Diabetes

Steve Brine Excerpts

Wednesday 9th January 2019 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

We were so close.

[Martyn Day]

Yes, but it had to come in, given the requirement to stockpile insulin. Diabetes charities have warned that lives could be put at risk without reliable supplies of insulin, as the UK imports the vast majority of its stocks of the medicines. In response, stockpiles have been increased, which is good. Dan Howarth, the head of care at Diabetes UK, said in September:

“Insulin and other diabetes medication aren’t optional extras for the millions of people in the UK who rely on them. It’s incredibly important that the companies involved in their production and distribution, and those involved in guaranteeing their entry into the UK, work together so that supply continues uninterrupted.”

I would be grateful for reassurances from the Minister that that will indeed happen and about how long our supplies will last should we face the worst-case scenario.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

It is nice to see you in the Chair, Mr Robertson. I thank all Members for their contributions and my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) for securing the debate. He introduced it with his usual flourish, and I know that people watching will have been interested in what he said and the issues that he raised.

We have to keep these issues high on the agenda. They affect a lot of people and we talk about them a lot in Parliament; I cannot think of a Health oral questions that I have been involved in as a Minister when diabetes has not come up. There is a reason for that: because it affects so many of us and our constituents. We must keep raising it.

This is a timely debate. We published the long-term plan for the NHS on Monday. Diabetes features prominently in the plan, which is no accident. We would expect it to, and if it did not, we would have a debate on why not. However, more than that, the plan has a strong focus on prevention and on building a health service for the needs of the 21st century that supports people to manage their own health—not only for diabetes but across the piece—and wellbeing.

We really support that agenda in this Department and with this Secretary of State. That matters for patients—our constituents—with diabetes and others. Chris Askew is a very good man and chief executive of Diabetes UK, and his welcome for the long-term plan and the diabetes sections within it greatly attests to that.

We have heard some excellent contributions. I very much enjoyed listening to the intervention from my right hon. Friend the Member for Wantage (Mr Vaizey) and his suggestion about Brine labelling; my right hon. Friend the Member for Ludlow (Mr Dunne), who gave us insights about his two-year-old daughter; and my hon. Friend the Member for South West Bedfordshire (Andrew Selous), who talked about the food industry and child obesity. We also heard speeches from the right hon. Member for Knowsley (Mr Howarth), who talked about an artificial pancreas, which was very interesting, and from the hon. Member for Workington (Sue Hayman). I should be able to cover all those items. If I do not cover everyone’s points, I will of course write to them, as is my usual practice.

I have to say that I particularly enjoyed the contribution from my hon. Friend the Member for Rochford and Southend East (James Duddridge). It was a very powerful and insightful speech, as it always is from him, and it was delivered from the heart. He made the very good point that we are all different. That is one of the challenges not just for diabetes care, but for healthcare generally. Healthcare is not an exact science. I say that not as a doctor, but as someone who spends a lot of time with doctors.

My hon. Friend also made a point about the complexity of diabetes. In reality, it is a spectrum. We have heard a lot of talk this morning about type 1 diabetes—from the right hon. Member for Knowsley, for instance—and about type 2 diabetes from many others. But increasingly we hear about—it is not a new term—type 1.5 diabetes, otherwise known as LADA, or latent autoimmune diabetes in adults. As I understand it, that is not a clinical definition, but is generally used to describe a slow-onset form of type 1 diabetes that is often mistaken for type 2 diabetes. There are many support services for that condition, and people are increasingly talking to their doctors about it. There is lots of clinical debate around it, but the topic has been around since the 1970s. That goes to the heart of my hon. Friend’s point. Diabetes is a complex condition. There is a spectrum for diabetes, as there is for many other conditions.

I, too, pay tribute to the NHS staff, to the diabetes nurses and the doctors, but also to the support groups. My constituency has the Winchester and Eastleigh diabetes support group, which I spoke to recently. We will all have those groups in our constituencies. As MPs, we are very used to having in front of us people who are far more expert on the subject that they have come to talk to us about than we are—every single one of my constituency surgeries is an example of that—but never is that more true than when we talk to people with diabetes, who have a great and expert knowledge of their condition and the management of it. If they do not, we need to help them to have better, expert knowledge of their condition, because that is as much in our interest as it is in theirs.

There are a couple of points to touch on. My right hon. Friend the Member for South Holland and The Deepings, in introducing the debate, and my hon. Friend the Member for South West Bedfordshire touched on the food and drink industry and healthier eating. It is important that we build on the world-leading action set out in both chapters of our childhood obesity plan. We have already seen real success. More than half of all drinks in the scope of the soft drinks industry levy are being reformulated. That is equivalent to removing some 45 million kg of sugar every year, as a result of the so-called sugar tax. And some products in the sugar reduction programme are exceeding their first-year targets. For example, a 6% reduction is being achieved for yoghurts.

We will consider further use of the tax system to promote healthy food—the challenge that my hon. Friend put to me. He mentioned sugary milky drinks. The Treasury was very clear, when former Chancellor of the Exchequer George Osborne launched the sugar tax, that in 2020—next year—we would review the sugar levy and whether to extend it to milky drinks. As the Minister, I for one will certainly be welcoming that.

As part of chapter 2, we have already held consultations on ending the sale of energy drinks to children and on calorie labelling in restaurants. We are reviewing the feedback and will formally respond in due course. We will very shortly be launching consultations on restricting promotions of fatty and sugary products by location and price, and we will be consulting on further restrictions, including a 9 pm watershed, at the earliest opportunity, with the aim of limiting children’s exposure to sugary and fatty food advertising and driving further reformulation. What I will say, in answer to the challenge that I have been given on those products, is that not everyone agrees that we should do this. Let us be honest: there are people in our party who do not. I challenge them to look at the challenge that we have in our country with obesity and what it is costing our country and our health service. If we believe in a publicly funded health service, we believe in a public health system that challenges these kinds of condition, so I say to my hon. Friends: keep raising the issue in the House. Next Tuesday they will have an opportunity to do so.

Alongside that, we are committed to exploring what can be done on food labelling when we leave the European Union. My hon. Friend the Member for Ochil and South Perthshire (Luke Graham), who is no longer in his place, raised traffic light labelling. We cannot do that as a member state, but we will soon be free. Some companies have decided to take it on themselves. Kellogg’s, the cereal manufacturer, which has been mentioned this morning, announced just before Christmas that it intends to do that. I welcome that and give credit to Kellogg’s for doing it.

Wherever possible, the aim is of course to prevent type 2 diabetes from developing in the first place, which is emphasised in the NHS long-term plan. I am very pleased that NHS England and Public Health England, for which I have responsibility, and Diabetes UK, working hand in glove, have had great success in working on what is the first diabetes prevention programme to be delivered at scale nationwide anywhere in the world.

[Andrew Selous]

Will the Minister give way?

[Steve Brine]

Very briefly—be quick.

[Andrew Selous]

I, too, am very pleased that Kellogg’s has brought in traffic light labelling, but does the Minister agree that, with Kellogg’s Frosties at 37 grams of sugar per 100 grams, there is much more to do as far as Kellogg’s is concerned?

[Steve Brine]

Not only do I agree with my hon. Friend, but the company would agree with him. It is very aware of how much pressure that I and the Government are putting on it to change its products. I would say that it is top of my Christmas card list. Many other manufacturers have not yet made it on to my list, and I ask them to step up and raise their game to the level of the best. I am sure that they can.

In 2018-19, the diabetes prevention programme achieved full national roll-out, making England the first country in the world to achieve full geographical coverage. That is a great achievement, and the figures are good. As set out in the long-term plan, NHS England intends to double the capacity of the programme up to 200,000 people per annum by 2023-24. As my right hon. Friend the Member for South Holland and The Deepings said, it is a modest number in context, but it is also a big number. This is still the largest diabetes prevention programme of its kind. He asked whether we keep these things under constant review and whether we have the ambition to go further. You bet we do, and I think we need to.

There has been much talk this morning about technology. We are also developing an online, self-management support tool called HeLP, comprising a structured education course that has content focused on maintaining a healthy lifestyle for people with type 2 diabetes. That includes content on weight management and alcohol reduction—that can of course help with many health challenges—and cognitive behavioural therapy related to diabetes-related distress. NHSE hopes, once the tool has been developed, to roll it out in the summer of this year.

[Sir John Hayes]

In my opening remarks, I called for a new system for appraising technology and ensuring that it is allocated according to need and consistently across the country. On education, it does seem to me that there is a littered landscape. We have Public Health England, the NHS and local authorities. That littered landscape could easily lead to complication, confusion and even, possibly, contradiction, so will the Minister look at that, too?

[Steve Brine]

Of course I will look at it. I talk to Public Health England regularly about all these matters, and I take my right hon. Friend’s challenge on board. In the time that we have, I cannot respond in any more detail, but I totally take his challenge on board.

There are public health campaigns such as One You, the behavioural change campaign aimed at people in the 40-to-60 age bracket—sadly, that now includes me—and designed to motivate people to take steps to improve their health through action on the main risk factors, such as smoking, inactivity, obesity and alcohol, which will help to reduce the risk of developing type 2 diabetes.

I would like to say so much more, but as ever in the House of Commons there is no time to do so. What I will say is this. We have great ambition in the long-term plan. The long-term plan is a living document, a document that we will build on—we have ambitions to go even further—but I hope that the Government and I, as the Public Health Minister, have shown our commitment to improving outcomes for people with diabetes and living with it through treatment, but also to helping to prevent people from developing it in the first place. Our constituents demand that from us, and our health service, if we believe in it as a publicly funded, free at the point of use health service, which we do, needs us to deliver on that, and we will.