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[Mr David Crausby in the Chair] — Diabetes

– in Westminster Hall at 12:00 am on 9th January 2013.

Alert me about debates like this

Motion made, and Question proposed, That the sitting be now adjourned.—(Mark Lancaster.)

Photo of Adrian Sanders Adrian Sanders Liberal Democrat, Torbay 9:30 am, 9th January 2013

It is a pleasure to speak under your chairmanship, Mr Crausby.

I want to put on the record the difference between type 1 and type 2 diabetes, although the debate is about diabetes more generally. Type 1 diabetes develops when the body’s immune system attacks and destroys the cells that produce insulin. As a result, the body is unable to produce insulin, which leads to increased blood glucose levels and in turn can cause serious organ damage to all organ systems in the body. About 15% of people with diabetes in the UK are type 1s. I wish to declare my interest as someone who was diagnosed as type 1 nearly a quarter of a century ago, and I am still here. Type 2 diabetes develops when the body does not produce enough insulin to maintain a normal blood glucose level or is unable effectively to use the insulin produced. The long-term complications that challenge both type 1 and type 2 sufferers are much the same.

Diabetes remains one of the largest challenges to our health care system, with about 3.7 million sufferers in the UK; almost 1 million more are estimated to have the condition, although they do not know it. The numbers are expected to rise, which all makes for a significant challenge to the NHS, with an estimated spend of £10 billion a year on diabetes-related treatments. Much of that spend is unnecessary: people with the condition far too often suffer from late diagnosis, preventable complications and variations in care; they are often overlooked for specialist care when being treated for other conditions, particularly as in-patients; and they can be prevented from accessing treatment by the short-term financial ethos embedded in some primary care trusts.

None the less, we have made progress in recent years. I pay particular tribute to my right hon. Friend Paul Burstow and the former ministerial team for the open and constructive way in which they pursued the issue and ensured that diabetes remained a high priority during the stormy times of NHS reform. The all-party group on diabetes, which I chair, has already met the new Minister, and I am confident that the good progress will be sustained, if not surpassed. I am already heartened by the new Secretary of State’s pledge to focus more on patient outcomes and the patient experience. Let us hope that that intention manifests itself in clear instructions for managers and commissioners.

One of the priorities on which Ministers can have a direct impact is the promotion of leadership by the Department of Health. In recent years, a problem has arisen from the apparent inability to disseminate best practice around the UK and the unwillingness of some NHS organisations to implement it.

Photo of Keith Vaz Keith Vaz Chair, Home Affairs Committee

I pay tribute to the hon. Gentleman for all his amazing work on diabetes over his parliamentary career. As he has done, I have tabled questions to ask simply how high the spend on diabetes was in individual PCTs last year, only to be told that the information was not available and so could not be given to me. Is not that kind of information vital for an effective strategy on diabetes?

Photo of Adrian Sanders Adrian Sanders Liberal Democrat, Torbay

That would certainly be extremely helpful and would complement the atlas of care by, in a sense, putting the actuality into the story behind the figures. It is extremely unhelpful not to be able to drill down to what is really happening on the ground; we could do that if such statistics were available.

Some of the problems of disseminating information have been offset by the work of NHS Diabetes. It has been instrumental, first, in monitoring variations in care and driving the collection of more robust data, which has culminated in an extremely important publication, the national atlas of variation; and, secondly, in working tirelessly to rectify the problems it uncovers, linking national policy intention with policy implementation on the ground, including support targeted on where the greatest improvements are necessary. It is important that that work continues, as much more could be done. I hope that the Minister will reassure me that, despite the upheavals in the commissioning architecture, NHS Diabetes will retain its central role.

Photo of Rehman Chishti Rehman Chishti Conservative, Gillingham and Rainham

I, too, pay tribute to the hon. Gentleman for his fantastic work as chairman of the all-party group on diabetes. Does he agree that there need to be performance targets, like those for cancer, stroke and heart disease? At the moment, there are not the mandatory performance targets for diabetes that there are for those other diseases.

Photo of Adrian Sanders Adrian Sanders Liberal Democrat, Torbay

I am grateful to the hon. Gentleman for making that point. When one puts together speeches, they sometimes go on too long, and I had cut out that bit, so I am glad that he has raised it. The big issue is that the cause of death is sometimes recorded as stroke or heart disease when the underlying problem is diabetes. We have targets for cancer, heart disease and stroke. We really ought to look at diabetes as the root cause of other conditions for which there are targets.

The variation in care across the country is probably the largest worry for patients now, and the new implementation plan should focus on that. Failings in diabetes care cause an estimated 24,000 premature deaths each year. In 2001, the Department of Health published the national service framework for diabetes, which set out clear minimum standards for good diabetes care. Those standards include nine basic care processes that aim to end preventable complications by looking for early warning signs. Despite those targets, much of the country has seen little progress towards improving detection of type 2 diabetes and reducing the number of preventable diabetes complications. In 2009-10, results from the national diabetes audit showed wild variations in inputs and outcomes for both type 1 and type 2, including the astounding figure that the proportion of type 1s receiving the recommended nine care processes ranged from as low as 5% to 50%, with an average of 32% in England. The figures were only marginally better for type 2s. It really is not good enough.

The point about the condition is that people treat themselves 364 days a year and see a practice nurse or sometimes a general practitioner—more rarely, these days, a consultant—only once a year, although they should receive the nine care processes. The chance of developing diabetic complications can be reduced by keeping blood pressure, blood glucose levels and cholesterol levels low. Regular monitoring, backed up by periodic checks, is the key. The results from the national diabetes audit demonstrate that more needs to be done to end the postcode lottery of care for people with the condition. When as few as 5% of people with type 1 diabetes are receiving all nine care processes in some areas, there is a definite failure of care. If all health care trusts followed the national service framework, such complications as blindness and kidney disease—as well as stroke, heart and other diseases—could be prevented.

I hope that we will explore a range of best practices, but I want to highlight a couple that have scope to bring immediate improvement at very little cost. An acute issue is the provision of insulin pumps for type 1s. That is an example of where the UK should look abroad for best practice. Type 1s in other developed countries, such as France, Germany or the US, can expect to benefit from a pump if that is required for their diabetes management. Somewhere between 15% and 35% of type 1s in those countries have pumps, which enables them to lead normal lives, but in the UK the figure is less than 4%. That is clearly a failure of the commissioning structure as it is now. Will the Minister address how that is likely to improve? The Work Foundation has estimated that, if pump usage reached 12%, the NHS would save about £60 million a year.

Another example of where best practice is needed is surprisingly simple: good local leadership. Good leadership, as I have been fortunate enough to experience in my own area of Torbay, is essential to promoting effective and integrated services. Integration is key to reducing costs in the long term and, more importantly, to improving patient outcomes, which all too often get lost in the debate over health care services.

The move to clinical commissioning groups, with the potential for better scrutiny and criticism from patient groups, local authorities and health care staff could, in theory, lead something of a revolution in spurring innovation, creativity and in the striving to find best practice.

Just as educating the commissioners is crucial, so, for diabetes, is patient education, which has the happy side effect of making patients far more aware of whether they are receiving a good service and enabling them to become better advocates for their condition. I have no doubt that the great knowledge possessed by volunteers for Diabetes UK, the Juvenile Diabetes Research Foundation, INPUT and the many other groups involved in diabetes will be a considerable asset in shaping good services at a local level now that we have better scope for patient scrutiny and involvement.

In the wider sense, patient education is the core to preventing complications, which diminish the quality of life for patients and which, all too often, reduce life expectancy and increase the costs to the NHS in the long term. Good patient education programmes may require some investment, but they would pay for themselves many times over.

On a broader level, work needs to be done on detection and prevention. The number of people suffering from type 2 diabetes is set to reach a staggering 5 million by 2025. However, what many people do not know is that type 2 diabetes is a largely preventable disease. At the very least, its onset can be delayed and complications reduced.

NHS checks are vital to the detection and prevention of diabetes. In theory, such checks are available to all 40 to 74-year-olds who are seen to be at risk of developing diabetes. Shockingly, a number of primary care trusts in the UK failed to offer a single person an NHS health check last year, which demonstrates the dangerous variations in provision in the NHS. The Government can look to rectify that if they create a new national implementation plan for diabetes. Indeed they may even take up the suggestion by Rehman Chishti to set targets for diabetes.

This year, the current national framework for diabetes comes to an end. It is important that we build on the successes of the framework, that we focus on reducing discrepancies in diabetes care and that the new framework emphasises the importance of health checks and prevention of the disease through simple means such as diet management. Indeed, it is essential for the Government to spell out to commissioners and to patients what services can be expected and to provide a road map to show where we want to be in a few years’ time and how to get there.

Photo of John Pugh John Pugh Liberal Democrat, Southport

My hon. Friend analyses the fair degree of regional variation that exists and talks about a postcode lottery. Does he think that that is primarily down to a lack of leadership at PCT level, or to the qualitative variations that we get anyway in primary care practice among GPs across the country?

Photo of Adrian Sanders Adrian Sanders Liberal Democrat, Torbay

It is a combination of both. We cannot prescribe from the centre precisely what must happen in every area. Of course local areas must reflect their own demographics and their own health picture and be able to apply priorities accordingly. However, there is something to be said for ensuring that local areas have the tools that they need, which is where NHS Diabetes did such a good job on the back of the NHS framework for diabetes.

It is equally important that health checks are used to detect diabetes in its earliest stages, as early detection and appropriate treatment can prevent the severity of the condition and the risks associated with complications such as amputations.

Photo of Rehman Chishti Rehman Chishti Conservative, Gillingham and Rainham

On health checks, the hon. Gentleman must have seen the report that says that, according to Diabetes UK, nine out of 10 people do not know the four main symptoms of type 1 diabetes. Surely, therefore, the education should look at ways in which people can identify for themselves the symptoms that can lead to type 1 diabetes.

Photo of Adrian Sanders Adrian Sanders Liberal Democrat, Torbay

That is a very good point. There is the 4 Ts campaign on diabetes. If I remember correctly, the four Ts are thirst, tiredness, toilet and one other—

I always remember three, but not four. Anybody who feels thirstier or more tired than usual or is visiting the toilet more often should see their GP. A simple test—it is not an invasive test—can be conducted and after an appropriate early diagnosis a patient can start to feel better very quickly. An ancient fear of great big hypodermic needles being stuck in their skin deters many people from going to a GP, but only 15% of diabetics are put on to an insulin regime on diagnosis and that is because they suffer from type 1. Most type 2 sufferers never have to take insulin via an injection device, and, in any case, those devices are subcutaneous and really nothing to fear. I speak as someone who has to inject four or more times a day, and it really is not as bad as people fear. People should see their GP. If they do not, matters will get worse, complications will set in and they will rue the day that they did not sort out the problem early on.

Photo of Anna Soubry Anna Soubry The Parliamentary Under-Secretary of State for Health

I know that it is unusual for a Minister to intervene at this stage, but will the hon. Gentleman help me in this matter? Is not it right that there have been huge advances in the administration of insulin? A constituent of mine showed me the pump on his stomach that gives him the right amount of insulin. He even had a device on his mobile phone that could calculate from a photograph of a particular meal the amount of insulin that should be administered to his body. He clicks on the app and the insulin is given to him at the appropriate time, before or after he has his meal. Does the hon. Gentleman agree that those are wonderful devices that should be prescribed to people as much as possible?

Photo of Adrian Sanders Adrian Sanders Liberal Democrat, Torbay

I cannot fail but to agree with every word that the Minister has said, and I am absolutely delighted that she has said that. Children in particular benefit from pumps, because they can go to school and lead normal lives alongside their school friends. It is difficult for them to find the space and time to inject, and these little devices are doing the job for them all the time. The technological advances are such that we may well reach a point in the not too distant future where there is a device that both tests a person’s blood sugar level and then injects an appropriate level of insulin, without them having to check what they are eating. The little device is like having a pancreas attached to the side of the body. That is where we are going. At the moment, however, pump usage is very low in the UK. It is about having not just the pump but the services behind the pump—the trained nurses who can train and educate the person to use the pump properly, the technological support that needs to be there to back it up and the medical expertise to understand the difference between a pump regime and any other regime. That is the detail, and I am really glad that the Minister is on the ball here.

The provision of education about diabetes seems to be somewhat of a lottery in terms of who is actually receiving information and advice. There needs to be a standardised programme of education on the condition that is accessible and effective for all.

We must not miss the opportunity to encourage healthier lifestyles as a consequence of the Olympic legacy. It is essential that funding and provision for sports facilities and physical education continue to be given priority in the coming years to capitalise on increased interest in active sport. The Olympics have given people who have perhaps never before enjoyed individual or team exercise a new drive and desire for sport, which needs to be harnessed and nurtured. Gym membership and even one-off sessions for swimming still seem to be extremely pricey, which makes those forms of exercise inaccessible for many who could perhaps benefit from them. However, I am aware that some inner-city areas have set up programmes that allow residents to use facilities at a reduced rate or even at no charge. I wonder whether that idea should be taken hold of by more UK communities, and whether the Government could assist all local authorities to find ways to subsidise it, perhaps by working in partnership with private sector organisations.

Having facilities and making them affordable is an issue, which is why I find it unbelievable that some local authorities, including my own, give permission for building on sports facilities; in Torbay, the only public grass tennis courts in the local area are about to be built on. Andy Murray won his Olympic gold medal on grass and generated more interest in the sport last year, and my area has produced some of the great British tennis players down the decades, including British men and women No. 1s in Mike Sangster and Sue Barker. That makes that act by my local authority one of unforgivable short-sightedness.

I have outlined many of the issues surrounding diabetes care, but I will concentrate now on some of the things that I hope the Minister will focus on delivering in the coming years. There needs to be a comprehensive national implementation plan, containing measures to ensure that local leadership is robust and long term in its thinking. Such a plan also requires measures to focus on detection and prevention, and it needs to ensure that best practice can be effectively disseminated. Three priorities face our NHS and other health care systems around the world: prevention; diagnosis; and care. We have a long way to go to meeting the challenges of each one.

K

With all due respect, Minister. It's not just tennis courts and affordable sports and leisure facilities that Torbay lacks. There are a number of important technological advances in healthcare that remain virtually inaccessible to Torbay's constituents. As an electrotherapist I'm particularly struck by the lack of therapies available to people in the area. Yet whenever you as much as mention the benefits of vibration therapy and infrared saunas to alleviate a wide range of age or obesity-related illnesses in this neck of the woods, you're immediately subject to some kind of community restraining order!

I suppose at the end of the day, the global food chain just cannot sustain the huge, calorific portions many in the West have grown accustomed to tucking away. And this - along with mandatory Victorian breeding programmes - has prevented us from improving healthcare provision in the UK to the extent some of us would have liked?

Sorry to be so unstatesmanlike in cutting to the chase like this, Ministers. It's a dirty job but someone has to do it!?

Submitted by Karen Jemmett

Several hon. Members:

rose —

Photo of David Crausby David Crausby Labour, Bolton North East

I will not impose a time limit on speeches, but four Members wish to speak and I would appreciate it if they could keep their contributions to around 10 minutes, or less, so that I can call all four of them.

Photo of Nick Smith Nick Smith Labour, Blaenau Gwent 9:51 am, 9th January 2013

Thank you, Mr Crausby, for calling me to speak. I congratulate Mr Sanders on securing this important debate.

Sadly, we had 23 amputations from diabetes last year in my constituency of Blaenau Gwent, despite having a valued specialist foot ulcer clinic run by an advanced podiatry practitioner. So last November I asked the Leader of the House for a debate on how to prevent amputations resulting from diabetes.

The Public Accounts Committee, of which I am a member, was given evidence that the NHS spends at least £3.9 billion a year on diabetes services. It is shocking that the lion’s share of that money is swallowed up in the treatment of avoidable complications. As we know, these complications are not minor; they include amputations, blindness and kidney disease. Such complications are extremely debilitating for the sufferer and extremely expensive to treat. In the worst cases, diabetes can lead to premature death. That is a waste of both precious lives and resources.

Health professionals say that there are 125 amputations weekly because of diabetes, yet 80% of those amputations are preventable. The National Audit Office says that we could save £34 million annually if late referrals to specialist teams were halved. So, it is in the interests of patients and NHS budgets to deliver effective services, with the emphasis—as ever—on prevention and early diagnosis.

The PAC’s report on diabetes services, which was published last November, found that fewer than half the people with diabetes receive the nine basic checks identified in minimum standards of care that were established more than 10 years ago. Unlike cancer, stroke and heart disease, there are no mandatory performance targets for diabetes.

The PAC report highlighted the postcode lottery in provision for people with diabetes, and it also said—to a chorus of consensus—what needs to be done. However, it is just not happening nationwide. Put bluntly, we found that money is being wasted. There is no strong national leadership; no effective accountability arrangements for health service commissioners; no appropriate performance incentives for providers, and no evidence to assure us that the new NHS structure would address the failings that have been identified.

The Leader of the House has told me that diabetes care is a Government priority. So I hope the Government will support a specific pledge that would be widely welcomed. The Putting Feet First campaign, the supporters of which include Diabetes UK and the College of Podiatry, wants there to be a realistic target of a 50% reduction in amputations because of diabetes by 2018. That is a crucial point, because the Health Minister, Earl Howe, told the House of Lords recently that

“Diabetic foot disease accounts for more hospital bed days than all other diabetes complications”.—[Hansard, House of Lords, 29 November 2012; Vol. 741, c. 331.]

Policies to deliver that target include having a multidisciplinary foot care team in every hospital. Shockingly, in 2011 31% of hospitals had no podiatry provision at all. We also need foot protection teams in every community, which will mean more, not fewer, podiatrists in post.

We need a strong message from Government that preventable amputations must be reduced, that local variations will not be tolerated and that precious NHS resources will not be wasted. In addition, as others have already said, the importance of patient engagement cannot be stated too often. In their current consultation on diabetes, the Welsh Government highlight the benefits of having more informed and more confident diabetes patients. Education is an integral part of personalised patient care.

I will now make some concluding comments about how we can turn the tide, given that current projections show that the number of people with diabetes will rise from 3.1 million to 3.8 million by 2020.

How can we improve diet, reduce alcohol consumption and encourage physical activity? Good ideas include: a reduction in the sugar content of soft drinks; a realistic minimum price for alcohol of 50p per unit; restrictions on advertising and sports sponsorship; action to maintain nutritious school meals; teaching our children to cook, and encouraging regular sport and exercise in schools. Together, these ideas are a promising mix of radical measures, unlike the Government’s “responsibility deal”, which is just another case of the triumph of hope over experience.

Last week, a report from the Royal College of Physicians called for a senior figure in Government to take charge of obesity issues across all Departments, covering every area from agriculture to work and pensions. In the US, we have seen the mayor of New York, Michael Bloomberg, ban the sale of “super-size” drinks at entertainment venues. Similar bold and symbolic action is now urgently needed from the coalition Government here.

As I said at the beginning of my speech, there were 23 amputations in Blaenau Gwent last year because of diabetes, and across the UK there will have been many thousands of such amputations, many of which were preventable. The Government need to up their game.

Photo of Rosie Cooper Rosie Cooper Labour, West Lancashire 9:57 am, 9th January 2013

It is a pleasure to serve under your chairmanship, Mr Crausby, for this debate.

I congratulate Mr Sanders on securing the debate on such an important issue, which affects a growing proportion of our population. Indeed, having listened to the contributions that have already been made, it is very clear that there are many facets of diabetes that could be covered during this debate, but I think that we will all probably concentrate on amputation. I will spend a few minutes focusing on the importance of podiatry services, which can reduce preventable amputations for those with diabetes.

Currently, 4% of the population live with diabetes, and a fifth of those people will develop a foot ulcer at some point. At any one time, there are 61,000 diabetics in England who have foot ulcers. A foot ulcer may not sound like a very serious condition, but for a diabetic the consequences of foot ulcers can be severe, and even fatal if the appropriate treatment is not given. Statistics for England alone show that, of those diabetics with foot ulcers, 6,000 people—that is 10% of the total number—had leg, toe or foot amputations in 2009-10. Based on current trends, that figure is projected to rise to 7,000 people by 2014-15. An amputation is devastating. If any individual loses a limb, it will have a far-reaching impact on their life. For many diabetics, an amputation can increase the likelihood of premature death.

Let me put those figures for diabetes in context. The five-year survival rate for those with breast cancer is just over 80%, but for those with a diabetic foot ulcer the five-year survival rate falls to just under 60%. For those people who have a lower limb amputation, their survival rate worsens after five years. The consequences are even more horrific when we consider that 80% of those amputations are preventable. In 2012, that is simply incredible. We are not doing everything we can to rectify that and to ensure that people have the information and services that will help them protect their limbs.

It is scandalous that with our 21st-century health care we are allowing people to go through the completely unnecessary, torturous and miserable experience of amputation. Prevention is supposed to be the watchword of the modern national health service; through prevention, people can enjoy a better quality of life and the NHS can save itself millions.

It is therefore hard to understand why better prevention is not deployed with diabetes and amputations. Why is more effective use of podiatry services not a priority for the health service? At a time when the number of diabetics is growing, and with it the costs of treatment, podiatry could be a means of improving a diabetic’s quality of life and saving the NHS money. Amputations cost the NHS considerable sums, which are estimated to be in the region of £600 million to £700 million each year.

Results from pilot projects can demonstrate the positive impact of investing in good podiatry services. A multidisciplinary foot care team for in-patients with diabetes in Southampton led to a reduction in the length of in-patient stays from 50 days to 18 days. Not only were patient outcomes improved but annual savings to the NHS of £900,000 were generated from an investment of £180,000. That savings ratio of £5 saved for every £1 invested was bettered in another example. In James Cook hospital in Middlesbrough, a multidisciplinary foot care team generated annual savings of some £250,000 at a cost of £30,000, which is a ratio of £8 saved for every £1 invested. Those figures show how it would be not only the Government and the NHS that reaped great rewards from a small investment, but diabetics and those who need podiatry care. Based on the pilot evidence, logic would suggest that even in these straitened times we should be investing in podiatry services, because that could save even more money and improve health.

There is evidence, however, that the opposite is happening and that services are not improving. The danger of the new arrangements is that important issues fall between the cracks, are left to local decision making and do not get the prioritisation they deserve. More than half of hospitals do not have a multidisciplinary foot care team. In fact, 31% of hospitals do not even have an in-patient podiatry service, according to data from the national diabetes in-patient audit in 2011. That reflects a worsening service, because in 2010 only 27% of sites had no provision. The amount of provision has dropped, and nearly a third of hospitals no longer have that service.

There is also evidence that there is a problem with GPs having no incentive to refer their patients on to a foot protection team for education or follow-up. Why is that? Why is this woeful situation tolerated? If more referrals were made, we would see a beneficial reduction in ulcer and amputation rates.

Photo of John Pugh John Pugh Liberal Democrat, Southport

Will the hon. Lady explain why a GP would need an incentive to do what is clinically desirable in the first place?

Photo of Rosie Cooper Rosie Cooper Labour, West Lancashire

I absolutely share that concern, which is why I cannot understand the current view that doctors do only what they get paid for and if there is no money attached to something, it may not be the first thing they do. As I pointed out in Westminster Hall yesterday, when we had a debate on the Liverpool care pathway, financial rewards to clinicians should not be the driver of what happens or the pathways that are followed. That is good clinical practice. Surely to goodness, if a referral to podiatry is required, that is what should happen. It could also be said that if the services are not there or are being reduced, the GP has less incentive to refer, knowing that it will take so long to get an appointment.

The College of Podiatry is

“fearful that public expenditure constraints mean that rather than being prioritised through the QIPP”— quality, innovation, productivity and prevention—

“agenda, current podiatric services are at best, being frozen and in some cases being reduced, with patient services including the diabetic foot service deteriorating as a consequence”.

That has massive implications for the NHS budget and for the patients themselves. During a debate in the other place on 29 November 2012, the Under-Secretary of State, Earl Howe, accepted that

“rapid access to multidisciplinary foot care teams can lead to faster healing, fewer amputations and improved survival. Savings to the NHS can substantially exceed the cost of the team.”—[Hansard, House of Lords, 29 November 2012; Vol. 741, c. 336.]

My question for the Minister is whether the NHS, which is in the throes of a reorganisation and being more localised through clinical commissioning groups, as well as being put under increasing financial pressure, will move towards or away from having more multi- disciplinary foot care teams, given that fewer than half of hospitals currently have such a team. Investment in more podiatry services would result in improved foot screening, appropriate follow-up services, enhanced care when required, better outcomes—including fewer amputations—reduced length of stay in hospitals, increased quality adjusted life years and reduced morbidity. We would all win; we would have a healthier nation and significant financial savings.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Human Rights) 10:07 am, 9th January 2013

First, I thank Mr Sanders for bringing this issue to the House. Secondly, I declare an interest, as I am a type 2 diabetic and have been for four years. It has given me a knowledge of, and an interest in, the issue, although not a total knowledge—far from it. It has also made me more aware when constituents come to me with issues relating to diabetes and has given me an interest in those issues.

The disease has completely changed my life, as it would, because it is type 2. Diabetes is a major issue in every constituency. As someone who enjoyed the sweet trolley more than anyone else—to use Northern Ireland terminology, when there was a bun-worry going on, I was at the front of the queue—the sweet stuff was something that I indulged in regularly. Along with my stress levels, that has meant that I am a diabetic today.

The statistics have been mentioned, but they bear repeating, due to the seriousness of the UK’s problem, which is etched in everyone’s minds. The UK has the fifth highest rate in the world of children with type 1 diabetes. In Northern Ireland, we have 1,040 children with type 1 diabetes, some of whom are born with the condition. I want to give a Northern Ireland perspective, but I will bring in the UK strategy, because diabetes affects the whole UK, and that is why it is important. Some 24.5 children in every 100,000 aged 14 and under are diagnosed with the condition every year in the UK. We had a reception where we met some of those young people, and if we needed a focus, the focus was there that day for those of us who attended. I think that most of the people in the Chamber were there.

The UK’s rate is about twice as high as that in Spain, where it is 13 children in every 100,000, and in France, where it is 12.2 children in every 100,000. The league table covers only the 88 countries where the incidence of type 1 diabetes is recorded. There are 1,040 children under the age of 17 with type 1 diabetes in Northern Ireland, and almost one in four of them experienced diabetic ketoacidosis before a diagnosis was made.

Diabetic ketoacidosis can develop quickly. It occurs when a severe lack of insulin upsets the body’s normal chemical balance and causes it to produce poisonous chemicals known as ketones. If undetected, the ketones can result in serious illness, coma and even death. The diabetes itself is not the killer; it is the offshoots from it, the effects on the heart, circulation, blood pressure and sight, and the possibility of strokes and amputations.

The number of people living with type 1 and type 2 diabetes has increased by 33% in Northern Ireland. In my Strangford constituency, the number has gone up by 30%, with 800 people—I am one of them, by the way—becoming diabetic in the past seven years. That compares to 25% in England, 20% in Wales and 18% in Scotland. In our small part of the United Kingdom, the total number of adults—aged 17 and over and registered with GPs—with diabetes is 75,837, and a further 1,040 young people under the age of 17 have type 1. There has been a significant rise in that number also, with the prevalence in Northern Ireland now at more than 4%. An estimated 10,000 people in Northern Ireland have diabetes and do not know that they do. They have a ticking time bomb in their bodies; they wonder why they are not well, and the cause is diabetes.

Photo of Gregory Campbell Gregory Campbell Shadow Minister (International Development)

My hon. Friend is talking about the different prevalence of diabetes throughout the UK. Does he agree that best practice regarding early detection and the promotion of an active lifestyle could be a target for all the devolved regions across the UK and here in England? The Minister would do well to respond in relation to Ministers in the devolved regions taking on such best practice to combat diabetes.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Human Rights)

Yes, I agree. When people make interventions, I always wonder whether they have read my script—preventive medication is the very next issue on it.

In my doctors surgery in Kircubbin and, indeed, across Northern Ireland preventive measures are in place. There are diabetic surgeries, and the matter is taken seriously. The UK strategy that we have had for the whole of the United Kingdom of Great Britain and Northern Ireland and that will come to a conclusion this calendar year has made significant progress towards reducing the potential numbers, but diabetes has increased over the same period. There are some 100 diabetics in my doctors surgery in Kircubbin.

Photo of Rehman Chishti Rehman Chishti Conservative, Gillingham and Rainham

The hon. Gentleman talks about the United Kingdom strategy. Does he accept that certain people from different ethnic backgrounds are more likely to get diabetes? For example, according to the Wellcome Trust, 50% of people from south Asian and Afro-Caribbean backgrounds would have diabetes by the age of 80. Any UK strategy would therefore have to take ethnic composition into account, because such people are affected differently.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Human Rights)

That is an excellent point, and I am sure that the Minister will address it in her response. There are groups in the whole of the United Kingdom in which diabetes is more prevalent, and we need to look at those target areas.

There are 3.7 million people in the UK diagnosed with type 2 diabetes. I was diagnosed four years ago. With me, it was down to bad eating habits, stress and the fact that there were no set hours to my job. I ate whatever was quickest, and that was Chinese, usually with two bottles of coke, five nights a week. That was why I was 17 stone. I am now down to 14 and a half stone because I no longer do that. The issue is eating and living styles—eating what is quickest rather than what is best.

Edwin Poots, the Minister at the Department of Health, Social Services and Public Safety in Northern Ireland, is very aware of the ticking time bomb that is diabetes. I am aware of the key initiatives in operation in Northern Ireland, and I know that the Minister here today has had discussions with the Minister in Northern Ireland. They are doing a great job, including setting aside funding to employ additional diabetic staff—specialists, nurses, dieticians and podiatrists. That is providing all the help that a diabetic needs, but it is still not enough.

We need a concerted effort across the United Kingdom, through the media, and even perhaps through the TV soaps. I am not a soap watcher. I could not tell anyone what happens in “Emmerdale” or “Coronation Street”, but my wife could. She knows everyone in them—what they are doing this week and what will happen to them next week. Could we not perhaps use the soaps to make people more aware of the issue? I understand that plenty of issues are brought up in them regularly, so perhaps we should try this one.

It is great that our children are taught about diabetes in school. It is surprising what a five or 10-year-old knows about food that their mum and dad do not. Who is educating the mums and dads at home who are making the dinner and buying the shopping? Nick Smith made a point about how the food coming into the house is controlled by the parents. Diabetes UK Northern Ireland is taking part in an organisation-wide campaign entitled “Putting Feet First” to raise awareness of amputations among people living with diabetes and to work to prevent unnecessary amputations.

The Minister might want to comment on the new medications that are available. In the press this week, there was talk about a new diabetic medication in tablet form that could replace—not totally but partially—type 1 injections. The figure used was a cost of £35 per month. It would be good if we could get some feedback about whether the new medications will be available across the United Kingdom and whether everyone will be able to take advantage of them.

In Northern Ireland last year, 199 diabetes-related amputations took place, and the “Putting Feet First” campaign highlights that an estimated 80% of lower- limb amputations are preventable. There must be a UK strategy to reduce diabetes-related amputations by 50% over the next five years. What can we put in place in this Chamber to highlight and support the campaign? How can we use our influence to see the number of cases of type 2 diabetes dropping, instead of this steady rise?

The links between type 2 diabetes and obesity are firmly established, and it is clear that, without appropriate intervention, obesity can develop into diabetes over a relatively short time. For instance, the risk of developing type 2 diabetes is about 20 times more likely in obese, compared to lean, people. A newspaper recently stated that academic sources have estimated that the predicted rise in obesity rates over the next 20 years will result in more than 1 million extra cases of type 2 diabetes, and that is really worrying. Can that go unchallenged, when it is within our power, as parliamentarians, to do something about it, at least by putting a strategy in place or by beefing up the ones that we already have? When the current UK-wide strategy ends, it will perhaps be time to do something more.

I live the life, as do many others, of testing my blood every day, of feeling unwell when my blood sugar is out of control and of worrying that the next visit to the doctor will bring worse news, which can be the case if we do not discipline ourselves and ensure that we do things right. That is not the life that I want to have, or the life that I want my family, friends or constituents to have. The way to take on the issue is to continue with the UK-wide strategy, with dedicated funding and with all the regions working together, which will save money in the long run and, more importantly, improve the quality of lives across the United Kingdom.

I urge the Minister to take the initiative. I believe that she will and that her response will be very positive, because she understands the issues. I urge her to work with the devolved bodies, in coming together to disarm the ticking time bomb of diabetes—the cost of which some people indicate will be £10 billion—before it explodes. Type 2 diabetes is preventable, and we must do all that we can to prevent it. Education, with attention paid by everyone in this Parliament and the regional assemblies, is the way to do that.

Photo of John Pugh John Pugh Liberal Democrat, Southport 10:18 am, 9th January 2013

I am happy to give way to Keith Vaz—in any case, I will make just a few remarks. I pay tribute to his efforts in the House of Commons in this area, as well as those of my hon. Friend Mr Sanders.

I am provoked to make a few remarks by things that other hon. Members have said. I think that we all recognise that diabetes is a major problem. Rates are increasing—it is almost a worldwide epidemic—and it is a killer, linked to a series of other sorts of organ failure. We all recognise and it has been clearly stated that type 2 diabetes is rampant in our society and is lifestyle-related. Diagnosis is important, but I got the sense that that is fundamentally not the problem. We can get diagnosis right. There are clearly failures in general practice, in not picking up the condition early enough, but we do tend to find out who has it and who does not.

The issue appears to be treatment, as has been phrased by most Members. From events that I have attended from time to time in the House, I am aware that the treatment of diabetes is becoming increasingly sophisticated. A series of technology is attached to that nowadays, and we also have the advent of telehealth. All the major practitioners of telehealth are keen to provide better services for diabetics.

Additionally, there is the expert patient initiative, about which I was slightly sceptical when it was launched. The initiative is becoming very effective in connection to diabetes. The charities are playing along with that, too. A lot of good things are going on, but we are recording a variation in practice. There is something of a postcode lottery. I wonder what will prevent that. In which direction will we go?

My hon. Friend the Member for Torbay voiced concerns about the future of NHS Diabetes, but, like Rosie Cooper, I wonder how that will play into the new system. There seems to be two ways in which things could go. Without the local primary care trust, there may be, temporarily at any rate, an absence of leadership, because one of the PCTs’ jobs was to manage GPs, to keep them up to the mark and to assess how well they were performing. Clearly, part of the problem that we are addressing today is the failure of GPs, first, to diagnose diabetes early enough and, secondly, to treat it as effectively as they might. It is a fact that, although they are slow to admit it, GP practices in this country can be something of a lottery; they are extraordinarily variable in quality and character. Such features may be more manifest in the new structure.

My hon. Friend the Member for Torbay sketched a more optimistic scenario, however, in which the health and wellbeing boards will become ever more vigilant and keep GPs up to the mark. GPs themselves have suggested to me that one of the best ways to produce good and more standardised practice is peer review, with every GP knowing what other GPs are doing.

I am not sure which of those two outcomes is more likely, but there is great concern that the Department of Health ensures that the right one results.

I am uncomfortable with the thought, as raised by several Members today, that we could simply impose targets and that that would somehow get things right. The hon. Member for West Lancashire and I attended a debate not 24 hours ago on the Liverpool care pathway, in which we considered the corrosive and dysfunctional effects of targets. Once targets are set, we do not always get the results that we want. What, for example, would a target to reduce amputations do? Would it mean people do not do amputations in circumstances where an amputation might be desirable for the patient?

We come back to the perennial dilemma of many of our debates, particularly on specialist conditions, in that we can identify good practice—we can see it, and we miss it when it does not occur—but the national health service has never successfully found the secret of spreading good practice fast enough, which is happening again with diabetes.

Photo of Keith Vaz Keith Vaz Chair, Home Affairs Committee 10:22 am, 9th January 2013

It is a pleasure to follow John Pugh. I am tempted just to say that I agree with everything that everyone has said and then to sit down, but this would not be Parliament if we were able to do that, so I will briefly contribute to the debate.

I pay tribute to Mr Sanders, who has dedicated his life in Parliament to addressing diabetes. Obviously, because he has type 1 diabetes, he has become the Commons expert on such matters, and I pay tribute to him for what he has done as chair of the all-party group on diabetes and for all his other work on diabetes.

I come to debates on diabetes as a type 2 sufferer full of optimism, because I want to hear about what other people are doing, but I hear about blindness, amputations, stroke and death, and I feel extremely depressed as I go out. In this debate, hon. Members have talked about amazing ideas and good practice in their own areas. I did not know about the specialist unit in Blaenau Gwent, and I did not know what a bun worry is—I now discover that it is a feast of sweets held in Northern Ireland, from which I am sure that Jim Shannon is kept away. The key to such debates is that we hear about good practice that we do not hear about in other areas.

I pay tribute to both Front-Bench teams, because they both understand the importance of the subject. I am sorry that I did not get diabetes earlier, because I would have done better at harassing the previous Labour Government on the issue. I was told that I had diabetes only in 2007, and, therefore, I did not dedicate myself to it in Parliament in the way that I should. I will make up for that in the next few years.

We have high hopes for the Minister, and not only because The Times has said that she is one of the rising stars of the new intake, which gives hope to those of us who have reached middle age—I am on the way down, but she is clearly on the way up. We have confidence in her and the way in which she has addressed diabetes in the Department of Health: she has ensured that diabetes is a priority; she has asked questions of the experts, and she has brought together charities such as Diabetes UK, Silver Star and others. She is doing what all good Ministers do, which is never to accept the status quo and to ensure that the Department’s bright civil servants are using their abilities and skills to deliver what Parliament wants.

I welcome what the Government have done to support the Change4Life initiative by backing the advertisements announced only on Monday to encourage people to address obesity by ensuring that they change their diet and understand that, by taking responsibility, there can be a difference. I know it is in the nature of parliamentarians always to blame the Government or to expect the Government to do more, and, yes, we do, but it is also in the hands of individuals.

The hon. Member for Strangford carefully considers what he eats in the Tea Room—I have watched him carefully as we line up to get our lunches. When we go to the Tea Room to get a cup of tea before Prime Minister’s questions, we are faced with Club biscuits, Kit Kats and every sweet thing that can possibly be found. I do not know what the English equivalent of a bun worry is, but it is there for us in the Tea Room. Let us start in this House by ensuring that the food available is acceptable.

I also praise my hon. Friend Ms Abbott for the work that she and the Labour Front-Bench team have done on the proposals not for a tax, which was the subject of my ten-minute rule Bill, but for a reduction in the sugar and salt content of foods, as announced by the shadow Secretary of State. That is a good thing and goes some way towards what Mayor Bloomberg is doing in New York. Actually, the proposal goes further—a tax was not proposed because, of course, Denmark introduced a fat tax but had to withdraw it because of lobbying from the food industry—by showing the need to do something now. The Secretary of State was on television on Sunday, and he agrees with the principles behind the proposal, although he does not support the idea of doing it through legislation. He was looking very cool, not in a suit and tie but in his cardigan, and he said, “Let’s leave it for the industry to do on a voluntary basis.” The industry has had its chance to do something, and we need to move forward.

The Opposition are right. I know that it is in the Opposition’s nature to say radical things, but they are right to press the Government on the proposal because it means that the clever civil servants and, indeed, the clever Ministers in the Department of Health, including the Minister with responsibility for diabetes, will take note and press the industry to react. Ultimately, being able to express such views is important, and I support what the Opposition are trying to do.

I have not mentioned this so far—Members of Parliament usually criticise GPs for not doing enough, and they do not do enough—but in the five or 10 minutes available when people go to their GP, there is not enough time to have a diabetes test and a long chat about diabetes issues. Rehman Chishti specifically mentioned the south Asian community—the Silver Star diabetes charity, with which I am associated, and Diabetes UK take this seriously—because certain communities are more susceptible to diabetes. He is right to raise that point. However, I think we should be getting pharmacists to do much more. Before she died of diabetes complications, my mum had great faith in her local pharmacist. Pharmacists have more time to talk to people than GPs, who are very busy. We should include them in our forward plans. We have not mentioned them today, but we need to consider them for the future.

I know that the Minister is off to India to speak at a major conference on the issue in Chennai. We have the best diabetes doctors in the world. I happen to have a few in Leicester—Professor Azhar Farooqi, Professor Kamlesh Khunti, Professor Melanie Davies—and there is also Professor Naveed Sattar in Glasgow, as well as many others. They are world-class experts, and we do not use them enough. As the Minister starts on her journey—not quite without maps, because some have been provided in this debate, and the hon. Member for Torbay has one in his back pocket that he has offered to successive Governments over the past 25 years—will she please use the expertise that we have? The world looks to our medical profession as the best in the world. Let us engage them in the work that we do.

Photo of Diane Abbott Diane Abbott Shadow Minister (Public Health) 10:31 am, 9th January 2013

I congratulate Mr Sanders on securing this debate. I am struggling with the aftermath of a new year flu, so I hope that my voice will hold out.

I should declare an interest: I have been diagnosed as a type 2 diabetic. As always, I follow humbly in the footsteps of my right hon. Friend Keith Vaz; I have spent 25 years doing that. I am grateful for the opportunity to speak on behalf of Her Majesty’s Opposition about diabetes, one of the leading health threats in the UK. As we have heard, there are 3.7 million people in this country living with the disease. As we have also heard, it is a particular issue for people of south Asian and African and Caribbean descent in our big cities. I am hopeful that one thing that will emerge from the changes to the NHS is more local targeting, both by clinical commissioning groups and in public health, of local issues and local demographics. We cannot engage with diabetes unless we also engage with local specifics in our cities and regions.

As we have heard, diabetes costs the NHS one tenth of its budget—more than £10 billion a year. We have heard in detail about foot care and amputations, but the general problem is that diabetes is a gateway condition to hypertension, stroke, kidney problems and amputations, leading to early death. I was struck by the figure given by my hon. Friend Nick Smith of 23 amputations in Blaenau Gwent. It makes one stop to think about the human reality of diabetes in communities.

The fact that diabetes is a gateway condition makes early diagnosis and engagement so important. It is important to be mindful of the new NHS architecture. It is not just a question of asking Ministers to do more; we must also take the debate to a local level, with CCGs and directors of public health, because healthy living issues will fall to directors of public health and local authorities, rather than Government, to deliver. We can also look to local authorities that have been innovative about healthy living issues by offering free swimming lessons and so on.

We have heard about the basic health service treatments and checks that people should have. The Minister will be aware that the Public Accounts Committee’s report was critical of the management of adult diabetic services in the NHS. The report said that every year, 24,000 people with diabetes die simply because their disease has not been effectively managed. That is not a satisfactory figure in the 21st century for one of the world’s leading economies. Although people now know what needs to be done for people with diabetes, the Public Accounts Committee found that progress in delivering the recommended standards of care and achieving treatment targets has been depressingly poor.

What is the Department’s response to the Public Accounts Committee’s report? What can the Minister tell us about improvements in policy and service in line with the Committee’s recommendations? Does the Department of Health have a plan for ensuring the effective implementation of the NHS health check programme after the NHS reorganisation in April?

I would also like to say a word about children and young people with diabetes. As many as one in four young people are diagnosed with type 1 diabetes. The UK has the highest number of children diagnosed with diabetes in Europe and, sadly, the lowest number of children attaining good diabetes control. Christine Cottrell, a diabetes nurse specialist from Warwick, told The Daily Telegraph last July:

“We are even getting children as young as seven with Type 2 diabetes”.

It is an important public health issue, and the prognosis is not good:

“These children end up having heart attacks, or losing a limb, or their sight, in their 30s and 40s.”

I know that it is difficult in a Westminster Hall debate to bring up issues that cut across Departments, but has the Minister had discussions with her colleagues in the Department for Education about what support could be offered to schoolchildren and young people to manage their diabetes effectively and prevent the development of early complications? What efforts are being made to ensure that both staff and pupils are aware of the nature of diabetic epileptic attacks, which can take place in schools, and the best way to assist sufferers in an emergency?

What steps are the Government taking to increase the number of people not previously diagnosed with diabetes who receive diabetes testing? What was said earlier about the role of pharmacists was an interesting suggestion. Do the Government have a plan in place to make the public aware of the symptoms of diabetes sufferers? Are there any plans for a nationwide public awareness campaign? On prevention, we know that the new NHS commissioning board will be mandated to prevent diabetes. I know that it is perhaps not reasonable to say that GPs do not perform things that are not targeted exactly as well as things that are, but is the Department considering introducing diabetes testing targets for GPs?

The Public Accounts Committee inquiry to which I referred earlier heard that out of 20 trusts that needed to improve their diabetes care, only three accepted the offered help. That is not reassuring. How can the Minister ensure that care through health providers meets the targets set by the Secretary of State? As clinical commissioning groups and directors of public health take over some of those responsibilities, what can the Department do to ensure that diabetes is on their agenda?

On some of the more general issues around diet and healthy eating, although diabetes management, foot care and preventing diabetes from becoming a gateway to even more serious conditions are important, the most important thing that we can do in medical and public health terms is consider diet and healthy eating and other prevention matters, particularly for young people. Most experts agree that the excessive consumption of sugar is a factor in both obesity and diabetes. Increasingly, people are saying that sugar is addictive.

Colleagues have mentioned some important things to engage with in terms of policy, such as minimum pricing for alcohol, about which the Government are consulting and which is supported by Opposition Members. We suggest looking at the sugar composition of some foods, particularly those targeted at children. Most parents want to do their best, and I hope that the advertising campaign launched by the Minister will shed some light on such issues for parents. However, how many parents know that Coco Pops are one third sugar? People joke about it, but although most parents would not sit their child down to breakfast and put a bar of chocolate in front of them, they will give them a bowl of Frosties or some children’s cereal, which can have a higher proportion of sugar than a bar of chocolate. Opposition Members are saying that we need to consider legislating to ensure that the proportion of sugar in some foods that are directly targeted at children can be brought down.

I am glad to advance Her Majesty’s Opposition’s position on diabetes. I congratulate the Government on what they have done up until now, but there is more to be done, both in locking in a concern for diabetes locally when clinical commissioning groups and directors of public health take up their new responsibilities and dealing with the broader issues of healthy eating and a healthy lifestyle and the preponderance of sugar in modern processed food.

Photo of Anna Soubry Anna Soubry The Parliamentary Under-Secretary of State for Health 10:41 am, 9th January 2013

It is a pleasure, as ever, to serve under your chairmanship, Mr Crausby. I pay tribute to my hon. Friend Mr Sanders for securing this debate and to every hon. Member who has spoken. As you may have gathered, Mr Crausby—and as those hon. Members who have heard or will hear or read about the debate will gather—this is a huge topic. We could have had a 90-minute debate simply on diabetes 1 and diabetes 2. We could have other debates about the causes of diabetes 2. I am the first to put my hands up and admit that, until I was lucky and fortunate enough to be appointed last September to the position that I hold, I did not know a great deal about diabetes, but, goodness me, I have learned a great deal in the months since my appointment. I thank the all-party group on diabetes, chaired by my hon. Friend, for all the great work that it does. I paid the APPG a flying visit and learned a lot; a number of matters were raised with me that caused me great concern.

I hope that you will forgive me, Mr Crausby, if this sounds like a mutual admiration society, because in many ways it is. Keith Vaz and I go back many years. I pay tribute to him for all the work that he has done. I know about his Silver Star charity and I look forward to its coming to Beeston in my constituency and to the van doing some work there. That highlights one thing that has come out of this debate and goes to the heart of the Government’s reforms of the NHS: the remarkable work that can be done and now has to be done locally to ensure that we improve the diagnoses and treatments—in addition to other matters raised by hon. Members—because it is fair to say that, although many localities share common themes, this disease will be more prevalent in certain communities, even down to ward level. My hon. Friend John Pugh raises concerns and, as ever, ideas. My hon. Friend the Member for Torbay makes a good point about how we can ensure that these improvements are delivered locally.

I pay tribute not only to the work of Silver Star, but to Diabetes UK, which must be an outstanding charity, because such was its ability to campaign on this issue that it persuaded Mr Paul Dawson, a constituent of mine who has suffered from diabetes 1 for many years, to visit me on Friday. I thought that that was just a remarkable coincidence, but he told me that Diabetes UK suggested that he visit me. The serious point is that he raised concerns, as a sufferer of diabetes 1, that I had heard at the APPG, so I had already taken up many of those, notably what seems to be a rationing of strips. Frankly, this is bonkers; people with diabetes who use strips need to use them and often need to use many in a day. I am not happy if there is any form of rationing of those strips. I have already met officers in the Department and inquiries are being made of primary care trusts, and beyond. Mr Dawson also told me about the great advances, which I have already alluded to, that have been made in medicine, which my hon. Friend the Member for Southport and others have mentioned.

I have been asked a number of questions and I cannot answer them all in the short time available, but I undertake to answer every question in letters.

Photo of Diane Abbott Diane Abbott Shadow Minister (Public Health)

The issue of rationing strips has been brought to my attention. What would the Minister suggest that people do if their general practitioner is attempting to ration strips?

Photo of Anna Soubry Anna Soubry The Parliamentary Under-Secretary of State for Health

I am concerned about it. It is unacceptable. I have already held a meeting with my officials and they are making further inquiries. I discussed with Mr Dawson what was happening locally in CCGs, which is where this will make a difference, when we see the power of our doctors and other health professionals to commission services, and the power and influence that patients and sufferers of diabetes will have. I am told that NHS Diabetes has now identified a diabetic lead in every CCG. There is an opportunity, through the reforms, to ensure that we now deliver locally as we should. All hon. Members who have contributed to this debate have identified a failure in respect of good outcomes and good practice throughout the NHS, right through to local level. That needs to be, and is being, addressed as a matter of urgency.

I have been alerted to problems with glucose metres and pumps—various new advances in technology. Some of this excites me. However, I am still concerned if there is not the availability that there should be, right across the NHS, notably for all sufferers of diabetes 1.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Human Rights)

It is not just about the provision of the insulin pumps; it is also about training. There are two facets to that.

Photo of Anna Soubry Anna Soubry The Parliamentary Under-Secretary of State for Health

Indeed. I was going to end this part of my speech by saying that my constituent, Mr Dawson, paid tribute to what he described as his brilliant diabetic nurse at the Queen’s medical centre in Nottingham. He highlighted, as the hon. Gentleman has done, that it is all well and good having wonderful, great technology, but if people have access to it they need, critically, the support to be able to use it themselves. We must ensure that they have the highest-quality support, not just from their GPs, but from diabetic nurses and others who are trained and specialise in this condition.

Diabetes is common and is increasing, as hon. Members have mentioned. It is estimated that, by 2025, 4 million people will have diabetes.

Photo of Nick Smith Nick Smith Labour, Blaenau Gwent

What are the Minister’s views of Mayor Bloomberg’s plan in New York to ban super-sized soft drinks in cinemas? Does she agree that that could be a good symbolic action that would help bring down diabetes?

Photo of Anna Soubry Anna Soubry The Parliamentary Under-Secretary of State for Health

It could be, but I make it clear, as I said on Monday in various media interviews, that at the moment the responsibility deal is working, which is why we have some of the lowest salt levels in the world. Other countries are coming to us to find out how we have achieved that by working with industry, retailers and manufacturers to reduce salt levels. On the reduction of trans fats, under 1% of our food now has trans fats in it. Again, we have done that by working with the manufacturers and retailers.

My natural inclination is against legislation, and I say that as an old lawyer. At the moment, I am confident that the responsibility deal is delivering in the way that I want it to. I make it clear that, if there is a need to introduce legislation, we will not hesitate to do that. I am almost firing a warning shot across the bows of the retailers and food manufacturers and saying, “Unless you get your house in order and accept responsibility, we will not hesitate to introduce legislation or regulation, because we know that we in this country have an unacceptable rise in obesity, to levels that are second only to those in America.” I will therefore consider everything. I always have an open mind. I am currently content, however, that the responsibility deal is delivering, but it has a great deal more to do. I hope that those who are signed up to the calorie reduction scheme later this month will encourage more manufacturers and retailers to sign up to the responsibility deal on calories. I want to ensure that we make some real, serious and tangible progress.

Ultimately, however, as Jim Shannon identified, the responsibility is ours. Nobody forces us to eat the sugar buns or whatever it may be. When we go into the Tea Room and we are faced with the choice between fruit or a piece of cake, my natural inclination might be for a piece of cake, especially since I have developed a sweeter tooth as I have got older and since I have stopped smoking. We all make the choice whether to eat a piece of cake. The ultimate responsibility lies with us as individuals and as parents, but I always have an open mind.

Diabetes is a growing problem and a major factor in premature mortality with an estimated 24,000 avoidable deaths a year—10% of deaths annually are in people with diabetes. A variation exists in the delivery of the nine care processes, with a range of 15.9% to 71.2% achievement across PCTs, which is not acceptable. However, 75% of diabetes sufferers receive eight out of the nine care processes, which is a huge improvement. In 2003-04, only 7% of sufferers received all nine care processes. In 2010-11, that figure was at 54.3%, but there is much more to be done. In the coming months, several documents will be published to guide the NHS in delivering improved diabetes care, including the response to the Public Accounts Committee report, the work undertaken on diabetes as a long-term condition and the cardiovascular disease outcome strategy.

We must ensure that people get an early diagnosis. I must commend again the work of Diabetes UK. Other hon. Members have mentioned how it is raising awareness of the early signs and symptoms of diabetes with its latest campaign on the 4 Ts, which has my full support. One in every two people diagnosed with diabetes already has complications. I thank the hon. Members for West Lancashire (Rosie Cooper) and for Blaenau Gwent (Nick Smith) for their contributions. I will not be able to answer their points specifically in my speech, but I hear what they say and will write to them if necessary to answer their questions. I am acutely aware of the complications and the devastating effects that those can have on people’s lives.

Photo of Adrian Sanders Adrian Sanders Liberal Democrat, Torbay

Can the Minister respond to the important point made by Keith Vaz about pharmacists? Some private pharmacy groups offer diabetes tests, which other pharmacies should be encouraged to do. I hope that we can see the roll-out of more collaborative working between the private sector and the health service in order to identify people with diabetes, so that they start to get treated.

Photo of Anna Soubry Anna Soubry The Parliamentary Under-Secretary of State for Health

I am grateful for that intervention not only because I was coughing but, most importantly, because I was going to mention that subject only in passing. I will now expand on that a little. I absolutely agree with the points of my hon. Friend and the right hon. Member for Leicester East about the importance of pharmacies. They are important for so much of the NHS’s work, but here is a good example of where we can link them in far more with delivering the successes, outcomes and diagnoses that we need so desperately. There is absolutely a role for pharmacies, and I look forward to clinical commissioning groups, which are already thinking in new ways about how to deliver better health care at a local level and working in exciting and imaginative ways, collaborating with pharmacies far more than has been done before. It is a good point, and I hope to see more action on it.

When people get a diagnosis, we need to ensure they are managed according to the latest clinical guidelines. The quality and outcomes framework, introduced in 2003-04, has incentivised primary care to perform the nine care processes for people with diabetes, but we know that there are difficulties—I have given the figures—and not enough people are receiving all nine. The National Institute for Health and Clinical Excellence has been asked to review the quality and outcomes framework and diabetes indicators, and we await its response and findings.

Last year, the National Audit Office reviewed the management of adult diabetes services in the NHS. While that highlighted the progress made over the past 10 years, it also highlighted the unwarranted variation that exists across the NHS and the significant challenges that we face over the next 10 years. There is no excuse for poor diabetes care. No one with diabetes should lose a leg or their vision if it can be prevented. We know what needs to be done and we need to ensure that we meet the challenge head on.

The prime objective of the NHS Commissioning Board will be to drive improvement in the quality of NHS services, and we will hold it to account for that through the NHS mandate, which makes it clear that we expect to see significant improvement in the outcomes, diagnosis and treatment of diabetes. In addition, through the NHS outcomes framework, we will be able to track the overall progress of the NHS on delivering improved health and outcomes. Diabetes is relevant to all five domains in the outcomes framework, so when work programmes are developed it is important to consider diabetes and how optimising care can deliver improvements.

My hon. Friend the Member for Torbay asked specifically about NHS Diabetes and whether it will continue to play a central role. NHS Diabetes is one of six current improvement organisations that are being replaced by the new NHS improvement body in the NHS Commissioning Board. In the overall context of what I have said, I hope that he will take comfort, will believe and be sure that diabetes is something that the NHS Commissioning Board has put much higher up its list of priorities. It is aware that much more needs to be done and is the ultimate driver of all of that.

Many hon. Members have mentioned diabetes 2, which is largely, but not always, a preventable disease. I have already paid tribute to those hon. Members who have raised the issue both in their local communities and nationally.

I want to end my comments by discussing an undoubtedly serious problem in our society, which is that almost all of us eat too much. We are overweight. Some 60% of adults are either overweight or obese. As a society, we find ourselves in a situation where one third of our 11-year-olds—our year 6 pupils—are either overweight or obese when they leave primary school. Those figures should truly shock each and every one of us, and something can be done about the problem. We can all take responsibility for how we feed our children and for our own lives and diets and what we eat and drink. The Government, however, can also do things, especially at a local level. When health and wellbeing boards identify the needs of their communities, if it is not a unitary authority, they can work with borough councils.

My hon. Friend the Member for Torbay made a good point about leisure services. We are already seeing evidence in shadow form. In my constituency, GPs are issuing prescriptions for activity, and the borough council is offering real assistance. It is almost as if there are no excuses not to go along to the various leisure centres and take up a class or gentle exercise. We even have walking football in Broxtowe. The point of all this is that local authorities are beginning to knit together all the various services to ensure that we all live longer, healthier and happier lives. The ultimate responsibility is ours, but local and national Government can do so much. It is all coming down to a local level. When we see the roll-out in the spring, I am confident that we will see great progress.