National Health Service

Baroness Ludford Excerpts

Thursday 14th January 2016 Lords Chamber

[Baroness Ludford (LD)]

My Lords, I also thank the noble Lord, Lord Turnberg, for this important debate. I have my own recent family reasons for having the deepest gratitude to wonderful NHS staff, who deploy life-saving skills. I also have a niece who is a junior doctor.

However, I want to concentrate on diabetes. There is huge potential—it is a no-brainer—to spend more wisely. Four million people live with diabetes, and they cost the NHS £10 billion a year—£1 million an hour—which is 1/10th of its budget. The total cost to individuals and society is £24 billion and rising fast. My particular focus is on those who are insulin-injecting, predominantly with type 1 diabetes. I have some, albeit second-hand, experience of this, having been with my husband for the 40-odd years since he was diagnosed. The NHS has never included me or learnt from me; for example, when it comes to coping with hypos. I should mention that my husband already has access to the technology I will refer to, that he is chairman of a health trust and that he was, for several years, chairman of the UK branch of the Juvenile Diabetes Research Foundation.

NHS England’s Five Year Forward View last summer referred to diabetes only as a preventable illness resulting from,

“the nation’s waistline … piling on the pounds”.

This completely ignored and insulted those with type 1, whose diabetes is not caused by obesity. As well as the integration of services, I urge an “invest to save” approach to both research and care. Around 400,000 people have type 1 and although they account for only one in 10 of those with diabetes, they consume, on some estimates, half of the £10 billion that diabetes costs the NHS annually. As much as 80% of the cost of treating people with type 1 is spent on avoidable complications. Two reports from the National Audit Office, and one from the Public Accounts Committee of the other place—a second is in progress—have been scathing about NHS care failures.

How do you invest to save? First, you do it in research. The glittering prize is a cure. JDRF and the researchers it funds do excellent work, but the UK Government spend only £6.5 million a year—10p per head of population—on diabetes research, backed up of course by crucial EU funding that Brexit could put at risk. This spending is puny and inexplicable.

Secondly, you invest to save in devices for self-management. The key to keeping type 1 diabetics well and avoiding debilitating and expensive complications of organ damage is good blood glucose control through self-management. Insulin pumps and continuous glucose monitors have proven benefits in the management of type 1 diabetes, and NICE guidance attests to their cost-effectiveness. Testing without finger pricks now exists, and NICE needs to look positively at this. Yet only 7% of people with type 1 in the UK have a pump, compared to 15% in Germany and 40% in the US. Only 1% or 2%, mostly self-funded, have a CGM.

I conclude by saying that spending to save on diabetes is an easy win; there is no excuse not to do it.