Health: Diabetes

Baroness Young of Old Scone Excerpts

Thursday 4th November 2010 Lords Chamber

[Baroness Young of Old Scone]

My Lords, I add to the thanks expressed to the noble Lord, Lord Harrison, for giving us this opportunity to talk about a subject as important as diabetes and foot care. I also thank other noble Lords for the broad sweep of diabetic issues that they have raised today. I did not quite expect chocolate to come into it, but the sweep was wide. I should declare an interest as the new chief executive of Diabetes UK. This is day four, so noble Lords should not expect too much of me at the moment.

When I was swotting for the interview for the job, one of the heart-stopping statistics that I learnt was that, every week, 100 people have a foot amputated as a result of diabetic complications. Even worse, 85 of those amputations are entirely preventable. The report and the issue that we are debating today are therefore extremely important for a variety of reasons.

Rather than go through the report’s recommendations, I shall highlight some of the principles. It is clear that early detection of potential foot complications, not only in patients with diabetes but in other patients where diabetes may as yet be undiagnosed, is vital on admission to hospital and throughout a hospital stay. It needs a proper history to be taken and a proper examination.

We also need to make sure that the threat of diseases of the foot is recognised by some of the key, non-specialist healthcare professionals. As the rise in the number of people with diabetes or potential diabetes is truly epidemic, we need to make sure that health professionals across the piece, not just the specialists, are capable of recognising complications before they get active. Once there is active foot disease, there needs to be a referral to a specialist team or to a professional with specialist skills. Last but not least, the noble Viscount, Lord Falkland, rightly said that this is a disease where the patient needs to be in the driving seat. People need to be at the centre of their own care and to have access to information and support from specialist teams. One in three people with diabetes is currently unaware of the potential problems that they could have with foot complications, which is a poor performance figure.

Those are the sorts of things we need to bear in mind, but I will talk about that particular complication of diabetes as just one of those indicative of a much wider issue in the care and management of diabetic problems in this country. As many noble Lords have said, diabetes is a big problem. It consumes 10 per cent of the National Health Service budget; that is, £9 billion. It is also a growing problem, as we have 2.8 million people with diabetes and a large number of people as yet undiagnosed. There is the potential for it to rise very shortly to 4 million people with diabetes in this country. Foot problems and amputations are only some of the complications. Others, which have been referred to, are blindness, stroke and heart disease. Those represent a huge cost, not just to the NHS but to the economy, because people with severe complications may be less able to work and more dependent on benefits and social care, apart from the huge human cost and misery that we are talking about.

We need to ensure that we somehow enable that 10 per cent of the NHS budget, which might have to become more, to be spent at an early stage in the pathway for diabetes—at a point where the prevention of type 2 diabetes and of complications in all types of diabetes can take place, avoiding the complications further down the line that are such a huge cost economically, socially and in terms of heartache. That needs collaboration between the commissioners of services, the providers of services and patients and their families but there is lots of guidance around; we are not short of guidance on what good practice might look like.

There is, for example, NICE guidance on the prevention of foot complications. Their subsequent management is currently being consulted on. NICE is going to work on quality standards for diabetes as one of the 150 quality standards that the coalition Government have asked it to develop. I gather that the diabetes standard will be an early one among those. Guidance for commissioners already exists, which Diabetes UK worked on some years ago. We are currently working on a kind of checklist for what an integrated quality diabetic service would look like. There is plenty of advice around and nobody is in any doubt about what the standard of the service should be. The problem is that its implementation is very patchy.

Diabetes UK, in the context of the NHS reforms, is very much going to put its shoulder to the wheel, as it were. Many things which the charity currently does will fit well with the principles of the health service reforms. There is considerable information and support for patients and their families and guidance for commissioners, as I said—we will be inputting very actively to the national standard-setting process. There is also our volunteer network, which will be active locally in fora where advice and decision-making about diabetes is taking place, both at the commissioner and provider level. We will very much want to work locally with the commissioners as the GP consortia emerge. I share the views of other noble Lords; we need to have larger commissioning consortia rather than smaller. I hope that we can learn from history, as the primary care trusts had to be clumped up and merged because they were too small to do a decent job. Let us not forget that lesson by having consortia that are too small. Another job that Diabetes UK will willingly turn to is monitoring the quality of services being received locally and their implementation nationally. We are very much there to play our part.

I want to ask the Minister two questions. First, how can the Government ensure that there is a change in the pattern of investment in diabetes care, to make sure that the services for early detection and for preventing complications are up front, as it were, and that the huge downstream costs of complications are not using up the NHS budget for diabetes inappropriately as well as generating the social costs and the personal heartache of complications?

Secondly—this reiterates the point made by the noble Lord, Lord Rennard—can the Minister let us know how the new arrangements with GP commissioning consortia will be able to ensure that people across the country with diabetes get the recommended standard of care, irrespective of where they live? We hear about localism and less central direction being very much a principle of the reformed NHS. I will not talk about the postcode lottery as a risk, although I have heard the phrase “postcode democracy”. We ought to hold the Minister’s feet to the fire to explain that before long.

I look forward very much to my new role and to hearing what the Minister has to say about this topic, which is hugely important not just for people with diabetes and their families but for the national economy.