Diabetes

– in the House of Commons at 10:45 am on 11th May 2001.

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Motion made, and Question proposed, That this House do now adjourn.--[Mr. Clelland.]

Photo of John Bercow John Bercow Shadow Spokesperson (Home Affairs) 10:55 am, 11th May 2001

It is a pleasure and a privilege to introduce the last Adjournment debate of this Parliament, and it is a particular and unexpected pleasure to do so in the knowledge that the Minister for Public Health will reply to it. If memory serves me correctly, and I am woefully faulty in those matters, as you, Mr. Deputy Speaker, are well aware, I first locked horns with the Minister on the BBC's "Any Questions?" on 21 November 1997. We have periodically jousted since, and it is a delight, albeit a surprise to her as well as to me, to see her in the House today.

The treatment of diabetes is a subject of the greatest importance, and interest in it in the House has been reflected since 1 May 1997 in six oral questions, 110 written questions, 14 early-day motions, three of which were tabled this Session, and no fewer than three Adjournment debates, each of was initiated by Mr. Sanders. They took place on 20 November 1997, 4 March 1998 and 30 November 1999.

In preparation for today's debate, I have received useful briefings from a number of individuals: the public affairs officer of Diabetes UK, Mr. Peter Bainbridge; the honorary secretary of the Aylesbury and district branch of Diabetes UK, Mr. Tony Ibotson; the marketing director of leading diabetes pharmaceutical operation Novo Nordisk, Mr. Adrian Haigh; and the House of Commons Library science and environment specialist on these matters, Dr. Alex Sleator.

What is diabetes? It occurs when there is an excess of glucose or sugar in the body, such that it cannot be used properly. People will probably be aware, and by the end of the debate they ought to know, that there are two main types of diabetes. The more severe version of the disease causes its victims to be dependent on regular supplies of insulin. That is called type 1 diabetes, from which approximately 20 per cent. of sufferers suffer. The other 80 per cent.--between 1 million and 1.2 million people--have been diagnosed as suffering from type 2, which is less serious, though still a worrying and painful affliction. Those individuals are not dependent on insulin and they can be treated by a combination of good diet, tablets and occasional provision of insulin.

We are discussing not only the 1.4 million people who have, as I advisedly said, been diagnosed as suffering from diabetes, but the large number of people--about 1 million--who suffer from the condition in ignorance of the fact. The Minister will know that, on average, people suffer from the disease for seven years before it is diagnosed, though it can be as many as 10 before diagnosis takes place. I shall come to the serious consequences of late diagnosis and, therefore, the corollary of it--the absence for several years of any treatment for the condition.

What causes diabetes? In truth, despite the many studies that have been conducted over a long period in this country and elsewhere, we do not know for certain what causes the condition. However, we do know that certain identifiable factors seem to provoke it. One is heredity. There is often a family history that can be regarded if not as a certain, but as a reliable predictor of someone getting this ghastly disease. A second factor is age. People over 40 are more likely to get it. Overweight--obesity, to give it its modern term--is also a significant cause of diabetes. In addition, we know from empirical evidence that there is, regrettably, a propensity to develop diabetes in the black and Asian communities. It is a truly horrifying fact that one in four Asians over the age of 60 suffer from the disease.

The symptoms of untreated diabetes are unpleasant. They range from extreme thirst to excessive tiredness to frequent urination to severe weight loss to genital itching and to blurred vision. The effects, as distinct from the symptoms, of untreated diabetes are even worse. To avoid doubt, and so that people realise the significance of the problem that we are confronting, let me spell those out. They are heart disease, kidney failure, amputation and, ultimately, blindness.

It is a not a common or garden disease to which we should not give much attention. People often imagine that it is not too serious. They think that it is regrettable and involves some inconvenience, but that it is not a big deal in overall medical terms. I want to emphasise that diabetes is a big deal. It is a big deal in terms of the number of people who suffer from one or other variant of it; it is a very big deal in terms of the costs to the national health service in its diagnosis and treatment; and it is a very big challenge for Governments and, indeed, all parliamentarians to do what they can to address the problem.

It is the significance of the disease that has propelled Diabetes UK to issue a challenge to Members of Parliament in all political parties to sign up to its pledge to recognise that diabetes is a serious disease, to appreciate the importance of early diagnosis--which is accomplished, not least, through early and comprehensive screening programmes--and to accept that each and every diabetes sufferer has a right to receive the best possible treatment available, irrespective of who he or she is, where that person comes from or what particular complications of the disease he or she experiences.

We are in possession of recent and valuable research, which is a result of work carried out in November 1999 by the Audit Commission. The findings were published in April 2000. The study makes salutary and alarming reading. It found that there were huge disparities--as much as fourfold--between the number of clinicians available in some parts of the country relative to others for the treatment of diabetes. The Audit Commission also found that there were substantial variations in the referral patterns in relation to the disease. There does not seem to be a consistency of practice between one area and another.

The quality of hospital care is variable. That is not because of a lack of will, but because of a significant disparity in the number of expert clinicians available to treat those suffering from the disease. There is also a problem at primary care level, where there is a major gulf between the expertise and understanding of some general practitioners and others.

So far as the sufferers are concerned, there are great differences in the level of education and understanding of the disease. Some people have a great understanding of it and know how best to minimise the symptoms and to improve their quality of life. Others, sadly, have not been well informed and are ill aware of what they can do to help themselves and how to seek expert and professional help from others.

We face a serious and growing problem. About 2.5 per cent. of the population suffer from diabetes. The threat--I do not want to be alarmist, but merely to interpret the facts available--is that that will increase in the coming years and 3 per cent. or more might suffer from one or other of the variants of the disease. That leads me, in the short time that I intend to detain the House, to highlight several challenges that I should like to put to the Government.

The Government are formulating a national service framework for the treatment of diabetes. I welcome that and am anxious, as I think everyone of good will in the House will be, to ensure that it best caters to those who suffer now, and offers the maximum hope of prevention and deterrence of the disease. I have three specific inquiries on the national service framework. The first relates to diabetic retinopathy. That phrase does not readily trip off my tongue because I am not expert in such matters. However, it is important that we do not allow complex medical terms to obscure the significance of the subject.

The strong body of opinion says that there should be regular screening for diabetic retinopathy on, for example, an annual basis, which is a modest suggestion. I am not entirely clear whether the Government have decided that that should be a headline objective and written commitment of the national service framework. The framework has yet to be published and I am not expecting the Minister to share all its details on the Floor of the House in advance of its publication, although debates are, regrettably, sometimes the best way to maintain a state secret. However, it would be helpful to hear about the kernel of the Government's thinking.

My second inquiry relates to the need to have a regular and comprehensive screening programme, which Diabetes UK also wants. That does not have to be of the whole population, because that would be superfluous and extortionately expensive, but of the groups that are most at risk. They are, indeed, known as the at-risk groups. Specialist opinion suggests that a regular screening programme could be invaluable in reducing the incidence of the disease. Do the Government intend to go ahead with such a programme? If they do, how is it to be implemented, what resources are to be made available and within what time scale will the objective be accomplished?

Thirdly, I should like to get a feel about how the Government envisage the balance will lie between the primary, secondary and tertiary sectors in the treatment of the disease. I mentioned the variable pattern of hospital provision--some good, some bad, some indifferent. Do they think that the volume of resources consumed in hospital care of sufferers should continue and be extended, or--as I suspect might be the case--are they thinking in terms of greater provision through general practitioner services? I shall be gentle, because I am always understated in such matters, but if the Government have the latter in mind, do they intend to put their money where their mouth is to extend training for general practitioners and provide specialist back-up services to complement the work of GPs in the localities?

Clearly, there will be cost and training implications. If we accept that the treatment of this disease will be multi-faceted, co-operation and co-ordination between the various sectors will be required. The treatment of diabetes is a complicated equation. No one suggests that it can all be dealt with in hospital or at general practitioner level. What is to be done about the shortage of specialist nurses, when is it to be done and how can we be reassured?

I want to refer to the guidelines produced by the National Institute for Clinical Excellence on two drugs that have been recognised as having a potential benefit and palliative impact--pioglitazone and rosiglitazone. Those drugs are of some significance, because they have been given a nudge and a recommendation by NICE and because, to be effective, they require sufferers to have a considerable knowledge and understanding of the disease.

I am well aware that those drugs are not suitable for all sufferers. They will probably be of little use to the many sufferers who, through no fault of their own, are ignorant of how best to minimise their burden. However, the medical experts suggest that if people know quite a lot about their condition--they may have suffered from it for a long time and have taken advice--those drugs can be of value to them.

It is only fair to note the great difference between the usage of those two drugs in this country and elsewhere. I am not making a partisan point, because that has been the position under successive Governments of both political persuasions. A tiny fraction of sufferers of type 2 diabetes use one or other of them. Perhaps we should be ashamed of our performance, or perhaps there are good reasons to explain the differential about which I shall shortly be enlightened by the Minister.

The lower usage of those drugs in this country than elsewhere provides food for thought. Do the Government intend to develop their take-up and use? If so, can we be sure that it is more than just an early pledge, as there will be a resource implication? Do the Government intend, in the very short time available to them before they make way for my hon. Friends and me to take over from them, to provide the resources consistent with adequate provision? I am sure that we are about to be enlightened by the hon. Lady, and that is an enticing prospect for me.

Funding is available through the Medical Research Council for important studies on the causes of diabetes, its incidence and the means by which it can be effectively controlled. In 1998-99, about £3.5 million was made available for that purpose, and in 1999-2000 the figure was about £6.5 million, which was a substantial increase. I do not cavil at that. Those resources would probably have been used to good effect, but I should like to be clear that a continuing value-for-money study is taking place. Are there benchmarks or yardsticks for future research? Is the availability of resources tied to an improvement in the findings of the MRC studies?

What can we expect in practical terms? We are all prone to talk about inputs. We are entirely justified in doing so, but what interests sufferers of this disease, as of others, and their families is not input, but output. What are the results? How are we improving? Are we detecting the disease earlier? Are we preventing it thereby? Are we treating it more effectively? Are we reducing its incidence? Can we hold out the prospect of a diabetes-free age, or at least of an age in which its incidence is dramatically reduced?

Finally, I should like to refer to insulin pumps. The usage of insulin pumps is also relatively low in this country--the figure is about 0.5 per cent.--by comparison with practice elsewhere. In Germany, the Netherlands, Norway, Sweden and the United States, usage by sufferers in the relevant category is 5 per cent. I am uncertain about what the Government have in mind.

In a consultation paper issued in July last year, Ministers said that it would be good if the expert reference group conducted research to see whether wider use of insulin pumps would be effective. Curiously, on 26 February this year, in a written answer to Sandra Gidley, the Under-Secretary of State for Health, Ms Stuart said that no comprehensive evaluation of insulin pumps had taken place, and that no specific guidance had been issued. Is that the Government's final position, or do they intend to do something about it?

There is a need for a vision, for a series of practical steps and, by way of reassurance and encouragement to sufferers, for an indication of a time scale within which these important objectives will be accomplished. I look forward immensely to what the Minister has to say.

I thank you, Mr. Speaker, for your indulgence. I want to pay tribute to the parliamentary and political giant of Mr. Benn, who is present for the final time in this Chamber. It is 51 years and three months since he was first elected to the House. I know that he does not want to be embarrassed by excessive effusions from his lifelong political enemies, but a modest dose of embarrassment does no harm to anyone's health, and what I say to him is sincerely meant. The term is much abused and much over-used in our political life, but he is genuinely a great man.

Photo of Mr Tony Benn Mr Tony Benn Labour, Chesterfield

I was not expecting the hon. Gentleman's comments. There will be no report of his speech in the press. His speech could in no way be linked to the election campaign. It was a scholarly speech about a matter of great interest. The Minister will reply, and it will be a good debate. When people say that Parliament has lost the confidence of the people, it is in part because they do not know that conscientious Members raise important questions and receive proper replies. Hansard is the only newspaper that will record his speech, but I shall long remember it.

Photo of John Bercow John Bercow Shadow Spokesperson (Home Affairs)

That was typically gracious of the right hon. Gentleman. I agree with him about the central point. The longer one is in this place--I have been here only four years and 10 days--the more one appreciates that the vast majority of Members of Parliament on both sides of the House are honest, conscientious, decent and hard working. The activities of the recalcitrant minority tend to besmirch the good name of the majority. It would be fatal for democracy if the profession of politics, which is a perfectly noble calling, were ultimately to be brought into disrepute.

The right hon. Gentleman is the particular champion of principle in politics, but sitting below him is Mr. Campbell-Savours, who has been a similarly principled, steadfast, dedicated and selfless representative of his constituents over a long period, and I wish him a long and enjoyable retirement.

There is no doubt in my mind that MPs have real opportunities to raise important issues on behalf of their constituents. This is one such opportunity. In concluding and in looking forward to the Minister's reply, I want to say that there is no greater privilege for any Briton than to be a Member of Parliament. Every day, when I come into the Palace of Westminster and take my seat in the Chamber--which, as you know, Mr. Speaker, I do with monotonous regularity--I have a glint in my eye, a spring in my step and a feeling of tremendous gratitude for what my constituents have given me the opportunity to do.

Photo of Sir Peter Emery Sir Peter Emery Conservative, East Devon 11:20 am, 11th May 2001

I thank Mr. Bercow for his speech. Four years and 10 days it may have been, but during that time my hon. Friend has earned himself a reputation as the terrier of the Opposition. One factor in that, which he was able to prove today, is that he is a very serious politician who has learned Mr. Benn observed, the case that my hon. Friend presented needs to be publicised much more widely, but when we look up at the Press Gallery we see that not one member of the press is there. That is a great shame, and it was never the case when the right hon. Member for Chesterfield and I were first in the House.

I want to make two points about my hon. Friend's speech. The tragedy that can be generated by this illness is frequently misunderstood or, indeed, not known. Many Members will remember my colleague, Sir Peter Hordern. His son, whose condition was unknown to the family, suddenly suffered a loss of insulin and became unconscious. Still four years later, he needs 24-hour nursing. He cannot speak, and has very little control over himself. Given whose son he is, his background enabled him to be looked after earlier and, luckily, subsequently; but his condition is a terrifying indication of how ghastly the effects of the disease can be. That is why I wanted to underline what was said by my hon. Friend.

The second case I want to raise concerns an employee whose seven-year-old son suddenly fell ill during a school trip. Fortunately, he was quickly diagnosed as being diabetic, has since been stabilised and is now back at school, and even able to play games. If the disease is dealt with properly, it is possible to get on top of it. Nevertheless, I ask the Minister to pay particular attention to the need to provide more information about the treatment of very young diabetics: if a young child has to have injections from the age of six, seven or eight, for the rest of his or her life, it is a terrifying worry for the parents and a ghastly situation for the patient. I should like an assurance that the national health service pays particular attention to cases where diabetes hits youngsters.

Finally, let me pay tribute to tens of thousands of people in Poplar, where the Labour votes were weighed and only mine were counted. I also thank those in Lincoln, where I had my first contact with Lady Boothroyd, as she now is. She was then aide to the sitting Member, Geoffrey de Freitas. I pay tribute also to my erstwhile colleague--I describe him as a colleague, although we were on opposite sides of the House--"Mik" Mikardo. I was able to defeat him in Reading in 1959, unfortunately for him but fortunately for me. He was then a vice-chairman of the Labour party, and when 1964 came around he would undoubtedly have been included in Mr. Wilson's Government. I defeated him, however, and he was out of Parliament for four years. Members on my side often made "reds under the bed" accusations about him, but most were massively exaggerated. He was a very solid Member of Parliament, and a very good constituency Member.

Lastly, I pay tribute to my constituents in Honiton and lovely East Devon, who have been kind enough to add 34 years to the seven during which I represented Reading. I am so lucky to have been given this opportunity. I thank not just those who voted for me, but many who, having not done so, have supported some of the work that I have done and tried to do in the House.

When people come here, they must remember that not everyone can become a Minister; only a limited number will do so. Members of Parliament have a vast job to do, in many different ways. As most Members know, I have concentrated largely on procedure. Since 1984 I have been associated with the effort to ensure that we can consider legislation more thoroughly, more simply and more properly. That aim has not yet been accomplished, but I pray that it may happen in the next Parliament.

The benefit that can be conferred by good Members of Parliament not seeking to be Ministers but doing their proper job in the House of Commons is very real. I am most grateful to have been given that opportunity: I am a very lucky man.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health) 11:28 am, 11th May 2001

I apologise to Mr. Bercow, and to you, Mr. Speaker, for missing the opening of the debate. There is a general election campaign going on, and I am afraid that I got involved somewhere else. I know that the hon. Gentleman was looking forward to hearing from the Minister for Public Health, Yvette Cooper, which he described as an enticing prospect. He is probably less enticed by the prospect of my response, but perhaps we can discuss that outside.

I echo the tribute paid to the hon. Gentleman by Mr. Benn. All of us who have had the privilege of sitting on the Labour Benches during this Parliament have become used to hearing the hon. Gentleman's lucid and assiduous explanations of his points. When he speaks about issues such as this, in the spirit in which he has spoken today, it is hard to find a word with which any Labour Member could disagree--although when he speaks about political issues, most of us tend to recoil. I know that he will not be offended by that.

Photo of John Bercow John Bercow Shadow Spokesperson (Home Affairs)

I am delighted. It is a compliment.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I am sure that the hon. Gentleman is delighted, and will understand the spirit in which the compliment was paid.

Before I respond to the points made in the hon. Gentleman's thoughtful and--as my right hon. Friend the Member for Chesterfield said--scholarly speech, let me pay tribute to two of my colleagues who are present, and who are retiring at the election. My right hon. Friend the Member for Chesterfield has made an outstanding contribution to this country's politics for many years. He is committed, as we all are, to the cause of democratic socialism, and cares deeply about the health and well-being of the party that has given him--and all Labour Members--such a wonderful opportunity to speak up for the people and to defend the principles and values that we hold so dear.

The same is true in spades of Mr. Campbell-Savours, who is a fellow Cumbrian Member and who is held in the deepest respect throughout Cumbria for the work that he has done over 20 years in representing his constituency with fantastic skill and dedication. I think that I speak for all of us here today, certainly for all Labour Members, when I say that I find it hard to believe that those two outstanding individuals will not be with us in the new Parliament to support the work of, I hope, a radical and reforming Labour Government, whom I hope will be elected on 7 June. I extend my warmest best wishes to my hon. Friends for the future and look forward, as I am sure we all do, to hearing their continuing contribution to the political debate in our society.

I also pay tribute to the work of the right hon. Member for East Devon (Sir P. Emery), who, as he reminded the House, was elected to this place in 1959--I was three years old at the time. One of the things that has always struck me about this place is the continuity between the generations, which speaks volumes not only for this place, but for the people who serve here. We get a bad press. Some of it is justified, but those of us who know about Parliament and the House of Commons would not want to call into question the right hon. Gentleman's commitment to this place and his service in the cause of parliamentary democracy. It is a distinguished record and I am happy to pay tribute to it.

Photo of Andrew MacKinlay Andrew MacKinlay Labour, Thurrock

The right hon. Gentleman keeps a very good wine cellar, too.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I have no knowledge of that. Perhaps in the light of my comments, I might get to sample some in the near future.

Photo of Sir Peter Emery Sir Peter Emery Conservative, East Devon

I extend an invitation to the Minister now.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

Great--your place or mine?

I also pay tribute to the right hon. Gentleman's wife, Lady Emery, with whom I have had dealings in my role as Minister with responsibility for social services, and who has done outstanding work with the International Social Service, which is a fantastic organisation. She has been a marvellous advocate and champion for what it does.

Having gone through the parliamentary pleasantries, which I am delighted to have had the opportunity to do, as the last Minister to speak in this Parliament, I turn to what the hon. Member for Buckingham said about the important subject of the treatment of diabetes. He referred to the diabetes pledge that was issued recently by Diabetes UK. It urged decision makers in this place and health care professionals to recognise the seriousness of diabetes as a growing health challenge, and we certainly do. Therefore, I assure the hon. Gentleman of the seriousness with which the Government take diabetes.

As the hon. Gentleman said, diabetes has a major impact on the lives of nearly 1.4 million of our fellow citizens, who have been diagnosed either with type 1, which is insulin dependent, or type 2, which is non-insulin dependent, diabetes. As he rightly said, the number of people with type 2 diabetes is forecast to increase significantly over the next decade, yet at the same time healthy eating, physical activity and weight management can prevent or delay the onset of type 2 diabetes.

If not properly managed, diabetes can result in a range of long-term complications--cardiovascular disease, blindness, renal failure, lower limb problems leading to amputation and, in some cases, earlier death. As a consequence, it has a significant impact on the national health service: diabetes and its complications cost the NHS nearly £5 billion a year, or 10 per cent. of its overall expenditure.

As the hon. Gentleman observed, there is evidence of unacceptable variations in the standard of the diabetes service provided throughout the country. The Audit Commission study of diabetes recently demonstrated that. That report showed some areas of very good practice, with staff working across sectors to improve patient care, but those examples are not always widely shared throughout the NHS. I strongly believe that there is nothing wrong with the NHS that cannot be put right by what is best about the NHS. That particularly applies to some of the issues to which the hon. Gentleman has referred.

It was the variations in the organisation and quality of service that prompted the Government to announce in 1999 the development of a new national service framework for diabetes in England. It is also worth highlighting that the Government have taken action in different spheres to help to improve the lives of people with diabetes. For example, we responded positively to a campaign by Diabetes UK by adding insulin pen needles and certain reusable insulin pens to the drug tariff last year, making them available for the first time on general practitioner prescription. On a different matter, following a review prompted by the House of Commons Select Committee on Science and Technology inquiry into driving and diabetes, new arrangements came into effect last month for individual medical assessment of people with insulin-treated diabetes who apply for licences to drive small goods vehicles. The Government are willing to listen to the concerns of people with diabetes and, where we can, to act on them.

The hon. Gentleman asked a number of questions about the national service framework for diabetes. I shall try to deal with the points that he made. The aims of the national service framework are to improve health outcomes for people with diabetes by raising the quality of services and reducing variations between them. In doing so, I expect it to deal with the issues highlighted in Diabetes UK's diabetes pledge.

The scope of the national service framework is broad and covers prevention, identification and management of diabetes and its complications, including rehabilitation and continuing care. The framework will set clear national standards that we shall expect to see implemented. It will also define new service models, put in place effective strategies to support implementation and delivery of the new standards, and establish performance measures against which progress within an agreed time scale will be measured and monitored.

As with previous national service frameworks, that for diabetes has been developed in close consultation with an expert advisory group that has brought together service users, patients, health care professionals and health service managers. As the hon. Gentleman must know, that group was chaired in an effective and distinguished way by Professor Mike Pringle, chair of the council at the Royal College of General Practitioners, and Peter Houghton, regional director of the eastern regional office of the NHS executive.

We have published information about and arising from the development of the national service framework for diabetes on the worldwide web. We expect to publish the framework itself later this year, for implementation throughout the NHS in 2002. In general terms, we are seeking to put the person with diabetes at the centre of the health care system. His or her needs must be paramount. It will be a model for how the NHS supports and cares for people who are disadvantaged in some way--in this case, as a consequence of chronic disease.

The national service framework for diabetes is an important plank of the Government's quality and modernisation agenda for the NHS. In 1997, shortly after taking office, we set out how we intended to set a clear structure that held those who deliver services to account. In the White Paper "The new NHS" and the policy document "A First Class Service", the Government introduced a range of measures that we hope will raise quality and standards and decrease unacceptable variations in service. Standards will be in the first instance set by the National Institute for Clinical Excellence and by national service frameworks; delivered locally by means of clinical governance; underpinned by professional self-regulation and lifelong learning; and monitored by the new Commission for Health Improvement, the NHS performance assessment framework and the NHS patients survey.

For the first time in the history of the NHS, we are trying to set clear national standards to guarantee fair treatment wherever patients live--whether in the hon. Gentleman's constituency or in mine. For the first time, we are inspecting all parts of the health service to ensure that patients get the top-class service that they deserve.

The quality agenda, which I am sure the hon. Gentleman also places heavy emphasis on, is at the heart of the Government's strategy for modernising the NHS. The NHS plan takes the agenda further still, introducing further steps to improve both customer service and the safety of patient care. The plan sets out how we will develop the role of primary care through better facilities--the hon. Gentleman was concerned about the balance between secondary and primary care--more staff and more integrated and multi-disciplinary working. That will raise the standard of care for people with diabetes in the primary sector, easing the pressure on hospitals, so that they can concentrate on providing the necessary specialist care.

Diabetes UK's diabetes pledge refers to the importance of patient-centred care. Care dictated by the needs of the patient, not the system, will be at the core of the NHS plan. The Government therefore attach great importance to involving patients, carers and the wider public in decisions about health service policy and delivery. That is why we have made great efforts to ensure that we hear the voices of people with diabetes and of parents of children with diabetes--I know that that is a concern of the hon. Gentleman--in the development of the national service framework. There were, for example, two people with diabetes on the expert reference group, plus Paul Streets of Diabetes UK. Other people with diabetes were on the various topic area groups set up by the expert reference group. There were more than 40 people with diabetes among the 120 or so who attended a 24-hour workshop in October 2000 to focus on patient and care pathways. The National Centre for Social Research was commissioned to run user focus groups and to conduct in-depth interviews with people with diabetes.

We want individual patients to play a greater role in determining the care that the NHS provides. We believe that an NHS that works effectively with patients will deliver better results for individual patients and better health for the whole population.

The hon. Member for Buckingham may be interested to know that an example of that objective in action is provided by the Bradford health action zone programme, which is developing models for delivering diabetes care within primary care. The local community and health care professionals are working together to improve the diabetes care within the sector through the development of new care models. Bradford demonstrates how our determination to modernise the NHS and tackle inequalities can improve services.

Encouraging people with diabetes to play a full role in the management of their own condition will be a cornerstone of effective care. To do that, we have to help them develop the knowledge and skills to become partners in their own care. Diabetes is an excellent exemplar of the need for a partnership between patient and clinician. As I have suggested, that will be a key focus of the diabetes national service framework. It is also central to the work of the expert patients task force, which I expect to inspire a major expansion of patient-led self-management programmes across the NHS. Indeed, the NHS plan committed us to establishing a comprehensive expert patients programme. We shall deliver that commitment.

The hon. Gentleman is right to draw attention to the particular prevalence of diabetes in south Asian, black African and black Caribbean people. The diabetes national service framework will therefore pay particular heed to the needs of those who are disproportionately affected by diabetes, including people from minority ethnic groups.

The hon. Gentleman also rightly stressed the importance of detecting diabetes as early as possible--an issue highlighted by Diabetes UK in its diabetes pledge and, indeed, in its missing million campaign. Whether or not there are as many as 1 million people in the UK with undiagnosed diabetes, as Diabetes UK estimates, early detection to enable early treatment is clearly important. That is why we asked the UK national screening committee to consider how that objective could most effectively be achieved and whether there was a case for introducing a targeted screening programme or more active case finding for type 2 diabetes. The evidence on screening for type 2 diabetes is not clear cut.

The national screening committee came back with proposals for a type 2 diabetes development project, which were approved by Ministers last month. The project will aim to assess the implications of targeted screening for those working in primary care and the practical issues in its delivery. It is being designed to dovetail with existing research projects on screening for type 2 diabetes and should ensure that we have a clear picture of whether screening is the most appropriate way of improving identification of the condition.

Once they are received, the national screening committee's conclusions will inform implementation of the diabetes national service framework, as, too, will its recommendations for a national screening programme for diabetic retinopathy, which the hon. Gentleman mentioned and which we published last November.

We know that, once diabetes has been diagnosed, tight control of blood pressure and blood glucose levels are of key importance in its management. The UK prospective diabetes study--UKPDS--found that the lives of people with type 2 diabetes can be saved by more frequent checks and better treatment to keep blood glucose and blood pressure levels as normal as possible.

The Department of Health and the NHS, with the Medical Research Council, Diabetes UK and other sponsors, have made a major investment over many years in the UKPDS. It is an example of the real, life-saving benefits that can come from investment in high-quality long-term research. The Government themselves make a significant contribution to diabetes research through both the Medical Research Council and NHS support for research and development.

The hon. Gentleman also mentioned the work of the National Institute for Clinical Excellence. A whole raft of other work on diabetes feeds into the new quality agenda to which I referred earlier, including that of NICE. NICE will help to ensure that the NHS provides the best possible treatment with the available resources, to bring an end to the lottery of care in which some treatments are available in some areas but not in others. The hon. Gentleman and all other hon. Members are concerned about that issue.

NICE will be issuing clinical guidance on aspects of the management of type 2 diabetes this autumn, and developing clinical guidelines for type 1 diabetes for publication next year. In recent months, NICE has also appraised the effectiveness of two new diabetes drugs to which the hon. Gentleman referred, and published guidance on their use.

NICE has recently reviewed the evidence on the clinical and cost-effectiveness of the two drugs. Its guidance on both drugs was similar--that either can be considered as a possible alternative to insulin for patients with type 2 diabetes whose condition is not being satisfactorily controlled by diet and other tablets. Of course, they will also give doctors another tool in the armoury of treatments available to them. However, prescription for individual patients will still be a matter of individual clinical judgment. Nevertheless, given NICE's guidance, use of both drugs, which are new on the market, can be expected to increase in the future.

Earlier this week, the Minister of State, Department of Health, Mr. Denham, announced consultation on the proposed next wave of appraisal topics to be referred to NICE. It includes three diabetes topics: insulin pump therapy, to which the hon. Member for Buckingham quite properly referred; insulin glargine; other long-acting insulin analogues; and patient education models for diabetes. We shall consider further diabetes issues for possible addition to NICE's future work programme.

The importance of giving the person with diabetes appropriate information, to which the hon. Gentleman quite properly referred, was one of the issues highlighted by the tragic death of a young woman with diabetes, on which the health service ombudsman issued a special report only last December. The ombudsman made specific recommendations to the general practitioner and the hospital involved. However, as the ombudsman suggested, there are wider lessons to be learned from that sad case about the diagnosis and treatment of diabetes which we are determined to learn. We shall seek to ensure that those lessons are taken on board in the diabetes national service framework.

Finally, I should like to highlight some of the dramatic improvements in health outcomes that research suggests we can expect once best practice becomes the norm. We aim to reduce deaths related to diabetes by one third, and to reduce the risks of coronary heart disease, strokes, kidney damage and serious deterioration of vision by at least one third. Diabetes is the biggest cause of blindness in people of working age. We should also be able to reduce amputations and ulcers significantly. We could also provide better co-ordinated patient and family focused services for children and young people making the transition to adult services.

Those are all major goals for the treatment of diabetes in the future. The diabetes national framework will, for the first time, give us the practical means of ensuring that those aspirations become a reality.

Photo of Mr Dale Campbell-Savours Mr Dale Campbell-Savours Labour, Workington 11:46 am, 11th May 2001

My hon. Friend the Minister has given a very substantial response to the debate, which was initiated by Mr. Bercow. I do not think that I can usefully add to what he has said, other than to say that, over the years, I have had a number of constituents who, having come to me on those matters, will reflect on his comments.

May I also thank my hon. Friend for his very generous remarks? I realise that this is an Adjournment debate, and I think that I have some understanding of procedure, but I should like to go slightly wider than procedure may strictly allow and still remain in order. I should just like to say one or two words to the House before I disappear off into the sunset in my retirement.

Often in the past few days, like many of my hon. Friends who are retiring, I have had cause to reflect on why I sought election to the House of Commons. I first sought election to this place in 1974, in a general election, and tried again in a by-election, in 1976, which I lost. Subsequently, in 1979, I was elected.

My reason for seeking election to this place was based on a conversation that I had with my mother when I was in my late teens. She told me that, in this life, to make a real contribution to the way in which the world works, one has to engage in public service in some way. Many of us who were then in our teens and twenties, formulating our political views, chose the political route as a way of entering public service. Some of us went on to become Ministers or parliamentarians; oMr. Benn, became great and eminent parliamentarians.

Over the years, I have watched with great interest new generations of young people coming into the House. I have often set out to help them in their early days and given them my advice, because I had been given advice. I was given advice by one man--Mr. Horam--who, although he subsequently defected to the Conservative party, was very good to me when I was elected. I was also given advice by the late Bob Cryer.

I have always remembered that. They helped me when I knew that many were not being helped, and I resolved that I would help others. I really think that that pays. Over the past few days, I have had a number of letters and many conversations with people who recalled times and occasions in their early political lives when I was able to give them some advice which they took and which proved useful to them. I hope that when the new crop of Members comes to the House after the election, there will be people who set aside time to help them, because it is rewarding for the giver and, in particular, for the receiver.

Over recent years, I have watched the developments in the Opposition with the new crop of young Conservative Members who, in many ways, reflect the approach that we took when we entered the House, which was to oppose the Government. To be frank, I have been quite impressed. The problem is that there are not enough of them engaged in the practice. It is strange that when I came here, some of the people who used to say to me, "Get on with it," were Conservatives. They said, "It is often easier for you, in the Opposition, to deal with issues that we find politically embarrassing." That is true.

We had a good crop of Members; we used to call them the "fighting 40". I remember that we used to come to the Chamber and hold the Government to ransom--we would run all night if we could, and we did so on memorable occasions.

The point is that opposition is an art, and one learned it and mastered procedure. We spent hours in the Chamber just learning. We looked forward to the procedural feasts when Members would get themselves in difficult procedural wrangles. I remember George Cunningham, who subsequently went to the SDP, and Alex Lyon as great parliamentarians. Such people were very good at teaching us how this place worked. There is no politics in that; it is about being a parliamentarian.

My plea, as I leave, is that more people recognise that being a great parliamentarian is more important in many ways than being a great Minister. Great parliamentarians, such as my right hon. Friend the Member for Chesterfield, will be remembered for generations, whereas Ministers may well be forgotten. I say that with no disrespect to my hon. Friend the Minister of State, because he will be remembered. He is my tip for the Cabinet in the next Parliament.

I want a whole career structure to be built up whereby Members choose a route when they are elected. They will decide whether they want to be held to account or whether they want to hold others to account. That is important. When we secure a Parliament with a career structure within which people can develop and within which Chairmen of Select Committees are paid, that will give Members an incentive to be part of the legislature and the House will benefit immeasurably.

I read what I regard as pap and drivel in the press about how my hon. Friends have formed part of a compliant Labour majority in the House. That is simply untrue. The quality of questioning by many of my hon. Friends over the past four years has been excellent. Many have been prepared to ask awkward questions of Ministers and to hold them to account, inside and outside the House. The problem is that the press are not prepared to face up to what is really going on. There is accountability, and all I would say is that it could be improved in future.

I have loved this place, as indeed have many of my hon. Friends, including those who are leaving and those who will remain, and I will love it more into the future. It has been a huge honour for me to be here. I am indebted to the people in my constituency who put me here, to my party and to all the friends whom I have made over all these years.

Photo of Michael Martin Michael Martin Speaker of the House of Commons

I understand that Mr. Tyrie wishes to make a point of order, but before he does so I have something to say. The Clerk advises me that is not normal for Back Benchers to rise after the Minister has spoken, and there is no precedent for the Speaker taking part in a debate, but I am going to do so today.

With a general election coming, Mr. Bercow could have applied for an Adjournment debate on a subject with more relevance to his constituency, which might have given him a political advantage, but he did not. He raised a matter that affects each and every one of us and our communities--the problem of diabetes. I hope that the tradition of the Adjournment debate, whereby a Minister can come here and give an account of his stewardship of any matter, always continues. The hon. Gentleman has done a good thing.

I look at our small gathering and I can say to everyone that I regard you all as friends. It is said that Speakers should not have any friends, but I say that they should have as many friends as possible, but no favourites.

I look at the right hon. Member for East Devon (Sir P. Emery) and I remember that when I was on my first Select Committee he was very helpful. He showed me a generosity and a kindness that I realise is typical of him. On our first trip abroad--it is not fair to say which land we visited--we went to a factory. There was no proper roof; there was coal and charcoal on the floor; molten metal was being pushed on a trolley and, to keep it from spilling, rags and sand were being thrown on to it by labourers. I was a great man with a camera, and I said, "Peter, I'm going to take a photograph of this, put it in my election address and call it 'Thatcher's Britain'." I wish the right hon. Gentleman very well indeed. I know that we will see him again because he is going to do a lot of work for the retired Members.

I remember that Mr. Campbell-Savours entered the House on the same day as me. We were very confused, and he decided that every day he would spend hours in the Chamber and learn procedure. I nipped off to the Tea Room, saying, "No, Dale, I don't want to do that", but he did it. Eventually, not only the younger Members but the older ones came to him to ask him about procedure. I take on board what he said about the fact that no new Member should come into the House and be thrown in at the deep end. They should be helped, and that is a tradition that I always upheld as a Member because I knew that some, but not all, of the senior Members did not bother with the new Members. They should give them every piece of advice possible. I will miss the hon. Gentleman.

Mr. Benn will recall mentioning to me that his dear wife Caroline had written a book about Keir Hardie. We in Glasgow always talk about the specific district we come from. I say that I came from the district of Anderson, and next door is the district of Partick, where Keir Hardie came from. I asked the right hon. Gentleman, "Please tell Caroline that she will find that Hardie spent some of his childhood years in Partick, where my mother and father had their first tenement flat--what we in Glasgow called a single end." The following day, a book arrived--the biography of Keir Hardie, signed by Caroline. It is now up in the Speaker's Study. I shall always treasure it. It was so nice that my conversation with the right hon. Gentleman in the Tea Room was carried home. I greatly appreciate that book, personally signed by the author.

I wish you all the best for the future. I say to those who are going out to participate in the election, I wish you all well.

Photo of Andrew Tyrie Andrew Tyrie Conservative, Chichester

On a point of order, Mr. Speaker. I hesitate to raise this point of order after so kindly and thoughtful a speech as yours. I rise to ask that the adjournment be delayed to enable the Government to answer for the inconsistency between statements made in the House on 14 May and 1 June 1998 and the action that they took a few days later, on 4 and 5 June, when, at the behest of the Hinduja brothers, the Prime Minister and the Foreign Secretary met the Indian Prime Minister's special adviser.

At that time, India had just conducted nuclear tests and the Foreign Secretary said that India

"should . . . pay for isolation within the international community."--[Official Report, 1 June 1998; Vol. 313, c. 21.]

The British Government cancelled visits by the Indian chiefs of staff and asked for a review by the European Commission of preferential trade treatment. We now know that, at the very time that the Foreign Secretary was making his statements to the House, arrangements were being made for the special adviser to the Indian Prime Minister to meet--

Photo of Michael Martin Michael Martin Speaker of the House of Commons

Order. My answer is no. The hon. Gentleman cannot make a substantive case through a point of order, and the Foreign Secretary will not be making a statement. It is as simple as that.

Photo of Dennis Skinner Dennis Skinner Member, Labour Party National Executive Committee

On a point of order, Mr. Speaker--and this is a bit more important. Did you read The Mirror this morning? In it, there is a column by Paul Routledge in which he talks about saying goodbye to Mr. Benn and others, but because he did not do his homework--it is all about sloppy journalism these days, as you will know from all the points of order on the subject raised by Opposition Members--he got it wrong and said that I, too, would be retiring.

Well, I have news for The Mirror and Routledge: I shall be back here, in this place, on 13 June, when we shall have an election for the Speaker--although you might get nodded through, Mr. Speaker. To Paul Routledge and everybody else, I say, I shall be back here, fighting for redistribution of wealth from the City financiers to the poor and those whom my hon. Friends have represented over the years, and those in Glasgow--and Partick in particular--will benefit as well.

Photo of Michael Martin Michael Martin Speaker of the House of Commons

I shall let the people of Partick know.

Photo of Mr Tony Benn Mr Tony Benn Labour, Chesterfield

On a point of order, Mr. Speaker. I do not know whether we are waiting for a message from the Lords or whether we are ready to go, but is it in order to thank you? You have broken another precedent today by making a speech from the Chair. I tell all visitors that it is a characteristic of the Speaker that he never makes a speech, but you have changed that. You have been a marvellous Speaker--kind to us personally and good in the Chair. I, for one, bitterly resent the wholly unfounded criticisms that have been made. I shall watch from afar as you are re-elected within the month.

Photo of Michael Martin Michael Martin Speaker of the House of Commons

I think that it was Harry Truman who said that if they were giving out compliments, he would be sure to be in the wrong queue.