Oral Answers to Questions

Debate between Rehman Chishti and Adrian Sanders

Thursday 14th March 2013 Commons Chamber

[Mr Adrian Sanders (Torbay) (LD)]

13. What steps he is taking to reduce the number of households in fuel poverty.

[Rehman Chishti (Gillingham and Rainham) (Con)]

14. What steps his Department is taking to tackle fuel poverty.

Diabetes

Debate between Rehman Chishti and Adrian Sanders

Wednesday 9th January 2013 Westminster Hall

[Mr Sanders]

That would certainly be extremely helpful and would complement the atlas of care by, in a sense, putting the actuality into the story behind the figures. It is extremely unhelpful not to be able to drill down to what is really happening on the ground; we could do that if such statistics were available.

Some of the problems of disseminating information have been offset by the work of NHS Diabetes. It has been instrumental, first, in monitoring variations in care and driving the collection of more robust data, which has culminated in an extremely important publication, the national atlas of variation; and, secondly, in working tirelessly to rectify the problems it uncovers, linking national policy intention with policy implementation on the ground, including support targeted on where the greatest improvements are necessary. It is important that that work continues, as much more could be done. I hope that the Minister will reassure me that, despite the upheavals in the commissioning architecture, NHS Diabetes will retain its central role.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I, too, pay tribute to the hon. Gentleman for his fantastic work as chairman of the all-party group on diabetes. Does he agree that there need to be performance targets, like those for cancer, stroke and heart disease? At the moment, there are not the mandatory performance targets for diabetes that there are for those other diseases.

[Mr Sanders]

I am grateful to the hon. Gentleman for making that point. When one puts together speeches, they sometimes go on too long, and I had cut out that bit, so I am glad that he has raised it. The big issue is that the cause of death is sometimes recorded as stroke or heart disease when the underlying problem is diabetes. We have targets for cancer, heart disease and stroke. We really ought to look at diabetes as the root cause of other conditions for which there are targets.

The variation in care across the country is probably the largest worry for patients now, and the new implementation plan should focus on that. Failings in diabetes care cause an estimated 24,000 premature deaths each year. In 2001, the Department of Health published the national service framework for diabetes, which set out clear minimum standards for good diabetes care. Those standards include nine basic care processes that aim to end preventable complications by looking for early warning signs. Despite those targets, much of the country has seen little progress towards improving detection of type 2 diabetes and reducing the number of preventable diabetes complications. In 2009-10, results from the national diabetes audit showed wild variations in inputs and outcomes for both type 1 and type 2, including the astounding figure that the proportion of type 1s receiving the recommended nine care processes ranged from as low as 5% to 50%, with an average of 32% in England. The figures were only marginally better for type 2s. It really is not good enough.

The point about the condition is that people treat themselves 364 days a year and see a practice nurse or sometimes a general practitioner—more rarely, these days, a consultant—only once a year, although they should receive the nine care processes. The chance of developing diabetic complications can be reduced by keeping blood pressure, blood glucose levels and cholesterol levels low. Regular monitoring, backed up by periodic checks, is the key. The results from the national diabetes audit demonstrate that more needs to be done to end the postcode lottery of care for people with the condition. When as few as 5% of people with type 1 diabetes are receiving all nine care processes in some areas, there is a definite failure of care. If all health care trusts followed the national service framework, such complications as blindness and kidney disease—as well as stroke, heart and other diseases—could be prevented.

I hope that we will explore a range of best practices, but I want to highlight a couple that have scope to bring immediate improvement at very little cost. An acute issue is the provision of insulin pumps for type 1s. That is an example of where the UK should look abroad for best practice. Type 1s in other developed countries, such as France, Germany or the US, can expect to benefit from a pump if that is required for their diabetes management. Somewhere between 15% and 35% of type 1s in those countries have pumps, which enables them to lead normal lives, but in the UK the figure is less than 4%. That is clearly a failure of the commissioning structure as it is now. Will the Minister address how that is likely to improve? The Work Foundation has estimated that, if pump usage reached 12%, the NHS would save about £60 million a year.

Another example of where best practice is needed is surprisingly simple: good local leadership. Good leadership, as I have been fortunate enough to experience in my own area of Torbay, is essential to promoting effective and integrated services. Integration is key to reducing costs in the long term and, more importantly, to improving patient outcomes, which all too often get lost in the debate over health care services.

The move to clinical commissioning groups, with the potential for better scrutiny and criticism from patient groups, local authorities and health care staff could, in theory, lead something of a revolution in spurring innovation and creativity and in the striving to find best practice.

Just as educating the commissioners is crucial, so, for diabetes, is patient education, which has the happy side effect of making patients far more aware of whether they are receiving a good service and enabling them to become better advocates for their condition. I have no doubt that the great knowledge possessed by volunteers for Diabetes UK, the Juvenile Diabetes Research Foundation, INPUT and the many other groups involved in diabetes will be a considerable asset in shaping good services at a local level now that we have better scope for patient scrutiny and involvement.

In the wider sense, patient education is the core to preventing complications, which diminish the quality of life for patients and which, all too often, reduce life expectancy and increase the costs to the NHS in the long term. Good patient education programmes may require some investment, but they would pay for themselves many times over.

On a broader level, work needs to be done on detection and prevention. The number of people suffering from type 2 diabetes is set to reach a staggering 5 million by 2025. However, what many people do not know is that type 2 diabetes is a largely preventable disease. At the very least, its onset can be delayed and complications reduced.

NHS checks are vital to the detection and prevention of diabetes. In theory, such checks are available to all 40 to 74-year-olds who are seen to be at risk of developing diabetes. Shockingly, a number of primary care trusts in the UK failed to offer a single person an NHS health check last year, which demonstrates the dangerous variations in provision in the NHS. The Government can look to rectify that if they create a new national implementation plan for diabetes. Indeed they may even take up the suggestion by the hon. Member for Gillingham and Rainham (Rehman Chishti) to set targets for diabetes.

This year, the current national framework for diabetes comes to an end. It is important that we build on the successes of the framework, that we focus on reducing discrepancies in diabetes care and that the new framework emphasises the importance of health checks and prevention of the disease through simple means such as diet management. Indeed, it is essential for the Government to spell out to commissioners and to patients what services can be expected and to provide a road map to show where we want to be in a few years’ time and how to get there.

[Mr Sanders]

It is a combination of both. We cannot prescribe from the centre precisely what must happen in every area. Of course local areas must reflect their own demographics and their own health picture and be able to apply priorities accordingly. However, there is something to be said for ensuring that local areas have the tools that they need, which is where NHS Diabetes did such a good job on the back of the NHS framework for diabetes.

It is equally important that health checks are used to detect diabetes in its earliest stages, as early detection and appropriate treatment can prevent the severity of the condition and the risks associated with complications such as amputations.

[Rehman Chishti]

On health checks, the hon. Gentleman must have seen the report that says that, according to Diabetes UK, nine out of 10 people do not know the four main symptoms of type 1 diabetes. Surely, therefore, the education should look at ways in which people can identify for themselves the symptoms that can lead to type 1 diabetes.

[Mr Sanders]

That is a very good point. There is the 4 Ts campaign on diabetes. If I remember correctly, the four Ts are thirst, tiredness, toilet and one other— I always remember three, but not four. Anybody who feels thirstier or more tired than usual or is visiting the toilet more often should see their GP. A simple test—it is not an invasive test—can be conducted and after an appropriate early diagnosis a patient can start to feel better very quickly. An ancient fear of great big hypodermic needles being stuck in their skin deters many people from going to a GP, but only 15% of diabetics are put on to an insulin regime on diagnosis and that is because they suffer from type 1. Most type 2 sufferers never have to take insulin via an injection device, and, in any case, those devices are subcutaneous and really nothing to fear. I speak as someone who has to inject four or more times a day, and it really is not as bad as people fear. People should see their GP. If they do not, matters will get worse, complications will set in and they will rue the day that they did not sort out the problem early on.