Health: Diabetes - Question for Short Debate

Part of the debate – in the House of Lords at 7:30 pm on 31 October 2018.

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Photo of Lord Morris of Aberavon Lord Morris of Aberavon Labour 7:30, 31 October 2018

My Lords, I have declared on more than one occasion the interest of one member of my family in the treatment of type 1 diabetes. I have taken part in many debates on diabetes and I am grateful to Diabetes UK and JDRF for the vigour of their campaigning and their advice.

The incidence of diabetes has doubled in 20 years, making it the fastest-growing health crisis. By 2025, it is estimated that 5.2 million people will be living with it. It costs the NHS £10 billion every year, largely spent on dealing with preventable conditions. Direct and indirect costs are much more. Tonight, I shall concentrate on type 1 diabetes. Although its effect has some of the characteristics of type 2 diabetes—I am not a medical man—it is largely a different problem, it is not connected to lifestyle and it strikes people of all ages, some of whom are very young.

Some years ago, I went to various research centres at universities. I went to Oxford, and I met Dr Hovorka’s team at Cambridge, my old university. I went to London, where ground-breaking research was taking place on the failure of the pancreas to produce insulin and its replacement but, so far as I know, results are limited. Over the last few decades, new technologies have transformed the way diabetes is treated and monitored and can help to reduce diabetes-related complications in the long term.

Tonight, I want to deal with the flash glucose monitoring system. Diabetes patients have to constantly monitor their blood glucose levels day and night. The flash system is a major advance over routine finger pricking. It works by inserting a small sensor into the upper arm. A reader device then scans the sensor and displays blood levels instantly, indicating whether they are going up or down. If patients can reduce their test strip use, which is presently done eight or more times a day, the expense of the flash sensor is cost-neutral or even cost-saving. Such self-management leads to lower fluctuations in glucose levels and fewer expensive complications in the future. Patients will have a reduced number of hypoglycaemic incidents, which lead to expensive ambulances and hospital admissions.

When it was announced some years ago that the Prime Minister had been diagnosed with type 1 diabetes, I wrote an encouraging note to her based on my family’s experience. I was delighted to notice that, at last year’s Lord Mayor’s Banquet, she proudly wore her sensor on her upper arm. No one would question the energy she puts into her official duties.

The heart of this debate is the countrywide variation in the availability of the sensor on the National Health Service. A few months ago, it was made available on the NHS drugs tariff in principle to NHS patients in the UK on prescription. On 5 July, the Minister stated that the NHS was committed to ensuring the principle of universal access and proudly claimed that the technology was,

“available across the country where clinicians think it is … appropriate”.—[Official Report, 5/7/18; col. 635.]

I was absolutely delighted. However, on 9 October, I had to draw attention to what was happening in practice. Only approximately 71% of the country is able to obtain the device. The hold-up is not with clinicians, who want to prescribe where appropriate, but with the clinical commissioning groups. They differ in their criteria. The noble Earl, Lord Courtown, replying very helpfully, faced up to this situation. He said:

“Many CCGs perform very well, but some do not provide this service. They are being encouraged to do so”.—[Official Report, 9/10/18; col. 10.]

I would specifically like to know three things. First, how are they being encouraged? Secondly, when can we expect universal NHS access to this important tool? Thirdly, is this situation because more than half of the areas in England and Scotland did not have training policies in place to support prescribing the device? Is it a question of resources? There has been some progress and it might be that this is now down to a third of areas not having supporting policies.

The lack of prescribed sensors is grossly out of proportion in England to Wales, Northern Ireland and Scotland. Let me tell your Lordships the grim facts. Where they are not available, patients have to pay privately around £1,200 a year. I am glad that they seem to be provided in my former industrial constituency; that amount would be out of reach for many of my former constituents. The present postcode lottery is a scandal, partly due to the differing criteria in too many CCGs. Patients in Coventry can get NHS access to sensors, but not those in Birmingham at the time the briefing was prepared. Likewise, they are available in Manchester but not in Liverpool.

I understand that the Secretary of State is deeply interested in new technologies. Diabetes UK has proposed a dedicated new national fund to support greater adoption of new diabetes technologies. This would operate over a fixed period and, coupled with the purchasing power of the NHS, would secure access to key products at fixed value for money. Diabetes UK believes that such a unified driving force would achieve considerable savings. What is the Government’s view of the proposal to set up a new fund of this kind?

Diabetes UK, working with NHS England, has developed a consensus guideline for type 1 diabetes technology. Its aim is to see a pathway in every area to ensure fair and equal access to the technology. If the Secretary of State accepts that failure to deal comprehensively with diabetes could lead to a major health crisis, there are modern technologies that could be available countrywide and substantial savings could be made. So will the Minister raise with his boss, the Secretary of State, the idea of appointing one Minister and one senior official to deal with, take charge of and monitor the whole of the field of diabetes, which will cost so much money to the NHS as a whole?