Diabetes: Artificial Pancreas

Keith Vaz Excerpts

Wednesday 12th December 2018 Commons Chamber

[Mr Howarth]

I am glad that the right hon. Gentleman, who has a background in these matters, has drawn attention to the distinction between type 1 and type 2 diabetes. That is not to say that one is superior to the other, but they are two entirely different conditions brought about by entirely different circumstances. As I said in opening my speech, type 1 diabetes is an auto-immune condition. Nobody is entirely sure what triggers it in some people, but those in whom it is triggered have some predisposition towards the condition.

[Keith Vaz (Leicester East) (Lab)]

Will my right hon. Friend give way?

[Mr Howarth]

I have not quite finished answering the right hon. Member for Hemel Hempstead (Sir Mike Penning). It is particularly important to draw the distinction for young people because, often, young people with type 1 diabetes are bullied very cruelly on the basis that their peers in school accuse them of having brought it on themselves by eating too many sweets or too much sugar. Of course, that is complete nonsense, but that does not stop that kind of bullying taking place.

[Keith Vaz]

I congratulate my right hon. Friend on securing the debate and on being a champion for those with diabetes throughout his parliamentary career. Can I take him back to the issue of structured education, which is one of the great pillars of diabetes care? We do not do it well enough and we do not give those with type 1 diabetes enough support. Does he agree that it is important to ensure that all CCGs give proper consideration to who delivers that kind of education? It should not be delivered by anyone other than those with the expertise to deliver it.

[Mr Howarth]

Yes. I pay tribute to my right hon. Friend, who does a massive amount of work as chair of the all-party group on diabetes. He is very knowledgeable on the subject and the issues involved, and he is of course right. I think I had already said more or less the same thing as he just said, but obviously I agree with myself and with my right hon. Friend.

Let me move on to the digital solutions, such as apps, which could offer platforms to deliver education in a convenient and personalised format. I should add the rider that mobile apps need to be safe, reliable and accredited to be clinically safe. It worries me that some apps out there are produced commercially but do not contain wholly accurate information. It is unsafe to rely on apps that are not properly accredited and that have not been assessed and evaluated by experts who know what they are talking about.

In addition to the low uptake of structured education, the number of specialists working in diabetes care is falling. Between 2010 and 2012, there was a 3% fall in the number of NHS sites that employ any diabetes specialist nurses. Anyone who has any experience of dealing with young people with diabetes will know that nurse specialists are often the very best possible source of advice.

In the light of this shortage, a national network of centres—possibly between eight and 10 expert diabetes technology centres, supported by virtual clinics—could well be a potential platform for the development of more effective structured education for patients, and for professionals as well. I shall say more about that in a moment. Such a network would be helpful for training future generations of diabetes clinicians effectively to provide artificial pancreases, and in the development and evaluation of new technologies.

One of the problems that type 1 diabetes sufferers tell me that they experience is the merry-go-round of different services that they have to access. They may have a problem with neuropathy, or a foot or eye problem, but they cannot access all those services in one place. Many diabetologists, although brilliant at dealing with the diabetes side of the problem, are not equipped to deal with young people who have, for example, psychological problems. All the services need to be better integrated.

--- Later in debate ---

[Keith Vaz (Leicester East) (Lab)]

It is an honour to follow my right hon. Friend the Member for Knowsley (Mr Howarth), who has been an hon. Friend for almost 30 years and is a great champion for those with diabetes, in particular type 1 diabetes.

I declare an interest, as a type 2 bordering on type 1 diabetic. The usual suspects are here, including my hon. Friend the Member for Heywood and Middleton (Liz McInnes) and the hon. Member for Strangford (Jim Shannon), who has popped out but I know will be back. The Government Benches are empty, apart from the Minister and the Lord Commissioner of Her Majesty’s Treasury, the hon. Member for Finchley and Golders Green (Mike Freer), because Conservative Members are listening to the most famous type 1 diabetic in the world, if we discount Halle Berry and Mary Tyler Moore. I admire so much the way in which the Prime Minister does her job, with all the demands on her, as a type 1 diabetic—we do not even notice, and that is because of the technology that has been developed and the way in which she conducts herself.

[Liz McInnes]

Among the most famous type 1 diabetics, we must not forget Sir Steven Redgrave, the Olympic rower.

[Keith Vaz]

Indeed. Before anyone else jumps up with another name, I include all diabetics in what I am saying.

The Prime Minister and others such as myself talk about diabetes, and we are not cowering in corners; we are debating it openly. Because of technological advances, we are able to do our jobs and continue with our lives in a way that was not possible when diabetes was first discovered 100 years or so ago.

The first artificial pancreas, which was developed by Sir George Alberti through funding from Diabetes UK, was the size of a filing cabinet. Madam Deputy Speaker, can you imagine walking around with an artificial pancreas of that size? We should always acknowledge the research and innovation of which my right hon. Friend the Member for Knowsley spoke and the power of science to change people’s lives.

I want to give a few examples from my own city of Leicester of the work that has been done on diabetes. There is the work done by Professor Kamlesh Khunti and Melanie Davies of the University of Leicester; my own general practitioner, Professor Azhar Farooqi, who diagnosed me with diabetes—had I not been diagnosed, I might not be standing here today, because I did not know what the symptoms were—and Professor Joan Taylor from De Montfort University, who began developing her own version of the artificial pancreas.

It was very interesting to learn from my right hon. Friend’s speech about all the other clever people—probably much cleverer than all of us here—who have been able to develop their own artificial pancreas. Not all of them will be able to fly, so to speak, but it is amazing that people are putting their minds to it, and Professor Joan Taylor at De Montfort has done the same. There is also Professor Hovorka of Cambridge University who, like George Alberti, was funded by Diabetes UK in developing the artificial pancreas. These people deserve our respect and admiration for what they do, because they spend day after day trying to make the medical breakthrough that will help people and save so many lives. I want to thank them for what they have done, because their work has enabled us to get to the position we are in today.

There are also the private companies. Members do of course criticise, as we are entitled to do, the profits made by drugs companies. The Minister will know because she has to sign the cheques—perhaps she does not sign the cheques, but she sends them to the Treasury to get them signed—when the bills come through for the artificial pancreases and the metformins or Glucophages and all the other things that we take. The cost has gone up and there is no doubt that the drugs companies do make very big profits, but they should be commended for putting back so much of their profits into research and development. That is something that the Government cannot do, but it is something that those companies do every single day.

In acknowledging the huge cost of drugs, we also have to acknowledge what companies such as Novo Nordisk do. I declare an interest in relation to Novo Nordisk, because it has worked with the all-party group on diabetes, which I chair, for a number of years. Roche Diabetes Care is another such company, and there are many more. There are so many of them that I cannot name them all, but they have all been involved, and they will all invest and research until the breakthrough comes.

We know from FreeStyle Libre what Abbott has done. I remember the former Prime Minister—it is of course based in David Cameron’s old constituency—telling me five years ago about Abbott and the work it was doing on FreeStyle Libre. Now, thanks to the decision of Ministers, FreeStyle Libre is available, as my right hon. Friend the Member for Knowsley has said. That is why, when we have that breakthrough, it is vital that such a facility and such equipment is available to all, irrespective of where they live.

We did not have access to FreeStyle Libre in Leicester, even though we have so many experts at Leicester University and De Montfort, until the decision taken by the Government. Actually, we will not get access to it until next April, so my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) and others will have constituents who still want to get FreeStyle Libre, but cannot do so. We do not want that to happen for those who need pumps and artificial pancreases, because it is vital that they get such equipment straightaway. If they do not, it will affect their lives.

What my right hon. Friend the Member for Knowsley said about wellbeing or mental health and diabetes was interesting. That is something that people very rarely recognise, and I have only myself recognised it, having been a sufferer, in for the past two years or so. They do not actually know it because they think it is part of their condition. For type 1 diabetics, it is even worse. We can just have our pills—I take six in the morning and three at night; some people take more—but the fact is that they live with the injection of insulin for this condition for the rest of their lives.

The deputy leader of the Labour party, my hon. Friend the Member for West Bromwich East (Tom Watson)—obviously, he is not in his place today, because he has other things to do—has reversed his type 2 diabetes. Anyone who sees him in the Division Lobbies will know that he looks a completely different man from the person I knew when I voted for him to be the deputy leader, because he has adopted the Pioppi diet and changed his lifestyle. He does all the things that I do not, because I do not manage my diabetes particularly well. However, people cannot do that with type 1—it is with them forever. The right hon. Member for Hemel Hempstead (Sir Mike Penning), who obviously has gone to Committee Room 14, mentioned that there is that fundamental difference. Sometimes when we talk about the thousands —or the millions, now—who have type 2 diabetes as opposed to type 1, we talk about people changing their lifestyle, their diet or their wellbeing, but that does not apply to the type 1s.

[Sandy Martin]

Does my right hon. Friend believe that it would help an awful lot of people with type 1 diabetes if we changed the name of the disease, given that it is completely different from type 2?

[Keith Vaz]

Of course. There is the possibility of doing that—as we do with cancer, for example, which is a much more emotive illness. Of course, people can die from diabetes complications. My mother died from diabetes complications. What I am noticing from the correspondence that I get as chair of the all-party group is that people are writing to say that their relatives have died of diabetes complications and that clinicians are now putting that on death certificates and, in some cases, voiding insurance. I had a very interesting meeting with an insurance company recently that wanted to void the insurance of a particular individual because they had not notified it that they had type 2 diabetes. I asked its chief executive, “If you cross a road and you are knocked down by a car, and you have type 2 diabetes but didn’t know it and had not notified the company, would you still have your insurance voided?” and he said, “Yes,” which is outrageous. The implications are huge. This is a wide area, Madam Deputy Speaker, and I do not want to try your patience by talking about the whole, global aspects of diabetes. We could be here all night. Forget about the 7 o’clock Adjournment motion—we would be here forever, but actually, we need to be specific about type 1.

In answer to the question from my hon. Friend the Member for Ipswich (Sandy Martin), perhaps there is a case for doing what he suggested, because “type 1” and “type 2” are still very technical, whereas with cancer, there is the type of cancer that someone is suffering from. People may not understand that, so it is worth exploring, and we could certainly do that at the all-party group. The vice-chair, my hon. Friend the Member for Heywood and Middleton, is here—we will be able to look at it—and my right hon. Friend the Member for Knowsley is a frequent visitor. Let us see what we can do about it in future.

I want to end with three asks of the Minister through the good offices of my right hon. Friend. We have talked about CCGs, but we do not have the capacity in CCGs for diabetes champions. We still do not know how many specialist diabetic nurses there are in regions or even in constituencies. The hon. Member for Gosport (Caroline Dinenage) is a Health Minister, so I am sure that everyone will jump about when she goes back to her constituency, but if she asks the question, “Do we have a list of specialist diabetic nurses?” the answer is no. Do we have a list of those doctors such as David Unwin and others who are doing incredible work on diabetes—even if that work is not shared elsewhere? The answer is no.

In answers to parliamentary questions, I have a list of “don’t knows” coming back from Ministers. That is no criticism of the Minister—it is just that Ministers do not know. They do not keep that information centrally. My right hon. Friend the Member for Knowsley and I, as former Ministers, know that we had to sign PQs like that, too, when we just did not have the answers, because the information is not kept centrally. However, some of this information should be—there should be information about who the specialist nurses are—so could we get the CCGs together in some way to talk to them about the issues raised by my right hon. Friend, because lives are time-limited if they do not have access to the equipment that he is talking about?

The second issue is that the Government must be prepared to make a commitment, although not to providing additional funding, because the NHS is stretched. Where private sector companies, such as Roche and others, are investing and doing research that will benefit the public, is there any way to assist them by providing them with greater capacity to research, whether through encouragement, incentives or some other means? We need to do that because we do not have the money to do the research ourselves.

The third issue concerns personnel in the Department. I was astonished to learn that the Secretary of State had still not met the diabetes tsar, Professor Jonathan Valabhji. I tabled a question asking when he last met him, and it turned out he had never met the very expert appointed by the Government to assist in these matters. He is an outstanding diabetes tsar—probably the best the country has ever had—a frequent visitor to our meetings and a professor at St Mary’s, but he has not met the Secretary of State. Please will the Minister talk to her colleagues and ask that one of them meet with Professor Valabhji? It would be helpful if it was the Secretary of State, though, and would be of some assistance to him.

My final point concerns that made by the hon. Member for Strangford and my right hon. Friend the Member for Knowsley. Diabetics such as myself—the same applies to type 1 diabetics—have to see nine different professionals, but we see them on different days, at different times and in different places. When we have our bloods done, there should be someone to help us with structured education, which is vital—we should not be made to book another appointment for another day when perhaps we cannot make it; there should be someone to check our eyes, too; and all this at the same time.

In Leicester, we are developing the first diabetes village, where a patient can do the lot on a Saturday morning—all eight of the main functions, including wellbeing, mental health and lifestyle. If someone with type 2 diabetes goes to the doctor in Doha and gets a prescription, before they get their medication, they are sent to a gym to make sure they make the necessary lifestyle changes before their medication kicks in. They have medical centres there with the panoply of services diabetics need.

Tomorrow, we will be holding an international diabetes summit in Committee Room 14, if it is vacated in time. In that respect, my message to Conservative Members is: get on with it, as the Prime Minister would say, and finish it off tonight—I do not have a vote in that election—so that we can have Committee Room 14 back. The Diabetes Minister, the hon. Member for Winchester (Steve Brine), and people from China, Denmark and Italy, are coming to share their experiences, and type 1 diabetes will be high on the agenda. The more of these meetings we hold in this place, the better it is to keep diabetes on the agenda.

Once again, I thank my right hon. Friend for securing this debate and for making sure we talk about these issues, and I thank my hon. Friend the Member for Heywood and Middleton, too, for her last debate on diabetes. We should keep putting in for these debates to make sure this is the highest possible priority for the Government.

[The Minister for Care (Caroline Dinenage)]

I thank the right hon. Member for Knowsley (Mr Howarth) for his incredible work highlighting the importance of the right treatment for type 1 diabetes and of making use of technology in that treatment. I also thank him for giving us this opportunity to debate the issue. He has made some incredibly valuable suggestions, as indeed has the right hon. Member for Leicester East (Keith Vaz). I have listened with great interest and will carefully consider some of their fascinating suggestions.

Supporting the rising number of people with diabetes is one of the major clinical challenges of the 21st century, and improving outcomes and care quality for those living with, or at risk of, diabetes are key priorities for the Government. The right hon. Member for Knowsley correctly highlighted the role that modern technologies, when properly used, can play in the care of people with type 1 diabetes. Key to managing it is, of course, monitoring and controlling glucose levels, and—as he explained in great depth—a number of different technologies are available for that purpose, including glucose monitoring devices and insulin pumps.

As the right hon. Gentleman said, artificial pancreas devices are an emerging technology that combines continuous glucose monitoring with insulin pumps. One system, the Medtronic 670G system, which he mentioned, was recently approved by the US Food and Drug Administration and a European licence is being pursued.[Official Report, 23 January 2019, Vol. 653, c. 3MC.] Large randomised clinical studies of similar systems are now beginning and several are expected to come to the market in the next five years. Teams in the UK are leading some of that work.

The right hon. Member for Leicester East talked about the funding of research on diabetes. The Department funds such research through the National Institute for Health Research. In the last five years, the NIHR has awarded just over £144 million for work on diabetes, and 346 active projects are taking place across the NIHR infrastructure. One of them involves the closed-loop insulin delivery system to which he referred.

Giving people access to diabetes technology as swiftly as possible is, of course, a priority. Simon Stevens, chief executive of NHS England, said recently:

“Tens of thousands of people with Type 1 diabetes across the country will benefit from life changing glucose monitors on the NHS.”

The announcement referred to the FreeStyle Libre, a device that the right hon. Member for Leicester East also mentioned. NHS England will ensure that flash glucose monitoring is available on prescription to all patients who qualify for it in line with current recommendations. From April 2019, all qualifying patients will be able to receive it from their local GP or diabetes team.

The right hon. Member for Knowsley talked a lot about structured education and psychological support. In line with existing NICE guidelines, structured education should be offered to all patients within 12 months of diagnosis of diabetes. As he said, reported attendance levels at structured education courses have historically been low, but they continue to increase, and this year alone NHS England has invested £10.5 million to improve attendance by people with type 1 and type 2 diabetes.

[Keith Vaz]

May I pursue another point raised by my right hon. Friend the Member for Knowsley (Mr Howarth)? I understand that the NHS is still paying providers, even though people do not turn up. That is a big problem. We need to look at the providers. There is a reason why people do not turn up. We need to change the system in order to make them more able to do so.

[Caroline Dinenage]

That is an excellent point. The purpose of the £10.5 million that I have just mentioned is to improve attendance. It is clearly necessary to look at the way in which the service is provided and at who is providing it, and to ensure that it is provided in a way that will make people attend.

The right hon. Member for Knowsley spoke about improving care for those with diabetes and eating disorders, including what is often referred to as diabulimia. I think he will be pleased to hear that NHS England is supporting two pilots to test, trial and evaluate the effect of integrated diabetes and mental health pathways for the identification, assessment and treatment of diabulimia.

We will continue to create a health system that supports innovation, promotes the testing and development of health technology, and ensures that the best innovations are used so that patients can benefit as quickly as possible.

Question put and agreed to.