Diabetes

Keith Vaz Excerpts

Wednesday 8th September 2010 Commons Chamber

[Keith Vaz (Leicester East) (Lab)]

I am most grateful for the opportunity to raise in this House the very important issue of the prevention of diabetes. I must first declare my interest as a sufferer of type 2 diabetes. I was diagnosed with this condition when I was asked by my local GP to open a diabetes awareness day in my constituency. I attended, I was given a test, and I was telephoned the next day by my GP to inform me that I had type 2 diabetes.

Since 1996, the number of diabetes sufferers in the United Kingdom has risen from 1.4 million to 2.6 million, and it costs the NHS £1 million an hour. I believe it is vital that we stop this epidemic. Diabetes is an incurable metabolic condition that leads to high blood sugar levels, which can have serious consequences for short-term and long-term health. The hormone insulin, which is made by the pancreas, helps glucose to leave the blood and enter the body’s cells, where it is used for energy. People with diabetes experience raised blood sugar because insulin is not being produced by the pancreas or there is insufficient insulin or insulin action for the body’s needs.

As the House will know, there are two types of diabetes: type 1 and type 2. In the UK, 90% of adults with diabetes have type 2, where the pancreas produces insufficient quantities of insulin and/or the insulin has a reduced effect on the muscle and liver cells. Type 2 diabetes can be managed through healthy eating and regular exercise, but if the disease progresses, anti-diabetes tablets, incretins or insulin injections may need to be taken. In type 1 diabetes, the body does not produce insulin at all as a result of the body’s defence system attacking its insulin-producing cells. Treatment involves daily insulin injections, in conjunction with healthy eating and regular exercise. Type 1 diabetes is usually diagnosed in children or young adults. For the purpose of this debate, I will be referring largely to type 2 diabetes, which is, in my view, preventable, as opposed to type 1, which is not.

[Mr Adrian Sanders (Torbay) (LD)]

May I pay tribute to the right hon. Gentleman for securing this debate and for his support for the all-party group on diabetes? Some studies have shown that preventive action can put off the diagnosis even of type 1 diabetes, so he is speaking for all diabetics tonight.

[Keith Vaz]

I am most grateful to the hon. Gentleman for his intervention. I pay tribute to him for the work that he has done in this House as chair of the all-party group, which has made a profound difference to Parliament’s understanding of the issue. He is quite right—the research does indicate that. It is important that we take on board the very important research that is being done in this area, as he describes, and indeed pay tribute to the work of other organisations such as Diabetes UK, which has campaigned for so many years on the issue.

Diabetes is a ticking time bomb—a time bomb that needs to be defused. It is estimated that by 2025 more than 4 million people will suffer with diabetes. That will be a shocking increase in the numbers.

[Mr George Howarth (Knowsley) (Lab)]

I congratulate my right hon. Friend on choosing this subject for debate. Will he also pay tribute to the work of the Juvenile Diabetes Research Foundation for the work that it is doing to try to highlight the difficulties of young people with diabetes?

[Keith Vaz]

I certainly will. As the House knows, my right hon. Friend has a debate next Wednesday in which he will explore the issue of young people and diabetes. I know that his own daughter is a sufferer of type 1 diabetes. I certainly pay tribute to the work that that organisation does. These voluntary organisations are of great importance in raising awareness.

It is not just diabetes itself that causes problems, it is also the complications and other conditions that arise from having it. For example, diabetes is the leading cause of blindness, amputation, renal disease and cardiovascular disease. Some 4,200 people in England are blind due to diabetic complications, and that number increases by 1,280 a year. Some 100 people a week lose a toe, foot or lower limb due to diabetes, and cardiovascular disease is a major cause of death and disability in people with diabetes, accounting for 44% of fatalities among people with type 1 diabetes and 52% among people with type 2. Diabetes is also the single most common cause of end-stage renal disease. It is evident that suffering from diabetes is detrimental to a person’s general health, especially when it is not managed effectively.

Diabetes currently costs the NHS 10% of its annual resources, and in the next 15 years the costs will continue to escalate significantly as the prevalence of diabetes increases. The NHS cannot allow or afford the diabetes explosion to continue. Diabetes and its complications cost the NHS about £9 billion each year, which, as I have said, equates to £1 million an hour. About 7% of that is attributable to the cost of prescription medicines, and a significant proportion is made up of the costs of treating serious long-term complications of the condition.

How do we avoid those costs, both human and financial? Early identification is the key. The later the diagnosis of diabetes, the higher the human and financial price that we have to pay. It is estimated that there are currently 1 million people living with diabetes in the UK who are simply not aware of having the condition. A fundamental problem is that type 2 diabetes is more often than not an asymptomatic condition. It is thought that many people with type 2 diabetes may have had it for nine to 12 years before diagnosis. As I said, it was sheer chance that I turned up in my doctor’s surgery that morning to be told that I had type 2 diabetes. Raising awareness of diabetes and making testing available is therefore essential if we are to get a grip on the problem.

I could mention a number of organisations, including Diabetes UK, and I pay tribute also to the Silver Star organisation, which was established in Leicester some years ago and continues to campaign among the south Asian community in particular. Such organisations are vital because the NHS cannot do it all on its own.

Diagnosis does not necessarily mean that a sufferer is getting the care and help that they need. It is thought that approximately 40% of people in the UK with diabetes are in poor diabetic health, which means that their condition is not being effectively regulated. Of all the reasons why people are liable to diabetes, obesity has been identified as having the strongest association with type 2 diabetes. Almost two in every three people in the UK are overweight or obese, and the National Audit Office suggests that 47% of type 2 diabetes cases in England can be attributed to obesity. That puts an extremely high number of people at risk of contracting it.

The most deprived people in the UK are two and a half times more likely than average to have diabetes at any given age. That is surely symptomatic of the inequalities that exist not just in our health system but in our society. Type 2 diabetes is up to six times more common in people of south Asian descent and up to three times more common among people of African and Afro-Caribbean origin. Although we must raise awareness in all sections of society, it is clear that knowing which groups are at the highest risk gives us an advantage in targeting campaigns and prevention programmes.

I welcome the Minister to the Dispatch Box. Whenever I have raised the issue with him, he has been extremely helpful and listened very carefully to what I have had to say. I am sure that when he responds, he will tell us about the programmes that currently exist, some of which were started by the previous Government. If there is one thing that I wish to stress to him, it is the need to prevent the condition rather than treat it. With the inevitable changes in our NHS—there will be reductions in some areas in the context of the coalition Government’s overall commitment to keep health expenditure at last year’s levels—the more we can spend on preventive work, the better it is in the long run. If we spent the £1 million an hour that we currently spend on treating diabetes on preventing it, in the long run, some of those in the Chamber tonight who are younger than me, and their children and grandchildren, will benefit greatly.

I shall conclude by raising one local constituency issue. About a year ago, I had a meeting with the then Health Secretary and the chief executive of the local primary care trust, Mr Tim Rideout, who recently informed me that he is leaving Leicester to go to London to work on the commissioning programme. I thank him and the PCT staff for their work, and I am sure that when the Minister meets him, he will find that he is an excellent officer of the NHS. Leicester was promised a state-of-the-art diabetes centre of excellence. In fact, when we went to see the then Health Secretary, we did not even ask for money—it was in the budget, so very unusually, a delegation led by an MP did not ask for money. We were told by the PCT that £6 million was in the budget and that a centre of excellence would be created in Leicester, principally because of the high calibre of diabetes experts in the city, and obviously because the diaspora who live there mean that it is the best place to conduct such research.

However, I understand that that money is no longer available because the PCT is to be scrapped. I know that budgets are very tight indeed, but I hope that the Minister will consider whether there are any resources that will allow Leicester PCT to fulfil its ambition of creating a centre of excellence, not just for the people of Leicester, but for the people of our country, so that we can be a leading part of diabetes prevention in Europe and the rest of the world.

I ask people in every country that I visit about their diabetes figures. I was recently told in the Gulf that 20% of the population of Dubai have diabetes or are susceptible to diabetes. Sometimes, people have the condition but do not realise that they have it. I was also recently in Kenya, where the figures were very high indeed. When I was there, I was told that you, Mr Speaker, will be leading the delegation next week to the Commonwealth conference. People in Kisumu, which is my wife’s place of birth, told me that it, too, has a diabetes explosion. They need not so much medicines, but food to enable them to change their diets. As in the Gulf, many of the community eat dates and, in the Asian community, sweets, especially at festival times. We could control diabetes if people changed their diets.

I know that this is an Adjournment debate and that it is not in prime time, but I am delighted to see so many right hon. and hon. Members here. If we act now, we can save the health service a huge amount of money and save lives. I hope that the Minister agrees.

[The Minister of State, Department of Health (Mr Paul Burstow)]

I am grateful to the right hon. Member for Leicester East (Keith Vaz) for taking the opportunity to apply for this debate, and congratulate him on his good fortune in securing it. It follows on from the questions he asked at Health questions yesterday. I know that he has an enduring, personal interest in pursuing this cause, and I pay tribute to his work, effort and leadership in raising awareness of diabetes among the south Asian communities in his constituency. He rightly paid tribute to the work of the Silver Star organisation.

Let me first address his final point, which was on his discussions with Ministers in the previous Administration and the intentions to create a centre of excellence. I need to be honest with him. I cannot give him an undertaking tonight other than the most important one that any Minister should give at the Dispatch Box, which is that I will go away and properly consider the matter and come back to him as speedily as I can. If that means a further discussion face to face, I would be happy to do that as well.

I also look forward to the debate that I will have with the right hon. Member for Knowsley (Mr Howarth) on type 1 diabetes, and I hope that we will get the opportunity to explore some other issues on that topic. While these are not prime-time debates, they are an opportunity to air issues that affect the lives of our constituents, so I am grateful to the right hon. Member for Leicester East for raising this matter tonight. He is right to highlight the disturbing rises in the rates of diabetes in this country, because it is placing a huge strain on the NHS, and has a profound effect on people’s long-term health, with the most deprived and excluded groups often paying the highest price.

Diabetes could be described as a head-to-toe condition. Complications—many extremely serious if poorly managed—can affect every part of the body. I was particularly shocked, as I prepared for the debate, to discover that 73 lower limb amputations occur every week due to complications from diabetes. More shocking still, 80% of those amputations could have been prevented, some by lifestyle changes and others by changes in the approach of the NHS. Every preventable amputation is an appalling human tragedy, and something we need to improve on, which is why I am so pleased that we are discussing these issues tonight.

There was plenty in the right hon. Gentleman’s speech that I supported and much common ground between us. I wholeheartedly agree that we must do more to prevent diabetes across all age groups and all social backgrounds. The Government’s approach therefore has three levels. The first is the population level, and in diabetes, this is about improving general health across the population at large, recognising—as the right hon. Gentleman rightly said—that diet and lifestyle are key risk factors in diabetes. Then come targeted interventions for people at risk, which recognise that we can reduce and even reverse the worst effects of diabetes if we intervene early enough. Finally, there is the long-term management of established disease, and people with diabetes and clinicians must work together to delay, reduce or prevent complications. We need to get all three aspects right in order to secure the better results in diabetes care that all hon. Members would wish to see.

On the population level, rises in diabetes are closely linked to lifestyle and behaviour, which makes this a considerable public health challenge. Much of this is about individuals taking responsibility for their own health—for example, choosing not to have some of the sweets that the right hon. Gentleman mentioned—by changing what they eat, drink and how much exercise they take. We are clear that the Government and the NHS, while they have their parts to play, cannot and should not do everything. But what we can do is educate people about the risks, and give them the information to lead healthier lives and understand and change the influences that govern their behaviour.

I can confirm that the Change4Life programme will continue to be a focal point, as it has been successful in putting the issue on people’s radar. The Change4Life brand will continue, but we will need to change it, as it can no longer be about glossy, national advertising campaigns directed from the centre. We need Change4Life to become less an old-style, centrally directed campaign, and more a genuinely social movement, owned collectively by communities, families, voluntary organisations and industry, and driven locally. Hand in hand with this, we need a much more targeted and community-led approach to health improvement as a whole. In the White Paper, we said that local councils will be given a central leadership role on public health, and we would expect local authorities to work with the NHS and other services to develop the appropriate strategies and approaches.

[Keith Vaz]

Some of the key people in this are GPs. I welcome everything that the Minister has said so far, but we need to get guidance out to GPs to tell them that they need to be proactive, as my GP Dr Farouki was. When they have a patient who matches the criteria and is therefore at risk, they should perform the test, which takes only five minutes. Such guidance could be very effective.

[Mr Burstow]

I am grateful for that point. I will say a little about guidelines in a moment, because good news is on the way in that regard.

I was talking about the public health role of local authorities that we are developing. It will be supported by a dedicated ring-fenced budget and the implementation of a new health premium, which will allow local areas to target reductions in health inequalities, including inequalities associated with diabetes and other cardiovascular diseases. We are also committed to working with industry on a new public health responsibility deal to ensure that business takes action together with others to support the nation’s health.

On early intervention and diagnosis, the right hon. Gentleman is right to emphasise the importance of identifying pre-diabetes. There are two developments that relate to the role of GPs. First, the National Institute for Health and Clinical Excellence is developing guidance on preventing adult pre-diabetes in the first place. This will be published next year and will inform and support local public health strategies and others, as I have already described. Secondly, NICE is also preparing guidance on preventing pre-diabetes from progressing to type 2 diabetes. That will be a valuable tool in our fight against diabetes, and will help GPs and other health professionals to advise and support people at risk, hopefully to stop the disease in its tracks.

The right hon. Gentleman is right that earlier intervention and better diagnosis is crucial. NHS Health Check, which was introduced by the last Government, can prevent more than 4,000 people a year from developing diabetes, and could detect 20,000 cases earlier, so it can be, and should be, a very powerful means of detecting and supporting people at risk.

--- Later in debate ---

[Mr Burstow]

My hon. Friend is right, and I certainly pay tribute to him for his work as chair of the all-party group on diabetes. He has been a powerful advocate on these issues for many years. I applaud what he has done, and he is right—pharmacists and other health care professionals are part of what we need to do in order better to equip the whole service for detecting and intervening.

I was told that the right hon. Member for Leicester East was going to ask about extending the age range. That is an important point that needs to be discussed. At the moment, NHS Health Check starts at 40 and calls people every five years. The best clinical and most cost-effective case was made for doing it at that age. However, there is nothing to prevent primary care trusts from commissioning services that widen the age range. They should be considering that, particularly in areas with more susceptible populations, and clearly Leicester is one of those cases.

[Keith Vaz]

Last year, I wrote to the chief executive of every PCT asking how much they spent on preventing diabetes and on health checks such as the ones the Minister described. Some thought it was a freedom of information request and became very defensive. Will the Minister go back and get this information from his Department and place it in the Library of the House?

[Mr Burstow]

I will look into that. My view is that we need far more transparency when it comes to such issues, so that people can make comparisons of the performance of their local organisations and hold them to account over how they spend taxpayers’ money on these services.

I want to move on to long-term management. Once diagnosed, people need personalised support to manage what is a highly complex and changeable condition. A person with diabetes must know how to spot and report changes in their health, and how to get the right services to prevent more serious problems. That issue was raised by my hon. Friend the Member for Torbay (Mr Sanders) in Health questions yesterday. He was right to do so, because it is important to ensure that we have good care planning, embodying the principle of “No decision about me, without me”, which is vital in starting to transform the relationship between GPs and patients. Indeed, the diabetes year of care programme, led by Diabetes UK and the NHS, is already looking at how we can improve care plans for diabetes. Education goes hand in hand with that. I know that many NHS organisations offer patient-structured education programmes, specialist diabetes advice, care planning discussions and annual checks. We need more of that: it needs to be consistently applied and we need to ensure that good practice becomes the norm.

On treatment, it is no surprise to learn that the best results are achieved when there is a fully integrated, multidisciplinary team working across primary and secondary care, which picks up on my hon. Friend’s point. Programmes such as the excellent “Think glucose” campaign and the guidance produced by NHS Diabetes on in-patient management are already helping hospitals to discharge patients sooner and give them a better experience of care. However, there is more to do on that—as well as in other services, such as foot care and eye services—to ensure that problems are dealt with early on, and certainly long before amputations become necessary.

Meanwhile, in primary care the relationship with GPs is crucial, as the right hon. Gentleman rightly said. We need them to be alert to the signs of pre-diabetes in routine consultations and to play a key role in the ongoing management of existing conditions. How we incentivise GPs to do so is a key issue. Clearly the qualities and outcomes framework is one avenue that could be explored, but it is for the National Institute for Health and Clinical Excellence to determine what QOF indicators are ultimately introduced. My hon. Friend referred to pharmacists. I certainly agree that they provide another channel for reaching those at risk, which is precisely why they are one of the ways in which health checks can be used in various settings.

In conclusion, the right hon. Gentleman spoke about his experiences in Leicester and the important lessons that he has drawn. He is right to point to the financial climate, which is undoubtedly a constraint on what any Government can do. However, it is also correct to say that this is not just about beds and buildings; it is actually about services and where they matter most in identifying diabetes early and then providing the appropriate care. The issue is fundamentally about outlooks, attitudes and priorities in the NHS and beyond. The principles that we have set out in the White Paper—pushing power downwards, paying for quality and strengthening the voice of patients—will bring fresh impetus to improving outcomes for diabetes.

It is clear that this issue is not just for the NHS, but for all of us—for the society in which we live. We need to strengthen preventive action on diabetes. Let me conclude by saying that I share the right hon. Gentleman’s commitment and passion. I look forward to maintaining a close dialogue with him, and with my hon. Friend and the all-party group on diabetes, and to participating in next week’s debate on type 1 diabetes.

Question put and agreed to.