Health: Diabetes

Baroness Thornton Excerpts

Wednesday 31st October 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I congratulate my noble and learned friend for putting this debate before the House this evening. I congratulate him and the noble Lord, Lord Rennard, on their excellent contributions to this debate: they have actually covered most of the waterfront on this. As my noble and learned friend said, in November 2017, flash glucose monitors were made available on the NHS after petitions from various organisations and people who thought that this new technology should be accessible to those living with type 1 diabetes across the UK. I join the other speakers in thanking Diabetes UK and others for their briefing.

Flash glucose monitoring is a major advance over routine finger-prick glucose monitoring. It is easier, quicker and less painful. The density of data and the ability to follow trends in glucose levels, which are not available from less frequent blood glucose testing, have been shown to help patients improve glucose control and reduce hypoglycemia. I have two friends with type 1 diabetes, both of whom use this technology, and both say that it is an enormous improvement in how they manage their conditions. Flash GM can be used alongside routine finger-prick testing to check their blood glucose levels. It can also be used as a management tool to obtain a more detailed picture of an individual’s glucose profile. Flash GM devices should be made available to any adult or child with type 1 diabetes and to people with other forms of diabetes when intensive insulin therapy becomes necessary because of severely reduced pancreatic function.

The short-term use of flash GM by healthcare professionals as a management tool, sometimes referred to as troubleshooting, can help someone who is having difficulty achieving their personalised treatment target or who is troubled by frequent hypoglycemia, hyperglycemia or both. It is clear from the debate that ongoing funding for flash GM sensors should be made available, on the condition that the person demonstrates active management of their glucose levels or progress towards achieving and maintaining their personalised treatment target. This should be assessed at least annually. People who use flash GM should have a good understanding of intensive insulin therapy and how to self-manage their diabetes. The completion of a structured diabetes education programme, as recommended by NICE, is absolutely vital.

People who use flash GM will still need access to test strips and meters for use in certain circumstances; for example, current DVLA regulations stipulate that people should use finger-prick testing of glucose levels before driving. Once flash GM devices are on the NHS Prescription Services drug tariff, local health decision-makers should make sure that flash GM readers and sensors are listed in the local formulary. That is the nub of the matter—and probably the point at which I should say that I am a member of a CCG board—because we are talking about availability becoming a postcode lottery, as my noble and learned friend said. While various CCGs have approved the use of flash glucose monitoring, it is still not available in certain locations due to either being under review, and so only tested on a sample of people, or simply not having been authorised. Local decision-makers have decided against prescribing flash monitoring in 52 areas in England, according to the latest information given to me by Diabetes UK. Thousands more people with diabetes await decisions by 38 CCGs across England and nine health boards in Scotland, which are currently reviewing their policies.

With the knowledge of the benefits of flash GM, and with some people across the country having access to it already, it seems unfair to deprive others of the chance to use it because of their location. During Prime Minister’s Question Time earlier this month, the Prime Minister, who uses one of these devices herself, stated that this is not a one-size-fits-all situation and:

“There is no one system that is right for everyone”.—[Official Report, Commons, 17/10/18; col. 634.]


But at the moment not everyone with diabetes even has the chance to test whether or not that is true.

I have a couple of questions for the Minister, in addition to those already asked. Will the Government and NHS England commit to a diabetes technology fund, as my noble and learned friend suggested, as part of the new NHS 10-year plan, to support the rapid rollout of new cost-saving technology? What can they do to ensure that CCGs follow nationally developed guidance on access to technology and treatments? Having to create 200 different policies for every new technology is just duplicating effort and means that it will take years to ensure equitable access—if this is ever achieved. This seems a ridiculous way to respond to the new technologies that are available and will become more widely available. This is a problem that will grow, not decrease. Finally, will the Government look at making funding available, as my noble and learned friend said, in the current NHS spending review, to pump-prime access to these life-changing and cost-effective diabetes technologies?