Baroness Walmsley
Main Page: Baroness Walmsley (Liberal Democrat - Life peer)
Baroness Walmsley (LD)
My Lords, I too congratulate the noble Lord, Lord Hunt, on his speech. I will focus on obesity and my colleagues will focus on other areas.
Chapter 3 of the plan proposes improvements in cancer, cardiovascular disease, stroke, diabetes, respiratory disease and mental health. But the disease of obesity is often the root cause of these and is one of the top-five risk factors for premature death. Obesity services are mentioned in chapter 2, but the problem is that there is no recognition that obesity is a disease, the prevention and treatment of which is vital to avoiding a wide range of other diseases. Bringing professionals of many disciplines together to work on this in primary care settings is essential to success. This is not all down to the NHS. Local authorities have a big role to play, along with CCGs. However, because of their progressive underfunding, many have had to withdraw services. From 2016 to 2017, the percentage of CCGs reported as commissioning tier 3 services went down from over 68% to 57%.
I was pleased to read that the NHS will provide more access to weight management services in primary care for people with a diagnosis of type 2 diabetes or hypertension with a BMI of 30-plus. But do you have to wait until you get sick to access these services? I was also pleased that the NHS has noticed the remarkable success of the GP Dr Unwin, who got hundreds of his type 2 diabetic patients into remission through low-calorie and low-carbohydrate diets, and is now going to run a pilot scheme of its own. However, professionals working in the field are clear that obesity is not just a lifestyle choice which can easily be reversed by exercising more or eating less—it is much more complex than that. Will the NHS follow the proven cost-effective model of the Fakenham weight management service, which uses a multi-disciplinary team to give personalised tier 3 services to suitable patients? They provide specialist nurses, dieticians, exercise professionals, consultant endocrinologists, psychotherapies and pharmacotherapy, and can refer some for bariatric surgery, which is also very cost-effective.
Recognition of this disease would remove the stigma and mental illness experienced by sufferers, and focus attention on treatment and research. The mechanism of obesity disease is not yet fully understood, but genetics play a part. It appears that the brains of sufferers respond differently to hormones generated in parts of the gut which tell the brain that the person is full and does not want any more to eat. So far, a few drugs have been developed to mimic this normal response, and these have been helpful to many patients. Patients who have undergone bariatric surgery show this phenomenon dramatically. Their diabetes disappears overnight and they lose weight rapidly but do not feel hungry.
Whatever the cause, will the Government make the commissioning of tier 3 weight management services mandatory, because then all CCGs would have to provide them? This could save a lot of misery, and save the NHS millions.