Diabetes

Nick Smith Excerpts

Wednesday 9th January 2013 Westminster Hall

[Nick Smith (Blaenau Gwent) (Lab)]

Thank you, Mr Crausby, for calling me to speak. I congratulate the hon. Member for Torbay (Mr Sanders) on securing this important debate.

Sadly, we had 23 amputations from diabetes last year in my constituency of Blaenau Gwent, despite having a valued specialist foot ulcer clinic run by an advanced podiatry practitioner. So last November I asked the Leader of the House for a debate on how to prevent amputations resulting from diabetes.

The Public Accounts Committee, of which I am a member, was given evidence that the NHS spends at least £3.9 billion a year on diabetes services. It is shocking that the lion’s share of that money is swallowed up in the treatment of avoidable complications. As we know, these complications are not minor; they include amputations, blindness and kidney disease. Such complications are extremely debilitating for the sufferer and extremely expensive to treat. In the worst cases, diabetes can lead to premature death. That is a waste of both precious lives and resources.

Health professionals say that there are 125 amputations weekly because of diabetes, yet 80% of those amputations are preventable. The National Audit Office says that we could save £34 million annually if late referrals to specialist teams were halved. So, it is in the interests of patients and NHS budgets to deliver effective services, with the emphasis—as ever—on prevention and early diagnosis.

The PAC’s report on diabetes services, which was published last November, found that fewer than half the people with diabetes receive the nine basic checks identified in minimum standards of care that were established more than 10 years ago. Unlike cancer, stroke and heart disease, there are no mandatory performance targets for diabetes.

The PAC report highlighted the postcode lottery in provision for people with diabetes, and it also said—to a chorus of consensus—what needs to be done. However, it is just not happening nationwide. Put bluntly, we found that money is being wasted. There is no strong national leadership; no effective accountability arrangements for health service commissioners; no appropriate performance incentives for providers, and no evidence to assure us that the new NHS structure would address the failings that have been identified.

The Leader of the House has told me that diabetes care is a Government priority. So I hope the Government will support a specific pledge that would be widely welcomed. The Putting Feet First campaign, the supporters of which include Diabetes UK and the College of Podiatry, wants there to be a realistic target of a 50% reduction in amputations because of diabetes by 2018. That is a crucial point, because the Health Minister, Earl Howe, told the House of Lords recently that

“Diabetic foot disease accounts for more hospital bed days than all other diabetes complications”.—[Official Report, House of Lords, 29 November 2012; Vol. 741, c. 331.]

Policies to deliver that target include having a multidisciplinary foot care team in every hospital. Shockingly, in 2011 31% of hospitals had no podiatry provision at all. We also need foot protection teams in every community, which will mean more, not fewer, podiatrists in post.

We need a strong message from Government that preventable amputations must be reduced, that local variations will not be tolerated and that precious NHS resources will not be wasted. In addition, as others have already said, the importance of patient engagement cannot be stated too often. In their current consultation on diabetes, the Welsh Government highlight the benefits of having more informed and more confident diabetes patients. Education is an integral part of personalised patient care.

I will now make some concluding comments about how we can turn the tide, given that current projections show that the number of people with diabetes will rise from 3.1 million to 3.8 million by 2020.

How can we improve diet, reduce alcohol consumption and encourage physical activity? Good ideas include: a reduction in the sugar content of soft drinks; a realistic minimum price for alcohol of 50p per unit; restrictions on advertising and sports sponsorship; action to maintain nutritious school meals; teaching our children to cook, and encouraging regular sport and exercise in schools. Together, these ideas are a promising mix of radical measures, unlike the Government’s “responsibility deal”, which is just another case of the triumph of hope over experience.

Last week, a report from the Royal College of Physicians called for a senior figure in Government to take charge of obesity issues across all Departments, covering every area from agriculture to work and pensions. In the US, we have seen the mayor of New York, Michael Bloomberg, ban the sale of “super-size” drinks at entertainment venues. Similar bold and symbolic action is now urgently needed from the coalition Government here.

As I said at the beginning of my speech, there were 23 amputations in Blaenau Gwent last year because of diabetes, and across the UK there will have been many thousands of such amputations, many of which were preventable. The Government need to up their game.

--- Later in debate ---

[Anna Soubry]

Indeed. I was going to end this part of my speech by saying that my constituent, Mr Dawson, paid tribute to what he described as his brilliant diabetic nurse at the Queen’s medical centre in Nottingham. He highlighted, as the hon. Gentleman has done, that it is all well and good having wonderful, great technology, but if people have access to it they need, critically, the support to be able to use it themselves. We must ensure that they have the highest-quality support, not just from their GPs, but from diabetic nurses and others who are trained and specialise in this condition.

Diabetes is common and is increasing, as hon. Members have mentioned. It is estimated that, by 2025, 4 million people will have diabetes.

[Nick Smith]

What are the Minister’s views of Mayor Bloomberg’s plan in New York to ban super-sized soft drinks in cinemas? Does she agree that that could be a good symbolic action that would help bring down diabetes?

[Anna Soubry]

It could be, but I make it clear, as I said on Monday in various media interviews, that at the moment the responsibility deal is working, which is why we have some of the lowest salt levels in the world. Other countries are coming to us to find out how we have achieved that by working with industry, retailers and manufacturers to reduce salt levels. On the reduction of trans fats, under 1% of our food now has trans fats in it. Again, we have done that by working with the manufacturers and retailers.

My natural inclination is against legislation, and I say that as an old lawyer. At the moment, I am confident that the responsibility deal is delivering in the way that I want it to. I make it clear that, if there is a need to introduce legislation, we will not hesitate to do that. I am almost firing a warning shot across the bows of the retailers and food manufacturers and saying, “Unless you get your house in order and accept responsibility, we will not hesitate to introduce legislation or regulation, because we know that we in this country have an unacceptable rise in obesity, to levels that are second only to those in America.” I will therefore consider everything. I always have an open mind. I am currently content, however, that the responsibility deal is delivering, but it has a great deal more to do. I hope that those who are signed up to the calorie reduction scheme later this month will encourage more manufacturers and retailers to sign up to the responsibility deal on calories. I want to ensure that we make some real, serious and tangible progress.

Ultimately, however, as the right hon. Member for Leicester East and the hon. Member for Strangford (Jim Shannon) identified, the responsibility is ours. Nobody forces us to eat the sugar buns or whatever it may be. When we go into the Tea Room and we are faced with the choice between fruit or a piece of cake, my natural inclination might be for a piece of cake, especially since I have developed a sweeter tooth as I have got older and since I have stopped smoking. We all make the choice whether to eat a piece of cake. The ultimate responsibility lies with us as individuals and as parents, but I always have an open mind.

Diabetes is a growing problem and a major factor in premature mortality with an estimated 24,000 avoidable deaths a year—10% of deaths annually are in people with diabetes. A variation exists in the delivery of the nine care processes, with a range of 15.9% to 71.2% achievement across PCTs, which is not acceptable. However, 75% of diabetes sufferers receive eight out of the nine care processes, which is a huge improvement. In 2003-04, only 7% of sufferers received all nine care processes. In 2010-11, that figure was at 54.3%, but there is much more to be done. In the coming months, several documents will be published to guide the NHS in delivering improved diabetes care, including the response to the Public Accounts Committee report, the work undertaken on diabetes as a long-term condition and the cardiovascular disease outcome strategy.

We must ensure that people get an early diagnosis. I must commend again the work of Diabetes UK. Other hon. Members have mentioned how it is raising awareness of the early signs and symptoms of diabetes with its latest campaign on the 4 Ts, which has my full support. One in every two people diagnosed with diabetes already has complications. I thank the hon. Members for West Lancashire (Rosie Cooper) and for Blaenau Gwent (Nick Smith) for their contributions. I will not be able to answer their points specifically in my speech, but I hear what they say and will write to them if necessary to answer their questions. I am acutely aware of the complications and the devastating effects that those can have on people’s lives.