Diabetes-related Complications

Derek Thomas Excerpts

Tuesday 7th June 2016 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I congratulate the hon. Member for Dewsbury (Paula Sherriff) on securing this vital debate on diabetes and related complications. This is important to me because my constituency, in particular, has a high level of diabetes-related amputations. As we have heard, diabetes is a significant problem for the UK, and it is right that the Government and the Department of Health have identified tackling diabetes as a priority for this Parliament.

The cost to people’s quality of life is dramatic and an increasing number are having to manage the condition, which can make holding down a job or going about their normal daily business very difficult. Some 3.5 million people have been diagnosed with diabetes and a further 500,000 may have it but have not yet been diagnosed.

Diabetes costs the NHS approximately 10% of its budget, with one in five hospital admissions for heart failure, heart attack and stroke involving people with diabetes. However, the cost of supporting people with diabetes goes far wider when we start to consider the costs associated with adapting people’s homes and workplaces following amputation or sight loss, for example.

The UK is a civilised, wealthy country and if more can be done, there is no real excuse for not doing it. We know that for many people, the risk of developing diabetes can be reduced through good diet and exercise, but this message must be communicated positively and early. Much more must be done to encourage outdoor physical education and activity from an early age. We will not be forgiven for having a nation of children who accomplish good results in year 6 SATS, only for many of them to live with life-limiting conditions. For me, physical education is as valuable as numeracy and literacy.

[Mr Gregory Campbell (East Londonderry) (DUP)]

On childhood obesity, does the hon. Gentleman agree that we need a generational change so that from this generation on we will raise young children with clear knowledge of the issues and the unfortunate and inevitable consequences of a sugary diet—so that we can try to prevent diabetes and make sure this is the last generation to suffer from this horrible affliction.

[Derek Thomas]

That is true, and I welcome that intervention. It is right to make the distinction between type 1 and type 2 diabetes. Type 1 often occurs in younger people and there is little, if anything, we can do about it other than manage the condition well. General practitioners in my area have teenagers and adolescents presenting with type 2 diabetes. The hon Gentleman is right that to address the issue in the long term we must be positive and provide information and education that is sensitive, but honest and truthful. We cannot pussyfoot around when people’s lives are at stake.

We have a responsibility to ensure that both those with type 1 diabetes and those with type 2 diabetes that cannot be avoided have easy access to the best treatment available and the best support, and can access modern devices that manage diabetes and reduce the development of further complications. Since arriving in this place in May 2015, I have attended several meetings and seen all sorts of innovations and devices that can be used, particularly by young people, to help them to manage their condition better.

In the past, I spent some time as a youth worker and I know it is a huge challenge to help young people with diabetes to manage their condition through finger prick tests and regular injections, and parents are frustrated that young people often do not realise the consequences of not looking after their condition well. New innovations and new devices must be made more available to them now because I believe they will embrace smart technology, which could be life-changing for children and young people who are managing a life-limiting condition.

We know that when diabetes is not well managed, it is associated with serious complications. I have referred to the cost of health and social care for diabetic patients. The tragedy is not just that 80% of these costs are spent on complications that are largely avoidable through better care, but that people’s health and quality of life are unnecessarily deteriorating because sufferers are not always able to access the care that we know they need.

I was keen to take part in this vital debate and I appreciate the opportunity because the situation in Cornwall and the Isles of Scilly gives cause for concern. One of the most serious diabetes-related complications is amputation. Nationally, an average of 2.6 diabetics in every 1,000 have a diabetes-related amputation. In Cornwall and the Isles of Scilly, the average is 4.4 amputations per 1,000 people with the condition. This suggests that in my constituency alone, eight people each year have a lower limb amputation as a result of diabetes. Last year, 40 people in Cornwall had a lower limb amputation as a result of diabetes. We know that four in five of these amputations could be prevented through better care, so six people in my constituency today could have avoided having a lower limb amputation in 2015 if everything we know about managing diabetes had been correctly applied. Six people’s lives have been changed dramatically and their outcome is grave indeed. It is essential that we reduce the number of amputations, not least because we know that up to 80% of people die within five years of having a lower limb removed.

As the hon. Member for Dewsbury said, NICE is very clear about what CCGs should do to improve treatment for diabetic patients. Earlier this year I wrote to my clinical commissioning group in Cornwall, Kernow CCG, to argue that it should ensure the NICE recommendations are properly implemented. I am encouraged by the action it is taking, which it set out in its response to me. It says that figures to be released this month demonstrate that its efforts have reduced the level of amputations in Cornwall and the Isles of Scilly. That achievement would be a phenomenal and significant success, and something to celebrate.

However, there is a role for the Government in improving patient outcomes and it is not fair to leave everything to the CCGs. I have referred to the need for a positive message about how to improve our own health to reduce the risk of developing diabetes, but those who have diabetes and are at risk of a lower limb amputation need to benefit from a cultural shift in the profession. We need to get to a place where major lower limb amputation associated with diabetes or vascular disease is considered a failure of treatment rather than a treatment choice. A functioning foot with minimal surgery should be a success.

The Government must do more to ensure that patients with a diabetic foot are diagnosed earlier and are on the right patient pathway. More must be done to ensure the right professionals are in place. If patients are seen by podiatrists, diabetologists and interventional radiologists as early as possible, patients can be treated appropriately and their leg can be saved. This means ensuring everyone with diabetes gets good quality annual foot checks. We have talked about what that might mean and perhaps we need clarity on what an annual foot check entails. Everyone with a foot infection should be urgently referred to those specialists.

The best way for patients to have access to those specialists is through a multidisciplinary team, where healthcare professionals meet to discuss patients and treatment choices. That sounds simple, but too often different parts of the healthcare system operate in silos and that is particularly the case in some parts of the healthcare profession in Cornwall. It is crucial that the right members of the team meet regularly and that multidisciplinary teams are fit for purpose. It must not be just a tick-box exercise for NHS trusts.

Clinicians also need access to the right technologies when they intervene on patients with advanced forms of diabetic foot and critical limb ischaemia. Data show that the use of drug-eluting technologies, when used by vascular specialists, can improve outcomes for diabetic patients to the equivalent of those patients without diabetes. NICE is about to review its clinical guidelines for peripheral arterial disease and I hope the updated guidance will include recommendations for the use of drug-eluting technologies for critical limb ischaemia and intermittent claudication.

In conclusion, the Department of Health has said it will assess CCGs on their provision of structured diabetes education as part of the new CCG improvement and assessment framework. I would like the Minister to say today what support the Department will provide to ensure that CCGs identified as underperforming are able to improve access to structured education, and thereby increase the number of people with diabetes who have the skills and confidence to manage their own condition. As was said early in the debate, many people with diabetes across the UK could manage their condition with the right support, education and resources. It is absolutely right that we do everything we can to give every person with the condition the support that should be available to them and that they deserve to have.