Health: Diabetes

Lord Rennard Excerpts

Thursday 4th November 2010 Lords Chamber

[Lord Rennard]

My Lords, I, too, congratulate the noble Lord, Lord Harrison, on securing this debate on a topic that is so important to so many people. Like many noble Lords present, I am a diabetic, so I begin by thanking the diabetic team at St Thomas's Hospital, who have done so much to help me and from whom I have learnt a great deal about diabetic management.

Whenever I talk to some of my American friends about how our NHS has supported me in this regard, they agree that we have a wonderful and cost-effective system of providing healthcare to all our citizens, and they share my amazement at the hostility shown by some in the United States this week to the principle of universal healthcare and the option of the public provision of health services. These are things that we are right to regard as hallmarks of a civilised society, so we are rightly very proud of the NHS in the United Kingdom.

I want to use this debate to raise a number of points about the current NHS reorganisation that may be of concern to the millions of people in this country who know that they have diabetes, the millions who either have it but for whom it has not yet been diagnosed or who may develop it in the future, many people who have experience of diabetes in their families, and the health professionals who support them all.

The stark fact that Diabetes UK has drawn to our attention in its report Putting Feet First is that 100 people a week in the UK have a limb amputated as a result of diabetes. The costs of these amputations, which can be measured in very many ways, are very large. The noble Lord, Lord Harrison, referred to the total costs of treating people with diabetes, which amount to approximately 10 per cent of the NHS budget. And the prevalence of diabetes is growing rapidly, so all issues concerned with it must be addressed very seriously.

On the planned NHS reorganisation, I recently spoke to many NHS professionals who say that the advent of GP commissioning in particular both provides opportunities for and threatens better provision of support for people with diabetes. To promote best practice, when there could be a greater number of GP consortia than the current number of PCTs, will make information-sharing between consortia absolutely essential. We know that there is already a problem in that knowledge of the issues about diabetes and best practice vary significantly between GP practices. It will therefore be very important in future that all GP consortia are properly aware of the sort of issues raised in the Diabetes UK report if best practice is to be spread and every GP practice is able to respond appropriately.

The new consortia may need to work together along the lines on which many good primary care trusts work now, otherwise knowledge and efficiencies may be lost. I should be particularly grateful if the Minister could comment on how relevant information and best practice will be shared among the GP consortia in future. In the new arrangements, there may need to be incentives and guidance for GPs who are not experts in diabetic care to involve other health professionals in this aspect of the care of their patients. This is something that a GP recognised in my own practice when I was fortunate enough to be referred to St Thomas's. We need to ensure that the new arrangements do not provide disincentives for such referrals when they are desirable. In funding arrangements, there needs to be recognition that diabetes is significantly more prevalent in certain communities—often those that tend to be most unhealthy generally—and in many ethnic minority populations, to which the noble Baroness, Lady Hussein-Ece, has just referred.

The provision of insulin pumps varies greatly across the country and the United Kingdom lags behind many other countries in such provision. I believe that funding arrangements should recognise that there may be a much greater need for such provision in some areas. There may be significant long-term savings overall to be looked at because of the cost of poor control and diabetic complications, such as amputations and blindness.

We need to make sure that all the consortia recognise the value of diabetic specialist nurses. A specialist team can be the catalyst and driver for improved services and for involving patients properly. The consortia need to be informed about what specialist diabetes services and expertise are available to them. They need to make sure that diagnosis remains a key area for improvement. As Diabetes UK states:

“The delivery of high quality specialist foot care is an essential component of every local diabetes service”.

The human and financial costs of failing to do these things will be very great.