Patient Diagnostic Services

Keith Vaz Excerpts

Monday 4th November 2013 Commons Chamber

[Barry Gardiner (Brent North) (Lab)]

As it is the first time I have had the pleasure of speaking in the House since your election to the Chair, Madam Deputy Speaker, may I congratulate you and say how pleased I am to be speaking this evening under your guidance?

The doctors and consultants in Brent, like those in the rest of the country, are highly respected members of our community. Their work is part of the glue that keeps our society together and enables people to function and get on with their daily lives. Doctors, though, would be the first to admit that they are not omniscient—well, some of them would. Their work depends upon the work of many others in the health care sector—in particular, the work of laboratory and radiography technicians who provide the evidential base for diagnosis and treatment. The quality of patient outcomes will always depend on the quality of diagnostic services because a diagnosis delayed is a treatment delayed, and an incorrect diagnosis is potentially fatal.

This evening, I wish to detain the House and suggest to the Minister that the structural changes that his Government have introduced in the national health service have had a seriously adverse and dangerous impact on patient care.

In May 2012, the decision was made to outsource pathology services in Brent and Harrow. Previously, it had been provided by the NHS at a facility at Northwick Park hospital. The decision was taken because the hospital wanted to invest in improvements to the system. Rather than incur those financial costs, it was considered more efficient to outsource the contract to TDL Ltd—otherwise known as The Doctors Laboratory. That was a mistake.

The first indication that there was a problem came when a GP identified a serious technical flaw in the way patient test results were presented through the computerised system. The GP had received a list of multiple test results in respect of a patient. When looking at one set of results on the list and closing it or archiving it to the patient file, the GP realised that it was possible inadvertently to apply that same action to all the other test results returned on that list. Pathology results that required urgent action could be accidentally archived owing to an error in the TDL reporting system. Critical patient test results could be missed altogether or inappropriately actioned.

The GP reported that as a serious incident and immediately flagged up the issue to the North West London Hospitals NHS Trust, on the assumption that pathology services were still being carried out there. In fact, the service has been provided by TDL since May 2012. The hospital trust passed the concerns on to the Brent and Harrow clinical commissioning group, which was now responsible for managing the contract with TDL. At that time, the matter was not thoroughly investigated and was deemed to be a single incident and not a cause for concern.

However, GPs began to talk to each other about their concerns and realised very quickly that they were not alone in seeing a sudden change in the quality of results they were receiving from the service that had, up until 2012, been carried out adequately at Northwick Park hospital. At an emergency meeting with representatives of NHS Brent and Brent CCG, the GPs were led to believe that steps were being taken to resolve the matter.

The problem got worse. GPs across the borough were receiving many more abnormal results than they would ordinarily expect: test requests were ignored or the results were never reported back to them; other tests were being returned incomplete with only partial results and data omitted; and some samples were being incorrectly marked as complete and being discarded without being tested.

This alarming downward trend in the quality of the results finally prompted NHS Brent and NHS Harrow to launch a proper investigation, which commenced on 20 December 2012. Let me quote this root cause analysis investigation report, which finally reported in March of this year and found

“spurious results, missing results and samples not processed...reference ranges had changed and...the presentation of the results into groupings that did not make sense”.

One GP wrote to me to say:

“In the new year the scale of serious anomalies and problems had become so great that individual practices started to send out e-mails to each other to see if the problems were as isolated as we were being led to believe…The response was shocking. Our patients are at serious risk. Unless we have these basic services reliably we cannot diagnose and treat our patients.”

[Keith Vaz (Leicester East) (Lab)]

The situation in north London is clearly shocking. Does my hon. Friend know whether any of the tests that were outsourced relate specifically to diabetes, which is a huge problem for people who live in Brent? About 10% of the population is thought to suffer from diabetes.

[Barry Gardiner]

I am grateful to my right hon. Friend for his intervention, and he is absolutely right that diabetes is a major problem in the Brent area. Given that many of the tests related to phlebotomy, I would assume that some of them might have related to diabetes, but I do not have that specific information to hand.

I was explaining that GPs across the borough were receiving many more abnormal results than they would ordinarily expect, that the downward trend in the quality of the results had prompted an investigation and that the GPs had expressed their own concerns by exchanging information among themselves to ascertain the extent of the problem.

The interim deputy director of quality and safety for Brent, Ealing, Harrow and Hillingdon CCGs reported

“many incidents of patients attending for repeat blood tests at both the practice and within the hospital and some patients…referred to A&E Department because of high potassium levels.”

Many consultants began to experience similar problems with the service and were also having to carry out further unnecessary tests. One consultant, when pressed, scribbled a note setting out a variety of issues:

“Immunology—assay results; Calcium results—change in calculations; Change in reference ranges; Potassium—delays in transfer and refrigeration”.

I am sure the Minister will agree that such failings in service are wholly unacceptable.

The question then arises how any competent company of qualified health professionals could come to make such errors. After all, its website states that it is

“providing quality accredited pathology services to the UK and worldwide”.

I trust the Minister will be as surprised and as disappointed as I was to learn that, at the time the service was outsourced, TDL was

“not currently registered with Clinical Pathology Accreditation (UK) but is working towards this”.

The words “working towards this” should be accompanied by some degree of scepticism, given that the final report on the root causes of the problem identified that TDL was so incompetent that

“There was an operational issue with the new robotic sorter which resulted in a number of samples being filed incorrectly as ‘analysis complete’ and subsequently discarded. There was also a problem with one of the lines in the calcium analyser as a result of which samples were transferred to another laboratory, and a number of issues were attributed to human error.”

Compounding the confusion, when the service was transferred, TDL used different reference value ranges to assess and analyse results in order to fit in with its own IT systems. Unfortunately, it failed to communicate this change to the GPs or consultants who were now expected to interpret results that they did not understand, based on reference ranges with which they were not familiar. TDL was found to have not followed its own procedures, which required it to flag up to its service users when systems were changing. Owing to this transition, GPs and consultants were effectively left blind about the difficulties they might experience with pathology reports.

Of course, the quality of any test results will always depend on the quality of the samples received. Just as in the world of computing, “garbage in leads to garbage out”. One would imagine that when the decision was taken to outsource the pathology courier service that delivers samples to the pathology laboratory, clear and appropriate clinical advice was sought about precisely how this contract should be specified—and it was. In fact, GPs suggested that a courier service carrying samples for potassium tests must be refrigerated in order to avoid the impact of temperature change on the quality of the sample. However, the terms of the contract failed to specify that, and the eventual service that was commissioned did not provide for temperature control.

I have also received complaints about delays in delivery, as well as allegations that damage to samples in transit has made it difficult to record and analyse them properly. Indeed, the NHS Brent CCG noted in a report to the Brent health overview and scrutiny committee that issues of transportation quality and service delays on the part of the courier service, Revisecatch Ltd —trading as Courier Systems—

“appear to play a seasonal role in the variation of potassium levels; in that they add to the instability of the samples due to fluctuation in temperature during storage at the GP practice and/or during transportation to the laboratory in both summer and winter”.

Another privatised diagnostic service, the London NHS Diagnostic Service, is provided by InHealth. It is designed to enable London GPs to make direct referrals for their patients so that they have already had tests before being referred to specialist consultants. The tests might include ultrasound, echocardiography, audiology, cardiac physiology, magnetic resonance imaging, X-ray, endoscopy or phlebotomy scans. The intention was to reduce the CCG’s consultant costs by referring only patients who really needed their attention. In other words, GPs would filter patients to avoid unnecessary and costly referrals.

GPs have objected that that practice has simply introduced a middleman to the process, and that delaying a diagnosis from a specialist consultant may put patients in danger. I am told that the problem is compounded because the scans received from InHealth are often themselves delayed, and are frequently found to be of such poor quality that the patient must be referred to a specialist consultant in any event. My office has also been given anecdotal evidence that staff at diagnostic centres do not possess the necessary skills or understanding to handle complex diagnostic services.

General practitioners are not specialists. They are not consultants, and they are seeing scans which they cannot decipher or which are in a format that they cannot use. The patients are sent for another scan, or often are simply referred to the consultant whom they would have seen under the old system, who then usually orders a further scan at his or her own site. What started off as a way of saving money and freeing consultants to focus on clear cases of need becomes a bureaucratic process that puts patient outcomes at risk and costs more money as a result of duplication and delay. I should like to know from the Minister whether it is still the case that a patient has a statutory right to see a consultant, and whether a patient can insist on a direct referral from his or her GP without the interposition of additional diagnostic tests.

However, it is not just those diagnostic support services that are being privatised; front-line diagnostic services are being outsourced as well. I am, of course, referring to the NHS 111 service. The service was designed to ease pressures on accident and emergency departments by providing telephone-based triage, but many criticisms have already been made of it. Reference has been made to patients’ calls being answered by medically illiterate staff and to failure to meet targets to transfer calls to a clinician or nurse within 60 seconds or return them within 10 minutes, and there have been stories of patients simply being referred to A and E departments because call centre staff do not know what alternative facilities are available.

I do not wish simply to add to that catalogue of failings. My concern is more specific. In Brent and Harrow, we have an NHS 111 service that was awarded to Harmoni. That in itself was cause for some concern, as the company’s shareholders included the majority of the Harrow clinical commissioning group board that had decided to award it the contract. However, that is not the potential conflict of interest on which I wish to focus.

The urgent care centre at Central Middlesex hospital happens to be owned by Care UK, the company that also now owns Harmoni. Let me make clear that I am not accusing Care UK of encouraging its NHS 111 staff to make referrals to Central Middlesex in the knowledge that they will benefit from the treatment of any patients at the urgent treatment centre there, because I have no information to suggest that that is the case. Nevertheless, it is clear that there is a serious conflict of interest that any contract must monitor and guard against.

The interests of Care UK are clear, but its performance is not. I wrote to the Secretary of State for Health asking how the service in Brent had performed relative to the service specification. I asked,

“how many calls have not been (a) answered, (b) referred to a clinician or trained nurse within the appropriate timescale or (c) in receipt of a call-back from an appropriate clinician within 10 minutes”.

I received the following response:

“Local commissioners are responsible for performance management of NHS 111 services, and set their own performance targets for services…Data…is not available in the format requested.”—[Official Report, 23 October 2013; Vol. 569, c. 213-4W.]

In other words, the only people responsible for policing such conflicts of interest are the very people who have stood to gain from them.

The final issue I wish to raise with the Minister is that of the National Clinical Assessment Service. In many respects, this could merit an Adjournment debate all of its own. NCAS was established to undertake performance assessments of GPs and clinicians when primary care or hospital trusts had expressed concern that their clinical results or statistics appeared to have been outside normal parameters. There are more than 1,000 referrals a year, and in the vast majority of cases NCAS will assist simply by advising the trust in order to return the clinicians to safe and effective practice. However, in 50 or 60 cases each year an extraordinarily detailed and intensive process of assessment and remediation is required. Only about 60% of those who undergo that process make it back into safe and effective practice, while 40% never return to work in the NHS. NCAS is therefore one of the key guardians of patient safety.

In 2010, it became clear that NCAS would be restructured as part of the reconfiguration of the NHS. Its budget was cut by 20%, and it was told that it would have to become self-funding by 2013. In 2012, Deloitte was asked to conduct a review of the service, but it is due to publish its report only on 14 November, 10 days from now. In April this year, NCAS was joined to the NHS Litigation Authority, which has since consulted on a new structure prior to publication of the Deloitte report.

I understand that senior clinicians in NCAS are deeply worried that the head of the NHSLA has simply dismissed the very serious concerns that senior and experienced practitioners fed into the consultation about the proposals and the impact they might have on patient safety. NCAS is now haemorrhaging junior staff, whom it is allowed to replace only with agency people. The advertisement for a replacement for the senior assessment adviser specifies that the person concerned must be someone on secondment, and for one year only. The restructuring proposals dispense with the post of the director responsible for the “back on track” service, but no one else in the service has the clinical capacity to perform the role.

For some 50% of those who come for assessment, previously unidentified patient safety issues are revealed, often involving the cognitive impairment of the clinician himself or herself. I believe that before the proposed changes are allowed to proceed, the Minister must provide satisfactory answers to two questions. First, how will those patient safety concerns be discovered under the new model? Secondly, how will doctors who present a risk to the public be remediated and returned to safe and effective practice, given that the proposal specifically does not replace the key post with the clinical capacity to carry that out?

The problems and failings I have outlined this evening are not a series of unfortunate but unrelated events, but the logical consequence of a restructured NHS that has put competition and cost, rather than patient care and patient safety, at the heart of the health service. There has been a failure to ensure quality commissioning of the services being provided. In fact, one GP has written to me noting:

“It perhaps raises an interesting learning point for the future; that being if GPs are going to commission services and deal with private providers, what mechanisms are in place to stop patients being harmed by”

our

“negotiating a less than water tight contract? We are GPs not lawyers.”

Certainly with respect to the takeover of the pathology laboratory by TDL, no risk assessment was carried out to predict the potential problems that might arise from a change in both system and process, and no suitable performance measures were implemented, nor was a structure of monitoring put in place to ensure that a good quality of service was maintained. The Health Secretary has been keen to argue that privatising these services is on the basis of improvements to patient welfare and sound clinical evidence. It is not.

The awarding of the contract to Revisecatch Ltd shows that the clinical advice was ignored on the basis of cost, despite the clear implications for patient safety. The irony is that the subsequent change in contract specification almost always results in much higher costs, to the benefit of the private provider.

Patient care and patient safety can only be prioritised in a system where transparency thrives. Only in such a system can mistakes be learned from and become the basis of better future practice, but it is not in the interest of private companies to disclose any aspect of failing service. The root cause analysis report notes:

“The report provided by TDL on 08 March, was light on detail in parts and so it was difficult to identify lessons learned. TDL enjoy a good reputation and it is understandable that they would wish to protect this. However, in light of the requirements to put patients first and the duty of openness, transparency and candour, as recommended by Francis, it is felt that all involved could have been more open throughout the process.”

This issue of transparency and openness will remain a serious challenge for as long as private companies compete for contracts on the basis of cost.

Too many medical professionals are having to discover to the detriment of their patients that, for all their clinical expertise, they were never trained in the dark arts of commercial contract law, contract specification, negotiation and monitoring. It is the dogma of this Government that has put competition at the heart of our national health service, where patients should rightly be.

Oral Answers to Questions

Keith Vaz Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Jane Ellison]

It is good as a Minister to hear the phrase “nanny state” get its first airing. We believe in the informed consumer, and that is the idea behind so many restaurants labelling calorie content on their food. Most of us want to be healthy and most of us know when we want to diet and lose weight. By working with business, we can enable the consumer to make an informed decision about their health.

[Keith Vaz (Leicester East) (Lab)]

I declare my interest and welcome the Minister to her new portfolio. I wish to support the nanny state to this extent: it is fine for companies to sign up to the responsibility deal, but they have to deliver. As her first act as Minister with responsibility for diabetes, will she ban sugar from all Department of Health canteens, and stop selling in our hospitals fizzy drinks that contribute to diabetes?

[Jane Ellison]

As the right hon. Gentleman might know, my first outing as public health Minister was to attend a diabetes think-tank, which I hope indicates how seriously I take the issue. I do not think what he asks for is within my powers, but obviously I will take a close interest in the Department of Health canteen. The right hon. Gentleman is right. We have never said that other measures will not necessarily be taken, but the responsibility deal has taken us a long way when many predicted it would not, and we are keen to inject new energy into it.

Oral Answers to Questions

Keith Vaz Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

I agree with my hon. Friend. He has campaigned very honourably and sensibly for children’s heart services at Leeds. This is not a time for speculation. We will announce this month what the new process will be for resolving Safe and Sustainable. He and I both want this to happen as quickly as possible to remove that uncertainty. Also, we have to find a way of making sure that the data are solid and that we can trust them.

[Keith Vaz (Leicester East) (Lab)]

T4. Will the Secretary of State join me in congratulating Abbey primary school on becoming the first “silver star” school in Leicester for banning sugary drinks and for promoting healthy eating and exercise? Does he agree that this is the best way of preventing diabetes and obesity in later life?

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Absolutely. I would be delighted to come along and visit the school. May I give full credit to the right hon. Gentleman for his campaign and to the Silver Star charity, which does great work? That is why it is so right that we put public health back in local authorities, where it should always have been and where it was, historically. This sort of local action is very much the way forward, so I congratulate the school and the right hon. Gentleman again.

Oral Answers to Questions

Keith Vaz Excerpts

Tuesday 11th June 2013 Commons Chamber

[Norman Lamb]

I know that my hon. Friend has campaigned vigorously and consistently on this issue and the needs of her local community, and I agree that GPs ought to explore all ways they can of improving health care for her community.

[Keith Vaz (Leicester East) (Lab)]

May I declare my interest, and ask the Minister whether he is satisfied with the progress being made by CCGs in the provision of diabetes prevention work?

[Norman Lamb]

I understand that all clinical commissioning groups have a lead on diabetes care, but we can do an awful lot more to improve prevention work. We know that if we guide people in self-care, we can achieve massive improvements in their own health and well-being, and reduce the number of crises that occur. I am happy to work with the right hon. Gentleman to ensure we do everything we can to improve diabetes care.

Childhood Obesity and Diabetes

Keith Vaz Excerpts

Wednesday 24th April 2013 Westminster Hall

[Philip Davies (in the Chair)]

Before I call Mr Keith Vaz, Members should be aware that although things are quiet at the moment, we have been advised that there is a possibility of lots of noise outside, due to the work being carried out to try and get the visitors’ entrance up and running. If the noise reaches an unacceptable level and people are struggling to hear, we can ask them to stop. Things are all quiet at the moment, but if that happens, please let me know and we can do something about it.

[Keith Vaz (Leicester East) (Lab)]

It is a huge pleasure for me both to serve under your chairmanship during this important debate, Mr Davies, and to raise the issue of childhood obesity and type 2 diabetes. In 2007, after a chance testing by my local GP, Professor Azhar Farooqi, who is now the clinical commissioning group lead in Leicester, I was diagnosed with type 2 diabetes. Before I discovered that I had diabetes, it was not really a subject that I was aware of. Since then, it has become my passion inside and outside Parliament.

I begin by paying tribute to the Minister, who has truly revitalised the debate on obesity and diabetes since becoming a Minister. I agree with what she said, in her interview with Total Politics this week, about the public health Minister’s job. I have deleted one or two words, but she said that

“this is not a soft…girly option, it is a…serious job”,

and she is absolutely right. That is why I am delighted to see, on the Opposition Front Bench, the shadow Minister for public health, my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), who entered the House with me in 1987.

I am also delighted to see so many other Members of Parliament who have either raised the issue of diabetes or have been involved in campaigns. There is the hon. Member for Strangford (Jim Shannon), who, like me, is a type 2 diabetes sufferer; the hon. Member for Mid Derbyshire (Pauline Latham), who has raised the matter many times in the House; and my hon. Friend the Member for Inverclyde (Mr McKenzie), who was in the Chamber, but has popped out. There is also the hon. Member for Southport (John Pugh), the hon. Member for Morecambe and Lunesdale (David Morris), who is my next-door neighbour in Norman Shaw North, and last but not least, the hon. Member for Torbay (Mr Sanders), who is the chairman of the all-party parliamentary group on diabetes and who, for many years, has raised the issue with such passion.

Childhood obesity has become an important political issue. The NHS report, “Statistics on Obesity, Physical Activity and Diet”, of February 2012, stated that in 2010, about 30% of boys and girls were classified as either overweight or obese. The study found that 17% of boys and 15% of girls were obese, which is an increase from 11% and 12% respectively in only 15 years. The factors that cause childhood obesity are a major part of the debate. A recent study by University college London found that 30% of the difference between the bodyweight of one child and another can be explained by their genes. However, genes alone cannot explain the rapidly increasing incidence of childhood obesity.

The ever-increasing numbers of overweight children must be addressed, or we will have a generation of obese children growing into obese adults. It will be a generation at risk from the associated dangers of being overweight, including having type 2 diabetes. Unless we do something about that trend now, the twin epidemics of obesity and diabetes will overwhelm the NHS.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Does my right hon. Friend agree that whereas a generation ago, if a child was overweight, adults used to say, “They will grow out of it”, we cannot afford that type of complacency now?

[Keith Vaz]

My hon. Friend is absolutely right. I hope that by securing the debate and by hearing the contributions of hon. Members, we can get a pathway to try and show that complacency will actually help people to get diabetes. That is why I hope that hon. Members will join me today in a war on sugar, a fight against fat, and a battle against the bulge.

We must address three key areas. The first is the role of Government in facing the obesity epidemic head on. That is closely linked to the second key area, which is the role of food and drink manufacturers. The responsibility deal was a flagship of the previous Secretary of State for Health, who is currently Leader of the House. It was launched in March 2011, but I am sorry to say, it appears to have failed. Voluntary agreements with industry have made little impact. The headline pledge to cut 5 billion calories a day is simply incalculable, arbitrary and misleading.

The Department of Health, in response to a parliamentary question of mine, said:

“It is not possible to measure the exact contribution of business’ actions to changes in consumers’ calorie consumption.”—[Official Report, 6 February 2013; Vol. 558, c. 339W.]

By February 2013, 122 companies had signed up to one or more of the responsibility deal’s six pledges, but it is what happens afterwards that really matters. Those pledges, sadly, in my view—I am ready to be convinced otherwise when the Minister replies—have, at best, paid lip service to the Government’s aim of getting the nation to eat more healthily, drink less, be more active, and have healthier working lifestyles.

[Pauline Latham (Mid Derbyshire) (Con)]

Does the right hon. Gentleman agree not only that parents have a huge responsibility to feed their children appropriately and ensure that they get adequate exercise, but that schools have a huge responsibility to give children nutritious, non-fattening and not sweet foods—healthy foods—and through sports, encourage them to take the exercise that will make them healthy and set in train for their whole lives the habits of exercising and eating healthily? It is not only about parents, because schools should help too, as well as the industry that he is talking about.

--- Later in debate ---

[Keith Vaz]

I thank the hon. Lady for her intervention. I fear that she may have seen a copy of my speech, because she has mentioned the very issues that I intend to raise. All three areas are extremely important. It is not one area alone that can deal with the issue; it is a combination of all three factors.

The first factor is the manufacturers. Coca-Cola pledged to reformulate its best-selling drinks to reduce calorie content by at least 30%, but it has chosen not to reformulate its classic, full-fat Coca-Cola, the world’s most popular drink. A can of full-fat Coca-Cola has eight teaspoons of sugar. If the responsibility deal is to be truly believed, it has to be more robust. The pace of change among food and drink companies must be dramatically increased. The only alternative to the responsibility deal, in my view, is legislation.

Last year, I introduced a private Member’s Bill, the Diabetes Prevention (Soft Drinks) Bill, to reduce sugar content in soft drinks by 4% and to establish a programme of research by requiring manufacturers of soft drinks to reinvest part of their profits in diabetes research. In 2010, 14.5 billion litres of soft drinks were consumed in the United Kingdom. According to research by Professor Naveed Sattar of the university of Glasgow, the average person in the UK consumes between a fifth and a quarter of their daily calorie allowance through non-alcoholic drinks. Those are somewhat hidden calories. Professor Sattar said:

“This analysis confirms that many people are perhaps not aware of the high calorie levels in many commonly consumed drinks.”

The consumption of sweetened soft drinks clearly has a part to play in the increasing waistline of the nation.

Attempts to legislate on the issue have been rather unsuccessful. In September 2012, New York’s mayor, Michael Bloomberg, introduced a ban on super-size fizzy drinks to tackle the city’s obesity problem. The ban was overturned in the New York supreme court by a coalition of drinks companies and industry groups.

Legislation has not been limited to sugary drinks. In October 2011, the Danish Parliament passed a so-called fat tax on foods containing more than 2.3% saturated fat. The tax was scrapped after concerns were raised about its adverse effect on the economy as increasing numbers of Danes crossed the border to purchase food in Germany. Clearly, that would be less easy if we did such a thing in England, because of the ability to go to Scotland and Wales.

The hon. Member for Mid Derbyshire mentioned schools. She is absolutely right. The third key area is the role of schools in childhood obesity. Healthy eating in schools has been given a real boost by initiatives such as Jamie Oliver’s “Feed Me Better” campaign, which successfully attempted to transform lunch-time menus. However, many schools still have vending machines offering fizzy drinks and sugary snacks. We should issue an ultimatum: schools should remove all vending machines by 31 December this year. That would go some way towards addressing the problem of bad nutrition in schools.

[Ms Abbott]

Does my right hon. Friend agree that it is regrettable that the new academies are not subject to the same regulations in relation to food and not having vending machines? Surely the strictures that apply to state schools should apply to the new academies.

--- Later in debate ---

[Keith Vaz]

I thank my hon. Friend for her intervention. I did not know that that was the case, but if it is, it should be put right. All teaching establishments should be treated on the same basis and should all get the same message from Government.

Let us consider the issue of where schools are situated and the ability of fast-food chains to mushroom around schools. Many children purchase fast food on their way home from school. For many, fast food is readily available. For example, in my constituency, there are 61 fast-food outlets within a 1-mile radius of Rushey Mead primary school. Positive action has been taken by some local authorities. Waltham Forest council, for example, banned fast-food outlets near schools in 2008. However, more must be done to address the issue. Since 1 April 2013 and the creation of health and wellbeing boards, the onus has surely been on local councils to consider sensible planning restrictions to tackle childhood obesity.

Schools need to do more to educate pupils about the benefits of eating a healthy diet. I commend the excellent report by Ella’s Kitchen, “Averting A Recipe For Disaster”, which urges the Department for Education to address poor nutrition for children by making cooking in schools compulsory and by giving free breakfasts to every child. We currently have an epidemic of childhood obesity, which in 20 years’ time will turn into an epidemic of type 2 diabetes.

The incidence of diabetes is truly alarming. Sometimes we repeat these statistics so often that they lose their impact, but I have to repeat them again today. There are an estimated 3 million people in the UK with the condition, and a further 850,000 are thought to have the condition but are not aware of it. The complications from poorly managed and poorly treated diabetes are shocking. It is the leading cause of blindness, kidney failure and lower-limb amputations. Each week, there are 100 diabetes-related amputations; and each year, 24,000 people die earlier than expected due to complications from the condition. Not only are the health risks extreme, but the cost to the NHS is enormous. It is astonishing. The NHS spends roughly £9.8 billion a year and 10% of its budget treating the condition and its associated complications.

[Pauline Latham]

The right hon. Gentleman talks about amputations. My father had his leg amputated because of diabetic complications, but his problem was that he never stuck to his diet. People must be given more help to understand the complications that they can and probably will incur if they do not take the prognosis seriously and control their diet, because if they do not do so, they will have those long-term problems.

[Keith Vaz]

The hon. Lady is absolutely right. I do not want to steal lines from the Minister’s speech, but when she recently addressed a forum on diabetes, that was exactly what she said: diet is extremely important. We are all busy people and when we walk into the Tea Room for our cup of tea, we are faced with Club biscuits, Jaffa Cakes, Victoria sponges—plural—and all kinds of other things that entice us, so even if I go in saying that I must have a banana or an apple, I end up, as the hon. Member for Strangford has seen, picking up a Club biscuit. The hon. Member for Mid Derbyshire is absolutely right: diet is crucial. That is why I wish the newly appointed diabetes tsar, Dr Jonathan Valabhji, the best of luck in dealing with those figures.

How do we cope with this situation? There are practical steps that health care providers, local authorities and the general public can take, but the key is prevention. The new NHS health checks will offer those aged between 40 and 74 a check to assess their risk of heart disease, stroke, kidney disease and diabetes. If only I had had that check when I was 40, I would have discovered six years earlier that I had diabetes. However, new research revealed by the university of Leicester on Friday suggests that the checks could detect at least 158,000 new cases of diabetes or kidney disease, but they are not being taken up. I pay tribute to the work of Professor Kamlesh Khunti of Leicester university, who was behind the research that revealed the number of cases that could be discovered. The health check has enormous potential to find those in the early stages of diabetes or even with symptoms of pre-diabetes.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I apologise, Mr Davies, for what may become something of a love-in. I will probably pinch some of the right hon. Gentleman’s speech, and I pay tribute to the great work that he has done. Does he agree that great work has been done in Leicester with the health checks that are being rolled out there? The approach is forward-thinking. Anyone who registers with a doctor and is in the right age group automatically gets a health check. The work is also being driven by the excellent charity with which the right hon. Gentleman is associated. Does he agree that real, positive work is being done in Leicester from which the rest of the country can learn?

[Keith Vaz]

Absolutely. I thank the Minister for her kind words. I know that she has to pass Leicester in order to get to London and I know that she has made a number of visits to the city; she was there recently. I thank her for the compliment that she has paid to Leicester and to Silver Star. The Government must not miss this opportunity to set targets for GPs, because it is only through setting targets that we can secure real change.

Another avenue that could be explored is the role of pharmacies in testing for diabetes. According to the Royal Pharmaceutical Society, there are more than 10,000 community pharmacies in the UK. I believe that those pharmacies are under-utilised. My mother, before she died, had absolute faith in her local pharmacist. Of course she listened to her doctor and she got her prescription. On occasion, she would listen to her son and her daughters. However, the person she really respected was the pharmacist, and because pharmacies are on the high street, they are available to local people, so they can get their tests. The benefits of testing for diabetes in pharmacies are twofold. Bringing testing into the community because the pharmacies are there means that hundreds of thousands of people who have not been diagnosed with the condition can discover whether or not they have it and, more importantly, it would reduce the pressure on already over-burdened GPs.

Finally, I want to talk about the new landscape of health care and its role in tackling diabetes. The Health and Social Care Act 2012 offers an unparalleled opportunity to revolutionise diabetes care and prevention. I warmly welcome the introduction of health and wellbeing boards, which will put local councils firmly in the driving seat to address public health. I have always believed that local authorities have a role in providing those services. Importantly, the boards will be able to work with charities, such as Diabetes UK, which have done outstanding work over many years and provided so much help to so many people. The first thing I did when I discovered I had diabetes was become a member of Diabetes UK. I receive constant updates about what I should do and a little loyalty card, which I have not used yet, but it has the telephone number.

It would be remiss of me not to bring up Silver Star, which the Minister mentioned and with which I am privileged to be associated. It targets at-risk communities. Indeed, having been established in Leicester, sent buses to Mumbai and Goa, and supported charitable work in Yemen, the charity opened its first London diabetes centre in Edgware only two weeks ago with the help of Mr Speaker, in the place he was born—not quite the hospital, because Edgware general is down the road. He was born in Edgware however, and it was great to have him back to open the new unit.

The charity has sought—this takes us back to the point made by the hon. Member for Mid Derbyshire—to deal with issues relating to children and sport; the importance of diet; and the role of parents and professionals. On Friday, the charity and I will unveil the winners of a painting competition held by Silver Star in association with Leicester City football club. All the school children of Leicester were asked to paint a picture showing the importance of a healthy lifestyle. I thank the football club’s chairman, Mr Raksriaksorn, and his son Top for naming the charity as one of their charities of the year and for working with it to ensure that children realise the importance of sport. I hope that on Friday not only will the winner of the competition be announced, but Leicester City football club will at last get into the play-offs where we belong, as it is one of the last games of the season.

The health clock on diabetes has reached 11.59 pm. We need either to toughen the responsibility deal or to pass legislation. Schools need to take immediate action to remove vending machines that sell sugary drinks. We need local councils to give fewer planning permissions for fast-food outlets near schools, or, better still, no planning permissions. We need a radically different approach to ensure that everyone at risk is tested for diabetes. If we do not do so, the NHS will be overwhelmed and it will not only affect our generation, but our children’s generation. That is why we must act now.

--- Later in debate ---

[Ms Abbott]

The hon. Gentleman has to understand that the problem is multifaceted and needs multifaceted solutions, one of which is more parental responsibility. The role of supermarkets, and what and how they market, is part of the problem. I live in east London, which is very varied demographically, and I can go half a mile to one supermarket that largely serves working class people—at the front and centre it has unhealthy foods—and half a mile in the other direction to Waitrose, which has fruit and wine. Supermarkets are part of the issue.

Hon. Members may remember the case last year of what The Sun newspaper described as the fattest girl in the UK. She became so obese that the back wall of her house had to be knocked down, and she had to be taken out of the house with a crane and taken to hospital. The point about her is that she had been obese all along, but had been sent to a health farm in America and had lost a considerable amount of weight. She and her mother were reported as saying that the day she came back after several months in the US on a healthy diet, her mother somehow did not have any healthy food in and sent out for fish and chips. With some obese children, it is almost an issue of co-dependency. If we are to work effectively with childhood obesity, we have to work with the family—whatever that family unit constitutes. Will the Minister tell us what action her Department is taking on marketing and promotions, and how it intends to encourage the reformulation of food products, because we need to reduce the high salt and sugar content of breakfast cereals and other items that are marketed at children online?

On the role of local authorities, we should—and I have said this more than once—move public health to local authorities. There are challenges to such a move, but also great opportunities. Potentially, it could mean an end to silo working, because in an ideal world, the education, environmental and leisure services departments work alongside public health professionals to achieve better public health outcomes. We must not forget that for every pound that is spent on things that affect our health, only 10%, I think, is spent by the NHS. The rest is spent by housing and leisure departments. Moving public health to local authorities represents a tremendous opportunity to deal with diabetes and obesity-related issues.

This has been a friendly debate, and people have fallen over themselves to be nice to each other, but let me perhaps insert a slightly cautious note. The great Professor Terence Stephenson, chair of the Academy of Medical Royal Colleges and of the Royal College of Paediatrics and Child Health, said this in relation to responsibility deals:

“The food industry cannot be relied upon to help lead the policy response to obesity. This is not a criticism of the food industry. It would be extraordinary if an industry with a duty to make profits for shareholders should act against its mission to push products and sell as much of them as possible. Asking the food industry to solve the problem is counter-intuitive; you would not put Dracula in charge of a blood bank.”

Of course it is fine to co-operate with industry, but industry must know that the Government are serious and that, in end they will legislate if it does not co-operate. Responsibility deals are fine in principle, but if industry thinks that it is all carrot and no stick, we will not get the results that we all want.

[Keith Vaz]

We must have a timetable. If we go for just a voluntary deal, everyone will sign up, but if there are no benchmarks and no timetable, this will just drift on for ever. The idea was a very good one, but it lacked teeth.

[Ms Abbott]

That is my exact point. Of course we want co-operation with industry, but there must be teeth—sanctions or at least the possibility of legislation—and, above all, there must be a timetable.

When it comes to childhood obesity, the most important thing is early intervention. Medical evidence shows that overweight children have, in proportional terms, gained most of that weight before they start school, so what we do in the very early years is absolutely key. Will the Minister tell us whether the Government plan to take action on training health professionals in weight management in accordance with the National Institute for Health and Care Excellence guidelines as well as emphasising the importance of parenting style and parents’ lifestyle when children’s weight is considered? Interesting research shows us that 70% of boys who have overweight fathers are overweight themselves, and 90% of girls who have overweight mothers are also overweight, which is why we stress the importance of early intervention and working with the family in an holistic way. We are talking about not any one measure but holistic working. Will the Minister tell us whether she is working with her colleagues in the Department for Education on these matters? In particular, is she following the example of Finland, where there is a high uptake of healthy free school meals, which means that children are getting accustomed to what is a proper balanced meal?

Furthermore, will the Minister tell us what she will do about the situation in academies and free schools, because they are exempt from the nutritional standards that apply to other schools? They can have machines selling fizzy drinks. Is the Minister looking at planning legislation and making public health a criteria in planning, which would make it much simpler to ban fast food shops around schools?

We appreciate the energy and enthusiasm of this Minister, but, partly because of the reliance on responsibility deals, not everyone is swept away with what the Government are doing around health, nutrition and obesity. A few months ago, Jamie Oliver said:

“This whole strategy is just worthless, regurgitated, patronising rubbish.”

Does the Minister agree that firmer and more comprehensive proposals are needed to encourage active travel and make the built environment more accessible for young pedestrians and cyclists, and that we need to take action on junk food advertising and promotions of such foods in stores?

Finally, the Public Accounts Committee report into the management of diabetes services in the NHS recently highlighted the need for action from central Government on reducing the rising numbers developing type 2 diabetes. It said:

“The Department of Health and Public Health England should set out the steps they will take to minimise the growth in numbers through well-resourced public health campaigns and action on the risk factors for diabetes”.

I understand that campaigners such as Diabetes UK have expressed their disappointment that the Government have rejected that proposal. Will the Minister tell us today why the Government chose to reject such sound recommendations made by a highly respected Committee of this House? Does she not agree that the rejection of the Committee’s recommendation might lead some observers to think that the Government will listen only to the food industry on obesity?

It is clear to me, and to all those who have campaigned for years on these issues, that self-regulation and voluntary targets alone will not work. Diabetes UK, the royal colleges and others are all coming together to call for a more robust approach to the regulation of the food and drink industry. However the Government appear a little reluctant about such a move.

Once again, I congratulate my right hon. Friend the Member for Leicester East on securing this important debate. I do not believe that there is any one measure that can impact on the matter of childhood obesity and diabetes. I have touched on some of the practical issues, but there are many others, such as culture and ideas of parenting. There is a generation of young women whose notions of parenting are limited. They hear advertisers say, “Give your child this healthy bar and that makes you a good mother,” and they do not have the information to think beyond that. Diabetes is the No. 1 public health issue facing us now, and childhood obesity gives a premonition of even worse public health problems to come. I wait with interest to hear what the Minister has to say about the points that I and some of my colleagues have raised in this interesting debate.

Oral Answers to Questions

Keith Vaz Excerpts

Tuesday 16th April 2013 Commons Chamber

[Dr Poulter]

I commend the work being done locally in Tamworth to address this issue. As we know, one of the biggest public health challenges facing this country is obesity. The risk factors for cardiovascular disease include diabetes and high cholesterol. If we can tackle obesity and improve lifestyles, we will address both those risk factors directly, so I wish my hon. Friend’s local organisations every success in tackling those challenges.

[Keith Vaz (Leicester East) (Lab)]

As the Minister has said, those with diabetes are five times more likely than others to develop cardiovascular disease, which currently costs the national health service £9.8 billion a year. Will he commit to a public awareness campaign and issue guidelines for local health and wellbeing boards so that they make this a priority?

[Dr Poulter]

I commend the right hon. Gentleman’s work in raising the profile of diabetes. A lot of the Government’s work is focused on the importance of improving public health in this country and in particular on obesity, and if we are to tackle that we have to deal with diabetes. As a key part of that, we are now giving 40% of the public health money to local authorities to do exactly what he has just described: to focus money in the right places to tackle cardiovascular disease in those communities that most need it, particularly in inner-city areas.

Immigrants (NHS Treatment)

Keith Vaz Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

My hon. Friend makes a reasonable point. Part of the problem is that when we should be identifying someone as a foreign national who should pay for their NHS care, that does not happen a lot of the time because of the incentives in the system. Under the NHS improvement initiative, which is taking place in London at present—it is worth looking at that closely, because it has a lot of promise—there is a centralised collection of debt from foreign nationals who owe the NHS so that that does not become the responsibility of individual hospitals, which is something that is putting them off registering people as eligible for their NHS care.

[Keith Vaz (Leicester East) (Lab)]

May I invite the Secretary of State to comment on the view that one of the reasons why these proposals are being made at this stage is the conclusion of transitional arrangements for Romanians and Bulgarians at the end of this year? The Minister for Immigration is sitting on his right. Is it possible for the Health Department and the Home Office jointly to commission research so that we can have some actual figures on how many people might be coming at the end of this year?

[Mr Hunt]

The right hon. Gentleman will have to raise the matter of the actual number of people coming to the UK with the Home Secretary or, indeed, the Minister for Immigration.

The right hon. Gentleman is right to say that the issues that we are dealing with are not just about foreign nationals from outside the EU or the European economic area. The rules for EEA members are complex. If people come here to work, we have an obligation under EU law to allow them access to free treatment, but if they are economically inactive or if they are temporary visitors, we should be able to reclaim the cost of that treatment from their home country in the EEA. The fact is that we do that very poorly indeed at the moment and that is one of the things we need to change.

Oral Answers to Questions

Keith Vaz Excerpts

Tuesday 26th February 2013 Commons Chamber

[Anna Soubry]

I am grateful for that question. I pay tribute to all my hon. Friend’s work on this matter, especially as Chair of the Environment, Food and Rural Affairs Committee. This has been a difficult time for all concerned. We need to ensure that all food is what it says on the label. Important work needs to be done to ensure that that is the case and to restore confidence to all consumers. We are very mindful of that in the Department.

[Keith Vaz (Leicester East) (Lab)]

I thank the Minister for her very kind comments. I know that the charity Silver Star is looking forward to visiting her constituency on Saturday and testing her for diabetes. I am sure that we will find her in perfect health. I remind her that, according to the national health service, it will take five years before all diabetics have access to the full nine checks. Will she consider issuing guidelines to local health and wellbeing boards to ensure that they raise awareness of diabetes?

[Anna Soubry]

I am concerned, as we all are, about diabetes and about the recent report. We have accepted all but one of its recommendations and a lot more work needs to be done. I pay tribute to Silver Star and to the work of Diabetes UK, for example in Boots. I was happy to go to the launch of a new system whereby people can go to clinics at Boots and get the sort of checks that Silver Star is doing. We recognise that there is a lot more work to be done and are making every effort to ensure that there is a huge improvement in the diagnosis and outcomes of everybody who is affected by diabetes.

Oral Answers to Questions

Keith Vaz Excerpts

Tuesday 15th January 2013 Commons Chamber

[Mr Hunt]

We are very keen to ensure that all reconfigurations of services have strong local, clinical support. We are making good progress in this area. There is always a trade-off between access, which I recognise is extremely important in a rural constituency such as the hon. Gentleman’s, and the centralisation of services, which sometimes leads to better clinical outcomes. I am happy to arrange for him to meet me or one of my colleagues to discuss his concerns in more detail.

[Keith Vaz (Leicester East) (Lab)]

Those with diabetes, such as myself, are five times more likely to get cardiovascular diseases. Last year’s National Audit Office report indicated that 1 million diabetics did not get their nine checks. What steps will the Secretary of State take to ensure that those checks are made available to all diabetic patients?

[Mr Hunt]

I congratulate the right hon. Gentleman on his campaigning work for people with diabetes, and I am aware that there are 24,000 premature deaths every year because we are not as good as we need to be at tackling the disease. It is shocking that only half those with diabetes are getting the full set of nine checks that everyone with diabetes should be getting every year, and when we publish the cardiovascular disease outcomes strategy—which I hope will be in spring—I hope we will address some of his concerns about how we can do a better job for diabetes sufferers.

Diabetes

Keith Vaz Excerpts

Wednesday 9th January 2013 Westminster Hall

[Keith Vaz (Leicester East) (Lab)]

I pay tribute to the hon. Gentleman for all his amazing work on diabetes over his parliamentary career. As he has done, I have tabled questions to ask simply how high the spend on diabetes was in individual PCTs last year, only to be told that the information was not available and so could not be given to me. Is not that kind of information vital for an effective strategy on diabetes?

[Mr Sanders]

That would certainly be extremely helpful and would complement the atlas of care by, in a sense, putting the actuality into the story behind the figures. It is extremely unhelpful not to be able to drill down to what is really happening on the ground; we could do that if such statistics were available.

Some of the problems of disseminating information have been offset by the work of NHS Diabetes. It has been instrumental, first, in monitoring variations in care and driving the collection of more robust data, which has culminated in an extremely important publication, the national atlas of variation; and, secondly, in working tirelessly to rectify the problems it uncovers, linking national policy intention with policy implementation on the ground, including support targeted on where the greatest improvements are necessary. It is important that that work continues, as much more could be done. I hope that the Minister will reassure me that, despite the upheavals in the commissioning architecture, NHS Diabetes will retain its central role.

--- Later in debate ---

[John Pugh]

rose—

[Keith Vaz]

rose—

[Mr David Crausby (in the Chair)]

John Pugh.

--- Later in debate ---

[Keith Vaz (Leicester East) (Lab)]

It is a pleasure to follow the hon. Member for Southport (John Pugh). I am tempted just to say that I agree with everything that everyone has said and then to sit down, but this would not be Parliament if we were able to do that, so I will briefly contribute to the debate.

I pay tribute to the hon. Member for Torbay (Mr Sanders), who has dedicated his life in Parliament to addressing diabetes. Obviously, because he has type 1 diabetes, he has become the Commons expert on such matters, and I pay tribute to him for what he has done as chair of the all-party group on diabetes and for all his other work on diabetes.

I come to debates on diabetes as a type 2 sufferer full of optimism, because I want to hear about what other people are doing, but I hear about blindness, amputations, stroke and death, and I feel extremely depressed as I go out. In this debate, hon. Members have talked about amazing ideas and good practice in their own areas. I did not know about the specialist unit in Blaenau Gwent, and I did not know what a bun worry is—I now discover that it is a feast of sweets held in Northern Ireland, from which I am sure that the hon. Member for Strangford (Jim Shannon) is kept away. The key to such debates is that we hear about good practice that we do not hear about in other areas.

I pay tribute to both Front-Bench teams, because they both understand the importance of the subject. I am sorry that I did not get diabetes earlier, because I would have done better at harassing the previous Labour Government on the issue. I was told that I had diabetes only in 2007, and, therefore, I did not dedicate myself to it in Parliament in the way that I should. I will make up for that in the next few years.

We have high hopes for the Minister, and not only because The Times has said that she is one of the rising stars of the new intake, which gives hope to those of us who have reached middle age—I am on the way down, but she is clearly on the way up. We have confidence in her and the way in which she has addressed diabetes in the Department of Health: she has ensured that diabetes is a priority; she has asked questions of the experts, and she has brought together charities such as Diabetes UK, Silver Star and others. She is doing what all good Ministers do, which is never to accept the status quo and to ensure that the Department’s bright civil servants are using their abilities and skills to deliver what Parliament wants.

I welcome what the Government have done to support the Change4Life initiative by backing the advertisements announced only on Monday to encourage people to address obesity by ensuring that they change their diet and understand that, by taking responsibility, there can be a difference. I know it is in the nature of parliamentarians always to blame the Government or to expect the Government to do more, and, yes, we do, but it is also in the hands of individuals.

The hon. Member for Strangford carefully considers what he eats in the Tea Room—I have watched him carefully as we line up to get our lunches. When we go to the Tea Room to get a cup of tea before Prime Minister’s questions, we are faced with Club biscuits, Kit Kats and every sweet thing that can possibly be found. I do not know what the English equivalent of a bun worry is, but it is there for us in the Tea Room. Let us start in this House by ensuring that the food available is acceptable.

I also praise my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) for the work that she and the Labour Front-Bench team have done on the proposals not for a tax, which was the subject of my ten-minute rule Bill, but for a reduction in the sugar and salt content of foods, as announced by the shadow Secretary of State. That is a good thing and goes some way towards what Mayor Bloomberg is doing in New York. Actually, the proposal goes further—a tax was not proposed because, of course, Denmark introduced a fat tax but had to withdraw it because of lobbying from the food industry—by showing the need to do something now. The Secretary of State was on television on Sunday, and he agrees with the principles behind the proposal, although he does not support the idea of doing it through legislation. He was looking very cool, not in a suit and tie but in his cardigan, and he said, “Let’s leave it for the industry to do on a voluntary basis.” The industry has had its chance to do something, and we need to move forward.

The Opposition are right. I know that it is in the Opposition’s nature to say radical things, but they are right to press the Government on the proposal because it means that the clever civil servants and, indeed, the clever Ministers in the Department of Health, including the Minister with responsibility for diabetes, will take note and press the industry to react. Ultimately, being able to express such views is important, and I support what the Opposition are trying to do.

I have not mentioned this so far—Members of Parliament usually criticise GPs for not doing enough, and they do not do enough—but in the five or 10 minutes available when people go to their GP, there is not enough time to have a diabetes test and a long chat about diabetes issues. The hon. Member for Gillingham and Rainham (Rehman Chishti) specifically mentioned the south Asian community—the Silver Star diabetes charity, with which I am associated, and Diabetes UK take this seriously—because certain communities are more susceptible to diabetes. He is right to raise that point. However, I think we should be getting pharmacists to do much more. Before she died of diabetes complications, my mum had great faith in her local pharmacist. Pharmacists have more time to talk to people than GPs, who are very busy. We should include them in our forward plans. We have not mentioned them today, but we need to consider them for the future.

I know that the Minister is off to India to speak at a major conference on the issue in Chennai. We have the best diabetes doctors in the world. I happen to have a few in Leicester—Professor Azhar Farooqi, Professor Kamlesh Khunti, Professor Melanie Davies—and there is also Professor Naveed Sattar in Glasgow, as well as many others. They are world-class experts, and we do not use them enough. As the Minister starts on her journey—not quite without maps, because some have been provided in this debate, and the hon. Member for Torbay has one in his back pocket that he has offered to successive Governments over the past 25 years—will she please use the expertise that we have? The world looks to our medical profession as the best in the world. Let us engage them in the work that we do.