Health: Diabetes

Viscount Falkland Excerpts

Thursday 4th November 2010 Lords Chamber

[Viscount Falkland]

My Lords, I, too, thank the noble Lord, Lord Harrison, for the chance to speak on what is really a very important health matter. I am a type 2 diabetic of 10 years’ standing. Like many men, I hid my head in the sand for a while, although I knew that something was wrong. Curiously enough—it was actually 11 years ago—the condition would manifest itself most strongly when I was speaking in your Lordships’ House: I could not see as well, I used to feel that my voice was failing and I would feel an enormous thirst come upon me. Eventually another Peer asked me whether I was all right. He turned out to be another diabetic—he is still with us today, alive and kicking—and, having spoken to me at lunchtime, he made an appointment for me to see his doctor at 4 o’clock that afternoon. I went to that appointment and I was in a clinic by the next day, where the principal doctor dealing with me said, “It’s a good thing you have come, because things aren’t very good and you are about one Coca-Cola away from a coma”. Diabetes is an insidious disease because generally you feel perfectly well, apart from under certain stressful conditions. I am grateful to the noble Lord for his actions, although I have not been able to repay him other than by suggesting that he might like to move to France because he was unhappy with his rubbish collections. Apparently, in France his rubbish is collected on six days out of seven. I feel that that is a poor exchange, but I was glad to be able to do something for him.

I was on ordinary medication for half the time before it became necessary for me to depend on insulin and, during that time, I was lucky enough to receive expert advice from health professionals on how to deal with my condition. I have become increasingly aware from people to whom I have spoken that diabetics are in a kind of a club. For instance, the man who collects my rubbish that will not be collected by the local council has diabetes. He is an ex-cruiserweight boxer, whom I like very much, but even though he has been a man of physical action he does not understand how the body works. His doctor has not told him why his metabolism has changed—why he cannot metabolise carbohydrates and so on—even though he is an intelligent man. Broadly, in a population in which diabetes is becoming an increasing problem, far too little information is given by the authorities on the basics of how the body works and why the body might not be working normally. It is one of the wonders of the human body that it can do all the things that we know that it has to do. With diabetes, it is rather like moving from an automatic car to having to do everything manually. The control of diabetes is extremely difficult, so people need education and training to deal with it. I know that the National Health Service does not have the time—I am a great supporter of the NHS, which is second to none in dealing with serious conditions—but, where a serious illness is some way off but it is known that a present condition could lead to such illness, I think that there are serious deficiencies in the NHS.

Happily, over the 10 years in which I have had diabetes there have been a number of developments, many of them from the United States. I know that the United States has problems with healthcare, but most of the developments in technology—pumps, monitors and so on—come from there. Much of the development is costly but it is extremely effective. For example, the pumps that are now available for children with diabetes 1 are minute, and they do not have to inject. There has been an absolutely transformation of that scene.

I have managed to keep reasonable, but not perfect, control of my diabetes. The condition can lead to issues with your feet, nerve endings, eyes and so on, but if you do not control it and you do not have regular check-ups to make sure that what is called technically your HbA1c, which is inescapable, is under control—any doctor can tell from a blood test whether it is or not—you will be in serious trouble. The problem with the National Health Service is in part due to the short-termism that exists in Britain in many other respects. I have spoken about this before. Quite naturally, the NHS is concerned about costs, but the expense of dealing with diabetes is all about cost-benefit analysis. For example, to give a pump to a person with an HbA1c in excess of 9 per cent or 10 per cent, which is very dangerous but can easily be dealt with by some of the new technologies, costs about £5,000—the price will probably fall—but for someone who is almost bound one morning to wake up with a red mist in front of his eyes, or his feet not working, or a pain in his chest that is then diagnosed as heart disease, a proper cost-benefit analysis would show that, if the NHS paid for the pump, it would save money in the long run by preventing the person from developing these serious conditions. That is the serious point that I wish to make. It is curious how you can get the serious point over quite quickly when you have nine minutes, whereas it is very difficult when you have only three.

Diabetes is generally a self-treating condition, on which you know more than your doctor—although not all doctors. I asked a question in the House as a result of a disagreement that I had had with one of the doctors in my practice. It was answered by the noble Baroness, Lady Thornton. I was very grateful to her, because she gave me the answer that I wanted to hear, which was not in accordance with what the doctor had said. He had said in sum that people’s HbA1c was generally more satisfactory when they never tested themselves, to which I had said, “That’s nonsense. You’re talking from a cost point of view, because you think the National Health Service shouldn’t pay for the strips and so on”. The answer from the noble Baroness and from NICE was in my favour. It was published, quite wisely, in the specialist diabetes press. There is a lot of difference between relying on your doctor in the normal way—doctors always do their best—and learning about the thing yourself, dealing with it, getting expert advice and going for tests at the right intervals and so on. I hope that the noble Earl will be able tell us when he replies to this debate that the Government have it in mind to approve that.

Not coming from an ethnic community, I did not realise that only 3 per cent of the general population have my condition, but I am proud that I share it with all kinds of people from the different ethnic communities in our country. I know that Indian friends of mine have it, particularly in the feet—I do not know why that should be so. Diet is a very important factor. I can assure the noble Lord opposite that chocolate—as long it is 85 per cent cocoa and he has only three or four squares—is very good for him and he can have it every day. However, he should not have a piece of white bread every day, which is much worse than a bar of chocolate. Having had to spend money on some of the new technology, I have a gadget that measures my blood sugar and shows it on a graph. One piece of toast has a dramatic effect; four squares of chocolate is negligible. One can learn from the new technologies.

I have come to the end of my time, although I could go on for ever. I hope that the noble Lord will introduce a debate on this subject again, because there is much more to say about it. More education and more awareness on the part of the Government and the National Health Service of the cost of not dealing with the disease in its early stages will have immense benefits, not just for individuals but for the state and the economy.