[Dr William McCrea in the Chair]
It is a pleasure to speak under your chairmanship, Dr McCrea, for what I think is the first time.
Diabetes is the fastest-growing health threat in the UK, the EU and across the globe. I will first talk a little about what diabetes is. It is a condition in which there is too much glucose in the blood because the body cannot use it properly. That happens because the pancreas does not produce any insulin, or does not produce enough, or because the insulin it produces is unable to work properly. That is a problem because insulin is the key that unlocks the door to the body’s cells so that glucose can enter them. Diabetes means that the body is unable to use glucose as fuel; instead, it builds up in the blood.
There are two main types of diabetes, type 1 and type 2. They are different conditions with different causes; the treatments can be different as well. Both types are serious, lifelong conditions that can lead to devastating complications if they are not managed well, but with the right treatment and support people with diabetes can reduce their risk of developing such complications.
People with type 1 diabetes cannot produce insulin. About 10% of people with diabetes have type 1; I myself have had type 1 diabetes for nearly a quarter of a century, and I am still here. No one knows exactly what causes it, but it is not to do with being overweight and it is not currently preventable. It usually affects children and young adults, starting suddenly and getting worse quickly.
People with type 2 diabetes do not produce enough insulin or else the insulin they produce does not work properly. About 85% to 90% of people with diabetes have type 2. They might get it because their family history, age or ethnic background put them at increased risk. People are also more likely to get type 2 if they are overweight. It starts gradually, usually later in life, and it can be years before people realise they have it.
There are of course exceptions with both types: there are people who have got type 1 quite late in life and there are quite young people, including children, who have type 2, which is not always the consequence of the weight a person is carrying at the time of diagnosis. As with all things, the exceptions mean it is difficult to make a comprehensive diagnosis of what is happening, precisely why it is happening and how it can be prevented.
In the UK, around 3.2 million people have diabetes, and the condition costs the NHS over £10 billion a year. Within the EU as a whole, one in 12 adults have diabetes, and one in three people with the condition apparently do not know that they have it. In this country we have done a lot of work on trying to find what was referred to as the missing million—the people who have diabetes but had not been diagnosed. I believe the figure is now around 750,000, so around 250,000 people have been diagnosed as a result of greater awareness. I will be referring to that a little later.
According to the International Diabetes Federation, globally there are 382 million people with diabetes, a figure that is expected to rise to 592 million by 2035. The number of people with type 2 diabetes is increasing in every country in the world, and 80% of people with the condition live in low and middle-income countries. The greatest number of people with diabetes are between 40 and 59 years of age, and diabetes caused 5.1 million deaths in 2013. A really frightening statistic is that every six seconds a person dies from diabetes somewhere in the world. It is a global problem—a global pandemic—and requires a global response.
That is really what the Melbourne declaration on diabetes was all about. Parliamentarians representing 50 different countries came together to talk about what was happening in their countries and what the problems were, and to discuss how we could co-operate better. We recognised that many bodies work transnationally: patient bodies, medical professionals and pharmaceutical companies all meet regularly on a transnational basis. One group that does not is parliamentarians, yet it is the parliamentarians who can initiate debates, vote on budgets, raise awareness and put pressure on Governments in a way that other bodies cannot. In a sense, the parliamentarians are the missing link.
The aim was to bring those parliamentarians together to work together to commit themselves to be advocates in the fight against diabetes and to recognise the global challenge. Those who attended committed themselves to raising the profile and working for the benefit of people with diabetes wherever they live in the world. Since the declaration was signed, over 100 parliamentarians have signed up as members and many more have declared themselves supporters. Two newsletters have been published and are hosted on the International Diabetes Federation website, a Twitter account is now active, and debates have occurred in Russia, Bolivia, Malta, Kenya, Scotland and now here today in the Parliament of the United Kingdom.
There are so many issues to address. One is prevention. Far more needs to be done on that. We may have reduced the number who are missing their diagnosis, but there are still 750,000 people out there with diabetes whose condition will develop and whose cost to the health service will increase the longer they go undiagnosed. Health education is vital, to make people aware of the risks involved. We also need information out there to combat people’s fears that if they are diabetic they will have to inject themselves with needles all their lives. Only 10% of people with diabetes are type 1 and have to take insulin subcutaneously by injection—believe me, when someone is confronted with the fact that they have to inject themselves with a needle or they are going to die, they no longer worry about injecting themselves with a needle—so 90% of people with diabetes do not have to worry about that. They can be treated by diet and tablet, and different regimes.
There is still a stigma. There are Members of this place who have diabetes but do not want other people to know about it, although it is good that increasingly Members are prepared to come forward. The situation is the same in other professions. One great thing the all-party group on diabetes achieved was a change of policy in the police, the ambulance service and the fire service: people who admitted that they had diabetes were being retired immediately, but now instead they are given individual annual medical assessments to see what they can and cannot do. Sacking people simply because of a condition seems such an obvious injustice, especially as many of them can control that condition and hold down their job as well as any other person so long as they are monitored and have that medical assessment.
Prevention will save millions. There is no doubt that the bulk of the cost of diabetes to health care systems is at the point when the complications come in and a person with diabetes has to be hospitalised. It is an interesting phenomenon that people with diabetes stay longer in hospital beds than people without it. That includes people who have been admitted to hospital for something that has absolutely nothing to do with their diabetes, or who have come in for elective surgery. The change of environment on going into hospital disables them in terms of being able to control their condition. Increasingly now, many hospitals are saying that, as people with diabetes basically self-medicate 365 days of the year, if they go into hospital, they may as well carry on self-medicating, because they know their body better than the health service is likely to.
The savings to the health service from prevention are quite phenomenal. Early diagnosis is also important, as it reduces complications, so we need to encourage people to come forward and be tested. That is linked to the need for education and information so that people do not fear being tested or being diagnosed with the condition.
Sadly, many people with the condition are not getting the checks that they are supposed to get from our health service. Diabetes UK has taken that up and argues that everyone should be entitled to 15 checks whenever they go to their GP for an annual check-up. The fact that they are not getting all 15 checks suggests that something is not working correctly in the system. Some GP practices are excellent, but others are not so good and we must ensure that everyone gets the minimum 15 checks.
The pump device for those who are insulin-dependent is a small device about the size of a pager. It is attached to the patient and provides insulin doses, almost mimicking the pancreas. It is a very good regime, particularly for children who do not want the paraphernalia of injection pens and so on. They can enjoy a life in which other children do not recognise that the diabetic is different. They must still check their blood sugar, but we are looking and hoping for the development of a single device that both tests blood and injects insulin, completely mimicking the pancreas. It is out there, but it is not yet widely available. The cost must come down and more testing is needed, but that is the future. People must live with diabetes now and the level of pump prescribing here is well below that in other EU countries. Any child who is diagnosed with diabetes should be automatically put on a pump unless there is an objection. It is the obvious way to get a child to control their condition early and to enable them to enjoy their life along with other children of the same age.
The treatment of people in care with diabetes leaves a lot to be desired, and a lot more needs to be done in the various care inspection regimes to ensure that people with diabetes who go into residential or nursing care are properly looked after.
There are questions about research. Are we spending enough on research on a cure? Are we researching better conditions and finding the best treatment regimes for people with type 1 or type 2 diabetes?
Children with diabetes must be supported in school and I hope that the Children and Families Act 2014 will go some way to helping parents with some of the problems. Some schools have refused to deal with a child with diabetes or to help them to test their blood sugar levels and take their insulin. Some schools insist that a parent must be in attendance at the school, which often means taking someone out of a job to be a full-time carer of their child with diabetes in school. Surely that is not desirable.
There are complications with transition when children move from primary school to secondary school, and then to university. They often have to deal with three health care regimes: paediatrics, adult care and student care services. Problems often arise as a consequence of those transitions.
I mentioned discrimination in the workplace in relation to blue light services. We were able to campaign against that to help to tackle it. That discrimination is still out there. People must have the courage to come forward in cases where there has been discrimination on the grounds that they have diabetes. There is probably much better understanding now in the workplace about diabetes, but there are still pockets of ignorance that need to be tackled.
All that occurs in the UK, with its well-developed health care service, many aspects of which are the envy of other countries. The Commonwealth study that has come out this week shows that the UK health service is at No. 1. That is testament to everyone who works in the health care service. They deserve our congratulations on delivering such a fantastic service cost-effectively for the majority of people who need to access services. I may list a whole load of issues and problems, but it would be wrong to be all doom and gloom and to think that we are lagging behind. We are way ahead, but we want to be even further ahead and to bring other countries up to our level. We must and can do more.
Internationally, the 66th World Health Assembly adopted a global target to halt the rise of diabetes and obesity by 2025. Every nation needs a national strategy and action plan to prevent and manage the diabetes pandemic. It is unfortunate that we no longer have a national service framework for diabetes in this country. The Government should think again about that because without a national plan and national strategy, it is difficult to determine whether we are achieving what we want to achieve in terms of reducing the number of people with diabetes, diagnosing those who have the condition and ensuring that treatment is as good as the best anywhere in the UK.
The Parliamentarians for Diabetes Global Network, which was set up through the Melbourne declaration, can help to facilitate the objective that the World Health Organisation has laid down for health care systems around the world. The network’s priority in its early years will be to build a coalition of advocates for action to prevent the pandemic at local, regional, national and transnational levels, with the focus on raising the matter in Parliaments and Assemblies across the globe to spread better understanding and awareness of diabetes and the urgency with which it needs to be addressed.
Following the declaration and events in Parliaments around the world, the ExPAND Policy Toolkit for Diabetes has gone live and will greatly assist the aims of the declaration. It is a practical guide to help diabetes advocates to challenge national Governments and to raise the profile of diabetes. It is the first comprehensive resource aimed specifically at helping MPs and other policy makers to shape and influence national policy to ensure that we prepare our health care systems for the challenges of the 21st century. With input from parliamentarians for parliamentarians, it provides a one-stop resource covering the economic case for investment, evidence of what works and best practice from across Europe, as well as practical steps for leading and developing new policies on diabetes that are fit for purpose. Key topics include prevention, self-management, innovation and person-centred care. There are also dedicated chapters on the care and treatment of children and older people. It is hosted on the International Diabetes Federation’s website and is available for any parliamentarians who want to avail themselves of its usefulness. The toolkit was the result of more than a year’s work by a network of parliamentarians, patient representatives and other opinion formers from across Europe.
The Melbourne declaration is a clarion call for action across the world and the ExPAND Policy Toolkit for Diabetes is a resource to turn words into action, but we also need momentum to reach that tipping point where no one questions why the global pandemic of diabetes receives priority attention for resources to prevent, to diagnose and to treat the condition.
It is always a pleasure to speak about diabetes. I am a type 2 diabetic, so the matter is important to me. I congratulate the hon. Member for Torbay (Mr Sanders) on securing the debate. I know of his passion for the subject, and it is always good to participate in a debate initiated by him. I hope that others will contribute and help him to pursue his ideas. I am fully behind the Melbourne declaration on diabetes. I am delighted at the attention the illness is receiving, and I look forward to great steps being taken to curb the effect of diabetes in our country and the world.
Many people have referred to diabetes as a ticking time bomb. We focus on many diseases, such as cancer and heart disease, in that way. Diabetes is a ticking time bomb because of the numbers of people who have it and do not know, or who will potentially be diabetic in the near future. I am sure that we are all very aware that it is estimated that there are 382 million people worldwide with diabetes, most of whom are aged between 40 and 59. Again, that middle-aged group is where the focus seems to be, and their number is expected to rise to 592 million by 2035. For one second, consider again that the figure will rise from 382 million to 592 million by 2035—another 200 million people will be diabetics by that time.
In 2013, diabetes caused 5.1 million deaths, which is one every six seconds. That is the magnitude of the issue of diabetes and what it is doing and has the potential to do. In world monetary terms, diabetes is taking up some $548 billion in health spending in 2013, right across the world. That is 11% of worldwide expenditure. Those figures get into what it means to be diabetic, and why the condition is a ticking time bomb not only for the United Kingdom, but for the world. The statistics are harrowing. It is an international problem. It is a disease that we are often too blasé about, and we must not let this dire situation continue. We must adequately assess the issue of diabetes and tackle the problem head-on.
I want to mention our colleague, Edwin Poots, the Minister for Health, Social Services and Public Safety in Northern Ireland. He has initiated a programme to bring in 400 insulin pumps to help type 1 diabetics and their families. He has also initiated training along with that, so that people who have the pumps are adequately trained in administering the insulin, and in helping the control of diabetes. Good things have been done in Northern Ireland, but good things have been done in England as well. As the Minister will know, I ask all the time about a strategy, not only regionally, but for the whole United Kingdom.
Obesity and diabetes-related illnesses combined cost the NHS an estimated £15 billion a year, and 80% of the available funding for diabetes is spent on treating preventable complications, because it is not diabetes that will eventually, to use strong terms, kill someone, but the complications. It can affect people’s kidneys, liver, circulation, heart and eyesight.
While my hon. Friend is on the issue of the cost to the NHS and to all of us as taxpayers, does he agree that any additional resource that is deployed in early detection, and in trying to ensure greater awareness in communities across the UK, will vastly be outweighed by the savings, in terms of what the taxpayer would have to pay out otherwise? That has been outlined by both the hon. Member for Torbay (Mr Sanders) and by my hon. Friend.
I thank my hon. Friend and colleague for that comment. He is absolutely right, and I will come on to some issues that I feel the Government need to address early on. He is correct to say that vast savings will be made if there is early detection. The need for early detection was mentioned by the hon. Member for Torbay, and other Members will make the same comment.
Although it is great that money is available to treat this illness, we must not merely chase after it, putting a plaster on it after it has inflicted damage. That is clear. We need to ensure that money is spent not only on treating it, but on prevention methods—which makes me wonder whether my hon. Friend the Member for East Londonderry (Mr Campbell) was looking over my shoulder at my notes, because he made the next point that I was coming to. We cannot allow ourselves to accept the fact that 3.2 million people in the UK have been diagnosed with diabetes. Again, that is the magnitude of the problem. We must look to the causes and stamp them out at the root.
One thing that we can address is the preventive measures that need to be taken. We have talked many times in the House about the sugar content in food. The right hon. Member for Leicester East (Keith Vaz), who is not here today, introduced a measure, which I was happy to put my name to, addressing the issues of sugar in manufactured products that we eat. We need to take that issue forward, and in the future, I hope we will be in a position to take legislation on that subject through the House with the support of food manufacturers, so that we can address the issue of the food we eat. We do not need all the sugar or salt that is in food. There is a way of addressing issues outside the Chamber—issues that are outside Government control—but something needs to be done at a manufacturing level.
Our annual intake of sugar is 33.7 kg per capita. To put that in perspective, it is equivalent to eating nearly 34 average-sized bags of sugar each year. Imagine if the sugar was piled up on the table here; it would block my hon. Friend the Member for East Londonderry from sight completely. That is how much sugar we are all eating every year, and some people even eat more. Surely when discussing the Melbourne declaration on diabetes, the Government need to take another look at sugar levels in our food. What steps are the Government taking on diabetes prevention to ensure that the next generation is not blighted by diabetes in the way that this one is? Projections show that if current trends continue, in 2025, 5 million people in the UK will have diabetes. Again, the magnitude of the issue is clear, so what are the Government doing to ensure that that does not happen? What preventive measures are they putting in place to decrease that number?
The correlation between weight and diabetes has been made clear: 80% of people with type 2 diabetes are overweight or obese. The Government need to do more to increase education on the danger of being overweight or obese and tighten controls on how much sugar goes into our food. Those are all issues that I feel we need to take on board.
What is so frustrating is that up to 80% of type 2 diabetes could be delayed or prevented. I am not saying that in any judgmental way, because many in the Chamber will be aware that I am a type 2 diabetic, as I declared at the beginning of my speech. The truth of the matter is that I have to blame myself and my lifestyle choices for the onset of the disease. It was the Chinese carry-out five nights a week, with two bottles of Coke—not a good diet for anybody. That is the reason why I was almost 18 stone and had to lose weight very quickly. Aside from that, it was also a lifestyle with high levels of stress. When the two are combined, diabetes will knock on the door of nearly everybody, as most of us know.
While I am on the subject, many people can be diabetic even though they are not necessarily overweight. It can happen through them having a stressful lifestyle. How many others living the same lifestyle are not aware of the damage that they are doing to their bodies in the long term, and how can we do better in highlighting that? I have to take two Metformin tablets in the morning and two at night. That dosage could have to be increased; a doctor could come along, as he often does, and say “By the way, you just need a wee blood pressure tablet now to keep you right as well.” People wonder just how many tablets they will have to take before they reach the age of 65 and retire, if they are spared until that age.
What are the Government doing to diagnose diabetes early and treat it effectively, preventing or delaying the complications that cause so much human suffering, require costly treatment, and reduce life expectancy? Only one in 10 people who are newly diagnosed with diabetes are offered education on how to manage their condition, despite strong evidence that education is a cost-effective way of giving people the knowledge that they need to manage their condition. On managing diabetes, after someone is diagnosed as diabetic, what help is given to them to ensure that they manage that in a sensible way? I accept that the person also needs to acknowledge that they have to manage the condition. I remember Dr Mageean, my doctor, telling me when I was first diagnosed, “Jim, it is up to you what you do.” He was very clear and said, “You must manage this yourself,” but at the same time, I think we need a wee bit of help, perhaps from Government and from the health service in particular, just to ensure that we know what that all means for everyone involved.
It is estimated that in my small Province of Northern Ireland, 80,000 people have diabetes. That awful statistic worries me very much.
The point about education is interesting. According to the National Audit Office, the estimated amount that the NHS could save annually through people better understanding and managing diabetes is £170 million. That is just from improved awareness and education.
I thank the hon. Gentleman for his intervention. That reinforces the point made by my hon. Friend the Member for East Londonderry and by me: prevention saves money for the NHS. I accept that the Minister’s budget is restricted, and that we cannot spend outside of that, but if there are ways and means of reducing the money that is spent and ensuring that we can still deliver the NHS that we are all very proud of, we should try to do that as well.
On 12 February 2014, I asked the Minister what discussions had been had with the Health Minister in Northern Ireland on UK-wide strategies for diabetes, obesity, heart disease and rare diseases. The Minister said that there had been no discussions with the Northern Ireland Executive on those issues. I am asking that question again, as she is here. I respect her greatly—she knows that—and I value the work that she carries out in this place, but I honestly believe that a UK-wide strategy is needed. We had one until 2013, but then it was not carried on. I believe that it would be to the benefit of all the regions of the United Kingdom of Great Britain and Northern Ireland if that UK-wide strategy was started again, so I ask the question again.
There is cross-House approval of and support for the Melbourne declaration on diabetes, which pushed for an international effort in the fight against diabetes, and that is what this is all about. Are the Government willing to work with the devolved Administrations of Northern Ireland, Scotland and Wales to use resources wisely and create a UK-wide strategy against diabetes? They have done it before; let us do it again, and do it even better this time.
The director of Diabetes UK Northern Ireland, Iain Foster, has said:
“We are in the middle of a diabetes epidemic…With the numbers rapidly increasing it is now more important than ever that everything is done to prevent serious complications which cost the NHS millions”—
as the hon. Member for Torbay said—
“and are absolutely devastating for the individuals and families involved.”
Let us never forget that it is not just those with diabetes but the families around them who are affected by the debilitating effects of diabetes on the individual.
Will the Government commit to implementing fully the NHS health check, which should be offered to everyone aged 40 to 74, to help identify people at high risk of type 2 diabetes? I say with respect that that programme has been patchily introduced so far, so there could be a lot of improvement. The Government need to do more to ensure that those at high risk benefit from lifestyle interventions to help to prevent the disease. The National Institute for Health and Care Excellence has recommended increasing the proportion of people with diabetes who get the nine annual checks. That should happen as a matter of course when people are in their GP surgery, or in hospital for whatever reason.
Those checks help people to manage their condition and to identify any signs of complications early. However, there is a large geographical variation in the proportion of people getting them. Again, if we had a UK-wide strategy, we could ensure that there were no differences geographically in who gets the nine annual checks and who does not. Will the Government commit to increasing the number of people who receive the checks? That is a positive way forward. It is another way of doing the preventive work that we need, and will ultimately lead to the savings that we need.
In 1922, insulin was discovered by John Macleod, Dr Banting and Charles Best, yet 92 years later, in 2014, we are still fighting against the dreadful disease of diabetes. In the UK this year, 59,000 people will die unnecessarily from diabetes. I strongly urge the Government, in the wake of the Melbourne declaration on diabetes, to take serious strides in the UK in preventing and controlling diabetes.
It is, as usual, a pleasure to serve under your chairmanship, Dr McCrea, and it is a pleasure to follow the hon. Members for Torbay (Mr Sanders) and for Strangford (Jim Shannon). The hon. Member for Torbay, in particular, has been making a superb contribution across this entire policy area for many years. As someone who is also “blessed” with type 1 diabetes, I look to him for inspiration, and he readily provides it on a regular basis. I cannot thank him enough for introducing a debate in this House on this subject yet again. His work as chair of the all-party group on diabetes, as president of the Parliamentarians for Diabetes Global Network and in the Global Parliamentary Champions for Diabetes Forum is commendable. His position and work there mean that the UK can be a world leader in ensuring high-quality treatments and support for those with diabetes. I am very sincere in all those comments. They are heartfelt.
The hon. Gentleman spoke on this subject in April, in a debate to which I contributed. He raised some very important issues, not least of which was the importance of an approach that respects the distinction between causes and treatments of type 1 and type 2 diabetes. In opening today’s debate, he has again raised matters of the utmost importance and concern, which I will also touch on.
The Melbourne declaration on diabetes was formally adopted on 2 December 2013, as we have heard, at the first Global Parliamentary Champions for Diabetes Forum. The declaration contains eight action points for parliamentarians, including encouraging the creation and adoption of a national plan that acknowledges that diabetes is a national health priority and that leads to action. I will focus my remarks today on the need to create an action plan. I hope that the Minister, whom I welcome to her place, can confirm that the Government are committed to that, especially given the clear will of parliamentarians from those parties that have contributed today, although I know from discussions and conversations with colleagues right across the House that there is a clear understanding of the need to support an action plan as a way forward.
There are more than 380 million people with diabetes in the world, and that figure is expected to reach almost 600 million by 2035. That is deeply worrying. In the UK, 3.2 million people are living with diabetes. That includes almost 35,000 children. One pound in every £10 spent by the NHS is spent on treating diabetes and the complications that arise from it. We have heard an awful lot about the economic and financial modelling of the effects of diabetes on the NHS. I think that we need to spend more time on that as a country. Diabetes UK says that diabetes is responsible for 20,000 premature deaths each year, and that 80% of cases of type 2 diabetes could be prevented or delayed. Let us just think about that: 80% of cases could be prevented or delayed. The financial savings that we could make, irrespective of the improvements that we could make to the lives of those people who go on to develop type 2 diabetes, are phenomenal.
We must always be aware of the distinction between type 1 and type 2 diabetes. Type 1 is a chronic, life-threatening condition that affects 400,000 people in the UK, including 29,000 children. Type 1, as we have heard, is not caused by lifestyle factors such as obesity, lack of exercise or poor diet. I should know, and I never resist the temptation to remind people that I did the London marathon earlier this year. Thanks go to the Juvenile Diabetes Research Foundation, if its representative is in the room. I want to do it again next year, by the way. Whereas those with type 2 diabetes can sometimes be treated with a change in diet and exercise and modest medication, those with type 1 diabetes need multiple insulin injections or pump infusions every day. I did mine before the debate started. My blood glucose level was 14.7, which is not particularly good—I will be getting told off for that.
Each year, a person with type 1 diabetes will undertake more than 2,000 finger-prick blood tests, have 1,500 insulin injections and count the carbohydrates in more than 1,000 meals. It is clear that any action plan will have to develop coherent and effective strategies for both conditions. A one-size-fits-all strategy simply will not do, so I hope that the Minister can reassure us today that she will not be cutting corners. Any plan must be workable and tailored to meet the specific needs of both conditions.
Diabetes UK has done excellent work, as always, on this matter. Its briefing in advance of today’s debate was superb. It endorses the view that there is a clear need for a national action plan. It has identified five key areas that must be included. Those are improvement in support for self-management; integration of care; improving safety; a focus on children and young people with diabetes; and prevention of type 2 diabetes. I am sure that if the Government introduced a comprehensive action plan built on those five principles, it would receive the support of the entire House.
Starting with self-management, it is obviously crucial that individuals and their families can successfully manage their condition, and the keystone of that is effective care planning and education. Positive care planning and strong education can ensure that an individual is equipped with the tools and resources needed effectively to manage their condition. Diabetes UK calculates that each year, care in a clinical setting totals about three hours, whereas self-care accounts for almost 9,000 hours. Improving self-management is not optional—it is absolutely essential. I appreciate that it could be culturally difficult for us to achieve that as a Parliament and a country, but it is something we absolutely need to crack.
Opposition Members have long advocated the benefits of integrated care across the whole NHS. With diabetes, a person will routinely have contact with many parts of the wider health care system, such as primary, community and secondary care. To improve integration, Diabetes UK has identified five key points that would, in effect, provide an integrated diabetes care pathway. Such a pathway would require strong networks of clinicians, commissioners and patients, a more integrated system of commissioning services, better information-sharing across services and the improving of skills in primary care, all of which should be overseen by effective clinical governance. Those actions are not out of reach, and the Government could easily ensure that they are part of any action plan.
The third point I want to cover is patient safety. There are major issues regarding the safety of in-patients with diabetes in hospitals. According to research undertaken by Diabetes UK relating to the past year, about 40% of in-patients experienced at least one medication error, more than a fifth experienced one or more hypoglycaemic episodes and fewer than a third were seen by a member of the diabetes team. Those problems can, as the hon. Member for Torbay said, contribute to patients with diabetes having to remain in hospital more than three days longer than patients without diabetes. Again, we should consider the cost implications for the health service in these tough times. Any plan the Government introduce must surely address that, because it is bad for patients, clinicians and the health service.
There must also be space in the Government’s plan to address young people’s experiences. There are 35,000 children with diabetes in the UK, which has the fourth highest number of children diagnosed with type 1 diabetes in Europe. Many children and young adults experience a marked deterioration in their care as they make the transition from children’s to adults services. Adolescence is often a time when many lifelong behaviours are established, including those that are health-related, so it is essential that young people can complete the transition at a time that is right for them. A deterioration in care and a forced transition have been shown to disengage young people from the service, resulting in worse outcomes and complications. There is an acute need to address that.
In the last debate on this issue, in April, I referred to support and education for young people, which are key to ensuring that they can manage and cope with their condition. Being diagnosed with any form of diabetes can be overwhelming if the proper support is not in place.
My next point relates to a focus on preventing type 2 diabetes. Recent reports by the British Medical Journal have shown that a third of adults have higher than normal blood glucose levels, which is an indication of pre-diabetes, and many health professionals project that there will be a huge increase in the numbers of those with type 2 diabetes. I am sure that that worries policy makers on both sides of the House, whether on the left or the right or in the centre. As I said, any action plan must take into account the differences between type 1 and type 2. Critically, any strategy for type 2 must be based on prevention.
I would be grateful if the Minister could outline what the Government are doing on the points I have raised, and I would expect her to be able to give us some indication of when they are likely to introduce a plan to address the issue. Given the importance of such a plan, I hope she will make a statement to the House when any plan is published, to give Members who are not present the chance to scrutinise the Government’s proposals. Indeed, I would go further. Every time we have such a debate, it strikes me that there is a real wealth of experience and understanding of these issues across the House. It would, therefore, be a tremendous gesture—not for its own sake, but from the point of view of those living with this condition—if Members who understand type 1 and type 2 diabetes were allowed to contribute their knowledge and experience to the production of a better plan that would better suit those with this condition.
Through the Melbourne declaration, the International Diabetes Foundation makes the incredibly important point that
“disadvantaged people in every country carry the greatest burden”
with regard to diabetes. That is important when looking at the levels of clinical care for diabetics across clinical commissioning groups throughout England. Speaking to diabetics around the country, I have seen for myself that if we are to make self-management as effective as it can be—we have a long way to go on improving not only the culture but the clinical ability of CCGs and other primary care providers regarding self-management—we must make a concerted effort to look at the literacy and numeracy of some of the people with this condition. Every day, before every injection, people must undertake a fairly simple and routine mathematical calculation of their insulin to carbohydrate ratio, but many of them simply cannot do the maths. There is no assistance, tool or device on the market to help them make those calculations simply, so we need to look at that, because it is a big cultural issue. There is an issue with not just numeracy, but literacy, and there are also issues about social exclusion, which I am sure we are all aware of. We need to put some time and effort into understanding and resolving those issues if we are properly to increase self-management among diabetics.
NHS England published “Action for Diabetes” earlier this year, but Diabetes UK said that it was not sufficient and did not present a comprehensive strategy or action plan. I have read it, and I think that is a fair comment. Diabetes desperately needs a national service framework—there are no two ways about that. The service around the country is incredibly patchy when it comes to not just the nine key diabetic tests, but other diabetic support services. Perhaps the Minister can tell us how the Government will ensure that CCGs step up to the plate. We really need a detailed plan, and I hope she can tell us when one will be introduced.
Will the Minister also tell us how many diabetics are missing their checks? That information should be understood and collated centrally, because the issue is of strategic national clinical importance. What are the clinical and financial effects on the service of people missing their appointments? We are failing people with diabetes, and that did not begin in 2010.
I touched earlier on self-management, which is incredibly important, but so are innovation and the use of data. For me as a type 1 diabetic, the most important issue in managing my condition is having access to data about it, such as my blood glucose readings and my insulin ratios. We need a framework and a strategy for medical innovation that incorporates diabetes research—from not just a scientific point of view, but a patient’s point of view—in a profound way. How can we become the best country in the world, in terms of medical companies and other pharma-based industries developing new and innovative ways of treating diabetes?
I wear all sorts of devices to monitor my fitness and my sleep—whether it is a Jawbone, a Misfit Shine or a Nike fuelband, believe me, I have them all. The data they capture about the individual is of incredible medical importance. We need, on a cross-party basis, to establish a strategy under which this country can genuinely innovate and become a global leader, with a view to enabling companies to produce the best suite of devices, applications and so on to assist in dealing with type 1 and type 2 diabetics. I look forward to the day when my data can be captured in real time and shared with my GP and my pharmacist, so that I do not have to phone up, text or e-mail to get my insulin prescription. My GP and my pharmacist will have the information and the algorithm, they will know when my prescription needs to be ready and how much I am using, and my doctor will know how I manage my condition. We can hothouse innovation—my office and I are doing an awful lot of work on this—but we need to make that innovation part of not only a national diabetes strategy, but a biotech and medical innovation strategy.
Finally, I say to the Minister that we are here to help. Will she please use the experience that exists across the House and not miss this opportunity to act?
Before I call the Minister, I want to mention that several Members have apologised for not attending because they are taking part in another debate. They wanted to be here and asked me to pass on their apology to the hon. Member for Torbay (Mr Sanders) and the Minister.
Thank you, Dr McCrea. I am aware that some colleagues who would normally be with us for a debate on this important topic have been speaking in the main Chamber. No doubt they will catch up with the debate online, at some point. I thank my hon. Friend the Member for Torbay (Mr Sanders), who opened the debate, and all those who have spoken. It has been another thoughtful debate on a topic that is very important, as he said. I congratulate him on his recent election as the first president of the Global Parliamentary Champions for Diabetes Forum. I am not sure whether he modestly did not mention that, but I give him credit for it. It is a tribute to his effective championing of the issue, and the global initiative is important.
As my hon. Friend said, we must not underestimate the global threat posed by diabetes. Other hon. Members have mentioned the numbers involved; the International Diabetes Federation estimates that by 2035 there will be 600 million people with diabetes worldwide, which is about one in 10 of the planet’s population. I think that the hon. Member for Strangford (Jim Shannon) described that as a ticking time bomb, but the debate has drawn out the fact that for the most part we do not have to accept that as inevitable. There are things that we can do, and it is right that we are beginning to talk about the issue as a global community, in global health terms.
In the UK, 3 million people are affected by diabetes. It is estimated that by 2025 the figure will be 4 million if we do not make progress. We estimate that around 850,000 people have undiagnosed type 2 diabetes. Diabetes is a priority for the Government. We have set clear objectives for the NHS and Public Health England to do more on prevention and to improve the care and management of people with diabetes. I accept that there is a challenge about the need for a national action plan. I have had meetings with Diabetes UK and it is one of the things mentioned in its briefing. We have set up clear objectives for the NHS and Public Health England and we ask them to deliver against those, so my contention is that we do indeed have a national plan, but that we may be carrying it out within a slightly different framework from the one advocated. The degree of priority we give it, and the importance that the Government accord to ensuring that the health and care system work together at all levels to give people with diabetes the care and support they need, should not be underestimated.
I hope that while I have been the Public Health Minister I have reassured colleagues about the personal priority that I give to the issue of diabetes. Indeed, my first public outing, slightly terrifyingly, was to speak to a meeting organised by my hon. Friend the Member for Torbay. Almost certainly, everyone in the room knew more than I did about the subject, but I attended to show, very early in my ministerial role, how important the issue was to me.
I have met the national clinical director. I try to have reasonably regular meetings with him, because the issue is such an important one. I have a continuing relationship with the all-party group on diabetes and the other diabetes campaigning groups and Members in the House. With respect to type 1 diabetes, I met my and other Members’ constituents at the JDRF event, which I have attended several times. It is always humbling to meet those fantastic young people who have learned very young to manage and live with a difficult condition.
What is NHS England doing to improve the management and care of people with diabetes? As I mentioned, I have several times met Professor Jonathan Valabhji, the NHS England national clinical director for obesity and diabetes. He has been generous with his time in attending parliamentary events, and is a great supporter of the work of groups and Members in the House. He regularly attends events focused on diabetes and is focused very much on improving outcomes for people with all types of diabetes.
Earlier this year “Action for Diabetes” was published, which describes the actions that NHS England is taking to improve diabetes care. It covers many areas, some of which have been highlighted during the debate, including developing GP contracts and incentives; working with primary care services to trial and roll out case-finding; and decision-support tools to help to detect and diagnose diabetes earlier. A national conversation is also going on about obesity and taking care of one’s own health. Hon. Members have touched on that with regard to the prevention of type 2. Every member of the public is a part of that conversation. We did not talk much about individuals during the debate, but I think we would all agree that we need constantly to emphasise personal responsibility in relation to preventable or avoidable type 2.
I sometimes worry—I talked about this with the head of Diabetes UK shortly after becoming a Minister—that, because few deaths are recorded as being due to diabetes, rather than its complications, there may be a slightly more relaxed attitude among people who think they might develop diabetes, which they would never in a million years have towards a disease such as cancer, which they would immediately identify as a threat. Through debates such as today’s, and the work that we all do, we can emphasise the fact that, although people may not know many people who can be said to have died of diabetes, they will know many whose diabetes contributed to premature death or a long period of ill health. There is more work for us to do, to get that message out. That is how we can empower people to help themselves.
The Minister could not have said a truer word, because many people see diabetes as a disease that they can manage—one that is not too bad. However, she is right: the complications are far reaching and can lead to consequences that are final. In my speech I talked about education, because people must manage the condition themselves, but they need to know what they have to manage. That is my point: some people need the information reinforced, with the seriousness that the Minister expressed.
That is right. We need to make sure of that. People cannot be empowered without information. We also know, having a duty to address health inequalities, that some people and groups in the community find things much harder. I was taken by some of what the shadow Minister, the hon. Member for Copeland (Mr Reed), said about deploying technology more. Work is going on, but I agree with him that we could go further faster with that, to find ways to empower people who may not have a good sense of what to do to take care of their health, and who find it harder than others to obtain the available advice. We must work harder to reach them and I shall talk about NHS health checks in relation to that.
As to the commissioning of integrated care, NHS England is working with other organisations to help to promote services that are integrated around patients’ needs across all settings. There has been much emphasis on that. That body is implementing what it calls a customer service platform to allow patients with diabetes to self-manage, through booking their own appointments, managing their prescriptions, monitoring the care they have received and being able to view their personal health records. That picks up on some of the shadow spokesman’s points.
NHS England has also produced a sample service specification for the management of type 1 and type 2 diabetes that is based on National Institute for Health and Care Excellence standards. It provides a model for commissioning integrated care for those with diabetes, and also highlights the specific needs of those with type 1 diabetes, where they differ from the needs of those with type 2. If the current trial of the service specification is successful, it will be offered as a tool that all clinical commissioning groups can choose to use to deliver high-quality care. That is therefore an important piece of work in progress.
There is always a challenge for any of us in making sure that the rest are as good as the best. Occasionally when we talk about the challenges of our current health infrastructure I worry about the assumption that there is a model out there, somewhere, that would absolutely guarantee the delivery of completely consistent care in a given area, across the country. In a country such as ours it is not possible to give such a top-down guarantee. Yes, we must find a way to drive care from the top, with a clear sense of direction from the strategy and mandate that we have given the NHS and Public Health England, but we must also put the tools in the hands of the clinicians, as I have been discussing. Most importantly, we must empower individuals and patients to know what they can expect and to demand good care. Nevertheless, I genuinely do not think that we could devise any system in which we could just issue a notice from the centre to say exactly how care will be delivered consistently across the country. We must find other ways to do it.
I understand the Minister’s point, but we are talking about nine very simple, fairly cheap tests for people with type 1 diabetes that must be done in a primary care setting by medical professionals. We are talking about blood tests, the blood being processed and the resulting data being made available, all of which are critical to the self-management of the condition. Surely we can insist on those nine tests for every single type 1 diabetic patient.
I think that the shadow Minister has slightly misunderstood what I said. Those are the tests and that is exactly the standard to which we want everyone to work. What I am saying is that there is no top-down guarantee. We cannot sit in Whitehall and say, “It must be done like this and that is the end of it.” We have said that that is the standard, and NHS England has set a range of other standards, but to deliver that and to drive that consistency of excellence throughout the country requires a range of tools. We must acknowledge that. That is not to say that we accept patchy service—far from it—but we cannot do it with top-down diktat only; we must drive change at all levels of the system and drive towards excellence.
On that point, there is a difference between a treatment, which must be down to the clinician and what is right for the patient, and tests, which should be the same for everyone. They are just tests that would then dictate the right treatment regime, if additional interventions are required. There ought to be a mechanism to ensure that the tests are consistent for every patient with diabetes in the country, otherwise what is the point of having them?
I agree. The Government, NHS England and Public Health England are all looking at how we drive that consistency. How do we drive consistent excellence? What tools can we use to do that?
Perhaps it would be helpful if I gave an example. Public Health England is developing a tool to drive improvements in diabetes care and iron out variation. It will be launched later this year, and although I am not able to give much detail now, I am sure that my hon. Friend the Member for Torbay will be interested when it is launched. It will provide a clear picture of how diabetes care and outcomes vary across the country and among practices, which will support decisions on how to make improvements.
The Government have made transparency of data a real priority, and being very transparent about what is being delivered and identifying variation is one of the ways in which we can drive the rest to be as good as the best. I suppose I am trying to explain that, although I could send out a memo tomorrow outlining my national diktat on diabetes, that is not how we drive change. It is crunchy, it is detailed and it is about getting to that local variation and ensuring that we drive up standards in every way possible. That is one of the tools we are developing, but there are others as well.
In my speech, I called for a strategy that was not just regional but UK-wide, and I hope the Minister can respond to that. Other Members have spoken about the need for an English strategy, but there must also be one for Wales, one for Scotland and one for Northern Ireland. All four must work together so that we can address the issue together. The Melbourne initiative is very much worldwide, so although people refer to England, we must go further. What are the Government doing to initiate a UK-wide strategy?
As the hon. Gentleman knows, health is a devolved matter. That is not to say that I am not at all interested in what is going on in Northern Ireland—far from it—but it is nevertheless a devolved matter. As I have said to him in other debates, there is clearly an awful lot that we can learn from each other. People can learn from everything that I report to the House on innovation and the progress that we make in England, as well as, indeed, things that other Health Ministers report from other parts of the United Kingdom. Nevertheless, I currently have no plan for a UK-wide strategy because health is a devolved matter.
If the hon. Gentleman does not mind, I am going to make some progress.
Of course, the fact that health is a devolved matter does not mean that we cannot find areas of joint working, and the Melbourne declaration shows us the way forward on that. That is probably where we end up—the fact that it is devolved does not mean that we cannot share learning and knowledge, learn from one another’s initiatives, or operate in that global context.
I hope that the Minister will accept that I am not being argumentative, but we had a UK-wide strategy until 2013—last year—so we have shown that we can work together. All I am asking really is: why do we not initiate a similar plan to what was there before 2013—a 10-year plan that started in 2003—and have the four regions work together? That is exactly what the Melbourne initiative is about, and we could do it because we have done it before.
I want to discuss another area in which we can make a difference by empowering patients. Colleagues might be interested to hear about the patient experience of diabetes services survey, part of the national diabetes audit, in which I know there is always great interest in the House—we regularly answer a number of parliamentary questions about it. The survey measures the health care experiences of people with diabetes in England and Wales. It collects information online from people with diabetes by asking questions about their care using a short, validated questionnaire, and it is being tested.
Any diabetes service in England and Wales should be able to use the survey to get feedback from patients. We want to publish the first results this month or this summer. That is going to be an interesting extra tool in the box, not only to help to drive excellence and drive out variation, but to empower local services to understand at a local level what is going on and how satisfied their patients are with the service being provided. That can lead only to upward pressure to improve services, not least from patients.
Let me talk a little about the NHS health check programme. Alongside the work being done by NHS England to improve the management and care of people with diabetes, the Government are working on prevention and earlier detection, which all Members mentioned. We are continuing to roll out the NHS health check programme, which identifies those aged between 40 and 74 who are at risk of diabetes and other vascular diseases and helps them to reduce that risk. More than 15 million people are currently eligible for an NHS health check. Our economic modelling has shown that the programme has the potential to prevent more than 4,000 people a year from developing diabetes and to detect at least 20,000 cases of diabetes or kidney disease earlier. It is all about helping people to better manage and improve their quality of life.
In the past year, almost 3 million NHS health check offers were made and almost 1.5 million appointments were taken up, during a time of great change across the health system. We are now looking to challenge the system to go further and faster and to continue to increase the number of people who participate in the programme. I have been out and about and seen some great local initiatives. I visited an NHS health check team in Southwark and witnessed the important conversations they were starting with people in their local area.
Another example is Bolton, where health trainers have worked with 134 people identified as being at risk of diabetes through the NHS health check. The health trainers have supported people to make lifestyle changes such as eating more healthily and increasing physical activity levels, and they have helped almost half the group to return their glycaemic level to normal. That is really good evidence of effective intervention.
In Tower Hamlets, where more than 50% of the population are from ethnic minority groups, the prevalence of type 2 diabetes has been growing rapidly. To help to combat that, Tower Hamlets has incorporated the health check programme into its managed practice network scheme. I have talked to staff about that and heard about how they are approaching it. Tower Hamlets has worked hard to ensure that all diabetic patients have a care plan, and that focus has resulted in a 70% increase between 2009 and 2012. There has also been a lot of focus on the take-up of retinal screening for people with diabetes, and, again, there has been a significant rise.
We are seeing that such local interventions can really work. I firmly believe that a localist approach is important in some of these areas, because there is no one-size-fits-all approach that we can devise in Westminster that will work for every community. Such local innovations are important. I constantly challenge myself to think about how we can ensure that we spread the word about some of this great local action. We have started initiatives in that regard, but Parliament has a great role to play, and I encourage Members to tell us of effective local initiatives, so that we can spread the word.
Research on the NHS health check programme carried out by Imperial college London and Queen Mary university of London is under way. That research will improve our understanding of who is taking up the opportunity, their risk of cardiovascular disease and the incidence of diseases such as diabetes in those groups. When that work comes back, it will help us to understand how we can make those interventions count more.
We have already talked a little about obesity and sedentary lifestyles. Physical activity is a big priority of this Government, and I have had a couple of meetings in the past couple of days alone on the cross-Government action we are taking to try to hardwire physical activity into all aspects of life. We have a long way to go yet because, for too long, physical activity was left in a silo marked “health” when it is more important than that. We know that all parts of local and national Government need to address inactivity; that is one of the factors that can help to prevent diabetes.
I also want briefly to address the responsibility deal. The Government have been working with business—the hon. Member for Strangford mentioned this—on its responsibility to consider calorie reduction and clearer labelling of food. We are starting to see calories and other contents displayed on the packaging of many more foods, as we roll out consistent food labelling on a voluntary basis across the country.
The Change4Life social marketing campaign, which is one of Public Health England’s flagship programmes, is encouraging individuals to make simple changes, and it is trying to work with people in the way that the shadow Minister mentioned. The campaign is trying to talk to people in language that makes it straightforward and easy for them to understand the good choices they can make for the health of both themselves and their family.
The national child measurement programme’s findings on childhood obesity are encouraging. We know that far too many people are overweight and obese, but we are seeing signs of encouragement. In 2012, childhood obesity rates fell for the first time since 1998, so we must not despair over the actions we have all taken and advocated over many years. We are beginning to see that such action can have an effect, but we must never underestimate how far we have to go.
In 2013, the global burden of disease study showed that the UK has the lowest rates of early death due to diabetes of the 19 wealthy countries included in the analysis. The last data on diabetes care showed a 60% completion rate for all eight care processes recommended by the National Institute for Health and Care Excellence, which is a five percentage point improvement on 2010. We see progress, but we know there is much more to do. The Melbourne declaration is a timely reminder of the serious threat posed by the disease across the world, as well as here in the UK. I assure the House and my hon. Friend the Member for Torbay, who led this debate and leads the all-party group in such an exemplary way, that diabetes is a priority on which we continue to work hard. We are pleased to see progress, but we do not underestimate how much more there is to do. Such debates are welcome opportunities to keep the issue firmly on Parliament’s radar.
When the Minister came to the all-party group, I do not think anyone recognised that it was her first meeting because she carried it off with distinction and quickly won over a lot of friends in the group. She has been a consistent friend throughout the period.
One of the challenges of a bottom-up approach, as has been highlighted in this debate, is getting people to use the information that is out there to drive up standards. People need to be aware of where the information is and how they can best use it, which is a challenge not only for diabetes but across the health service. I thank all hon. Members for their contributions.