Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether her Department is taking steps to increase uptake in the use of monitoring technologies by patients with diabetes.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The National Institute for Health and Care Excellence (NICE) has recently issued clinical guidelines in relation to the management of insulin dependent diabetes, covering patients living with type 1 and insulin dependent type 2 diabetes. This includes devices to support blood glucose monitoring. These recommendations are now being implemented by integrated care boards (ICBs).

On 19 December 2023, NICE published its final recommendation on the hybrid closed loop system for people with type 1 diabetes. NICE has agreed with NHS England that all children and young people, women who are pregnant or planning a pregnancy, and those people who already have an insulin pump will be first to be offered a hybrid closed loop system as part of a 5-year roll-out plan. NHS England has set out priorities for access, to help reduce healthcare inequalities through their implementation plan.

Responsibility for the delivery of services and the implementation of NICE recommendations rests with the appropriate National Health Service commissioner. As diabetes care is commissioned by local ICBs, they are responsible for developing commissioning policies. ICBs must pay due regard to NICE guidance, however local decision making applies in terms of deciding whether to utilise their funding to implement the recommendation or not.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, pursuant to the Answer of 29 February 2024 to Question 15459 on Diabetes: Medical Equipment, what the evidential basis is for growth in the prescribing of diabetes technology for people living with type 2 diabetes.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The National Institute for Care and Excellence (NICE) published a recommendation in March 2023 that people with type 2 diabetes, who have multiple daily insulin injections and a condition or disability that means they cannot use capillary blood glucose monitoring, should be offered Continuous Glucose Monitoring (CGM) technology, either real time or intermittent, to support self-monitoring.

The NICE also recommended in March 2023 that adults with insulin-treated type 2 diabetes having their blood glucose monitored by a care worker or healthcare professional, are offered CGM. The rationale is that CGM can help to improve glycaemic control in adults with type 2 diabetes who use insulin.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether her Department plans to take steps to ensure that every person with diabetes has access to medical technology that helps them manage their condition.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

Standard care for type 1 diabetes involves regularly measuring blood glucose levels by self-monitoring, blood testing, or by using a continuous glucose monitor, real-time or intermittently scanned.

The NHS Long Term Plan committed that 20% of people with type 1 diabetes would benefit from life changing flash glucose monitors. Data to quarter three of 2022/23 shows that 73% of people with type 1 diabetes were prescribed flash glucose monitoring, against the 20% target.

In March 2023 the National Institute for Health and Care Excellence (NICE) recommended that insulin dependent patients with type 2 diabetes should also benefit from flash or continuous glucose monitoring devices. We are now starting to see a growth in prescribing within the type 2 diabetes patient group.

On 19 December 2023 the NICE published its final recommendation on the hybrid closed loop system. The NICE has agreed with NHS England that all children and young people, women who are pregnant or planning a pregnancy, and those people who already have an insulin pump will be the first to be offered a hybrid closed loop system, as part of a five-year roll-out plan. Access to hybrid closed loop systems will be through a five-year phased roll out, in line with NHS England’s implementation plans.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, how many and what proportion of patients with type 1 diabetes use (a) finger-pricking monitoring and (b) continuous monitoring to track their glucose levels.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

Standard care for type 1 diabetes involves regularly measuring blood glucose levels by self-monitoring, blood testing, or by using a continuous glucose monitor, real-time or intermittently scanned.

The NHS Long Term Plan committed that 20% of people with type 1 diabetes would benefit from life changing flash glucose monitors. Data to quarter three of 2022/23 shows that 73% of people with type 1 diabetes were prescribed flash glucose monitoring, against the 20% target. As a result of the recent National Institute for Health and Care Excellence guidance that also recommended that insulin dependent patients with type 2 diabetes should benefit from flash or continuous glucose monitoring devices, we are now starting to see a growth in prescribing within the type 2 diabetes patient group.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, how many and what proportion of patients with type 1 diabetes use real time continuous glucose monitoring to manage their diabetes.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

Standard care for type 1 diabetes involves regularly measuring blood glucose levels by self-monitoring, blood testing, or by using a continuous glucose monitor, real-time or intermittently scanned.

The NHS Long Term Plan committed that 20% of people with type 1 diabetes would benefit from life changing flash glucose monitors. Data to quarter three of 2022/23 shows that 73% of people with type 1 diabetes were prescribed flash glucose monitoring, against the 20% target. As a result of the recent National Institute for Health and Care Excellence guidance that also recommended that insulin dependent patients with type 2 diabetes should benefit from flash or continuous glucose monitoring devices, we are now starting to see a growth in prescribing within the type 2 diabetes patient group.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether she has made an assessment of the adequacy of the availability of continuous glucose monitoring for people with type-1 diabetes; and if she will make an assessment of the potential merits of taking steps to increase access to that monitoring.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The NHS Long Term Plan made a commitment that 20% of people with type 1 diabetes would benefit from life changing flash glucose monitors. Data up to the third quarter of 2022/23 shows that 73% of people with type 1 diabetes were prescribed flash glucose monitoring, against the 20% target. As a result of the recent National Institute for Health and Care Excellence guidance that also recommended that insulin dependent patients with type 2 diabetes should benefit from flash or continuous glucose monitoring devices, we are now starting to see a growth in prescription within the type 2 diabetes patient group.

Variation ratio in prescribing between the most and least affluent Indices of Multiple Deprivation (IMD) quintiles has been monitored on a quarterly basis. Variation between these IMD quintiles has reduced in every English region. When the programme started, Flash was twice as likely to be prescribed to patients living in the most affluent areas. The current ratio between most and least affluent geographies is now at a ratio of 1 to 1.02, meaning there is virtually parity between the most and least deprived patient groups across England.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps she is taking to monitor the effectiveness of hybrid closed loop technology implementation on (i) glycaemic control, (ii) quality of life and (iii) reduction in complications for patients.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The National Institute of Health and Care Excellence (NICE) has published their draft guidance on hybrid closed loop (HCL) technology for managing blood glucose levels in type 1 diabetes.

HCL technology represents a step change in care for patients living with type one diabetes, which is why NICE has agreed a five-year roll out of this technology with NHS England. This is to ensure the National Health Service has the staff training and patient support in place to safely roll out this new technology.

Access to medical devices should be determined by clinical need. It is our priority to ensure that all patients have access to the most innovative treatment options, wherever they live in the country.

Integrated care boards (ICBs) are responsible for developing a plan for meeting the health needs of their population, managing the NHS budget, and arranging for the provision of health services in the integrated care systems.

For HCL, NHS England will make clinicians aware of priority patients to help ensure equality of access and will keep this under review as it rolled out expands to other groups over the implementation period. NHS England will engage with patient representative groups, ICB leads, trust clinical leads working within children, young people and adult services, and professional bodies as part of the implementation strategy’s development.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether she plans to (a) involve patients with and (b) raise awareness of the (i) potential merits and (ii) availability of hybrid closed loop technology.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The National Institute of Health and Care Excellence (NICE) has published their draft guidance on hybrid closed loop (HCL) technology for managing blood glucose levels in type 1 diabetes.

HCL technology represents a step change in care for patients living with type one diabetes, which is why NICE has agreed a five-year roll out of this technology with NHS England. This is to ensure the National Health Service has the staff training and patient support in place to safely roll out this new technology.

Access to medical devices should be determined by clinical need. It is our priority to ensure that all patients have access to the most innovative treatment options, wherever they live in the country.

Integrated care boards (ICBs) are responsible for developing a plan for meeting the health needs of their population, managing the NHS budget, and arranging for the provision of health services in the integrated care systems.

For HCL, NHS England will make clinicians aware of priority patients to help ensure equality of access and will keep this under review as it rolled out expands to other groups over the implementation period. NHS England will engage with patient representative groups, ICB leads, trust clinical leads working within children, young people and adult services, and professional bodies as part of the implementation strategy’s development.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps she is taking to support equal access to (a) hybrid closed loop and (b) other new medical technologies.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The National Institute of Health and Care Excellence (NICE) has published their draft guidance on hybrid closed loop (HCL) technology for managing blood glucose levels in type 1 diabetes.

HCL technology represents a step change in care for patients living with type one diabetes, which is why NICE has agreed a five-year roll out of this technology with NHS England. This is to ensure the National Health Service has the staff training and patient support in place to safely roll out this new technology.

Access to medical devices should be determined by clinical need. It is our priority to ensure that all patients have access to the most innovative treatment options, wherever they live in the country.

Integrated care boards (ICBs) are responsible for developing a plan for meeting the health needs of their population, managing the NHS budget, and arranging for the provision of health services in the integrated care systems.

For HCL, NHS England will make clinicians aware of priority patients to help ensure equality of access and will keep this under review as it rolled out expands to other groups over the implementation period. NHS England will engage with patient representative groups, ICB leads, trust clinical leads working within children, young people and adult services, and professional bodies as part of the implementation strategy’s development.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps she is taking to help ensure access to hybrid closed loop technology.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The National Institute of Health and Care Excellence (NICE) has published their draft guidance on hybrid closed loop (HCL) technology for managing blood glucose levels in type 1 diabetes.

HCL technology represents a step change in care for patients living with type one diabetes, which is why NICE has agreed a five-year roll out of this technology with NHS England. This is to ensure the National Health Service has the staff training and patient support in place to safely roll out this new technology.

Access to medical devices should be determined by clinical need. It is our priority to ensure that all patients have access to the most innovative treatment options, wherever they live in the country.

Integrated care boards (ICBs) are responsible for developing a plan for meeting the health needs of their population, managing the NHS budget, and arranging for the provision of health services in the integrated care systems.

For HCL, NHS England will make clinicians aware of priority patients to help ensure equality of access and will keep this under review as it rolled out expands to other groups over the implementation period. NHS England will engage with patient representative groups, ICB leads, trust clinical leads working within children, young people and adult services, and professional bodies as part of the implementation strategy’s development.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether his Department plans to take steps to promote to patients the use of hybrid closed loop technology for patients with type one diabetes.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The National Institute for Care and Excellence (NICE) has published its draft guidance on Hybrid Closed Loop (HCL) technology which recommends the cohorts of patients with type 1 diabetes that it should be rolled out to. The draft guidance is out for comment until 28 November 2023. If there are no appeals, then the final guidance will be published in December 2023. Recognising HCL represents a step change in care for patients living with type 1 diabetes, NICE has agreed with NHS England a planned five year roll out for this technology recognising that both clinicians and patients require training to safely use the HCL technology.

The Department welcomes NICE’s draft guidance and supports the NHS England phased approach to adoption. NHS England will make clinicians aware of the priorities for access, to help reduce healthcare inequalities.

If a patient meets the eligibility criteria for the hybrid closed loop, then their clinician can recommend this in line with NICE recommendations. NHS England is engaging with integrated care board leads, trust clinical leads working within children, young people and adults services, professional bodies and patient representative groups as part of the implementation strategy’s development.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether his Department plans to take steps to promote to clinicians the use of hybrid closed loop technology for patients with type one diabetes.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The National Institute for Care and Excellence (NICE) has published its draft guidance on Hybrid Closed Loop (HCL) technology which recommends the cohorts of patients with type 1 diabetes that it should be rolled out to. The draft guidance is out for comment until 28 November 2023. If there are no appeals, then the final guidance will be published in December 2023. Recognising HCL represents a step change in care for patients living with type 1 diabetes, NICE has agreed with NHS England a planned five year roll out for this technology recognising that both clinicians and patients require training to safely use the HCL technology.

The Department welcomes NICE’s draft guidance and supports the NHS England phased approach to adoption. NHS England will make clinicians aware of the priorities for access, to help reduce healthcare inequalities.

If a patient meets the eligibility criteria for the hybrid closed loop, then their clinician can recommend this in line with NICE recommendations. NHS England is engaging with integrated care board leads, trust clinical leads working within children, young people and adults services, professional bodies and patient representative groups as part of the implementation strategy’s development.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether her Department plans to take steps to ensure that all patients with protected characteristics are included in the roll-out of hybrid closed loop technology for patients with type 1 diabetes.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

National Institute for Health and Care Excellence (NICE) has published final draft guidance on the use of the hybrid closed loop (HCL) systems for managing blood glucose levels in type 1 diabetes to the National Health Service in England. The draft guidance is out for comment until 28 November 2023. If there are no appeals, then the final guidance will be published in December 2023.

NHS England are engaging with integrated care boards (ICBs) and other stakeholders as part of the development of the HCL implementation strategy. The strategy will provide advice and guidance to ICBs and NHS providers on the phased approach to implementation. Prioritisation will be based on patient need within the eligible population and through the National Diabetes Audit, activity rates and outcomes will be reported to monitor unwarranted variation in access and address health inequalities.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what assessment his Department has made of the adequacy of the diabetes workforce across NHS England in the context of the NICE Technology Appraisal on Hybrid closed loop systems for managing blood glucose levels in type 1 diabetes.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The National Institute for Health and Care Excellence (NICE) has published final draft guidance on the use of the hybrid closed loop (HCL) systems for managing blood glucose levels in type 1 diabetes to the National Health Service in England. The draft guidance is out for comment until 28 November 2023. If there are no appeals, then the final guidance will be published in December 2023.

NICE has accepted a funding variation request from NHS England which will see the technology rolled out across England over a five-year period.

The introduction of the HCL systems represents a step-change in care for people living with Type 1 diabetes and NHS England is ensuring that the NHS has the staff, training and patient support in place to safely rollout the technology across the country.

NHS England is engaging with integrated care boards and other stakeholders as part of the development of the HCL implementation strategy. The strategy will provide advice and guidance to integrated care boards and NHS providers on the phased approach to implementation.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what funding his Department plans to allocate to support the adoption of the NICE Technology Appraisal on Hybrid closed loop systems for managing blood glucose levels for people living with type 1 diabetes.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The National Institute for Health and Care Excellence (NICE) has published final draft guidance on the use of the hybrid closed loop (HCL) systems for managing blood glucose levels in type 1 diabetes to the National Health Service in England. The draft guidance is out for comment until 28 November 2023. If there are no appeals, then the final guidance will be published in December 2023.

NICE has accepted a funding variation request from NHS England which will see the technology rolled out across England over a five-year period.

The introduction of the HCL systems represents a step-change in care for people living with Type 1 diabetes and NHS England is ensuring that the NHS has the staff, training and patient support in place to safely rollout the technology across the country.

NHS England is engaging with integrated care boards and other stakeholders as part of the development of the HCL implementation strategy. The strategy will provide advice and guidance to integrated care boards and NHS providers on the phased approach to implementation.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what plans his Department has to ensure the NICE Technology Appraisal on Hybrid closed loop systems for managing blood glucose levels in type 1 diabetes is adopted by integrated care systems.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The National Institute for Health and Care Excellence (NICE) has published final draft guidance on the use of the hybrid closed loop (HCL) systems for managing blood glucose levels in type 1 diabetes to the National Health Service in England. The draft guidance is out for comment until 28 November 2023. If there are no appeals, then the final guidance will be published in December 2023.

NICE has accepted a funding variation request from NHS England which will see the technology rolled out across England over a five-year period.

The introduction of the HCL systems represents a step-change in care for people living with Type 1 diabetes and NHS England is ensuring that the NHS has the staff, training and patient support in place to safely rollout the technology across the country.

NHS England is engaging with integrated care boards and other stakeholders as part of the development of the HCL implementation strategy. The strategy will provide advice and guidance to integrated care boards and NHS providers on the phased approach to implementation.