Diabetes: Tailored Prevention Messaging

Keith Vaz Excerpts

Thursday 24th October 2019 Westminster Hall

[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!

[Paul Girvan]

On food and how manufacturers can help, does the right hon. Gentleman agree that much of the focus is on sugar, and little is on carbs, which normally convert to sugar in the body? With the Dose Adjustment For Normal Eating—DAFNE—programme, instead of counting sugar, people count carbs. It is really only for type 1 diabetics, but it helps them administer their insulin according to the carbs they have eaten during the day.

[Keith Vaz]

That is extremely important. I support the DAFNE programme and the work being done on the conversion to sugar. That brings me on to the sugar tax—a great achievement of the previous Government. All praise to George Osborne for introducing it.

[Ms Karen Buck (in the Chair)]

Order. I gently encourage the right hon. Gentleman to stay within the topic.

[Keith Vaz]

I will. I hope that was not related to my mentioning George Osborne. We want to thank him for introducing the sugar tax, which has made a huge difference. Sugar in soft drinks has gone down by 28.8%, which is a huge achievement.

We have all praised the great Jonathan Valabhji, but I also want to mention the work of Partha Kar, who only this morning set right the statement by Mr Paul Hollywood on “The Great British Bake Off”, who said that one of the dishes looked like “diabetes on a plate”. I am sure he meant it as a joke, but for type 1s it was a real surprise that someone should speak like that. We desperately need structured education. We have all talked about the three hours of care, but there are 8,757 other hours.

In a few days’ time, we will be launching in Leicester the diabetes log book by the Leicester physician Dr Domine McConnell. I hope the Minister will spare some time to come and read it and perhaps launch it with us. It will give patients a better understanding of how they can record and monitor information. They can keep it with them and take all their readings wherever they go. Far too often, when I visit my GP I cannot remember my last HbA1c reading, and I need to make sure that is done. I realise that it can be done on a phone, but not everyone is able to do that.

My last plug for Leicester before I end is about the pilot that has been put together by the chair of the clinical commissioning group, Dr Azhar Farooqui, and Sue Lock, its retiring chief executive. It allows, on a Thursday, all diabetics to go to the Merlyn Vaz Health and Social Care Centre in Leicester. It is a very important initiative. People can have their feet looked at, their eyes looked at, their blood tested, their lifestyle dealt with—all the things they need to do, on one morning in one place. The opportunity to put that together makes a great difference.

[Jim Shannon]

Will the right hon. Gentleman give way?

[Keith Vaz]

I think Ms Buck might object.

[Ms Karen Buck (in the Chair)]

indicated dissent.

[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?

[Ms Karen Buck (in the Chair)]

Earlier, I was advising the right hon. Gentleman not to stray in terms of breadth, not in terms of length.

[Keith Vaz]

Well, I will go on longer, then—excellent! That makes me feel much better.

I hope the Minister will come and visit the Merlyn Vaz Health and Social Care Centre. People like me and the hon. Member for Strangford have to go to eight different professionals to have our diabetes checked. In one visit on one morning in Leicester, people can have it all done, from the top of their head to their feet and everything in between—they can get it all tested.

I will end with an anecdote; I was going to end, Ms Buck, because the House has heard enough from me. I recently saw a film—the hon. Member for Strangford will like this, because it was about the Beatles, and people of our general age will remember them—called “Yesterday”, directed by Danny Boyle. It was about how the internet went down on a particular day, and references to the Beatles disappeared, so nobody knew about them. Nobody knew their songs or who they were. When they typed in “Beatles”, they just got a beetle on the screen.

There is a scene in that film when somebody turns to another person and says, “I’m going outside to have a cigarette.” The person says, “What’s a cigarette?” because the cigarette had disappeared from the internet along with the Beatles. No one could remember it. When we introduced the smoking ban, it had a profound effect on cancer issues. We want to ensure that diabetes is reversed for type 2s and that we are able to manage and help those with type 1. We start that with a war on sugar and changing the way we live. Working together, I think the House can achieve that.

--- Later in debate ---

[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.

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.

Childhood Obesity Strategy: Chapter 2

Keith Vaz Excerpts

Monday 25th June 2018 Commons Chamber

[Steve Brine]

I cannot say that I have considered that personally, but I know about lots of the technology solutions that supermarkets are bringing in. I am not surprised to hear the news about my hon. Friend’s local council, and yes, this is absolutely about prevention. Last week, the Prime Minister announced a record investment of new money in the NHS, alongside our new long-term plan, of £20.5 billion a year, but that must go hand in hand with prevention. Investment and prevention are always better than cure.

[Keith Vaz (Leicester East) (Lab)]

I also warmly welcome these proposals. These have been asks of the all-party parliamentary group on diabetes and of Diabetes UK for a number of years. There is a clear link between childhood obesity and diabetes, and 4.1 million people in the UK suffer from diabetes. Does the Minister agree that retailers do not have to wait for the consultation? As with the sugar tax, they can start to make the changes now to prevent diabetes in the future.

[Steve Brine]

Yes, and I thank the right hon. Gentleman for his support for this. Diabetes UK has said:

“Diabetes UK welcomes the ambitious range of measures outlined by the government in their commitment to tackling the childhood obesity crisis facing the UK.”

Its brilliant chief executive, Chris Askew, has been very supportive of this plan. This is one of the drivers of the need to tackle this issue, and no, nobody has to wait for this. There have been many examples, and I am happy to name-check Waitrose, which took the lead on not selling energy drinks to children. Its example was followed by all the other mainline supermarkets.

Oral Answers to Questions

Keith Vaz Excerpts

Tuesday 8th May 2018 Commons Chamber

[Mr Speaker]

Order. It is very good to welcome back to the Chamber the right hon. Member for Leicester East (Keith Vaz).

[Keith Vaz (Leicester East) (Lab)]

3. Whether he plans to include information on mental health in the national diabetes audit.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

People with long-term health conditions such as diabetes are at a higher risk of mental health disorders, and we are determined to improve co-ordination between services. That is why the national diabetes audit has started collecting information from GP practices on people who have both diabetes and severe mental ill health.

[Keith Vaz]

I should like to declare my interest. As the Minister knows, three out of five people with diabetes suffer from emotional and psychological problems, including depression and anxiety. A survey recently showed that 76% of diabetics were offered no emotional or mental health support. Will she look at the excellent work that is being done by the NHS in Grampian in Scotland, to see whether its programme could be rolled out for the rest of the country?

[Jackie Doyle-Price]

I would be delighted to look at the progress being made in Grampian, and we are always keen to learn from the experiences of other nations. The right hon. Gentleman makes an excellent point: people with long-term physical conditions are more likely to suffer from mental ill health. As for NHS spending, at least £1 in every eight that is spent on long-term conditions is linked to poor mental health and wellbeing spend. We have also produced a pathway for people with long-term physical health conditions to deliver more effective IAPT—increasing access to psychological therapy—services for them. However, we can always continue to learn about this subject.

--- Later in debate ---

[Mr Speaker]

Order. The hon. Member for Wigan (Lisa Nandy) need not worry; her Zebedee-like qualities will always make her visible. I am saving her for later. We will hear from her shortly.

[Keith Vaz (Leicester East) (Lab)]

T4. There is a clear connection between obesity and type 2 diabetes. Will the Secretary of State confirm that that issue will be addressed in the national diabetes prevention programme?

[Steve Brine]

Obesity has rightly had a strong outing today. We know that it is a leading cause of type 2 diabetes; supporting people to live healthier lifestyles can only reduce the incidence of the disease. So far, more than 170,000 people have been referred to the national diabetes prevention programme. Those who are referred receive tailored, personalised help, including education on healthy eating and lifestyle choices, and bespoke physical exercise programmes.

Diabetes

Keith Vaz Excerpts

Monday 26th February 2018 Commons Chamber

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

I am grateful for the opportunity to talk about this very important health issue. I should first declare an interest as an active member of the all-party parliamentary group on diabetes, ably chaired and led by my right hon. Friend the Member for Leicester East (Keith Vaz).

We have come a long way with the treatment of diabetes since 1921, when Banting and Best isolated insulin from dog pancreases, and then, working with Scottish physiologist J. J. R. MacLeod, purified a form of insulin that was suitable for human treatment from cows’ pancreases. This was at the time, and remains, a major scientific and Nobel-prize winning breakthrough. Before insulin therapy was discovered, diabetes was a deadly illness. The first medical success was with a boy with type 1 diabetes—14-year-old Leonard Thompson, who was successfully treated in 1922. Close to death before treatment, Leonard bounced back to life when treated with insulin.

Now, almost 100 years later, we understand a lot more about diabetes. We are able to explain the difference between type 1, an autoimmune disorder that is treatable by insulin; and type 2, insulin resistance or insufficiency, much more influenced by other health factors such as obesity and physical inactivity. We also know that a diagnosis of diabetes is no longer a death sentence. Nevertheless, diabetes remains a serious illness that affects 4.5 million people in the UK.

[Keith Vaz (Leicester East) (Lab)]

I congratulate my hon. Friend on all the excellent work she does as vice-chair of the all-party group on diabetes. She mentioned those who have diabetes, but there are still about half a million people who have type 2, as I do, but do not know that they have it. Does she agree that prevention is the most important thing that we can do to try to help those who have type 2 but are not aware that they have it?

[Liz McInnes]

I thank my right hon. Friend for that intervention. I think he must have read my speech, because I will be talking about the prevention of type 2 diabetes, and how important it is that we are aware of that and also make the population aware of the measures they can take.

There are more people living with diabetes in the UK than with any other serious health condition—more than dementia and cancer combined. The complications of diabetes are many. They include eye, foot and skin complications; anxiety and depression; hearing loss; gum disease; neuropathy; infections; slow wound healing; strokes; heart failure; heart attacks; lower limb amputations; renal problems; and early death.

Oral Answers to Questions

Keith Vaz Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Dunne]

My hon. Friend will be aware that the professor to whom she refers has presented his findings to the Secretary of State. Partly in response to that, we have set up an £8 million innovation fund to help to take such initiatives forward and to spread best practice throughout the country.

[Keith Vaz (Leicester East) (Lab)]

May I endorse what the hon. Member for Bristol North West (Charlotte Leslie) said? In the area of diabetes, for example, our country has some of the best clinicians in the world. Will the Minister ensure that the next time the Prime Minister goes on an official delegation she takes one of these professors with her to show the rest of the world what we are able to do for conditions such as diabetes?

[Mr Dunne]

The right hon. Gentleman is an acknowledged expert on diabetes. I have visited facilities around the world, including in Abu Dhabi, where Imperial College London has a joint venture with the diabetes centre there. The UK is an acknowledged expert, and we are launching the national diabetes prevention programme, which will roll out across 10 pilot sites for type 2 diabetes prevention work. I shall encourage the Prime Minister to consider the right hon. Gentleman’s proposal that we expand that work on other trade visits, certainly those for health, around the world.

Oral Answers to Questions

Keith Vaz Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Dunne]

My hon. Friend consistently expresses concern about the arrangements in Essex as we consider a possible reconfiguration of urgent emergency care arrangements. Ensuring that there is good access to A&E is as vital in that county as it is everywhere else.

[Keith Vaz (Leicester East) (Lab)]

In Leicester, the CCG is proposing to close a walk-in centre in North Evington and move it to another part of the city. Rather than being a walk-in centre, it will become a drive-in centre. Does the Minister agree that it is important that local people are consulted fully on the proposals?

[Mr Dunne]

As the right hon. Gentleman knows, service reconfigurations require public consultation. I am not sure whether that particular walk-in centre qualifies, but I am happy to have a look at that. A number of walk-in centres were established under the previous Government in a random way, and they need to be located more appropriately for local people.

Oral Answers to Questions

Keith Vaz Excerpts

Tuesday 20th December 2016 Commons Chamber

[Nicola Blackwood]

NICE obviously considers complementary and alternative medicines when developing its guidance, where there is evidence, and it has been able to recommend some therapies, such as acupuncture for tension headaches and a range of complementary medicines for multiple sclerosis. We expect healthcare professionals to take that guidance into account when designing local services, but they must use their best understanding when treating the individual patients in front of them.

[Keith Vaz (Leicester East) (Lab)]

The evidence is very clear that eating more sugar increases the risk of diabetes. Apart from introducing the sugar tax, what further evidence-based research can be used by the Government to reduce the risk of diabetes?

[Nicola Blackwood]

The right hon. Gentleman is a great proponent of tackling the risk of diabetes. He knows that the Government take tackling and preventing diabetes extremely seriously. That is why we have introduced the world’s first national diabetes prevention programme, which we have piloted and are rolling out across the country. It includes not only education programmes but testing, and we are making sure that we use the evidence from the programme to bring about improvement and that we are rolling it out effectively.

Health Service Medical Supplies (Costs) Bill

Keith Vaz Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 6th December 2016 Commons Chamber

[Justin Madders]

I rise to speak to new clause 1, which stands in my name; to amendment 8, which is in the name of my hon. Friend the Member for Burnley (Julie Cooper); and to the other amendments in the group. The Opposition do not oppose the Bill. Our proposals are a constructive attempt to help the Government to achieve their stated aims, and to close the growing gap between the UK’s record on developing new drugs and the ability of NHS patients to access them.

New clause 1 would put a duty on the Secretary of State to commission a review within six months of the Act coming into force, focusing on its impact on the pricing and availability of drugs and medical supplies; on research and development; and on the NHS’s legal duty to promote innovation. The pharmaceutical industry in this country employs more than 70,000 people, in predominantly high-skilled and well-paid jobs—just the sort of jobs Members on both sides of the House would want to encourage and see more of.

This country’s record in the pharmaceutical sector has been one of our great success stories, but we cannot take that success for granted, particularly because investment decisions are often taken by parent companies in other parts of the world. There is considerable unease in the sector about the relatively low take-up of new and innovative medicines by the NHS compared with that in comparable nations, and about the ongoing uncertainty surrounding the future of the European Medicines Agency. A number of major companies have based themselves here because of the EMA, and the worry is that they might wish to follow it if it relocates following Brexit.

The impact assessment for the Bill states, as we might expect, that there will be an impact on the revenue of the pharmaceutical sector, and that it could lead to a reduction in investment in research and development and consequent losses for the UK economy estimated at £l million per annum.

While we fully agree with what the Government seek to achieve with the Bill, we are mindful of the storm clouds on the horizon. We therefore believe that prudence requires that such a review takes place within a reasonable timeframe to ensure there are no unintended consequences and that we can remain confident that the pharmaceutical sector in this country will continue to be at the forefront. We face competition not only in Europe but from emerging nations such as Brazil and China. We also need to ensure that the NHS does not trail in the take-up of the new drugs. Worryingly, the Office of Health Economics studied 14 high-income countries and found that the UK ranked ninth out of those14 across all medicines studied.

Successive studies have demonstrated relatively low take-up of new medicines in the UK compared with other countries. That is bad for patients and bad for our pharmaceutical industry. The Bill therefore needs to achieve a balance. We need to ensure the best possible patient access to medication at the fairest price, but we also need to encourage the pharmaceutical industry to invest in research and development.

[Keith Vaz (Leicester East) (Lab)]

I am intervening in my capacity as chair of the all-party group on diabetes. The diabetes drugs bill is enormous: it runs into hundreds of millions of pounds. I accept what my hon. Friend says—that we need to ensure that pharmaceutical companies are able to invest in the provision of new drugs for diabetes—but there are other choices, such as those relating to lifestyle. Does he agree that they need to be investigated while we look for new drugs?

[Justin Madders]

I thank my right hon. Friend for his question. Indeed, if I had known he was in the Chamber, I would probably have anticipated it. He is absolutely right to raise the issue of diabetes drugs and the need for more measures to improve prevention. I attended the launch of the all-party group’s report last week, at which there were a number of interesting initiatives. The “diabetes village” is an interesting concept, which in the long term will hopefully reduce the cost of diabetes treatment for the NHS.

The review would look at the impact of the Bill on the pricing and availability of medicines and other medical supplies. We would gently point out to the Minister that two years ago, when the previous voluntary agreement was introduced, the Government said that it would

“provide an unprecedented level of certainty on almost all the NHS branded medicines bill.”

Evidently that has not come to pass. The review would enable us to identify any issues at an early stage and take the appropriate action. I know that the Government were not willing to commit to such a review in Committee. The Minister referred us to a clause in the draft regulations, referring to a review one year on from the introduction of the regulations. However, that is simply not the same thing as looking at the impact of the legislation in its totality. The way the regulations are currently drafted means that there is more than a little of the Minister being able to mark his own homework, so to speak. The draft regulations talk about the review in a much narrower sense: enabling the Minister to set out the objectives intended to be achieved by the regulations in the report itself rather than at this point, and only specifically mentioning whether those objectives could be achieved with less regulation.

--- Later in debate ---

[Keith Vaz]

I will not detain the House for long. I know that that normally means the start of a very long speech, but I will be very brief. I declare an interest as the chair of the all-party group on diabetes and as a type 2 diabetic.

I welcome the proposals put forward by my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) from the Labour Front Bench. I hope the Government accept them. They are reasonable proposals that are designed to look at the impact of the Act and ensure it achieves what it hopes to achieve. That is not always the case with legislation.

There is a lot of agreement on the Bill, and the Minister should be commended for how he has introduced it. The reason for the Bill is the ever-rising cost of drugs to the national health service. We know of the work done by The Times in particular. It is always a battle for diabetics, especially when we meet in informal circumstances, as happened last week when the new report of the all-party group was launched by the Secretary of State for Health. I think the Minister was due to come—I may have gone before he arrived. [Interruption.] He is nodding. [Interruption.] No, he didn’t come. I am sorry, Madam Deputy Speaker. I know you do not like Members tempting sedentary interventions. But certainly the presence of the Secretary of State and departmental officials was very helpful to the all-party group.

--- Later in debate ---

[Mark Tami (Alyn and Deeside) (Lab)]

Does my right hon. Friend agree that we have to educate people and make them aware of what can happen, particularly given the rising obesity levels?

[Keith Vaz]

My hon. Friend is absolutely right. We both serve on the Administration Committee, and whenever banqueting is raised, we all highlight the need to make sure that the food MPs get, especially in the Tea Room, is compatible with decreasing obesity and calorie levels. You will know, Madam Deputy Speaker, when you have your cup of tea, that on offer are Club biscuits and Victoria sponges and all these other things. I am not saying that all this comes within subsection (1)(c) or that it could be regarded as a question of innovation; I am simply saying that innovation is not just about new technology.

None the less, there is incredible new technology around as far as diabetes is concerned, as I saw for myself last week. People no longer need to do the finger prick test. The HbA1C test can be bought at the local chemist. It costs slightly more than a finger prick test, which is obviously free for diabetics, but it allows us to test our diabetes without having to fast, and it gives a three-month reading. Moreover, there are now machines that clamp to the side of one’s arm and which, when a mobile phone is put to them, will give a glucose reading. These incredible innovations show why the new clause is worth accepting. It has been carefully thought out by my hon. Friend the Member for Ellesmere Port and Neston, who is doing an amazingly important job on the Front Bench on these matters.

The new clause would benefit the taxpayer. Innovation is very important as far as an illness such as diabetes is concerned, but, as I said, the solution is not just about the technological revolution; it is also about lifestyle changes. I notice that the SNP spokesperson, the hon. Member for Central Ayrshire (Dr Whitford), is here. Scotland is highly advanced in terms of diabetes monitoring. One can get diabetes statistics centrally in Scotland, whereas here we cannot get them even if we write to our local clinical commissioning groups. That is why new legislation of this kind, designed to bring down the cost of drugs to the taxpayer, is very important, and why I support subsection (1)(c) and the review.

Finally, in respect of research and development, as mentioned in subsection (1)(b) of the new clause, pharmaceutical companies make an enormous amount of money—they are some of the biggest companies in the world—and we need to encourage them to plough back a good proportion of their profits into research and development. The Steno centre in Denmark only exists because of money from Novo Nordisk, one of the biggest diabetes drugs companies in the world. A person can go to the Steno centre, and in the first room they can have their blood taken by a diabetes nurse; in the next room, they can have their feet looked at by a podiatrist who is an expert in diabetes; in the next room, they can have their eyes tested—those of us with diabetes have eye problems; in the next, they can have their consultation with a GP; and if necessary, they can see a consultant. That is what I meant when I talked about the diabetes village. It comes from the concept of the Steno centre. At the moment, as a diabetic I have to go to different centres and hospitals to see my GP and others. In one case, I had to carry my own blood—

[Rob Marris]

I carry mine all the time.

[Keith Vaz]

In a little test tube! I carried my own blood to the laboratory, because it was the quickest way I could get a reading. Incidentally, from the look of him, my hon. Friend carries his blood very well. We want this innovation and research and development. The drugs companies should be able to plough back profits within the industry, and in the long run this innovation will make a great deal of difference.

When I went to New York for a meeting on Yemen, I stopped in at the diabetes centre of the Mount Sinai Hospital, and was told about the incredible innovation in diabetes in the US. I also went to see Mayor Bill de Blasio’s diabetes team. As Members will know, New York cut the level of sugar in soft drinks, as we are doing now, but the centre of its diabetes initiative is the lifestyle coach, not the GP.

As we look at these provisions, we see every opportunity for a cogent and coherent review that will particularly help—this is my main argument today—those with diabetes, but also others with similar problems connected with their illnesses. I urge the Minister, who I know has been extremely reasonable on this Bill, to look seriously at the new clause. If he cannot accept new clause 1 itself, will he at the very least give an undertaking from the Dispatch Box that the points embodied in it will be reported back to Parliament in a few months’ time?

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Like the shadow Health Minister, we will not obstruct the Bill, because we support the basic aim to control prices in order to achieve a good return to the NHS from the drugs that it uses.

We also support in principle new clause 1. Six months might be a little early technically to bring things together, and there should not be just a single report because we will only see change over time. To look at the success of these actions, we need to see a price being controlled, and to spot when prices are sliding out of control. I would therefore suggest looking at the data and information on an annual basis and perhaps laying it before Parliament to show that the Bill’s aim is being achieved and that the concerns of the official Opposition are being allayed.

We support amendment 8 because it advocates the same approach that we have in Scotland. While the Cancer Drugs Fund in England is welcome and has clearly helped many patients, it is limited in the sense that if people do not have cancer they cannot access the medicines fund. That means that people with rare diseases are left somewhat abandoned. Frankly, if it were left solely to NHS England, those people would be left in the desert. It is important that significant money will be released, and the provision could gain support from the pharmaceutical industry if it sees that the money it is returning is enabling innovative medicines to come to the NHS earlier. Sometimes when we compare certain illnesses such as cancer, we find that the gap is in relation to people with more advanced diseases struggling to access the newest medicines. If the amendment helps to address that, we would support it.

The Scottish Medicines Consortium was reformed in 2014, and Scotland has now moved up from passing 53% of all applications to 77%, with a further review going ahead at the moment to see how to improve this further. The aim is not to avoid using drugs; the aim is to access them at a decent price. If the pharmaceutical industry is returning money to the NHS, it should enable earlier access.

Amendment 9 was tabled by SNP Members and we put it before the Public Bill Committee. It deals with clause 5, which extends a power that in fact already existed but was never used—to control the price of medical services and medical supplies as well as drugs. I am slightly disappointed that we did not manage to get this amendment adopted, so I raise again the issue of quality control and ask the Government to consult on it.

I know I spoke extensively in Committee about surgical gloves, but they provide a good example in that the range of quality is vast, and if poor quality gloves are used, there is likely to be extra cost to the NHS either when gloves have to be changed two or three times within one operation or more subtly if a surgeon is exposed to blood at the end of an operation from a tiny pinhole that was not visible. The same point applies to gowns and drapes. Taking off a gown that is meant to be protective and discovering that you are soaked to the skin in blood is a pretty unpleasant experience, and it obviously increases the risk to staff. The idea that surgeons are not exposed to diseases such as HIV or hepatitis B and C is naive. I knew colleagues over my career who suffered from those conditions, which they caught from patients. There is clearly a responsibility to staff and to patients to avoid any possibility of cross-contamination. I mentioned in Committee, too, some fairly cheap items such as gauze swabs, because if they are shedding threads, it can lead to intra-abdominal infection—something that we do not want. This amendment is about consultation and looking further at the mechanism.

National Health Service Funding

Keith Vaz Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Mr Hunt]

My right hon. Friend is right that just occasionally we should listen to experts—but only very occasionally. In the spirit of listening to experts, and as the Leader of the Opposition is here, I will tell my right hon. Friend something else the King’s Fund has said that he will agree with, which is that

“claims of mass privatisation were and are exaggerated.”

Let us not go chasing down rabbit holes.

The result of this Government’s commitment to the NHS is that real-terms spending per head has gone up by 4.6%, which is double the rate in Scotland and three times the rate in Wales. The hon. Member for Leicester South also mentioned the National Audit Office. He did not mention that the numbers quoted in the NAO report are last year’s figures. He chose not to mention this year’s numbers, which were published last week. They show that 40 fewer trusts are in deficit. Yes, a year ago, half of trusts were missing their financial plans, but now 86% are hitting those plans.

The latest figures, from Friday, show that the deficit will fall 73% from last year, and even lower than the year before. Why is that? It is because of a sustained effort by the NHS to tackle the problem. [Interruption.] The Opposition do not want to hear this, but the truth is that the NHS is gripping the very problem the shadow Health Secretary called a debate on. Agency spend, one of the biggest challenges, is on track to go down from £3.7 billion to less than £3 billion. The rates paid for agency nurses are down 18% on a year ago, and for locum doctors they are down 13%. Our procurement changes are on track to save half a billion pounds. The money we raise from international visitors is up three times, from £84 million to £289 million.

[Keith Vaz (Leicester East) (Lab)]

It is important that we focus not just on the level of spending but on where we spend the money. With long-term conditions such as diabetes, is it not essential to focus on preventive work, which in the long term will save the national health service a huge amount of money?

[Mr Hunt]

That is absolutely right. In all frankness, that argument could have been made from the Opposition Front Bench this afternoon, and we would be having a much better debate.