Diabetes: Tailored Prevention Messaging

Jo Churchill Excerpts

Thursday 24th October 2019 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Ms Buck.

I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate, on its tone and on how informative it has been. It is a powerful indicator of how a debate in this place can help to educate and spread information. As the hon. Member for Heywood and Middleton (Liz McInnes) said, types 1 and 2 are distinctly different conditions. It is important for us to note that so that when people talk about diabetes, they do not talk about it in the round as one condition, but nuance it. That goes to the heart of what the hon. Gentleman was asking for—information to be tailored to the patient and every individual, so that people receive the information appropriate for them.

I thank the hon. Member for Strangford and all Members who sit on the all-party parliamentary group for diabetes for their fantastic work. It is one of the most dynamic APPGs in this place. In particular, I thank the right hon. Member for Leicester East (Keith Vaz), who chairs it. I am afraid that I do not share his and the hon. Member for Strangford’s love for Leicester City, but as a regular visitor to Welford Road, I know his city and I like the tiger in it. I will leave it there.

More than 3 million people in England have been diagnosed with diabetes and, as the hon. Member for Washington and Sunderland West (Mrs Hodgson) said, an estimated further 1 million remain undiagnosed. Public Health England estimates that 5 million people are at high risk of developing type 2 diabetes, and that number rises each year. Like everyone in this room, and probably everyone in the country, I know someone with diabetes. My mum is in remission—she has lost a lot of weight and she exercises, but she is in her 80s, which shows that no matter people’s age, they can take steps to help them live healthily, even with a condition.

The hon. Member for South Antrim (Paul Girvan) spoke about his wife, and the importance of people looking after themselves during their journey with diabetes, so that they know they are as in control of their condition as they can be. As we have heard from several Members, diabetes has other effects on the body, and it is important that people with the condition look after their eyes, their kidneys and, in particular, their feet. That presents challenges for people attending multiple different clinics for multiple different things.

I will also mention Professor Jonathan Valabhji, the national clinical director for diabetes and obesity. I look forward to working with Jonathan, who strikes me as a truly inspirational person in this area. Only last week, he told me not to be too hard on the situation, and that we have come a long way over the decades. We no longer see the same number of amputations or complications. There has been improvement in the treatment, and it is important to recognise that clinicians have done an awful lot.

Preventing type 2 diabetes and promoting the best possible care for all people is a key priority. I am proud to say that NHS England, NHS Improvement, Public Health England and Diabetes UK have had great success with the first diabetes prevention programme to be delivered at scale nationwide.

[Keith Vaz]

With a new Minister, we get a new broom and, therefore, a fresh pair of eyes. The collection of data is a key issue. We have tabled parliamentary questions to Ministers and asked, for example, how many diabetic nurses there are in the country or how many doctors have a specialism in diabetes. Those facts are available in Scotland, but not in England. Will the Minister make it a priority, as a result of this debate, if nothing else, to get more of that data? With good data, we can plan better.

[Jo Churchill]

I certainly agree that good data and evidence lie at the heart of delivering good patient-centred programmes. I will take that issue away to look at it and write to him on it.

[Sir George Howarth]

Further to the points made by my right hon. Friend the Member for Leicester East (Keith Vaz), I tried to get information about waiting times in clinics and hospitals for various kinds of appointments related to diabetes out of the Minister’s Department, but I was unable to. When she looks at my right hon. Friend’s list, will she look at mine too?

[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.