Health: Diabetes

Lord Morris of Aberavon Excerpts

Thursday 2nd July 2015 Lords Chamber

[Lord Morris of Aberavon (Lab)]

My Lords, not for the first time, I congratulate my noble friend Lord Harrison on initiating a debate on diabetes. I am grateful to the House of Lords Library for its briefing pack. We have just heard from the noble Viscount, Lord Falkland, an exceedingly valuable speech on education, which was of service to the House. That certainly is paramount in the subject of the debate.

The background to our concerns are the words of the noble Baroness, Lady Young—we have just had the advantage of hearing her speak and it has been most helpful to have her participate in this debate—in the foreword to Diabetes UK’s State of the Nation report. She said that diabetes is,

“doubling in prevalence every 17 years, and 13 million people were already directly affected or at serious risk”.

I hope that the Government will acknowledge that this is indeed an epidemic and a national crisis, and that the sooner we learn this, and in particular look at the way that expenditure is allocated in the National Health Service, the better.

Understandably, the documentation provided concentrates on type 2 diabetes because of the sheer numbers. I have, in the past, declared a family interest in type 1. The striking comment about type 1, where the numbers are much smaller and which I shall concentrate on, is that it is one of the examples of poorer care. The report states:

“What is particularly striking is that … those with Type 1 … are receiving considerably worse routine care than other people with diabetes, and are achieving poorer outcomes”.

It was a disappointment that the department, in setting up the national commissioning service, rejected a request from clinicians and researchers that type 1 be commissioned separately or at least differently. I fear that the outcome stated in the document underlines the concern that they expressed at that time. In the absence of a disaggregation of expenditure on type 1, could I return to the issue by asking for up-to-date figures for medical research into finding the answer to the problems of type 1? There is, I fear, despite what we have heard, no simple solution.

As I have told the House previously, I have visited research centres at Cambridge—my university—at Oxford and at King’s College Hospital, London, to discuss the research into the only possible solution, which is the successful creation of an artificial pancreas. I have had its progress explained to me, for which I am most grateful, and I have maintained an interest in the great work being done at those three centres and, I am sure, at others as well.

We are told that NHS England will also have a direct commissioning role to support the new commissioning system. I would like to know from the Minister what exactly is in mind and proposed for NHS England as opposed to the commissioning boards locally.

However, in the documentation, there are repeated references to type 2 and its prevention but much fewer to the management of type 1, with its effect on an incredibly high and unexplained number of children suffering from it. My interpretation may be wrong, but it would helpful if there could be much clearer differentiation in figures, guidance and advice between type 1 and type 2.

Perhaps I may select a few figures. In 2012, fewer people with type 1 diabetes received each of the eight recommended care processes: 41% of people for type 1 compared with 62% of people for type 2. Type 1 is less likely to meet the recommended treatment targets for blood glucose and cholesterol. Similarly, and particularly important for this debate, structured education was offered to 2.4% of people with type 1 diabetes compared with 6% of those with type 2. There were similar figures for actual attendance for structural education. These figures mean something, and this is what this debate is about. They are exceedingly low and need some kind of attention. The high number of children with type 1 underlines the problems of underachievement.

Although the figure for children receiving care processes has almost doubled, it is still well below results for adults. There are considerable variations between CCGs in terms of care process completion rates and achievement of treatment targets. The key question that is asked in the Diabetes UK document, which appealed to me considerably and I repeat, is:

“Would you want to live in a place where less than 10 per cent of people with Type 1 diabetes meet all their treatment targets?”.

That is a fundamental question. My assertion would be that, where there is a responsibility and supervision nationally, there cannot be justification for this postcode lottery. I ask the Minister in his reply, or perhaps by letter, to address specifically how the postcode lottery will be dealt with.

The documentation refers to England. Regrettably I am not aware—certainly no one has recently corresponded with me—of the up-to-date figures for Wales, a devolved responsibility. Perhaps Welsh Ministers may tell me. I am sure that the noble Baroness, Lady Young, as the head of Diabetes UK, which is a UK organisation, will fill that gap in my knowledge so that I can compare my own country with England.

I could go on with the differing achievements for type 1 and type 2 in glucose levels, development of cardiovascular disease and achieving realistic targets in checking cholesterol levels. It is quite frightening to read of the emphasis on eye screening, foot checks and kidney checks and the questions posed by differing degrees of achievement. More than a quarter of children and young people have unacceptable blood glucose levels and only 12% receive all the recommended health checks. These are salutary and frightening figures. Can we allow these poor standards to continue?

We have been told, and rightly so, by many in this debate, from the noble Lord, Lord Harrison, to the noble Baroness, Lady Young, that education can equip people with skills to manage their conditions effectively, but only a handful of people attend courses. There is both an individual and an institutional health responsibility. I am sure we will be told by the Minister how it is proposed that the differing commissioning boards will be encouraged to make an increased effort to meet the need of availability and an update of education and learning opportunities. Otherwise, the cost to the National Health Service of resulting complications will be enormous in the years ahead.