NHS: Diabetic Services

Lord Morris of Aberavon Excerpts

Thursday 29th November 2012 Lords Chamber

[Lord Morris of Aberavon]

My Lords, I am particularly grateful to my noble friend Lord Harrison for choosing to raise the subject of diabetic services. I will concentrate on type 1, in which I declare a family interest. I have had the advantage of consulting Professor Amiel of King’s College Hospital and hope to visit the research unit of Professor Johnson in Oxford in January for further discussion. I am grateful for the excellent briefing by JDRF.

The recently published report by the House Of Commons Public Accounts Committee, which has already been referred to, notes that the incidence of diabetes has doubled in the past five years. The report concentrates on type 2, which comprises the greater number, and is one of the most damning I have ever read. It states:

“There is no strong national leadership, no effective accountability arrangements for commissioners, and no appropriate performance incentives for providers. We have seen no evidence that the Department will ensure that these issues are addressed effectively in the new NHS structure”.

My simple question for the Minister is: are things going to get better after that damning report?

Type 1 diabetes is a chronic, life-threatening condition which has a lifelong impact on those diagnosed and their families. I hope that this debate will send a clear message that the cause of type 1 diabetes does not involve lifestyle factors such as obesity, poor diet or lack of exercise. There is currently no way to prevent the condition and no cure.

I have been trying for some time to get a complete breakdown of the cost of management of type 1, as opposed to type 2. I have had only modest success in the disaggregation of the figures. I firmly believe that when you have a clear idea of specific costs, you can start to prioritise and direct funds. It is estimated that the direct and indirect cost to the National Health Service of treating type 1 is nearly £2 billion a year; 400,000 people are affected, including 26,000 children; and the numbers are growing at 4% per year. The current spending for research on type 1 is inadequate and falls way behind that of other developed countries. In 2009, government spending bodies committed £51 million to fund research into diabetes. Of this, only £6 million was applicable to type 1.

When I was a young Transport Minister in 1966, just before the ark, I learnt of the methods of cost-benefit analysis. It must be painfully obvious that as 26,000 children are already affected and they are growing in number, the cost of lifetime care will be disproportionately high and merits the targeting of research funding. There is an immense issue of management to achieve a target of long-term blood glucose levels. The challenge for the family is that a child aged five faces 19,000 injections by the time he is 18, and will have pricked his finger to draw blood 50,000 times, according to the JDRF.

NICE recommends insulin pump therapy as a clinically and cost-efficient treatment option for type 1. A report by the Medical Technology Group points to significant inequality of provision of pumps across England and a lack of adherence to NICE guidelines. NICE recommends that 12% of people with type 1 should be eligible for a pump and that for children under 12 it should be 33%. The average rate of pump utilisation is 3.9%, which is still the lowest in Europe though substantially better than it was a few years ago. In the United States, provision is estimated at 33%. Mr Burstow, a Health Minister, was able to assure me on 25 April this year that we were generally in line with the United States. How he could reach that conclusion is beyond comprehension. Perhaps the Minister will be able to correct it. If the number of pumps was increased by seven percentage points to reach the 12% benchmark, additional savings on consultant visits and hospital admissions would add between £37 million and £62 million, hence my attachment to cost-benefit analysis.

I welcome the announcement of the publication of NHS scoreboards for availability, delays and access to treatment. Those PCTs not complying—a number of which have been indicated in the various reports—will have to explain themselves, I trust.

It has been emphasised to me by clinicians that providing a pump is part of a package, with structured education first. If injections do not achieve treatment targets, then there is a move on to the provision of a pump. Many achieve the required outcome without it. Evidence-based work is still evolving on how best to provide such education for children. Increasing the skilled force within the NHS to provide such structured education is not without cost. We need to raise the profile of this need if we are to achieve equity of access to such skilled healthcare professionals across the country and across the range for people with type 1 diabetes.

It would be a tragedy if the needs of those with type 1 were lost within the greater number of those with type 2. The current reorganisation of the NHS could be a great opportunity to improve the availability of treatment for those with type 1. I understand that representations were made to the Department of Health for recognition that type 1 people are a small group with a need for highly specialised support. However, the request that type 1 diabetes be commissioned separately, or at least differently, from type 2 has not been approved.

I welcome the work that is being done at King’s, Cambridge, Oxford and Sheffield on the artificial pancreas. It is vital that adequate funding is provided for what could be a welcome and major breakthrough and that, particularly in this period of change, the general issue of funding for type 1 will be addressed. I am told that there has never been a real budget for type 1 services, which have been developed on the back of academic interest and clinical recognition of need. Greater investment by the Department of Health in both the research still required to develop a viable artificial pancreas and in providing technology, as and when it becomes available, and on its role, benefits and limitations, would be very welcome to all concerned for those who suffer from type 1 diabetes. I hope that in my short remarks I have highlighted the separate needs of those with type 1 as well as type 2.