Diabetes: Artificial Pancreas

Liz McInnes Excerpts

Wednesday 12th December 2018 Commons Chamber

[Mr Howarth]

I am grateful to the hon. Gentleman, who must be psychic, because that is the very next point I was going to make.

There have been, as the hon. Gentleman says, postcode lottery-style problems with accessing the technology. For example, with FreeStyle Libre, a flash glucose monitoring device, patients in Liverpool are able to get it on prescription if they meet the criteria. That is very welcome, but many patients from outside the area cannot get one, as up to 30% of CCGs do not fund them. There needs to be more work done on that and I know the Government have made an announcement, which I will refer to in a moment.

Thanks to Diabetes UK’s campaign on 14 November, World Diabetes Day, NHS England announced that from April 2019 the FreeStyle Libre will be made available to all who meet the clinical criteria regardless of where they live. That is a very welcome development. I do not think it will apply to Northern Ireland, but I hope a similar policy is adopted in Northern Ireland. Innovation in diabetes technology is evolving rapidly in exciting ways.

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

I thank my right hon. Friend for giving way. To go back to the postcode lottery of funding, I wonder whether the Minister will talk in her winding-up speech about the work of the Scottish diabetes technology improvement plan, which was supported by £12 million of funding and has resulted in increased insulin pump usage in Scotland. I wonder whether we might emulate that scheme.

[Mr Howarth]

The common-sense approach is to look at what is going on elsewhere—in Scotland and in other parts of the world—to get the best of what is available and use it in the most effective way. My hon. Friend is quite right about that.

It is pointless giving type 1 diabetics the latest technologies, such as an artificial pancreas system, if they are not given structured education to support them to use the technology that is available. The limited uptake of educational programmes is a matter of great concern, and I hope the Minister shares that concern. Despite guidance from the National Institute for Health and Care Excellence, in 2014-15 only 2% of people newly diagnosed with type 1 diabetes were recorded as having attended structured education courses. For some, that lack of knowledge of the key principles of self-management is a major barrier to the use of technology, because without sufficient education, type 1 diabetics are not equipped to get the best results from the technology available.

--- Later in debate ---

[Mr Howarth]

My hon. Friend is right. This is not just about technology, important though that is. Anyone with diabetes who manages it well—and technology will help to do that—will have fewer hospital emergency admittances. I do not have the statistics to hand—I am not even sure they exist—but those people will clearly have fewer hospital admittances and fewer complications with their diabetes, and therefore cost the NHS less. As I am sure the Minister will acknowledge, however, the NHS is not very good at doing cost-benefit analysis. It needs to get smarter at it, because the point that my hon. Friend makes is right, not only as regards the support we give to people with type 1 diabetes, but about the cost to the NHS of dealing with the consequences.

[Liz McInnes]

I want to echo the point about cost-benefit analyses and how bad the NHS is at joining up different departments’ budgets. It really needs to get better at being able to identify that spend in one area leads to a huge reduction in spending in another.

[Mr Howarth]

My hon. Friend makes the point more clearly and eloquently than I did.

A new device that takes us closer to the artificial pancreas has been developed by Medtronic: the MiniMed 670G. A number of people with type 1 diabetes have started using the system in the UK in a pilot phase before it is rolled out more widely across the country. However, only 15.6% of those with type 1 diabetes are using insulin pumps, and it is potentially a concern that healthcare professionals would be unlikely to recommend an artificial pancreas if someone was not already using a pump and continuous glucose monitoring. If the issues to do with NHS access to today’s type 1 diabetes technology can be addressed, a path can be cleared towards adoption of the artificial pancreas.

We need to ensure that people living with diabetes are equipped with the skills to self-manage. That would support patients in using current technologies effectively, and ultimately in using artificial pancreas systems. Structured education is central to enabling people living with type 1 diabetes to best manage their condition through effective use of monitors and insulin pumps. The NHS can support type 1 diabetics to do that by increasing the provision and uptake of diabetes education. To do that, it needs to make diabetes education courses more accessible and convenient, possibly through digital solutions.

A recent survey by Dexcom revealed that more than three quarters of people with diabetes suffer from stress, anxiety attacks or bouts of deep depression. While healthcare teams help, and teach people how to manage their blood glucose levels, type 1 diabetes is largely a self-managed condition. The NHS needs to ensure that the resources and community support that people with type 1 diabetes require are well advertised, well recognised, well understood and well invested in. I believe we are on the threshold of being able to make type 1 diabetes not a thing of the past, but a thing that can be well and easily managed, and I hope the Minister will take these words seriously and do everything she can to advance that day.

[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.