Diabetes Technologies

Baroness Blackwood of North Oxford Excerpts

Wednesday 23rd November 2016 Westminster Hall

[Mr George Howarth (Knowsley) (Lab)]

I congratulate the hon. Member for St Ives (Derek Thomas) both on raising this very important subject and on the constructive and helpful manner in which he raised it.

I intend to confine my remarks to type 1 diabetes and, in particular, young type 1 diabetics. I should say that I am indebted to both Diabetes UK and the Juvenile Diabetes Research Foundation for the very helpful briefing that they provided and for the important work that they do on behalf of people with diabetes.

Diabetes, whether type 1 or type 2, is a life-changing condition regardless of the age at which it is diagnosed, but for young type 1 diabetics, it is also a lifelong challenge. Young type 1 diabetics face a daily and lifelong routine of monitoring glucose levels and administering the appropriate doses of insulin. It is not insignificant that one quarter of hospital admissions for ketoacidosis are of 16 to 25-year-olds; that is quite a shocking statistic.

At the same time, dealing with the transition to adulthood, with all the attendant biological, psychological and physiological changes that occur, can be even more challenging for young diabetics and their families. Many young diabetics face bullying. The hon. Member for Upper Bann (David Simpson) referred to a problem in schools. Quite often, because of the misconception about what type 1 diabetes is, young diabetics will face taunts: “Well, it’s your own fault because you don’t eat properly”, “You’re overweight” and so on. It is bad enough that young diabetics face bullying in school. Very often, as the hon. Gentleman signified, schools simply do not know how to deal with this issue.

One thing about being a type 1 diabetic is that because their blood glucose levels can be very unreliable, they sometimes need to take glucose, which means that at a certain point their absolute priority is to eat something. They have to be able to eat something to even out their blood sugar levels, yet all too often teachers will not allow them to use the classroom in those circumstances.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

indicated assent.

[Mr Howarth]

I see the Minister nodding. This really is a problem. Schools need to be advised on how to deal with these situations, so that in every classroom the teacher is aware, whether or not they have a type 1 diabetic in their class, of what they are supposed to do in those circumstances. The lack of understanding in many schools—not all of them, as some deal with the matter very well—must be tackled.

However, I do not want to be overly gloomy about the problem. Organisations such as the JDRF and Diabetes UK, in conjunction with others, including the all-party parliamentary group for diabetes, of which I am a member, are both raising the profile of the way type 1 diabetics are being failed by the healthcare system and suggesting constructive ways of improving the situation. Later today there will be the launch of a report, not specifically on type 1 diabetes but on how services can be better organised. That is the result of many months of taking evidence from expert organisations. I hope that Ministers will study that report closely.

With regard to progress, scientific research is making great headway. The hon. Member for St Ives, who opened the debate, highlighted some of the scientific research going on and the technologies that are available. It is in my view highly likely that a cure will be found well within the lifetime of today’s young diabetics. Building on the technology that already allows automatic continuous glucose monitoring and automatically pumped insulin, an algorithm for combining the two into an artificial pancreas already exists. The hope is that it will not be long before that technology becomes the norm. More development work is going on, but the research and tests that have been carried out indicate that that system works and can bring about a massive improvement in the lives of young people and others who suffer from diabetes, because it enables them to keep their blood glucose at an even level.

I want to say a few words about a particular problem that some young type 1 diabetes sufferers experience. As we know, as a society we face a problem—particularly, although by no means exclusively, among young women—as regards body image. The media, magazines and society in general put forward an idealised view of what a woman or, for that matter, a man should look like. We know about eating disorders that arise from that wholly inappropriate promotion of a “perfect” shape. I do not profess to be an expert on this issue, but my experience of life is that human beings come in all shapes and sizes, none of which is more acceptable than another—but that is just a personal view. However, some young type 1 diabetics discover—this is easy to find out through social media—that by manipulating their insulin intake, they can achieve rapid weight loss. To some young people, that sounds like a great thing to be able to do. Someone can lose perhaps half a stone in a week simply by not taking the amount of insulin that they require. Of course, the problem is that it leads to major medical complications and, in some cases, can end fatally.

Those who do fall into the habit, which amounts to a highly specialised eating disorder, need to be able to access support from diabetologists and from either psychological or psychiatric specialists. All too often, though, that support is not available—at least not in one place—at the time when the young person needs it most and they are left trying to negotiate a sort of medical specialists ping-pong game between, on the one hand, diabetologists, who do not understand the psychological problem that the young person is experiencing, and on the other hand psychologists or psychiatrists, who do not understand all the scientific and medical issues about their diabetes. I know that that is not the Minister’s specific area of responsibility—[Interruption.] Oh it is, she tells me, great—but I put in a plea for her to really give some thought to how those services can be co-ordinated in such a way that means those young people are not left travelling from one place to another, often with long distances involved, to try to access support, when all they can get is somebody who understands one aspect of their disease and the particular manifestation of that disease they have. We are not talking about tens of thousands of young people; we are talking about hundreds, but nevertheless these are young lives and they need to have proper access to all the services that they require.

I will conclude with a couple of questions, which are asked in an entirely constructive spirit. Can the Minister give an assurance that the Government will take an active interest in the research that is going on into technology, and that it will be properly supported? Does she agree that the achievement of making these technologies normal, particularly the artificial pancreas, needs to be pursued with absolute rigorousness? That could be delivered very quickly if the Government took an active interest in it. Will she commit—both through the technological means and better treatment design—to ensuring that the various services that can prevent serious complications are properly integrated so that the medical ping-pong is overcome?

I hope that I have not gone on for too long. Knowing you as I do, Mrs Gillan, I know that you would have told me if I had. Again, I thank the hon. Member for St Ives for giving me the opportunity to say the things that I wanted to say. I am sure that the young diabetics around this country who have the opportunity to do so, will be glad that at least their plight has been raised by at least one Member of this House.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is a pleasure to serve under your chairmanship, Mrs Gillan. I thank my hon. Friend the Member for St Ives (Derek Thomas) for giving us the opportunity to have such an important debate. His timing is impeccable, as always, as I found on the Science and Technology Committee, of which he was such an excellent member—we exist in a mutual admiration society. This debate follows on from world diabetes day last month. I want to add my voice to the tributes already paid to the all-party groups on diabetes and on vascular disease and to Diabetes UK for the work they do on this issue. It is invaluable, as we have heard from the very high quality and personal contributions this afternoon.

As the shadow Minister says, diabetes is one of the biggest health challenges facing this country today. The figures are truly sobering. Almost 3 million people in England are currently diagnosed with diabetes and we estimate that a further 940,000 remain undiagnosed. Furthermore, around 5 million are at high risk of developing type 2 diabetes. If nothing changes, by 2025 more than 4 million people will have the condition. As the right hon. Member for Knowsley (Mr Howarth) said, type 1 diabetes affects 400,000 people in the UK and its incidence is increasing by about 4% a year. It is not preventable, so the emphasis is on improving the lives of people with type 1 diabetes and helping them to manage their condition.

I absolutely associate myself with the words of the Prime Minister: the message should be that people are able to live full and active lives, and the Government are there to do whatever they can to support them to do so. I shall certainly undertake to study the upcoming report mentioned by the right hon. Gentleman and consider its proposals carefully.

Type 2 diabetes is much more common. Diabetes as a whole is a leading cause of preventable sight loss in people of working age and is a major contributor to kidney failure, heart attack and stroke. As my hon. Friend the Member for St Ives said, diabetic foot disease, including lower limb amputations and foot ulcers, account for more days in hospital than all other diabetes complications put together. We are determined to change that.

According to Public Health England and Diabetes UK, 5 million people in England are at high risk of developing type 2 diabetes, and one in 10 will develop the disease if current trends continue. Type 2 diabetes is largely preventable and manageable through lifestyle changes, as the shadow Minister has testified—I was very impressed by her testimony today.

There is also a huge financial cost—as well as a personal cost—to diabetes and its complications. It already costs the NHS in England more than £5.6 billion a year, and that continues to rise. In addition, the annual social care costs associated with supporting people with diabetes are estimated to be £1.4 billion. Managing the growing impact of diabetes is one of the major clinical challenges of the 21st century. That is why preventing type 2 diabetes and promoting the best possible care for all people with diabetes is a key priority for me and for the Government.

It will not surprise my hon. Friend the Member for St Ives to hear that, as the Minister for Public Health and Innovation, I believe he is absolutely correct to highlight the role that modern technologies, properly used, can play in the care of people with diabetes. We are extremely fortunate to have a thriving, world-class life sciences industry in this country—it is one of the jewels in the crown of our industrial sector. That is why we are investing an extra £2 billion a year in research and development by the end of this Parliament to help to put post-Brexit Britain at the cutting edge of science and technology, as the Chancellor announced today.

The development of new, innovative technologies is continuing at pace and is revolutionising health systems throughout the world. However, that will not help if patients do not benefit from it, so we want to make sure that patients here benefit as quickly as possible. As my hon. Friend the Member for St Ives said, we can do better. That is exactly why we commissioned the accelerated access review to support the NHS to become a system that embraces innovation and works in collaboration with innovators to get products to patients more quickly. The review was published last month. We are carefully considering its recommendations and will respond as soon as we can.

It is not surprising that we are seeing the emergence of technologies that have real potential to improve the lives of people with diabetes in the context of such a thriving life sciences sector. As many colleagues have mentioned, key to managing diabetes is monitoring and controlling glucose levels. Various technologies are available. Insulin pump technology is prime among these and is recommended by NICE as an option for people with type 1 diabetes. Many people are already benefitting from blood glucose monitoring with testing strips and a machine to read blood glucose levels, as well as continuous glucose monitoring. The shadow Minister went into great detail about how that already provides hundreds of readings a day to provide a clear picture of people’s glucose levels.

People also benefit from flash glucose monitoring, where the glucose concentration and trend is shown when the monitor is waved over the sensor. Other devices are also available; I understand that many people are already finding them useful in reducing hyperglycaemic and hypoglycaemic attacks. In some cases, as my hon. Friend the Member for St Ives said, such devices can offer life-changing support to patients living with diabetes. They can play a particularly valuable role for certain patient groups, including children and teens, when they are properly managed, as the hon. Member for Upper Bann (David Simpson)—who is not in his place—said earlier.

Clinical commissioning groups are responsible for commissioning diabetes services. In doing so, they need to ensure that the services they provide are fit for purpose, reflect the needs of their local populations and are based on the available evidence, taking into account national guidelines. In the end, none of the guidelines can supersede the best judgment of clinicians, formed with their patients, about the best treatment option for them. I know that NHS England is actively investigating the potential of technologies for use within the NHS with manufacturers and patient groups to understand and identify areas of need and barriers to adoption so that they can improve access.

Looking to the future, artificial pancreas technology, as was mentioned, continues to be developed. One system has recently been approved by the US Food and Drug Administration, and a European licence is being pursued. Large randomised clinical studies of similar systems are now beginning, and several are expected to come to market in the next five years. Teams in the UK, including in Cambridge and London, are leading on some of this work, but these technologies need to be used optimally as part of holistic treatment pathways so that we get the best patient outcomes from them. That is exactly what the NHS innovation accelerator aims to deliver.

The NHS innovation accelerator is supposed to realise the commitment in the five-year forward view to create the conditions and cultural change necessary for proven innovations to be adopted faster and more systematically through the NHS for the benefit of patients. This is being delivered in partnership with all 15 academic health science networks. AHSN initiatives are patient-facing. Monster Manor, for example, is a free app launched by the Oxford AHSN—which I mention very selfishly—diabetes clinical network to encourage children with type 1 diabetes to track their blood glucose readings and become more engaged in their diabetes management. By logging readings, players earn rewards that help them to advance through the game.

The Yorkshire and Humber AHSN is implementing a locally developed set of tools to support general practice and community pharmacy in fostering greater self-care and health literacy among patients with diabetes and encourage them to do something to prevent severe hypoglycaemic episodes. A particular benefit of the AHSN network is the best practice sharing system, which is now in place, to ensure that improvements in one area can more quickly spread across the whole country.

Another example of accelerator innovation is the internet of things innovation diabetes test bed, which is funded by the Department. This enables people with type 1 or type 2 diabetes to do the right thing at the right time in self-managing their condition. It can be difficult to manage any long-term condition, so help is particularly valuable. People get a real-time view of their own data so they can take prompt action to prevent their condition from getting worse. This also encourages more timely and appropriate interventions from healthcare professionals. It is hoped that using technology in this way will also create genuine partnerships between patients and their healthcare professionals.

Realistically, the only way we are going to make measurable progress in halting the diabetes epidemic is to put strong measures in place to prevent those at risk from developing type 2 diabetes in the first place. Healthier You, the diabetes prevention programme, is the first type 2 diabetes prevention programme of its kind to be delivered at scale nationwide anywhere in the world. By 2020, the programme will be made available to up to 100,000 people at risk of diabetes each year across England. Those referred will get personalised help to reduce their risk, including education on healthier eating and lifestyles, and physical exercise programmes tailored to the individual. Building on that, NHS England is investing an additional £40 million each year to support CCGs in promoting evidence-based interventions to improve the care that all people with diabetes receive. In line with the points that my hon. Friend the Member for St Ives made, NHS England is encouraging GPs to refer people who are at high risk of diabetes into the national diabetes prevention programme, although referrals also come through the NHS health check, so there are two routes.

The role of structured education is widely recognised to be hugely important. The Department, NHS England and Diabetes UK are working together to improve the take-up of such education, including through digital and web-based approaches. Furthermore, NHS England is planning to make additional investment from 2017-18 to support the expansion of structured education to help patients to understand their condition better and manage it themselves more successfully.

The right hon. Member for Knowsley made some important points about the interaction of mental health services and diabetes provision. There is already significant activity to tackle the challenges of negative body image, and the Government announced a body image taskforce in 2010. It reports annually and is led by the Government Equalities Office. Simultaneously, in response to the priorities put forward in the five-year forward view on mental health, we are currently significantly improving care pathways for eating disorders. I have not so far investigated the specific challenge of how young diabetic patients interact with that context, but as a result of the right hon. Gentleman’s comments I undertake to do so.

I hope I have demonstrated not only the Government’s commitment but my personal commitment to harnessing new and innovative technologies as part of our drive to improve outcomes for the millions of people already living with diabetes and the many others at risk of developing the disease, as well as to sending out the clear message that diabetes does not in any way limit the ability to live an active life and to contribute well.