Health: Diabetes

Lord Collins of Highbury Excerpts

Tuesday 19th March 2013 Grand Committee

[Lord Collins of Highbury]

My Lords, I have no doubt that my contribution will be interrupted very shortly. I, too, thank my noble and learned friend Lord Morris for initiating this important debate. As a type 2 diabetic, I am acutely aware of the possible causes of my condition and how lifestyle changes can improve matters. That is not the case with type 1 diabetes, which is a chronic, life-threatening condition with a lifelong impact on those diagnosed and their families. It cannot be prevented and there is no cure. No one is quite sure what causes it; possibly it is triggered by an auto-immune disease. It does not involve lifestyle factors such as poor diet or lack of exercise, as my noble and learned friend has said.

Although the major increase is in type 2 diabetes, type 1 is also rising. As my noble and learned friend said, estimates suggest that between 300,000 and 400,000 people living with type 1 diabetes in the UK, which accounts for around 10% of all people with diabetes. People with type 1 diabetes are at greater risk of dying younger. The first ever report into mortality from the National Diabetes Audit was published just over 18 months ago, and I referred to it in the previous debate. It found that up to 24,000 people with diabetes are dying in England each year from causes that could be avoided through better management of their condition. About three-quarters of those are aged 65 and over. However, the gap in the death rate between those who have and who do not have diabetes becomes more extreme when comparing younger people. It is truly shocking to learn that so many young people are dying from diabetes. Type 1 is a particularly difficult condition to live with, as my noble and learned friend pointed out. We need to raise awareness and campaign to help to prevent and detect diabetes, as my noble friend Lord Hoyle said. I am therefore sorry that the Government decided not to accept the Public Accounts Committee recommendation on this particular aspect of its report about mounting public campaigns.

According to the 2012 Impact Diabetes report, the current cost of direct patient care for those living with type 1 diabetes is estimated at £1 billion, along with indirect costs of just under £1 billion related to increased death rates and illness, work loss and the need for informal care. Last year’s Public Accounts Committee report also recognised that while the department had improved information on diabetes, it was not being used effectively by the NHS to assess quality and improve care. It recommended that the department should work with the NHS to ensure that the costs of diabetes are fully captured and understood in order to promote appropriate services and better outcomes for patients. In their recent response, the Government agreed with the committee’s recommendation. I would therefore like to ask the noble Earl what progress has been made in implementing it, especially on the further work required to improve the underlying financial information collected at both the local and national level, and how quickly this will be made available to commissioners.

As we have heard, people with type 1 diabetes can live long, healthy lives if their condition is well managed. However, too many are not getting the help and care they need, leading to devastating complications, avoidable deaths and greater costs to the NHS. Everyone with diabetes should receive the nine agreed care processes recommended by NICE as part of their annual review. However, two-thirds of those with type 1 diabetes do not receive all nine. Can the noble Earl give more detail on how the target of 80% coverage by 2018 given by the department in the PAC response will be met? The concern is that the disbanding of NHS Diabetes may result in a number of established work programmes either not continuing or being suspended. It is really important that these programmes continue. They include integrated care supporting self-management, clinical safety, paediatric care and education, specialist foot care, older person’s care, inpatient care and, as we have heard from my noble and learned friend, insulin pump networks. Will the noble Earl support further development of these work programmes with the input of clinicians and patients to drive quality improvement?

Data from the National Paediatric Diabetes Audit show that only 6% of children and young people whose checks are being recorded are getting all of the recommended diabetes care, services and support that they are entitled to. Over 85% of children and young people over the age of 12 have blood glucose levels higher than the recommended targets. As many noble Lords here will know, on 13 March, Diabetes UK launched its type 1 essentials for children and young people campaign. In seeking to help end the variation in levels of diabetes care, the organisation wants to see specific diabetes leadership and a diabetes service improvement function in the new NHS improvement body. Assuring the effective commissioning of integrated models of diabetes care across primary and specialist services by working closely with clinicians and patients is vital.

Despite the fact that type 1 diabetes is a condition which people have to live with every day of their lives, my noble friend Lord Hoyle pointed out that education for people with diabetes is not universal or guaranteed. NICE guidance recommends that people with type 1 and type 2 diabetes should be offered patient education programmes to help them understand more about their condition and develop the skills needed effectively to self-manage their diabetes. An economic analysis performed by the York Health Economics Consortium, referred to by my noble friend Lord Harrison, revealed that DAFNE, a structured education course for people with type 1 diabetes, would pay for itself within four to five years due to the reduced complication rate expected from improved management of an individual’s diabetes.

As my noble friend Lord Hoyle said, the National Diabetes Audit has been collecting data on structured education in England and Wales since 2005. However, the completeness of the data is limited and therefore has not previously been reported nationally. The 2009 data show that of the 6,444 people who were diagnosed with type 1 diabetes during that year, just 180 recorded offers of education. In Diabetes UK’s 2009 membership survey, only 36% of people had attended a course to help them manage their diabetes since diagnosis. All people with diabetes, whether recently diagnosed or those with pre-existing diabetes, should receive access to the education and support they need to enable them to manage their condition. It should be available in their local area and be accessible and flexible enough to meet their individual needs. Like other noble Lords today, and like Diabetes UK, I welcome the appointment of Dr Jonathan Valabhji as the National Clinical Director for obesity and diabetes for England. However, I would seek from the Minister an assurance that type 1 diabetes will not be forgotten and that it will remain a core part of the new director’s responsibilities. I have completed my speech without interruption.