distress. NHSE hopes, once the tool has been developed, to roll it out in the summer of this year.