Diabetes-related Complications

Jamie Reed Excerpts

Tuesday 7th June 2016 Westminster Hall

[Paula Sherriff]

I thank the hon. Gentleman for that intervention; once again, I agree with those points.

It makes sense both clinically and financially to improve access to diabetes self-management education. Managing diabetes well is time-consuming and can be complicated, but 69% of diabetics said they did not fully understand their condition. On average, people with diabetes spend only three hours a year with a healthcare professional. For the remaining 8,757 hours they manage their diabetes themselves, for which they need the right skills and knowledge—not to mention confidence. Diabetes self-management courses empower people with diabetes to take charge of their own care. Nine out of 10 people with diabetes who attended a course stated that they felt more confident about managing their diabetes afterwards.

Evidence collated by Diabetes UK shows that diabetes education courses reduce an individual’s risk of developing serious and costly complications and prove very cost-effective. However, more than a third of CCGs do not currently commission specific courses for people with type 1 and type 2 diabetes, despite national guidance, and less than 2% of people newly diagnosed with type 1 diabetes—and just 5.9% with type 2 diabetes—attend a diabetes education course. Investing in diabetes education is the big missed opportunity in diabetes care. Will the Minister agree to look at what can be done to ensure that we do not continue to miss it?

[Mr Jamie Reed (Copeland) (Lab)]

My hon. Friend is making a fantastic case. I speak as somebody who is a type 1 diabetic, the father of a type 1 diabetic and the uncle of a type 1 diabetic. Does she agree that when we look at providing the education that she has talked about, we also need to give regard to the fact that such courses require a basic level of numeracy and literacy, so provision needs to be made for people accessing those courses to be given help in those disciplines in some cases?

[Paula Sherriff]

I thank my hon. Friend for his contribution; he speaks with a great deal of experience, having experienced diabetes himself. That is an incredibly interesting point, and I hope that the Minister will give her views on that issue.

Finally, we must tackle the significant variations in the care and support received by people living with diabetes. The postcode lottery is exacerbated by additional differences according to age and the type of diabetes. People of working age with type 1 diabetes receive considerably worse routine care than other people with diabetes. For example, although 41% of people with type 2 diabetes achieve the three treatment targets—on blood pressure, HbA1C, or haemoglobin A1c, and cholesterol—less than 20% of people with type 1 diabetes achieved them in 2014-15. Because of that variation, far too many people are experiencing short and long-term complications that have a huge impact on their health and quality of life and prove incredibly costly to our NHS.

The universal provision of healthcare is one of the founding principles of the NHS, and we have warned of the impact of wider Government policies on that, but there is also a specific issue in the case of diabetes. We should acknowledge that the Government have recently made some steps to improve care and address wider problems through the new improvement and assessment framework, but those measures will require sustained resources and national leadership. I hope that the Minister will outline not just a commitment, but some detail on how she will ensure that those intentions result in long-term action. In particular, will she tell us more about what support will be provided to CCGs that are identified as poor performers as part of the new improvement and assessment framework?

As well as better care to reduce complications and enable people with diabetes to live long and fulfilling lives, urgent action is needed to tackle the rise in type 2 diabetes. Nearly 12 million people are currently at increased risk of developing it. As obesity accounts for 80% to 85% of the risk for type 2 diabetes, the main strategy for reducing the rising prevalence of type 2 diabetes must be to tackle the rise in obesity. I welcome the NHS diabetes prevention programme—a joint commitment from NHS England, Public Health England and Diabetes UK—which will identify those at high risk of developing type 2 diabetes and refer them to evidence-based behaviour change programmes to help reduce that risk.

The first wave of 27 areas in that programme covers 45% of England’s population, with the aim of supporting 20,000 individuals to reduce their risk of type 2 diabetes. Can the Minister give us any assessment of the programme’s record to date? Will she confirm that it is due to cover the whole country by 2020 and that she still expects a full 100,000 places to be available on the programme each year?

The Obesity Health Alliance identifies three other priority areas for action that should be fundamental components of the forthcoming governmental childhood obesity strategy. They are restrictions on unhealthy food marketing, including a 9 pm watershed for TV advertising of junk food; the implementation of independent and mandatory reformulation targets to reduce the sugar, saturated fat and salt content in our foods; and the implementation of a levy on sugary drinks manufacturers. We have, of course, recently had some progress on the last of those, although the levy that the Chancellor of the Exchequer is implementing perhaps does not quite match up to that envisaged by public health campaigns. Perhaps the Minister can tell us more about that strategy and about the Government’s views on the other policies put forward by the alliance.

The Government have also promised to take action to reduce childhood obesity, with the aim of publishing a childhood obesity strategy. The strategy was initially due for publication in autumn 2015 but has been delayed. The latest indication is that it is to be released in summer 2016, but quite frankly, they have been holding off for far too long already. Can the Minister give us a specific date for exactly when the strategy will be published?

I know that other hon. Members are keen to speak, so I will conclude by saying that, both as a former NHS worker for many years and as a member of the Select Committee on Health, I see this issue as absolutely critical for the future of our health service as a whole, as well as for the many thousands of my constituents who live with diabetes. There are a disproportionate number of diabetics in my constituency, so this is a big issue for the people of Dewsbury, Mirfield, Denby Dale and Kirkburton. I hope that the Minister has some answers today for them and for everyone who relies on our NHS.

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[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to my hon. Friend the Member for Dewsbury (Paula Sherriff) for securing this important debate. We both have a background of working in healthcare and we share an interest in health issues, particularly when it comes to health inequalities and postcode lotteries of healthcare provision.

As my hon. Friend said, we recently visited the excellent diabetic foot clinic at King’s College hospital. I will be honest: when I received the invitation, it was only my interest in diabetes that led to my accepting it. I did not expect to come away from a diabetic foot clinic feeling inspired, but inspired I most certainly was. I spoke to the doctors, nurses, healthcare assistants, researchers and, most importantly, the patients. I heard from patients whose limbs had been saved from amputation by the amazingly skilled, dedicated and knowledgeable staff—patients who had arrived at the foot clinic clutching letters from their doctors that stated, “There is no alternative other than to amputate this limb.” Those patients were lucky because they had talked to people such as diabetes specialist nurses, who had suggested that they consult the diabetic foot clinic to get a second opinion.

We spoke to a farmer from Kent who had been kicked by one of his cows. He had a wound on his foot that would not heal and he had been advised by the hospital that a below-knee amputation was the only solution. The farmer talked to us about his family farm, about how he would have been unable to carry on working had the amputation gone ahead and about how grateful he was for his referral to the foot clinic. The staff there had been able to treat the wound and it was well on the way to recovery by the time we saw it. They had saved his limb and consequently his business and his family’s livelihood, with all the concomitant savings to the NHS. So many of the people we spoke to told us stories like that; he was just one of them.

I was absolutely blown away by the incredible work done by that clinic, but, as has been pointed out, the care provided there is not universal and there are currently no national drivers to lower amputation rates across the country. It has already been stated that four out of five of these amputations are avoidable. I particularly liked the comment by the hon. Member for St Ives (Derek Thomas) that we should aim to get to a point at which amputation is seen as a failure rather than as a form of treatment.

My hon. Friend the Member for Dewsbury has quoted quite a lot of my speech. [Laughter.] So I will be brief. She referred to this, but it deserves repetition. In 2013, the Health Secretary committed to reducing the rate of diabetes-related amputations by 50% over five years. The amputation rate has in fact remained steady. Little progress appears to have been made towards the commitment. I do not think it does any harm to repeat that point and to hope for a response.

[Mr Jamie Reed]

My hon. Friend is making an excellent point. Does she agree that there is a regional dimension? There is a GP shortfall of 40% across the north of England. If the gateway treatment for type 1 and type 2 diabetes is through primary care and accessibility is limited in certain parts of this country, clearly, we will get much worse outcomes.

[Liz McInnes]

I thank my hon. Friend for that intervention. He is absolutely right. In my own constituency of Heywood and Middleton, I have also come across the problem of people being unable to get access to GPs. I am a member of the all-party group on diabetes and we have come across the problem time and again.

Patients have told the APPG that, when they first went to see the GP with the full-blown symptoms of diabetes, the GP took weeks to diagnose them. We have a real problem with GPs’ awareness of the condition of diabetes, even though it is common. Perhaps it is just the patients who come to our APPGs, but they all seem to come with the same tale, so perhaps there is a job of work to be done to standardise GPs’ education on diabetes.

We have touched on the subject of variations in care around the country. Because of the regional variations, far too many people are experiencing short and long-term complications, which can have a huge impact on their and their family’s quality of life. It is also very costly to the NHS.

I want to talk about a major clinical audit that is going on at the moment, the national diabetes audit, which measures the effectiveness of diabetes healthcare against NICE clinical guidelines and NICE quality standards in England and Wales. That audit provides an overview of the quality of diabetes care at national, clinical commissioning group, acute trust and GP practice levels. Through the collection of the data, the national diabetes audit can produce reports for a range of stakeholders to drive changes and improve the quality of services and health outcomes for people with diabetes.

Again, we see regional variations in participation in the national diabetes audit. The latest NDA report produced in January this year showed that participation in the audit had dropped to 57%; it is thought that that can be attributed to a change from an opt-out to an opt-in system for GP practices, plus variations in the ease of use of the three different IT systems used by GP practices. I am very disappointed to say that, in my constituency, which is covered by the Heywood, Middleton and Rochdale CCG, not one GP practice is participating in the national diabetes audit. It is really important that participation be improved; better data help CCGs to more effectively set priorities and evaluate improvements. If we are not collecting the data, there is no way we can plan for improving the outcomes for people with diabetes. NHS England should make participation in the national diabetes audit mandatory as an important step towards improving diabetes care.

Several Members have already talked about the importance of education. An important aspect of avoidance and prevention of complications of diabetes lies in educating diabetics to help them to better understand and therefore manage their condition. With 69% of diabetics saying they do not fully understand their condition, there is clearly a need for education to be made available and accessible.

As has already been pointed out, more than a third of CCGs do not currently commission specific courses for people with type 1 and type 2 diabetes, despite national guidance. In my own constituency, only about 20% of people with diabetes are offered a course, and the take-up is alarmingly low, at around 6% to 7%. One reason that people give for not taking up the offer of a course is that their employer will not give them time off to attend. There is a real job of work to be done to persuade employers that supporting their employees to attend the courses will have all-round benefits for the employer and the employee in terms of reduced sickness absence and a healthier and more productive employee.

I know that the Minister shares my interest in promoting diabetes education, which is key to preventing the major complications of diabetes. I am interested to hear her views and whether she has any plans to improve access to education.

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[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?

[Mr Jamie Reed]

Does the shadow Minister agree that some consideration ought to be given to the funding allocation for CCGs with particularly large concentrations of people with type 2 diabetes, which is, after all, linked to obesity and lifestyle, especially considering that obesity is increasingly statistically linked—there is a clear correlation—with the incidence of poverty and socioeconomic disadvantage? Does he agree that CCGs with those significant populations should have their funding allocation reviewed?

[Justin Madders]

I agree that that needs due consideration. In some written answers, the percentages of people with diabetes per constituency are shown, and there are some definite peaks and troughs. If we are to get the issue under control, we must think more strategically about where the resources are put.

At the moment, a third of CCGs do not commission specific courses, which is contrary to national guidance. I hope that the Minister will be able to tell us what she will do to try to end the current postcode lottery. One of the most convenient and effective sources of education for many people with diabetes is their local pharmacy. There is a need—possibly, a demand—for expanding the role that pharmacies play in supporting people with diabetes. What are the opportunities and possibilities for thinking again about the Government’s plans to slash the community pharmacy budget, which may lead to the closure of up to 3,000 sites?

More significant than the variation in education is the variation in the levels of care and support offered depending on location, the age of the patient and the type of diabetes. There is evidence of markedly different routine care throughout the country, which has a huge impact on the quality of life of diabetics, as well as being costly to the NHS. One in six people in hospital has diabetes, yet one in three hospitals has no diabetes specialist nurse. The national diabetes in-patient audit paints a worrying picture of the variations in the way in which the condition is managed by hospitals, and the unacceptable number of in-patients suffering avoidable complications.

Some of the most serious diabetes-related complications are avoidable amputations and foot ulcers. We have heard that £1 in every £150 that the NHS spends is in that area, and such action has a dramatic, life-changing impact on individuals and their families. As my hon. Friend the Member for Dewsbury said, in 2013 the Health Secretary committed to reducing the rate of amputations by 50% in five years. Will the Minister tell us what progress has been made towards achieving that goal, particularly given that Diabetes UK has said that no progress has really been made? Will she confirm that she still hopes to meet that target?

NICE recommends that all people with diabetes undergo an annual foot check but, in the worst performing CCGs, one in four people are not receiving a foot check at all. Part of the reason for that is the shortage in the number of podiatrists, particularly following a recent reduction in the number of students from 361 to 326. I am concerned that the plan to scrap bursaries for podiatry students and to push them into about £50,000 of debt will make the situation even worse. I ask the Minister to reconsider the direction of travel on this policy. Will she advise us what assessment has been made of the likely number of podiatrists who will be trained each year under the new funding regime?

I will close by making a few remarks about prevention. As I said at the beginning of my speech, the number of people suffering from diabetes continues to rise. The primary driver of that is, of course, lifestyle. Some 11.9 million people are currently at an increased risk of developing type 2 diabetes as a result of their waist circumference or weight. Two in every three people in the UK are now overweight or obese. As other Members have said, people might not necessarily feel that that relates to them, but we must reflect on those figures. Obesity accounts for 80% to 85% of the risk of developing type 2 diabetes, and therefore we need to focus on education and treating the condition. The main strategy to address the prevalence of type 2 diabetes has to be to address the rise in obesity, particularly at a young age, as the hon. Member for St Ives said.

We welcome the Government’s announcement of a sugar tax in the Budget, but that measure will only be effective as part of a wider strategy to address childhood obesity. I do not know whether the Minister will be able to tell us, but what is holding back the publication of the strategy? Is there disagreement on what will be in it? Is it at all possible for her to give us a date for when it will be published? [Interruption.] I suspect I have my answer from the grin on her face.

Both sides of the House are alert to, and supportive of, the need to get on top of this challenge but, as with all such matters, the Government will be judged by the results, on which we will keep a close eye in the coming years.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. What an excellent debate we have had, and I thank the hon. Member for Dewsbury (Paula Sherriff) for securing it. She is a passionate health campaigner and has made her mark in a very short time in the House. This is the second time I have seen her today, as I gave evidence to the Select Committee on Health this morning. It is excellent to see so many colleagues from both sides of the House in the Chamber today.

Diabetes-related complications are a vital issue and, sitting here, I agreed violently with much of what was said about the scale of the challenge, the need to step up and, indeed, some of the things that we need to do. I hope to use my time, as much as possible, to update the House on practical measures that the NHS and the Government are taking, as well as to hint, where I can, at policy yet to come. There is more to be said later in the summer on some areas. One reason why it is so important to have such debates is to keep up a drumbeat of discussion. One thing I have realised as a Minister is that momentum is a funny thing in politics.

[Mr Jamie Reed]

It certainly is.

[Jane Ellison]

I make no comment. Political momentum is important because it drives change in a way that is hard to pin down. We now have momentum on obesity and diabetes in a way that we did not a few years ago. The level of interest in this House is a good measure of that, so it is vital that we have such debates. It is also a measure of how seriously we take diabetes that we have included reducing diabetes care variation and preventing diabetes in the NHS’s mandate—it is right at the heart of our big asks of NHS England.

Before I continue, I take this opportunity to pay tribute to the many NHS staff who provide invaluable support to patients. Inevitably, in a debate where we are rightly stress-testing the system and asking where we can improve, it is easy to forget that masses of people out there are doing brilliant work. We have heard inspiring words today from two colleagues about their visit to see real specialists in action. Across the country there are people supporting patients with diabetes. There are also excellent third sector organisations such as Diabetes UK, with which we work closely, and JDRF, which does such great work on type 1. They both work with and independently challenge the Government, all with the aim of improving the lives of those with diabetes or at risk of it.

[Jane Ellison]

I sat here thinking how interesting the visit sounded. My team has made a note of that. We had heard about the visit and how it had gone well, so it is great to hear that first-hand from the hon. Lady.

I will not repeat the shocking facts on diabetes, which have been well rehearsed and explained by Members in this debate, but suffice it to say that the impact is huge. My hon. Friend the Member for St Ives (Derek Thomas) and others have made notable contributions drawing out the human cost of diabetes. People tend not to understand how devastating diabetes can be for patients and families, as well as the cost to the NHS, which in England we estimate to be £5.6 billion a year.

We have to work together to address diabetes. Before I talk about the action we are taking now and the progress we need to make, it is worth noting that we have come a long way. I have discussed that in some detail with our national clinical director, Dr Jonathan Valabhji, over the past year. The progress we have made through the quality and outcomes framework over the past decade has driven a step change in delivering better management and care for people in GP practices. Last year’s National Audit Office report showed that the relative risk of someone with type 1 or type 2 diabetes developing a diabetes-related complication has not changed, and indeed has fallen for most complications, despite the growing number of people with diabetes, so we have made progress. Clearly, the question now is how we can go much further. Diabetes is a key priority for us, and we want to see a measurable difference in the lifetime of this Parliament. There are four main areas in which we are taking action.

[Mr Jamie Reed]

Before the Minister moves on to the progress that is being made—she is right that we have come a long way over the past 10 years—will she undertake that the Department will consider not just the cost to the NHS of all diabetes-related complications, because we have been talking about this from a very NHS-centric point of view, but the cost to the economy of such complications?

[Jane Ellison]

We have been preparing and working on the childhood obesity strategy for some months, and I assure the hon. Gentleman that we have been looking at the wider cost to society and, obviously, projecting that forward, as has been done by many other economies in the developed world. There is an interesting piece by the McKinsey Global Institute on the cost to the developed world.

Specifically in the NHS, and going to the heart of the debate, there are four main areas in which we are taking action that we expect to deliver reductions in complications: reducing variation in the delivery of the three NICE treatment targets for blood pressure, blood glucose and cholesterol control; improving the take-up of structured education; improving foot care; and improving in-patient care. Reducing variation is always a theme of health debates and, frankly, it is a constant challenge in any system. The question is how we drive out variation, and Members have made a good point about how we support people to drive out variation. One of our goals for 2020 is a reduction in such variation in the management and care of people with diabetes.

The newly established CCG improvement and assessment framework has been mentioned by a number of Members. Diabetes is one of the clinical priorities in that framework, which will play a key role in delivering the challenge to variation. The chief executive of Diabetes UK is the chair of the panel of independent experts who are involved in the assurance process for that rating system. Diabetes is high on the IAF agenda. The framework will identify CCGs in need of improvement, and then NHS England will work with those CCGs to identify the nature of the changes needed and the type of support required to facilitate those changes.

To give some idea of the support available, we will be working with CCGs to consider the nature of the tasks they need to address. A key focus will be to help CCGs to map how their services compare with those in similar areas, to help them look at best practice from which they can learn and to introduce specific peer support through other programmes. CCGs will be supported in practical, hands-on ways. As we build the data picture of what is going on, we obviously need to support CCGs as they discover that they have variation, of which they may not even have been fully aware.

There are other areas not covered by the IAF that the Public Health England “Healthier Lives” website addresses. I encourage people to look at the vast amount of publicly available data for their local area. NHS Right Care is an important programme that has reducing variation at its core, and it is there to help CCGs and other partners to make step changes in the way they improve care. It will be very focused on diabetes care, and it has been improving services. It will be rolled out to all CCGs over the next 18 months, with practical support and sharing best practice at its heart.

The hon. Member for Heywood and Middleton (Liz McInnes) and I have discussed structured education, and I share her frustration. Essentially, we know that structured education works and that it is being offered to far more people, but that take-up is low. We cannot keep doing the same thing; we must look at things differently. For example, working people with diabetes straight away pose a challenge involving the amount of time that they can take to attend a course. We want to improve take-up. We know that structured education makes a difference to people’s quality of life and, importantly, reduces their risk of developing complications, but we also know that we are not where we need to be.

It is one of my personal priorities to change that. The Department is working with NHS England and Diabetes UK on ways to improve the take-up of structured education, particularly by considering more diversity of provision through digital and web-based approaches, as well as what can be done to improve access to more traditional forms of support. Again, the improvement and assessment framework includes an indicator for the number of newly diagnosed diabetes patients who attend a course. However, we have to make it possible for CCGs to refer people to a course that they think is likely to be taken up. There is something in why such courses are not commissioned as much as they should be: people are aware of low take-up and it is a vicious circle. We need to address that. Next week, an expert round table is taking place with the national clinical director. It will consider options to update structured education, potentially including working with employers, and practical actions that we can take to overcome barriers. I expect to be able to say more about it in due course.

We regularly discuss improving foot care. Particularly for people with late-stage diabetes, it is a challenge and a threat, for reasons that have been well explained. The number of amputations is unacceptably high, and we want to reduce it. NHS England is working with a number of key stakeholders to publish a new framework to improve the delivery of hospital-based diabetic foot services. The framework makes it clear that all patients with diabetic foot problems should have rapid and equal access to services, and describes for commissioners what key elements are in place that they need to commission. The new national diabetes foot care audit provides data on all diabetic foot care services so they can measure their performance against the NICE clinical guidelines.

I note the concern expressed about the survey and the lack of take-up. NHS England is taking action on the issue of GP participation, but I might ask NHS England to write directly to the hon. Member for Heywood and Middleton to say specifically what it is doing, because I share her concerns about having the fullest possible picture. Again, transparency of information, along with improvement support through initiatives such as Right Care, will drive improvement. Interestingly, the variation on amputations does not follow many of the traditional patterns in terms of the burden of disease that we see in some other areas. We need to be able to examine the information at quite a local level, as support for patients is variable even within local areas, and we must expose that.

On inpatient care, the NHS’s focus is on ensuring that all hospitals have inpatient specialist teams to assess and help to manage inpatients with diabetes. Again, if we get that right, it can lead to a significant reduction in complications.

I will say a few words about prevention, as it is at the heart of any public health Minister’s agenda. Preventing people from developing type 2 diabetes in the first place helps to take them off the conveyor belt that can lead ultimately to complications and all the burden of disease that we have been discussing. At all points along that conveyor belt, there are things that we can and must do, and are doing, to make life better for people with diabetes. For example, I welcome the increasing focus of our major charities on prevention and explaining the role of prevention in fending off some of the most serious diseases from which people suffer.

Healthier You, the NHS diabetes prevention programme, goes to the heart of tackling the rising prevalence of diabetes. Around 90% of adults with diabetes have type 2, and an estimated 80% of cases of type 2 are related to lifestyle; as Members have said, it is a huge factor. The national diabetes prevention programme is, we think, the first at-scale diabetes prevention programme to be delivered anywhere in the world. This year it will refer at least 10,000 people to an evidence-based behaviour change intervention that has been proven through randomised controlled trials to reduce the risk of type 2 diabetes.

I can confirm that the programme will be made available to up to 100,000 people by 2020. I know that there is great interest in it. We are learning from the seven demonstrator sites, which tested different approaches over the past year. Although the nature of the intervention is essentially common, there are different ways to deliver it, and we have learned a great deal. We are taking a phased approach, and the first wave of 27 areas covering 26 million people, or half the population, will open their doors to patients in the next few months and throughout 2016.

We are building up at pace. The interventions offer tailored, personalised help to reduce risk, including education on healthy eating and lifestyle and bespoke physical exercise programmes. If there is one thing that I ask of Members, it is to encourage their constituents to attend their NHS health check when invited to do so, as it is one of the gateways into the national diabetes prevention programme.

Of course, that is only part of a wider public health programme of preventing disease in the first place. Members have mentioned children. It is absolutely right that we should go way upstream to consider what we can do to tackle overweight and obesity in children. We will be launching our childhood obesity strategy in the summer. It will examine everything that contributes to children becoming overweight and obese and set out what can be done by all. We are looking at the entire environment around a child, so everything that Members have said that they hope will be considered as part of the strategy is being considered.

All parts of society, the public health system, Government and local government and industry have a part to play. The soft drinks industry levy announced by the Chancellor in the Budget is an important first step, and it has turbo-charged our discussions on the childhood obesity strategy. Its introduction in 2018 is driving reformulation of product, which every expert identifies as a key way to tackle obesity at population level. That is why there is a delay. I cannot comment in detail, but I assure hon. Members that we care about the same things that they do, and that all are being considered extensively.

[Mr Jamie Reed]

There are approximately 500,000 type 1 diabetics in the UK. Will the Minister undertake to ensure that continuous glucose monitors, flash glucose monitors and other emerging diabetic technologies are made available as a right on the NHS for people with type 1 diabetes?

[Jane Ellison]

Yes, I should say that many of my remarks have addressed type 2 diabetes, but that is not to say in any way that type 1 is less important. I will undertake to write to the hon. Gentleman on that, because there is work going on. As I said, many of my comments have dealt with type 2, but that is not to say that we are not also interested in addressing the challenges of type 1.

I am hugely heartened by the continuing parliamentary interest in this important subject. We will introduce the childhood obesity strategy and I have described all the other work on diabetes. It is good to know that there is so much parliamentary support from all parties for doing more, and particularly on investigating how to prevent diabetes from developing, to ensure that the next generation does not carry the same burden of disease as this one. It is a big challenge, but an unprecedented level of activity is taking place across our health system and the wider public health system, and in government at all levels. I look forward to updating Parliament further.

Question put and agreed to.

Resolved,

That this House has considered diabetes-related complications.