Diabetes: Tailored Prevention Messaging

Jim Shannon Excerpts

Thursday 24th October 2019 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered tailored prevention messaging for diabetes.

It is a pleasure to serve under your chairmanship, Ms Buck. It is good to see a group of MPs here who have made the effort and taken the time to come to a Thursday afternoon debate. I am pleased to see the Minister in her place. As she knows, I am particularly fond of her as a Minister and look forward to her response. I have given her a copy of my speech, so we can perhaps get some helpful answers. I thank her in advance for that. I am also pleased to see the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), who is always here, and other right hon. and hon. Members who regularly come to diabetes debates.

I am particularly glad to see the right hon. Member for Leicester East (Keith Vaz), who chairs the all-party parliamentary group for diabetes, of which I am the vice-chair. We have many things in common. Not only are we both type 2 diabetic—I make that clear at the beginning—but we are faithful fans of Leicester City football club. We have followed it for years, and it is third in the premier league. Tomorrow night, as I understand, it plays Southampton away, where I hope Brendan Rodgers will do the best for us again.

We are here to discuss diabetes. I have been a type 2 diabetic for 12 to 14 years or thereabouts. I was a big fat pudding, to tell the truth—I was 17 stone and getting bigger. I enjoyed my Chinese and my two bottles of Coke five nights a week. I was probably diabetic for at least 12 months before I knew I was. When I look back, I can see the symptoms, but I never knew then what the symptoms were—I was not even sure what a diabetic was. When the doctor told me that I was a diabetic, he said that there were two things to know. They always tell people the good news and the bad news, so I said, “Give us the good news first.” He said, “The good news is that you can sort this out. The bad news is that you’re a diabetic.”

I went on diet control and stayed on it for four years. When I talked to my doctor again, he told me that the disease would get progressively worse. Even after four years of diet control and dropping down to 13 stone—about the weight I am now, although I am a wee bit lighter at the moment, because of not being that well for the last couple of months—I went on to metformin tablets. A few years later, they were no longer working, so he increased the dosage. He also said, as doctors often do, “You might have a wee bit of bother with your blood pressure. You don’t really need a blood pressure tablet, but take one just in case.” I said, “Well, if that’s the way it is, that’s the way it is”, but he said, “By the way, when you take it, you can’t stop it”, so it was not just about blood pressure.

I say all that because diabetes is about more than just sugar level control. It affects the arteries, blood, kidneys, circulation, eyesight and many other parts of the body. If people do not control it and do not look after it, it is a disease that will take them out of this world. That is the fact of diabetes.

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

I congratulate my hon. Friend on securing the debate. He is an assiduous attender; he attends so much that I think the Speaker of the House said on one occasion that he thought my hon. Friend actually slept in the Chamber. He is alluding to his personal circumstances, but I and other hon. Members have raised the issue of juveniles and underage individuals who have an obesity problem that, over time, begins the process of type 2 diabetes. Although we need to tackle the problems in adulthood that he is raising, we also need to tackle them among children.

[Jim Shannon]

My hon. Friend is absolutely right. The figures that he and I have indicate that almost 100,000 people over the age of 17 live with diabetes in Northern Ireland, out of a population of over-17s of 1.6 million. We know it is more than that and that there are a lot of diabetics under 17, so he is right to bring that up. Northern Ireland has more children who are type 1 diabetic in comparison with the population than anywhere else in the United Kingdom.

[David Simpson (Upper Bann) (DUP)]

I congratulate my hon. Friend on securing the debate. He referred to having been a big fat pudding; well, I probably am, but we will not go there. Importantly, we have young children in schools who need insulin, but there is a difficulty with teachers and classroom assistants giving it to them. What more can we do about that? How can we encourage the education people to do it?

[Jim Shannon]

I know the Minister will reply to that, because that is one of the questions that I had hoped to get an answer on.

On the Monday before last, we had a diabetes event in the House. Before I came over, some of my constituents said, “Will you go along to this event about diabetes? It is really important, because some great things are being done in some parts of England and we would like to know about them.” When I got there, the people were most helpful and informed me that Northern Ireland has one of the better type 1 diabetes schemes, which is reaching out to 70% of people. As we often do in Northern Ireland, in this case we have a scheme in place that is almost voluntary. We have an un-functioning Assembly, which is disappointing, but we have a system whereby that scheme is working. Some of the things that we are doing, we are doing quite well.

There are 4.7 million people living with diabetes across the UK, each of whom should be treated as an individual. In Northern Ireland, we have 100,000 people with diabetes in that 17-plus bracket, but obviously it is more than that when it is all added up. Every day across the United Kingdom of Great Britain and Northern Ireland, 700 people are diagnosed with diabetes; that is one person every two minutes.

I had a good friend—he is not in this world any more, but that is not because of diabetes—who was a type 1 diabetic. He ate whatever he wanted and I always said to him, “You cannot eat all those things.” He said, “Oh, I can. All I do is take an extra shot of insulin.” I said, “That’s not how it works!” I do not know how many times I told him that. My three hon. Friends—my hon. Friends the Members for East Londonderry (Mr Campbell), for South Antrim (Paul Girvan) and for Upper Bann (David Simpson)—will know who it is, so I will not mention his name. He was very flippant about the control of his diabetes, but it seemed to work for him. I could never get my head around the idea that an extra shot of insulin seemed to cure the problem.

[Paul Girvan (South Antrim) (DUP)]

I thank my hon. Friend for bringing this important debate to the Chamber. My wife is a type 1 diabetic who is insulin-dependent. She has already—she is a bit younger than me—lost a kidney, because of lack of control, which can cause problems. That needs to be identified: control is vital, and it is important for people to monitor regularly. New technology is available that can actually give readings constantly, as people go. It is important that people start to use the available technology, so they do not have to take more insulin than they need, but can take it only when it is needed.

[Jim Shannon]

Like my hon. Friend, my wife is younger than me. It must be a Northern Ireland DUP MP thing—we look for younger wives to keep us young. I am not sure if that is right or wrong, or if it is politically correct to say that, but my wife is nine years younger than me. She understands the issue of me and diabetes.

Some 10% of people with diabetes have type 1 and 90% have type 2. I will refer to both throughout my speech, and I encourage hon. Members to do the same and to acknowledge the different factors at play with each. We can manage type 2 with medication, provided we control what we eat and what we put in our bodies. Of those living with diabetes, we have the broadest cross-section of society. The condition affects all genders, ages, ethnicities and financial situations. However, too often I see that policy makers and clinicians fall into the trap of treating people with type 1 or type 2 diabetes as homogenous groups that will respond to the same approach and message, but they respond in different ways.

During this debate I want to focus on four things: the primary prevention of type 2 diabetes; the need to offer different messaging to ensure that the support is appropriate for each individual living with diabetes; the necessity of preventing the complications of all forms of diabetes; and innovations in technology—there is marvellous technology —and patient pathways that can improve outcomes for people living both type 1 and type 2 diabetes. I wish that I had known 12 months before I was diagnosed that the way I was living—the lifestyle, the stress—was putting me at risk. We all need a bit of stress; it is good and keeps us sharp, but high stress levels with the wrong eating and living habits is harmful. I do not drink fizzy lemonade any more because it was one of the things pushing me over the edge. That was probably why I lost most of the weight fairly quickly.

Let us talk about prevention. Today more than 12 million people are at increased risk of type 2 diabetes across the UK. More than half of all cases of type 2 diabetes could be prevented or delayed. If I had known a year before my diagnosis, I could have stopped the downward trend in my health, but I did not know, and I wish that I had done. Many in this House offer leadership on type 2 diabetes prevention; the right hon. Member for Leicester East is certainly one of them. England is a world leader on this front, having recently committed to doubling its national diabetes prevention programme.

I was pleased to attend a roundtable discussion last summer, chaired by the hon. Member for Enfield, Southgate (Bambos Charalambous), at which we considered the link between obesity and diabetes and the importance of tailored messaging for the different subsets of the population. During the discussion I met the inimitable Professor Valabhji, the national clinical director for obesity and diabetes at NHS England, whose leadership in this space should be celebrated. I put that on the record because his knowledge and help for those around him, and his research into and development of how we deal with diabetes, are incredible.

For people with type 2 diabetes, there is the additional aspiration of achieving remission. I echo colleagues’ congratulations to the deputy leader of the Labour party, the hon. Member for West Bromwich East (Tom Watson). We watched him almost shrink. One day I stopped him and said, “Tom, is everything all right?” He was losing so much weight, but it was his choice to diet as he did. He is an inspiration for many people because of what he has done, and I commend him for it. The concept of remission can be alienating, however, because it is not possible for every person with type 2 diabetes.

Central to the effectiveness of all types of support for the individual and the wider population is the messaging used, which is what this debate is about. Tailored messaging should be developed for the sub-groups most at risk of type 2 diabetes. For example, those in the most deprived areas of the country are nearly 50% more likely to be obese and have type 2 diabetes than those in the most affluent areas: there is type 2 diabetes in areas where people do not have the same standard of living.

Obesity is responsible for around 85% of someone’s risk of developing type 2 diabetes. Additionally, south Asians are six times more likely to develop type 2 diabetes than Europeans are. It is a well-known cliché that men are not so open or proactive—I can say this is true—about their health needs, and men are 26% more likely than women to develop type 2 diabetes. I am willing to speculate, as one who fell into that category, that that is in part due to messaging not being in a format that reaches men. I did not know what it was, did not know what it meant, did not know what the symptoms were, but it was happening.

We need to focus some of the messaging on the importance of prevention and the risk of type 2 diabetes for men. Will the Minister commit to ensuring that all messaging to support those with type 1 and type 2 diabetes, as well as for type 2 diabetes prevention, is tailored to the relevant sections of our society?

I have to manage my diabetes every day. I take my tablets in the morning and at night. I am careful about what I eat. By and large, I manage it. I check my sugar levels every morning. The doctor tells me to check and I do it every day so that I know where I am. I am a creature of habit; I do it all the time so that I know exactly where I am. Some days it is out of kilter, probably because I transgressed and had a cream bun when I knew it was the wrong thing to have. None the less, we do such things.

On self-management, the average person with diabetes will spend just three hours a year with a healthcare professional. That means that they will spend most of their time managing the condition themselves and will need appropriate education. The right hon. Member for Leicester East chairs the all-party parliamentary group on diabetes. He organised a seminar where we looked at healthcare professionals and how people manage their own condition and therefore need appropriate education. The current delivery of structured education does not reflect the varying needs of each individual living with diabetes. We are all different.

The best efforts of healthcare professionals and those who provide education often focus on perfect self-management or no self-management at all. In reality, the daily struggle of living with a long-term condition means that every marginal improvement should be seen as a true achievement. We have to manage it and encourage ourselves as we move forward. We have to make sure that by moving a step forward we can then move forward again. There has been an admirable drive to increase the uptake of education, but education alone will not help an individual manage the ups and downs of living with the condition. They need the tools and confidence, as well as the education, necessary to manage their condition.

When I speak to people in my constituency who live with diabetes, they often highlight the feeling of isolation. I am sure we can all agree today that there is a need to provide each of those individuals with the support they need to take away the isolation. Being a diabetic can be lonely if someone does not know how to manage it. They might think they are doing the right thing when they are not. Issues have been highlighted to me about the delivery and format of education programmes. Digital solutions and coaching services should be explored. The Minister referred to that in a conversation that we had prior to this debate. I look forward to her response. We always get something positive from her, and we will certainly get something positive today.

Will the Minister commit to ensuring that the delivery, format and content of structured education programmes is improved through the use of digital solutions, and that national guidelines are adapted to accommodate that? Health apps could also be used to refine and augment diabetes training programmes by enabling clinicians to learn from patients about what motivates them and therefore what support to provide.

I want to congratulate the hon. Member for Wolverhampton South West (Eleanor Smith) on her leadership on how health apps can be used to improve care and patient self-management. Many MPs in this House are diabetic or have an interest in diabetes. That is why we are here today. We are either diabetic or interested in the matter and here to make a contribution. I commend and thank right hon. and hon. Members for their commitment.

Will the Minister commit to undertaking an extensive public engagement and education programme, using digital platforms where appropriate, to showcase effective and evidence-based health apps and encourage their wider usage? Support needs to be tailored to individuals’ particular needs, in recognition that no single solution works in self-management for everyone. Everybody’s needs are different. I was the first diabetic in my family. When the doctor diagnosed me as a diabetic he asked me about my mum and dad and my wife’s mum and dad, and whether there was anybody in my family tree with the condition, but there was no one there. Unfortunately, my condition was caused by my diet and my lifestyle, so I created the problem. It was not hereditary, but it is how we deal with such things and tailor our responses that matters.

I have recently been convinced that health coaches—the Minister will comment on this—can play a key role in this space. Coaches can bring a distinct non-clinical skillset that poses questions for patients to help them devise the solutions that work for them, to help build their self-confidence and self-motivation—in stark contrast to the more prescriptive approach taken in clinical settings. Coaching needs to be clearly defined, and the full range of support that coaches can provide to support tailored prevention messaging needs to be identified. I look to the Minister’s response, because I believe it will have some positivity in relation to what we seek and what will happen.

It has been brought to my attention that the health service may ultimately need to decide whether to adopt a population-based approach to support improved outcomes across the entire population, or a more targeted approach aimed at those facing the greatest barriers to effective self-management. Will the Minister ensure that the health system explores the full range of ways in which health coaches can support people living with long-term health conditions, as well as carers and family members, through the development of an NHS definition of health coaching? Does she agree with me—and I hope with others in the House—that the UK has an opportunity to be an exemplar in the use of health coaches? It is an excellent opportunity and I hope that through the Minister we can make those changes.

I want finally to discuss the potential of innovations and technology in addressing issues related to self-management. That is what I do—I self-manage my diabetes. A flexible approach to the provision of structured education is vital to support self-management. Once equipped with the information and skills necessary to self-manage, people must have access to, and choice from, a range of proven technologies to help them manage their condition in everyday life. There has been a big investment in technology recently in the NHS.

We welcome the Government’s commitment to the extra spend on health, which we talk about regularly. All us in the House are particularly appreciative of the Government commitment. People with type 2 diabetes are now provided with glucose monitors; my hon. Friend the Member for South Antrim (Paul Girvan) referred to those in an intervention. However, people are offered little education on how to use them appropriately. There may be something more that we can do about that. It is good to have the technology, and to be taking steps forward, but it is also good for people to understand how to use it appropriately for management.

The level of investment in innovative hardware for people with type 1 diabetes is substantial and should be commended. However, individuals can be left lost if timely support is not available to help them to interpret and utilise those tools as a means of preventing complications. Many people with type 1 diabetes choose not to access the technologies now available to them. Why is that? I do not know the reason, but it is a question we must ask. I believe that it is partly because of a lack of individual awareness. In the case of my diabetes, that would be right. It could, potentially, be linked to a lack of information. If information is not being provided, I should hope that something could be done about that.

Later in the month an event is being held in Parliament, chaired by the right hon. Member for Knowsley (Sir George Howarth). The event, held in partnership with the type 1 diabetes charity JDRF, is to do with the development of a new report on access to technology for people with type 1 diabetes, “Pathway to Choice”. I look forward to reading the report when it is published, and I know the Minister will be keen to read it.

All of us with an interest in diabetes—and that is why Members are here for the debate—will be interested to read it. Can the Minister inform colleagues here today what measure will be introduced to ensure that all people living with either type 1 or type 2 diabetes can access the latest proven technologies that are right for their situation?

[Sir George Howarth (Knowsley) (Lab)]

The hon. Gentleman has highlighted two important themes: self-management and knowing how to go about it properly; and the more recent theme of the potential of technology to achieve good control. He knows I am keen on both. However, does he accept that artificial intelligence can never replace the human element of having someone to talk to, who can give good, accurate information about how to deal with the condition?

[Jim Shannon]

The right hon. Gentleman is absolutely right. Artificial intelligence is beneficial: it can help where it can help. However, it is better for people to have the chance to talk to someone who can instruct them. I think probably we all want to talk to someone face to face, so we can understand the issues better.

An event that I attended here—with the hon. Member for Heywood and Middleton (Liz McInnes), I think—was about diabetes and also bariatric surgery. It may have been in the Thames Pavilion. I mention it because sometimes bariatric surgery may be the only way to reduce weight and enable someone to get to the other side, to address the issue of diabetes. That, as the right hon. Member for Knowsley said in his intervention, is something that people need to talk about. It needs to be discussed so they know what the options are. It is not for everyone, but it is for some people. A number of my constituents over the years have had that surgery and it has always been successful. It has reduced their weight in such a way as to control their diabetes. They are fortunate. Not everyone would have been able to have that surgical operation, but bariatric surgery is important.

To conclude, there is no one solution to diabetes prevention or management. Sometimes, no matter how well informed we are, diabetes can present new and potentially insurmountable challenges. I have some recommendations for the Minister. Primary prevention of type 2 diabetes should take a broad population approach, while ensuring that there is a range of programmes, including digital ones, so that no groups are excluded. There should be someone to speak to—access to someone to converse with who can advise and take things forward. Messaging should be varied and regularly re-evaluated, to ensure that there is engagement from those subsets of the population at the highest risk of type 2 diabetes. We cannot ignore the issue of obesity and diabetes. That was referred to at business questions and will probably be referred to during Health questions on Tuesday.

Finally, a holistic approach should be taken to diabetes care both to ensure value for the individual and to maximise the benefits to the NHS. When we are dealing with the NHS we must look at the money we have to spend, and how to spend it better. Prevention and early diagnosis are among the ways to do that, and the area of type 1 diabetes technology is important. Over the years I have had a number of constituents under the age of 10 who had early-onset type 1 diabetes. I can picture some of their faces, as I speak. They will always have to manage their diabetes. Mine came about through bad diet and bad management, but for some people it is hereditary. I ask the Minister to ensure that the Department for Health and Social Care will continue to focus on the important issue of messaging, in relation to diabetes.

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[Keith Vaz (Leicester East) (Lab)]

It is a pleasure and honour to serve under your chairmanship, Ms Buck—for the first time, I think. I thank the hon. Member for Strangford (Jim Shannon) for securing this debate, not only as vice-chair of the all-party parliamentary group on diabetes, but as a fellow Fox—a supporter of Leicester City Football Club. As we heard from the hon. Member for South Antrim (Paul Girvan), he is also probably one of the most assiduous Members of this House.

I am pleased to see the Minister in her place and congratulate her on her appointment. I hope she will last longer than the last three diabetes Ministers—I am not one of those who wants a general election tomorrow, and we would like to see her build herself into her portfolio. I hope she will last as long as the shadow Minister, who has been there a while and so has been through many Ministers. We hope they will be able to share information. Let us keep the Minister in her place for some time—until the election, of course.

I declare my interest as a type 2 diabetic and chair of the all-party parliamentary group on diabetes. I have a family history: my mother, Merlyn, and my maternal grandmother both had diabetes, which gave me a 4% higher than average chance of getting diabetes. Added to my south Asian heritage, that makes me six times more likely than my European counterparts to be someone who would get type 2.

We have heard some amazing statistics. We should all just sit down, as if we were sitting in the Supreme Court, and say, “We agree with the hon. Member for Strangford,” because we agree with practically everything that he and my hon. Friend the Member for Heywood and Middleton (Liz McInnes) have said. However, it would not, of course, be the nature of Parliament if we all just agreed with the speech of the person before us, so I will plough on; I apologise if I repeat some of the things already mentioned.

As we know, every two minutes someone is diagnosed with diabetes. In my own city of Leicester, a higher than average number of people have diabetes—8.9% compared with 6.4% nationally—and that is expected to rise to 12% of the city’s population by 2025. That is due to the higher proportion of black and minority ethnic residents compared with the UK national average—BAME communities are genetically more likely to get diabetes.

In the time that I have spent as a type 2 diabetic, which is about 10 years, and as the chair of the APPG, I have come to the conclusion that there are five pillars of diabetes care, and I want to talk briefly about each one. The first is putting consumers first: we must put diabetics at the heart of diabetes care. There are meetings, seminars and events—a whole industry around diabetes care. We need new technology, experts and so forth, but we must never forget that it is the consumers—the diabetics—who should be put at the forefront of the debate on diabetes. Sometimes we forget the user: the people at the end of the process.

As we have heard, we need better technology. Members of the APPG and I visited the Abbott site in Witney in July 2019. I was first invited to go there by the former Prime Minister, in whose former constituency Abbott is based, because we wanted to look at the company that produced flash glucose monitoring devices, which have transformed the lives of so many people with type 1 diabetes. We went there because there are shortages of the equipment. In the past, one could go on the website and take one’s own device. There has been a shortage since the Government very kindly decided that everyone with type 1 diabetes would be able to get a machine on World Diabetes Day last year, so we went to talk to the chief executive about it. I know the company is working hard to ensure that the situation is reversed—I suppose we win the lottery by being able to provide the machines, but then we find that we do not have enough machines. I hope that this is going to improve.

I would like to show you my fingers, Ms Buck, so you can see the holes from my twice-daily finger pricking—I am surprised that I have any blood left. I use my GlucoRX device in the morning and am shocked at the reading in the evening, but I just carry on. I would love to have a flash glucose monitoring device—I cannot get it on prescription, because it would probably bankrupt the NHS if all type 2 diabetics received it, but it is a very important device.

My hon. Friend the Member for Heywood and Middleton, who is an assiduous member of the APPG, reminds us of the importance of diabetes specialist nurses such as Debbie Hicks in Enfield and Jill Hill, who have both given evidence to the APPG at one of our meetings. They have an incredible amount of knowledge. To go back to what the hon. Member for South Antrim said, we know that doctors are gods—they have a better reputation than MPs, anyway. Who wants to listen to an MP when they can listen to their local GP? However, they do not have the time. From our constituents, we all know that doctors are unable to see all their patients and spend sufficient time with them talking about diabetes. The point that has been made about diabetes specialist nurses is very important: we need to ensure that we have more of them.

The second pillar of diabetes care, after the need to put consumers first, is awareness. We all know that diabetes is a ticking timebomb. There are 4.6 million people with diabetes in the country, but an additional 1.1 million people, which is equivalent to the entire population of Birmingham—imagine the whole of Birmingham suddenly getting diabetes overnight—are undiagnosed. We therefore need to support awareness campaigns, which have been led very much by the private sector but supported by the Government, because that is the best way to tell whether people have type 2 diabetes and whether they can change their lifestyle.

We have heard from the former Chinese-meal eating, lemonade and fizzy drink-drinking hon. Member for Strangford how he changed his lifestyle. If only he had been told before, he might have changed it earlier. I remember that when my mother had type 2 diabetes, I had just been appointed Minister for Europe by Tony Blair and had no time to look after my mother. I was flying around Europe trying to enlarge the European Union by bringing in Poland and Hungary—as we are about to leave the European Union, I will not start another debate about that. The fact is that I did not spend enough time with my mum, which is a source of great guilt for me personally—finding out about diabetes, how she got it, what she was doing about it, and why she was still eating chocolate when she was a type 1 diabetic. Looking back at it, it seems amazing. It is important that we diagnose earlier, because then we can take our medication.

[Jim Shannon]

The right hon. Gentleman is absolutely right, and I thank him for putting forward his own personal story. The Government have taken some steps in the right direction on the sugar tax. Does he think we should be looking at things such as a soft drinks levy; trying obesity reduction through sugar in schools, in food and in the standards that are put forward; addressing the issue of takeaway food and restaurants, where the level of sugar in meals is incredibly high; introducing a 9 pm watershed for junk food advertising; banning multibuy offers; and providing clearer labelling? Those six things would be a step in the right direction.

[Keith Vaz]

I say yes to the hon. Gentleman on all those points—I agree with them all. I will come to the sugar tax later, but I can take a chunk out of my speech by saying that I agree with all those six points. His shopping list is fine with me, and I will happily copy it.

However, campaigns are extremely important. Very soon, we will have World Diabetes Day. Diabetes UK writes to everyone, asking them to turn buildings in their constituency blue. That is in just 26 days’ time. As chair of the APPG, I have written to mayors across the country, asking them to turn their landmark buildings blue. I ask the Minister to turn the Department of Health and Social Care blue on the outside—it may well be blue on the inside—on World Diabetes Day. I say to the hon. Member for Strangford that he should turn the Castle Ward or the statue of St Patrick blue in his constituency to raise awareness. Of course, one day we will have a statue to the hon. Gentleman himself in Strangford, next to the one of Jamie Vardy, and we will turn them both blue.

We in the all-party parliamentary group, of which we have so many members here—one could call them the usual suspects, but I call them the all-stars—meet every month. We produce reports, one of the most important of which is on mental health and diabetes, something that diabetics are simply not aware of when they get diabetes. I certainly was not aware of it. Support for mental health and wellbeing is critically important to people who have type 2 diabetes. It is an ongoing thing; people do not know why they have depression or why their lifestyle has changed, but it is to do with diabetes. I pay tribute to Diabetes UK, to Chris Askew, and to Nycolle Diniz for the work she does for the APPG.

It is not only specialist nurses who can help us, but other professionals, such as pharmacists. Everyone knows that pharmacies and pharmacists have great expertise in diabetes. My mum—I go back to talking about my mum—could spend more time with her pharmacist in Evington in Leicester talking about her condition than she ever did with her doctor. Maybe the Government should run the awareness campaigns through the pharmacies. That would mean reducing the money going to the doctors a little, and they will quaff around and complain—but if we fund pharmacies to do the testing, we will save so much money in the end. Pharmacists such as our APPG ambassador, Jimmy Desai in Ilford, have done an amazing job. Let us empower them to do things.

The third pillar is prevention, which we have all talked about, and reversal if possible. The hon. Member for Strangford has changed in terms of his weight; we have heard from people such as Dr David Unwin, another of our ambassadors at the all-party parliamentary group, that around 60% of cases of type 2 diabetes can be delayed or prevented by making those lifestyle changes and having a healthy, balanced diet.

At the Health Hub in Doha, which I recommend the Minister visits—although obviously not if there is a crucial vote, as the Government will need her here; I am happy to pair with her and we can go together—if a doctor says, “You are borderline diabetic,” they do not give the patient tablets. Rather, they say, “Here is a prescription to go to the gym downstairs. Start doing your gym work, and don’t see me again until you get your lifestyle sorted out,” because lifestyle makes a great deal of difference. Some of us have our watches connected to our phones—I do not know whether my right hon. Friend the Member for Knowsley (Sir George Howarth) does—so we know about our steps. I very rarely hit 10,000, but at least there is a willingness to try to do more exercise, and walking round the Palace is a way to make sure we do that.

As we have heard, obesity is a killer. Obesity-related conditions cost the NHS—cost the Minister—£6.1 billion a year. I adopt as my own the shopping list of the hon. Member for Strangford: the six things he has asked for, from the watershed to multiple offers in supermarkets. We should all do that and say, “Let’s do it.” The private sector has done its bit. Kellogg’s has put traffic light labelling on most of its cereal packs sold in the United Kingdom since 2018—well done to it!

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[Jim Shannon]

Will the right hon. Gentleman give way?

[Keith Vaz]

I think Ms Buck might object.

[Keith Vaz]

No, she will allow it.

[Jim Shannon]

In my GP surgery, and I think across the whole of Northern Ireland, GPs have classes for diabetics. They bring them in and do all those things: they do their feet, check their blood, check their eyes, talk about their health and check them over physically. They send those tests away, and they are brought back to make sure they are clear. Things are often done in other parts of the United Kingdom of Great Britain and Northern Ireland that could be used as examples here. The right hon. Gentleman is talking about what is happening in Leicester, and it is good to hear that, but we are very fortunate to have that in my clinic and other clinics across Northern Ireland, where we get those checks twice a year.

[Keith Vaz]

Could I have just one minute, Ms Buck, given that the hon. Gentleman intervened?

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[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Buck. In my long tenure as shadow Minister for Public Health, it has been a pleasure to speak in many debates with the hon. Member for Strangford (Jim Shannon), on all sorts of health issues. I congratulate him on securing this debate and on his excellent speech. I know that diabetes is an important issue to him and I thank him for speaking so honestly about his own journey with diabetes. In the past, I have spoken about my own journey, but I do not plan to dwell on that too much today.

I thank other hon. Members for their excellent contributions: my hon. Friend the Member for Heywood and Middleton (Liz McInnes), my right hon. Friend the Member for Leicester East (Keith Vaz) and the SNP spokesperson, the hon. Member for Linlithgow and East Falkirk (Martyn Day). Although there are not many of us in attendance, we have heard some excellent contributions and the debate has been full, detailed and excellent. I also thank charities such as Diabetes UK for the work that they do, both to support people with diabetes and to prevent diabetes.

Like the Secretary of State and, I am sure, the Minister, we all believe that prevention is better than cure. We all say that, and I honestly think that we all believe it. As hon. Members have said, however, the Government repeat that mantra but have cut public health funding to the tune of £700 million since 2013. Those cuts have had a serious impact on the nation’s health, but they have hit those in low-income areas the most, as we have heard. That is particularly concerning, given that children and adults living in deprived areas are substantially more likely to be obese, and obesity is a risk factor for diabetes—particularly type 2 diabetes, as my hon. Friend the Member for Heywood and Middleton made clear.

According to NHS Digital, one quarter of people living with type 2 diabetes in England are from the most deprived fifth of society, compared with 15% from the least deprived. We have had that knowledge for a long time, so it really is time that the Government used the knowledge and took action to tackle both the obesity and the diabetes epidemic, both of which disproportionately affect those in the most deprived areas.

Opposition Members have been clear that there is no silver bullet to fix the issue. However, we support the proposal to introduce a 9 pm watershed on the advertising of food that is high in fat, salt and sugar. We also support a restriction on the sale of energy drinks to under-16s and clearer labelling on food and drink—that would help us all. Those are all policies on which the Government have consulted, but we have yet to see anything from the Government setting out whether they will be implemented. Can the Minister update us on the consultations when she responds?

[Jim Shannon]

I congratulate the hon. Lady on her contribution and her comments. I was sitting here thinking about families and diabetes. In a family of four or five, there may be one diabetic member of the household. I believe that the whole family—mum and dad, brothers and sisters; whoever it may be—need to give consideration to the person with diabetes to ensure that their battle with diabetes is one that the whole family fights together. That is difficult to do, but it is important that families realise that they have a job to do.

[Mrs Hodgson]

I am not sure whether there is a hereditary aspect to it, but I am aware that sometimes there can be a number of people with diabetes in the same family. I am the only one I know of in my family with the condition, but then again I do not know my father’s side. My mam always says that I take after my dad with regard to my size, so perhaps there is a link and I am just not aware of it. The eating habits of members of a family can be very similar. If eating habits have led someone to get diabetes, the condition could have affected others in the same family, so the hon. Gentleman makes a valid point.

The evidence shows that the policies proposed by the Government, if they are fully and quickly implemented, could help us to make real progress towards reducing childhood obesity by 2030. Will the Minister tell us what the delay is? Instead of just window-dressing with the childhood obesity plan chapters 1 and 2 and the former chief medical officer’s special report on childhood obesity, which we had in the past couple of weeks, the Government must now take bold action and implement all the policies in the reports. The time for reports and consultations is over. We all know what needs to be done, and now we need urgent action.

According to NHS England, managing the growing incidence of diabetes in England is set to become one of the major clinical challenges of the 21st century, as we have heard expressed clearly in this debate. Estimates suggest that the number of people with diabetes is expected to rise to 4.2 million by 2030, affecting almost 9% of the population, with all the associated costs.

More than half of all cases of type 2 diabetes could be prevented or delayed. The hon. Member for Strangford and my right hon. Friend the Member for Leicester East both spoke about that in detail. By reducing the number of people who are overweight or obese, we can reduce the number of people who develop type 2 diabetes and live with the life-changing complications that are associated with it. Like the hon. Gentleman, I wish I had known much sooner the irreversible damage that I was doing to myself. I have done a detailed blog post about it, which is available online, if anyone is interested in my thoughts—I will go into them no further in this debate. Steps that the Government take today will benefit people greatly tomorrow, so will the Minister please outline the Government’s plans to prevent further incidence of diabetes?

There is no one-size-fits-all approach to diabetes, which is why targeted messaging and support is so important, alongside societal and environmental changes to tackle obesity, as I have mentioned. Interventions such as NHS health checks, weight management programmes and the NHS diabetes prevention programme should therefore be offered and taken up more often in order to identify risk and to prevent diabetes. Many people who are eligible for the NHS health checks are not invited to them or do not attend.

What will the Government do to encourage people to attend their NHS health check and to ensure that everyone who is eligible is definitely invited for a check? About 1 million people live with undiagnosed type 2 diabetes, and one in three people already have diabetes complications by the time they are diagnosed with type 2 diabetes, so that service could be invaluable in preventing further incidence of diabetes and of the complications that sufferers experience.

Those who have diabetes know that it is possible to put type 2 diabetes into remission through substantial weight loss. As the hon. Member for Strangford mentioned, my hon. Friend the Member for West Bromwich East (Tom Watson) has been incredibly vocal about his very visible journey. He has been an inspiration to many. We need to make sure that when people go into diabetes remission, they continue to get support, access to diabetes monitoring and, where necessary, care, because, as I was told, “You are never cured.” Even if someone with diabetes is in remission through diet, they will still forever be a diabetic—we have broken our bodies, basically.

People who wish to go into remission must have continued support. There is still a need for more research to understand the long-term impact of remission on reducing complications, but for now the future in that regard looks positive. This debate has been excellent, and it has demonstrated that there are clearly steps that the Government can and should take to prevent diabetes. I hope that the Minister will take them on board. I look forward to her response.

In closing, I thank and congratulate—on behalf of all us who are living with diabetes—Professor Ian Shanks, the inventor of the blood glucose monitor some 40 years ago. I was so pleased to hear the news overnight that he is to be paid a small award. I say “small” because, although it is £2 million, I understand that most of it will be eaten up by the legal costs of a 13-year battle. He might not be a rich man after he has paid all his legal bills, but he will be rich in terms of gratitude for the millions of lives he has saved, and no doubt improved, with his invention.

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[Jo Churchill]

I truly will. That brings me to the hon. Member for Heywood and Middleton, who wrote to me about the meeting she mentioned. I have written back to say I would really appreciate the chance to meet her to discuss the various challenges. Having already had an obesity roundtable and a Green Paper roundtable, I know there is an awful lot of overlap in these areas. I feel we could work on that. If she will forgive me, I will get back to answering the hon. Member for Strangford.

Over 2018 and 2019, the diabetes prevention programme achieved full national roll-out, making England the first country in the world to achieve full geographic coverage, which is a great achievement. There is strong international evidence demonstrating how behavioural interventions that support people to maintain a healthy weight and be more active can significantly reduce their risk of developing the condition in the first place, which I think the hon. Member for Washington and Sunderland West referred to. The programme identifies those at high risk and refers them on to behaviour change programmes, which, as we know, is very much more likely to lead to positive results than sending someone away and telling them, “Get on with it yourself.”

The NHS long-term plan commits to doubling the capacity of the diabetes prevention programme to up to 200,000 people per year by 2023-24 to address the higher than expected demand and specifically to target inequalities. Furthermore, NHS England and NHS Improvement have enabled digital routes to access the programme, which will support individuals of working age in particular. As the hon. Member for Strangford pointed out, it is important that people can get information where it is most accessible. Those digital routes went live across nearly half the country in August 2019, and full digital coverage is expected in the next year.

The hon. Members for East Londonderry (Mr Campbell) and for Upper Bann (David Simpson) spoke about children. That is where the prevention Green Paper, “Advancing our health: prevention in the 2020s”, targeted support, tailored lifestyle advice and personalised care using new technologies will all have an effect. I take on board the point that there have been a lot of consultations and so on in this area. We received an awful lot of responses to the Green Paper and we are considering them, but I will make announcements shortly, particularly on ending the sale of energy drinks, on promotions and on one or two of the other areas the hon. Member for Strangford mentioned, so watch this space. I have been in position for only 12 weeks, but this whole area is of huge importance to the nation’s health. I hope that, if we can target children and young people through their lifetime, we can stop problems later on.

[Jim Shannon]

I am very encouraged—I think we all are—by the Minister’s response on that point. When she brings recommendations and legislation forward, I think she will find that Members across the House will be very supportive of them. I am greatly encouraged by what she says.

[Jo Churchill]

I thank the hon. Gentleman. I hope Members noticed that yesterday we launched the National Academy for Social Prescribing. I think Members across the House understand that people do not always need a tablet when they go to the doctor. The hon. Gentleman spoke about the importance of mental health support, referral to exercise classes and various other things for people with diabetes. I was lucky enough to go to Charlton Athletic yesterday and see some brilliant things being put into practice in the community, where the messaging was much better received. Twenty-six per cent less men feel able to go and talk to their doctor, so perhaps we can give them the message at their football club, their rugby club or just their workplace. That applies to women too, now they have much busier lives and many more of them work. Targeting people appropriately so we can get messages to them in the right places about how they can look after themselves better has to be the right way to go.

A dedicated Type 2 Diabetes Prevention Week campaign was launched in 2018. The campaign aims to raise awareness among healthcare staff in primary care about the causes, complications and groups at risk of type 2 diabetes, which I think was mentioned, and the services available to manage patient health. Following the success of the last two years, the campaign will be rolled out again in 2020.

The hon. Member for Strangford mentioned the importance of ensuring that messaging to support those with diabetes is tailored to relevant sectors of society. In June 2018, Language Matters was launched to encourage positive interactions with people living with diabetes, to ensure tailored messaging to relevant sectors of society and to expand routes into the prevention programme. It is a little like health checks: people have to know about it, and know how to use it, in order to access it.

In 2017-18, and again in 2018-19, an additional £5 million per year was made available for diabetes specialist nurses. There is a need to beef up support in that area. Diabetes UK, which I have already met—I happen to be lucky enough to have known its chief executive for some time, and it was at the obesity roundtable, as was Cancer Research UK—does a fantastic job in helping to spread that message and to provide information. Another message that has come out is “think pharmacy first” to empower pharmacists. The 11,500 pharmacists on our high streets are a resource that is just waiting to be used, and I hope the new pharmacy contract will be the start of that relationship.

We will do more in the future to support those with type 2 diabetes. There are a range of apps in the NHS app store to further overcome many of the issues people currently face with traditional, face-to-face structured education. NHS England and NHS Improvement are developing online self-management support tools called Healthy Living for people with type 2 diabetes. Many in the Chamber will be familiar with DAFNE and DESMOND—dose adjustment for normal eating, and diabetes education and self-management for ongoing and newly diagnosed—as well as other programmes for those living with diabetes.

Healthy Living will consist of a structured education course with additional content focused on maintaining a healthy lifestyle, including content on weight management, alcohol reduction and cognitive behavioural therapy for diabetes-related distress. Once the course has been developed, NHSE hopes to commence its roll-out from January 2020. It will have universal availability, it will be free to users and local commissioners, and it is intended as an online resource to supplement other quality assured digital coaching programmes that can be commissioned in local health economies. However, it will be in addition to face-to-face support, because everyone has a preferred method of getting information.

As the right hon. Member for Leicester East said, the risk of developing type 2 diabetes is higher in black, Asian and minority ethnic communities. I am pleased to say that NHS England and NHS Improvement are working with the Cultural Intelligence Hub to deliver an insight project to support future communications and improve engagement with those communities. The aim is to support an increase in available places on the NHS diabetes prevention programme and the take-up of those places; to raise awareness of type 2 diabetes, its risk factors and complications, and ways to prevent it; and to promote messages.

NHS England and NHS Improvement have invested £39 million in each year of transformation funding. That funding is key to improving structured education, reducing variation and helping with foot care for diabetic foot disease.

I agree that new technology is key to the management of diabetes. I hope the shortage in the supply of flash monitors will be overcome shortly, but what fantastic news it is that so many people, including many of our colleagues in this place, now have access to those monitors. I know how much difference they can make to people’s lives, and that is only to be welcomed.

I thank the hon. Member for Strangford for highlighting this issue. I look forward to meeting the all-party parliamentary group and working further with it on these messages. I hope I have demonstrated that we are working hard so people can receive the treatment and support they need to live longer but enjoy quality of life.

[Jim Shannon]

I thank the right hon Members for Leicester East (Keith Vaz) and for Knowsley (Sir George Howarth); the hon. Members for Heywood and Middleton (Liz McInnes) and for Linlithgow and East Falkirk (Martyn Day); the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson); and my hon. Friends the Members for East Londonderry (Mr Campbell), for Upper Bann (David Simpson) and for South Antrim (Paul Girvan). Most of all, I thank the Minister. We are all greatly encouraged by what she said and look forward to working with her to deliver a good, effective, positive and evidential diabetes strategy that can make lives better. All of us here are committed to that. Let’s do it together.

Question put and agreed to.

Resolved,

That this House has considered tailored prevention messaging for diabetes.