Diabetes: 9th January 2013

Mr Sanders
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.

The Parliamentary Under-Secretary of State for Health (Anna Soubry)
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 it not 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?

The Parliamentary Under-Secretary of State for Health (Anna Soubry)
It is a pleasure, as ever, to serve under your chairmanship, Mr Crausby. I pay tribute to my hon. Friend the Member for Torbay (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. The right hon. Member for Leicester East (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 the Member for Southport (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.
 
Ms Abbott
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?
 
Anna Soubry
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 meters 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.

Jim Shannon
It is not just about the provision of the insulin pumps; it is also about training. There are two facets to that.
 
Anna Soubry
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.
 
Nick Smith
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?

Anna Soubry
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 the right hon. Member for Leicester East and the hon. Member for Strangford (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.

Mr Sanders
Can the Minister respond to the important point made by the right hon. Member for Leicester East (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.

Anna Soubry
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.