Health: Diabetes - Question for Short Debate

Part of the debate – in the House of Lords at 7:53 pm on 31 October 2018.

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Photo of Lord O'Shaughnessy Lord O'Shaughnessy The Parliamentary Under-Secretary for Health and Social Care 7:53, 31 October 2018

My Lords, first, I thank the noble and learned Lord, Lord Morris, for instigating this high-quality debate, and the small but select group of Peers who have contributed to it. I will attempt to answer all the questions, as seems only reasonable.

The noble and learned Lord, Lord Morris, mentioned the letter I wrote to him—or perhaps it was a Written Answer—about the principle of universal access. Obviously, that principle is at the foundation of the NHS and is one to which the Government are absolutely committed. Part of that commitment means making sure that when effective technologies come around—whether digital, devices, drugs or diagnostic—people have access to them once their benefit is proven. Diabetes is no different. As the noble and learned Lord, Lord Morris, and the noble Lord, Lord Rennard, brought out, this is a growing public health crisis: 400,000 people alive today in the UK have type 1 diabetes, many more have type 1 and type 2. The cost is not just the £10 billion a year but the lives and the quality of life being lost. It is a major public health crisis, with very individualised consequences, as the noble Lord, Lord Rennard, brought to life from his own family’s experience. That is the challenge.

With regard to the NHS more broadly, it is fair to say that in this country we are very good at coming up with new ideas—innovating—but traditionally poor at the uptake, or adoption, of good ideas. We have been carrying out a review over the past year with NHS England and the Office of Life Sciences, and we have found that the description I just gave is reasonably accurate. A lot of the money that we spend on supporting innovation is at the upstream end—coming up with new ideas—so that we are doubling down on our strengths while not addressing our weakness, the uptake of new technologies. That is the topic of discussion tonight.

Before turning to flash monitoring, I will give a few examples of how we are trying to address this weakness. The first is through the accelerated access collaborative, now chaired by the noble Lord, Lord Darzi. It recently announced a list of seven high-potential technology areas and 11 rapid-uptake products that are already on the market, and for which an evidence base exits, but are not being taken up. Currently they apply to cancer, heart disease and MS—not, it has to be said, diabetes, but there will be further rounds once the accelerated access pathway is considered, so that new technologies for treating diabetes will be able to apply through that route. That initiative involves all the key players—NHS England, the Department of Health, industry, and so on—so that we are sure that we horizon-scan, know what is coming and do not get caught out when new technologies come along that can have a really life-changing effect.

Secondly, we are strengthening the Academic Health Science Networks; they spot these innovations and make sure that they can be spread. One example, which has been adopted through that route, is a free app launched by the Oxford AHSN diabetes clinical network, brilliantly titled Monster Manor. It is a game that encourages children with type 1 diabetes to track their blood glucose readings and become more engaged in their diabetes management. It is very important to ingrain those habits early on.

We have also expanded the NHS test-bed programme, a couple of whose projects are focused on the management of diabetes. One, in Greater Manchester is called My Diabetes My Way—again a digital platform—and is designed to help people self-manage. In south London the diabetes test-bed is working with Year of Care Partnerships to train GP practices to adopt a more collaborative approach with patients, to support self-management using digital technologies. There is, therefore, good technology going on; it is getting into the service and the challenge, as ever, is to make sure that it is spread.

This brings me to flash glucose monitoring, which is clearly an incredibly exciting technology. I was delighted to be able to sign it on to the tariff last year as FreeStyle Libre—that is one brand, there are others. Everyone, from the Prime Minister downwards, can attest to its benefits, but it is worth saying—as the noble Baroness, Lady Thornton, brought out—that it is a new product with quite limited clinical trials data and economic analysis, so it is appropriate that we take a more staged approach. I will explain how we are doing that—there is cause for optimism.

In relation, however, to the role of NICE, I can assure the noble Lord, Lord Rennard, that NICE takes long-term perspectives into account in its economic analysis. The cost per QALY approach tries to take a broad measure of quality—QALY stands for quality-adjusted life years—so that we can make sure that all the benefits, not just health but social and other benefits, are accounted for. The challenge, however, is that because this is a new, exciting technology that we want to get on to the tariff, there is not yet the data to enable us to understand exactly for whom it works and when. That is why it has been up to CCGs to prescribe it and develop their prescribing policies. As the noble Baroness, Lady Thornton, pointed out, it is not for everyone—not least those who are not in a position to carry out the high levels of monitoring and use that it requires.

The noble and learned Lord, Lord Morris, asked what we are doing to encourage its use. I can tell him that a regional medicines optimisation committee was asked to provide advice to support local decision-making. I would be interested to understand, perhaps as a follow-up, whether Camden CCG—where I think the noble Baroness, Lady Thornton, sits on the board—has found that useful. The committee was tasked to provide that advice to deliver much more consistent policy-making and it has produced a set of criteria for use by GPs, CCGs and others. At the start of the year, NHS England wrote to GP groups to remind them of their responsibilities and of the guidance that exists.

We have seen some progress. About 70% of CCGs—144 of them—have now approved FreeStyle Libre for use and are putting together plans to bring it forward. If we look at spend on patches, for example, in November a year ago CCGs provided 421 sensor packs at a cost of £15,000. In August 2018 that figure was 14,412 packs at a total cost of £500,000—so there has been a fairly steady ramp-up. As we go along, we are of course gathering information about which populations this is most suitable for. Ultimately, this is the responsibility of CCGs; I know that that in itself is a cause of discussion, shall we say, and debate about whether that is a proper role. But as evidence grows about for whom it will be most beneficial, we will clearly have a better opportunity to define who should have immediate access to it and who should have access only after other routes have been pursued.

I will not detain the House by talking about the various other things that we are doing to support diabetes, other than to say that obviously a huge amount of work is being done. The noble and learned Lord, Lord Morris, asked about responsibility. We have a national programme for diabetes, and health checks and personalised and tailored support are being provided. It has been incredibly effective: about 250,000 people have been referred to the service and just over 100,000 have taken up the offer of a programme—so we are starting to see that kind of lifestyle support going in.

I was asked what we are doing specifically to support diabetes technology. While it would not be right to have a fund only for diabetes, as we develop the long-term plan—which we are looking to publish very soon—we are intending to explain in it how we have a much more systematic approach to spotting new technologies, getting them into the system, gathering data on them, establishing their efficacy and value for money, and then ramping them up through a much greater national push so that we deal with the issue of postcode variation. That is something I hear about all the time from patient groups, industry and clinicians themselves. We are conscious that it is a long-standing weakness of our service but is also something that we can do something about. I hope that as we move ahead with the long-term plan in the next few weeks, and with the updated sector deal that we are working on, noble Lords will see policies going into place which provide that—for the benefit not just of diabetes sufferers but everyone in this country.

I hope that I have managed to answer all the questions that the noble and learned Lord asked. Obviously I would be delighted to discuss this with him further afterwards, but I thank him again for bringing this very important topic for debate in this House.

House adjourned at 8.03 pm.