Diabetes-related Complications

Chris Evans Excerpts

Tuesday 7th June 2016 Westminster Hall

[Chris Evans (Islwyn) (Lab/Co-op)]

It is an honour to serve under your chairmanship, Mr Pritchard. I, too, congratulate my hon. Friend the Member for Dewsbury (Paula Sherriff) on securing this debate on diabetes-related complications. Diabetes is a huge public health issue in highly developed countries such as ours, and the complications of diabetes, if left unchecked, can be life-changing and, ultimately, fatal.

Approximately 4 million people live with diabetes in the UK—that is one in 16 of us—and more than half a million of those are undiagnosed and unaware that they have a potentially life-threatening condition. About 700 people are diagnosed with diabetes every day and it is estimated that, by 2025, 5 million people will have the disease.

Although we are not quite sure what causes type 1 diabetes, which affects approximately 10% of those with the disease, we know that the far more common type 2 diabetes can be caused by lifestyle factors. In 2014, Public Health England said that 90% of adults with type 2 diabetes are overweight or obese, and that men are five times more likely to develop type 2 diabetes if they have a waistline of more than 40.2 inches, while women with a waistline of more than 34.7 inches are three times more likely to develop the disease.

The link between unhealthy lifestyles and a higher risk of diabetes is clear and very well established. Is it any wonder that diabetes is on the rise when it is easier to live a sedentary lifestyle and eat unhealthily? We have more temptations, in terms of food, than ever before. The principle that prevention is always better than cure is particularly apt when we are thinking about diabetes and the serious complications that can arise from the disease.

In the first instance, it is imperative that everything that can be done is done to ensure that children and young people who have not yet developed the disease or become overweight are encouraged to lead healthy lifestyles. Schools have a very important part to play in that. They must ensure that pupils and parents are made aware of diabetes, including the causes of the disease and what might happen if they develop it. Sport in school is a fantastic way to get young people active, yet a University College London study in 2013 found that, of the 6,500 seven-year-olds included in the study, only 51% achieved the recommended hour of physical activity every day. That situation simply has to improve.

Although physical education lessons in schools often focus on competitive sports such as football, hockey, rugby and netball, they should also put emphasis on general fitness training. Schools should also be given the tools and resources that they need to encourage after-school sports clubs in addition to community-run sports clubs. The Rhymney Valley athletics club, based in my constituency, is a fantastic example of a community-run sports club for children and young people. On the occasions when I have had the opportunity to visit it, I have always been impressed by the enthusiasm of the coaches and the positive atmosphere that they create, which is impressed on the children. The number of children taking part is growing quickly, simply because they enjoy going. Whether they know it or not, by taking part in physical activity, they will be reducing their risk of type 2 diabetes and, more importantly, having fun along the way.

However, parents must bear much of the responsibility for ensuring that children lead a healthy and active lifestyle. It may be easier for parents to allow children and teenagers to eat sugary, high-fat treats with low nutritional value and drink sugary pop, but that puts their health at risk in the long term. The new tax on high-sugar drinks that was announced in March is a welcome step in the direction of tackling child obesity, and I hope that parents will take the message on board by encouraging children and teenagers to drink and eat more healthily. One of the most important skills taught to me by my mother was the ability to cook my own food—not to rely on ready meals, a takeaway or the fish shop, but to go home of a night and make myself a meal.

If young people do not develop a healthy lifestyle while they are at school, it is reasonable to expect that they will find it much harder to do so once they have left. If we make a serious effort to point children in a healthy direction from an early age, we will give them the best possible chance to avoid becoming overweight. It follows that, if they do not become overweight, they are less likely to develop diabetes and, as a result, less likely to suffer health complications caused by the disease.

Adult obesity in the United Kingdom is showing a sustained upwards trend. By 2014, more than 28% of adults were considered clinically obese, and that is expected to rise to one third by 2020. Overall, 62% of adults in the UK—a significant majority—are classed as overweight or obese. That is the third highest level in western Europe, and it is not a league table we particularly want to be at the top of. It is clear that, if we are to tackle excess weight and obesity to tackle diabetes, radical public action must be taken to reduce the UK’s average waistline.

A key reason for increasingly sedentary lifestyles is the rapid growth of office and desk work during the past few decades. Employees stuck behind a computer screen for most of the day do not get the opportunity to exercise, which we know is vital to maintaining a healthy weight. Perhaps great benefit would be gained if employers were incentivised to incorporate physical activity into office work or to set aside time during the working day for the desk-bound to exercise. The expansion of accessible after-work exercise clubs for all would also be a huge and radical step forward.

Incentives should be given for healthy eating. When living on a budget, as so many people are, it is often cheaper to eat unhealthily than healthily. That extraordinary situation must be turned on its head. Equally, disincentives such as the sugar tax should be used to discourage unhealthy eating. Only once we as a country have truly got to grips with our weight and obesity problem will we be able to prevent the very serious health complications caused by diabetes.

--- Later in debate ---

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I congratulate my hon. Friend the Member for Dewsbury (Paula Sherriff) on securing this important debate and on the eloquent and powerful way she set out the issues in her opening speech. Several hon. Members have echoed what she said, and I will no doubt repeat it to an extent. After just a year as an MP she has established herself as one of the most effective campaigners in this place, and she is a passionate advocate on a range of issues—particularly public health matters. She spoke of her visit to King’s College with my hon. Friend the Member for Heywood and Middleton (Liz McInnes), and described the excellent care there, as well as mentioning the fact that, sadly, that experience is not replicated throughout the country. She highlighted the cost of diabetes and described education as a missed opportunity to reduce complications. That is a theme that has come through in several of the contributions today.

I also want to mention the contribution from the hon. Member for St Ives (Derek Thomas), who made a powerful point about what kind of future the next generation is heading towards, if we do not put more focus on the issue now. He gave us constituency-specific figures on amputations. I wonder whether all hon. Members would be interested to find out the specific figures for their constituencies. They really bring the issue home. I agree with the hon. Gentleman that the matter should not just be left to CCGs, and that there is a need for more co-ordinated national support. He was also right to say that we should aim to reach the point where amputation is seen as a failure and an exception.

My hon. Friend the Member for Islwyn (Chris Evans)—I hope that is the right pronunciation of his constituency—

[Chris Evans]

Someone once said it as “insulin”.

[Justin Madders]

We could have been forgiven for making that error today, but we will talk more about pronunciation afterwards. My hon. Friend spoke with great sincerity about the benefits for children of taking part in sport, and about how once they get into it they can enjoy the physical activity. I know from experience that dragging kids off the Xbox can be a difficult challenge, but once they actually get out there they enjoy themselves, and that contributes to a healthier lifestyle. He also made a valuable point about the world of work, in that so many more jobs are now sedentary in their nature. Of course, a healthy workforce is a more productive one, and productivity is a challenge for the whole country.

My hon. Friend the Member for Heywood and Middleton spoke with great experience of health. It was great to hear that she had been inspired by her visit to King’s College. She spoke about the national diabetes audit, and the importance of using the data collected to drive improvements. Again, she highlighted the need for more education. It was interesting to hear that some of her constituents have difficulty attending some education courses because employers are not agreeing to give them the time off. It will be interesting to hear the Minister’s reflections on that and it comes back to the point about a healthy workforce being a more productive one. We really need to get that message across to employers.

The hon. Member for Inverclyde (Ronnie Cowan) spoke about his family’s experience and gave us a useful personal insight into the everyday challenges faced. We can all reel off the figures but hearing from someone who has had a close relationship with the condition for a considerable length of time brings home some of the practical challenges that people face.

There is a consensus, as the hon. Member for Linlithgow and East Falkirk (Martyn Day) said. All hon. Members acknowledge that diabetes is one of the most significant healthcare challenges, given the impact that it has on NHS resources and, more importantly, the impact it has on people. We heard very powerful details of that today.

To put the condition in perspective statistically, 45 people in the UK will have been diagnosed with diabetes in the time it takes to complete today’s debate. In that time, one person will have undergone a diabetes-related amputation and four people will have died prematurely due to diabetes-related complications. According to figures produced by Diabetes UK, there are currently 4 million people living with diabetes in the UK, of whom 549,000 are undiagnosed.

The number of people with diabetes is increasing, as various hon. Members have said, and it has more than doubled since 1996. More than doubling the number of people with any condition in 20 years is bound to lead to serious questions about how our society is operating. Indeed, several hon. Members have given some good examples of the challenges we face. Part of our role is to question and support, where possible, how the Government respond to those challenges, particularly when we are talking about something that can be preventable. The level of interest shown by hon. Members today shows that there is at least recognition and agreement that the issue demands significant attention.

The number of people with a diagnosis is huge, as is the cost to the health service. The NHS now spends about £10 billion on diabetes each year, which is equivalent to about 10% of its budget, and £8 billion of that is estimated to be spent on complications, which, as we have discussed, are largely avoidable. Diabetes is an important issue to tackle at any time but, when we have such financial pressures on the NHS, it becomes even more pressing to really get on top of trying to avoid the complications it can cause.

At the heart of the issue are the people involved. Although many are able to manage their diabetes effectively, it is still a life-changing condition that has an impact on those living with it on a daily basis. We heard from the hon. Member for Inverclyde about how it really has an impact not only on the individual, but on their family. For somebody with type 2 diabetes, managing their condition means learning how to treat it with diet and exercise, and possibility coming to terms with the need to take medication and insulin. For someone with type 1 diabetes, it means constant diet management and carefully working out the correct amount of insulin to take. However, for everyone living with diabetes, it means being aware of the potential complications that can occur, and keeping a careful watch not only on blood glucose levels, but on cholesterol, weight, blood pressure and the conditions of eyes and feet.

Put simply, living with diabetes means becoming an expert on the condition. Despite that, less than 2% of newly diagnosed individuals with type 1 diabetes, and just 5.9% of those newly diagnosed with type 2 diabetes, attend a diabetes education course, which is a theme that has been mentioned by various hon. Members. Those figures alone are disappointing, but they are even more so given that there is clear evidence that the courses reduce the risk of individuals developing complications, and given the fact that a worrying 69% of people say that they do not fully understand their diabetes. The very nature of the condition means that self-management is the only practical way to reduce the risk of complications.

We welcome the publication of the Government’s new improvement and assessment framework for CCGs, which will assess CCGs on the attendance of structured education schemes and on the NICE recommended treatment targets. Will the Minister tell us what steps the Government are taking to improve access to diabetes self-management education, what steps she envisages taking against CCGs that perform poorly in the improvement assessment framework, and what support will be available to those identified as poor performers in order to bring them up to what is considered best practice?