NHS: Diabetic Services

Viscount Falkland Excerpts

Thursday 29th November 2012 Lords Chamber

[Viscount Falkland]

My Lords, I, too, am very grateful to the noble Lord, Lord Harrison, for this debate. Particularly after the long discussions that we had about the House of Lords and its future, this debate so far has shown how it combines expertise, such as my noble friend Lord Kakkar’s expertise as a doctor, experience, such as those of us who are here as diabetics, and those like the noble Lord, Lord Roberts of Llandudno, speaking with articulate concern. It has been a wonderful debate.

A light has been shone on this subject this week. It was unfortunate for the MP for Slough, who is apparently a doctor, to imply that diabetes is a result of a poor lifestyle, and that those who indulge in a poor lifestyle and have diabetes should be deprived of the funding for their medication. That was stupid and irresponsible. What has been said so far in this debate shows that this is a complex condition that we have; I know that I have a complex condition. As I hope your Lordships can see, I am relatively well. I have had diabetes for 13 years. It was diagnosed in this House and I fully admit that I had been in denial. My wife had suggested that I might have diabetes. A good friend of mine in this House asked me to join him for lunch with his guest. After about five or 10 minutes, he noticed that I had been drinking a lot of water, which is one of the signs of a surplus amount of glucose in the bloodstream. He asked me some further questions and said, “Look, I am a diabetic and I think you are too”. He asked me whether I had a doctor. I said that I had hardly ever seen a doctor and that I belonged to a National Health Service panel. He excused himself, saying, “You wait here. I’m going to make an appointment for you this afternoon”.

My friend got me an appointment for that afternoon, which was the last appointment with that particular private doctor before Easter—I did not have a private doctor at that time. The doctor conducted a simple test and said, “You’ve certainly got diabetes and I’m going to pass you on; I don’t feel capable of dealing with it and I think you need immediate attention”. He rang a specialist diabetes clinic and I got an appointment for the following day, which, again, was the last appointment before Easter. I have been with that clinic ever since. However, I use the National Health Service and I talk to the doctor about my diabetes when we have a regular discussion about my medication. I am very thankful to the National Health Service for providing me with my medication and I am very thankful for the nurses, who have been mentioned, in my practice. They often seem to be more on top of the developments than the doctors.

Being a diabetic has been an extraordinary experience. I have had to give up certain things, and I am not talking about just Mars bars and pastry: I have had to give up playing golf; I cannot play with the same concentration that I used to because the blood sugars alter the whole time in one’s bloodstream. For six years I have been an insulin-dependent diabetic, which makes it even more difficult to do certain things, although I can drive a vehicle because I am very conscientious.

I wonder how many diabetics are conscious of the fact that they should report their condition to the DVLA. The DVLA guidelines are rather strange but basically they point in the right direction. If you are an insulin-dependent diabetic, you should check your blood sugar every time you go anywhere near a vehicle. If you are caught in an accident with a low level, you are committing an offence and will pay a penalty.

Generally speaking, my life is pretty good. When I first saw the specialist, he said, “You are in a very bad condition, aren’t you? Do you realise what your blood sugar level is?”. I will not mention the technical term for it but for the average person—for those in this Chamber even—whose pancreas is working properly, the blood sugar level would be about 5.5 or 5.7. Mine was 29 and the specialist said, “You are one Coca-Cola away from a coma”. I said, “I feel perfectly all right”. He said, “That is odd. I have people with a quarter of your level who are almost crawling in through my door”. It is curious because I have a reasonable feeling of well-being most of the time, although not all the time. I think that diabetics can feel like that.

However, I am not convinced that the NHS generally, as has been mentioned today, gives the kind of service that allows people to have the lucky break that I had when my diabetes was spotted. The number of people who are undiagnosed has been mentioned. I think that the noble Lord, Lord Rennard, mentioned the cost and ramifications of that. If you have nearly 1 million people with diabetes all wandering around the streets not feeling 100%, they are likely to have complications without having had the original diabetes diagnosed. Finally, something may bring them to realise it, but it will be a serious business and they may not have long to live. The cost of dealing with that emergency to the NHS is out of all proportion to what would have to be spent on medication on a daily basis.

I do not want to decry the NHS—I am the first person to praise it—but diabetes is an extremely odd, and serious, condition; one’s requirements change the whole time. One very important thing that the noble Lord, Lord Rennard, mentioned, and which saved my life, is the specialist diabetic nurses. It is all that they do, and they are absolutely essential; if you have any stress or worry, they talk you through it and get you to make the necessary adjustments, such as going to see your doctor or changing your medication. So it is quite extraordinary what can be done on a personal level. That is where the NHS is in trouble, because it is really not equipped to deal on a personal level with all the people who have diabetes.

There must be a better interface between the NHS and the private sector. Education and training is essential and can be provided to the NHS, if it cannot handle the problem, by the private sector, and not expensively. In any case, even if it is expensive, it is going to save a lot of money in the long run by preventing the kind of complications that cost all the money. We have already mentioned amputations and heart disease, and all the rest.

That is my first suggestion and question to the Minister. Why can we not work towards closer co-operation on these services with the NHS? When I go to my NHS people, they are sent everything from the private clinic but they do not have a compatible computer, which seems strange. That would seem to me the first step. They get the written stuff, which goes into a file. So when I go in, nobody ever knows what has happened the previous year. I have taken to having just a brief summary of what happened at my last inspection. I go regularly and have all the things that have been mentioned—a carotid examination, a foot examination, everything. I am thankful for that and for the course that my condition has taken. Whether I shall be standing here much longer in this condition, I do not know; I shall not say that I do not care about it, but I am optimistic. I think that I will probably have a pump, in the long run; they have been mentioned for type 1 diabetes but I think that in the end, most people like me, with type 2, will also have pumps. Then perhaps I will be able to go back to the golf tee and play golf again. Who knows?

How can we reduce the number of people who do not realise that they have this condition? As long as it remains at this level, we are in trouble.