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House of Commons Hansard
23 November 2016
Volume 617

    [Mrs Cheryl Gillan in the Chair]

  • I beg to move,

    That this House has considered access to diabetes technologies.

    It is a pleasure to serve under your chairmanship, Mrs Gillan. It is also good to see the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), in her place; I served under her chairmanship when she chaired the Select Committee on Science and Technology. I intend to use this debate to consider what can be done to accelerate access to new, innovative diabetes technologies.

    This is a complex subject. I know there are patients who would benefit from technologies such as insulin pumps and glucose monitoring systems but are not able to access them. For many, access to diabetes technologies will have a transforming effect on their lives, enabling them to live full lives, be economically active and reduce the burden on primary and secondary care.

    First, I recognise that progress is being made in this area. The intention behind the debate is to highlight the opportunity we have dramatically to transform people’s lives by accelerating access to diabetes technologies. I am here not to criticise but to say, as my schoolteachers regularly said to me, “You could do better,” because I believe we can in this area. Secondly, I want to use this opportunity to pay credit to the work of the all-party parliamentary group on vascular disease, and in particular its inquiry into patient access to technology last summer. The APPG recognised that access to technology facilitates the earlier and more accurate identification of people at potential risk of diabetes-related complications.

    I want to refer to three of the 12 recommendations listed in the APPG’s report. The first is that the NHS must consider steps to become more flexible when commissioning or supporting the commissioning of new technologies designed to improve patient outcomes. Its second recommendation is that the NHS and industry should work together to harness innovation and promote better treatment for patients. Thirdly, it recommends that NHS England should consider how to introduce measures to incentivise the screening and diagnosis of patients at risk of peripheral arterial disease in primary care settings. Those recommendations help me to impress on the Minister a matter of great urgency, importance and opportunity for diabetic patients in the UK.

    I would like us to consider the need to accelerate access to existing technologies; how the NHS can accelerate the development, testing and application of new technologies; and how information technology can be used to inform and educate patients, giving them greater power to manage their condition and lead full and free lives.

  • I congratulate the hon. Gentleman on obtaining this debate. He will be aware that in our schools today there is a problem with young children administering insulin where teachers are not trained to do it and cannot, because of child protection rules. If new and innovative technologies were used, we could perhaps get over that difficulty.

  • I thank the hon. Gentleman for his intervention. I will speak later about the opportunity as regards children. If we do not help them to manage their condition, the complications later on are significant indeed.

    I do not intend to go over the sheer scale of the problem of diabetes in the UK and its impact on people’s quality of life, our health system, community and social care services and economic productivity. We all know the stats. Despite that, it is my belief that the NHS fails to take full advantage of the latest technology available to patients, including flash glucose monitoring technology, known as FGM. That issue is being targeted by NHS England via the national obesity and diabetes prevention programme. The programme is a joint initiative between NHS England, Public Health England and Diabetes UK, and it aims significantly to reduce the 5 million people in the UK expected to have diabetes by 2025.

    Flash glucose monitoring technology is available to support the NHS and NHS England to achieve their objectives related to diabetes. Today’s debate is an opportunity to see how the Government might take full advantage of that and other technologies in the future. It is timely therefore to concentrate our minds briefly on the benefits of technologies such as flash glucose monitoring. Just a few years ago, who would have thought that someone with diabetes could turn their back on routine finger pricking to test their glucose readings and instead rely confidently on readings taken via a small sensor worn on the body?

    Just a few years ago, diabetics must have dreamt of a day when they could take a glucose reading as many times a day as they liked, without having to worry about pain, discomfort, inconvenience or running out of test strips. Imagine a world where schoolchildren or people in full-time employment avoided the interruption of finger prick testing and the stigma of testing in public. That world exists, and accelerated access to FGM, which delivers those benefits, could help to improve people’s health, avoiding the need for people who are in work to take extra sick leave by simply enabling better management of their condition.

    Flash glucose monitoring provides a current glucose reading, an eight-hour history and information about the direction glucose is going in. That allows people to monitor whether their glucose levels are rising or falling quickly and can support them to take action before their condition worsens. That can only be a plus for patients, GPs and the wider health system. Furthermore, long-term accurate data on glucose levels must be invaluable for clinicians and patients as they make choices about how they manage diabetes.

    I would like to ask the Minister a few questions. How confident is she that patients are accessing the treatments and technologies that are available today? What action is required of the Department of Health to ensure that the patient pathway is smooth, well signposted and not too long? Are clinicians fully aware of what technologies are available and how to operate them? Are they equipped to train patients to operate these technologies and make the best use of any data provided? What more can the Minister do to apply pressure to clinical commissioning groups to make diabetes technologies such as insulin pumps and glucose monitoring systems available? I know of patients in my constituency who have waited and waited before getting an insulin pump. In the meantime, their condition has been unbearable, and living any sort of normal life has not been possible. I am glad to say that once they get the insulin pump, their lives are transformed. However, I know others who still wait.

    I want to move on to the opportunity we have to embrace emerging technology. One of the greatest developments in healthcare and public health must be the availability and use of emerging technologies. In 2004, Derek Wanless described the NHS as a “late and slow adopter” of innovation. I know that the Government are committed to improving that and to taking advantage of the opportunities on offer from innovative technologies. An excellent example of that is the commissioning through evaluation programme, launched in 2013, which was an innovative solution to the problem of developing real-world data to support the use of innovative medical procedures. I would like the Minister to shed some light on where we are with that programme.

    I recognise that CTE set out to accelerate treatments for a far wider group of illnesses and conditions and should be a subject for another Westminster Hall debate. However, commissioning through evaluation is an example of good forward thinking that has been successful in accelerating access to treatments for patients and is the perfect tool for accelerating diabetes technologies and treatments. The reality is that patients, the NHS and UK plc will see the benefit if we find ways quickly to develop the technologies and give patients accelerated access.

    Finally, I am keen to know what role the Department believes information technology has in informing and educating people so that they can play a greater role in managing their condition. If a diabetic only gets to see a specialist once a year, can online information help to close the gap? What responsibility does the Department of Health have to ensure that patients with diabetes are signposted to reliable, safe and helpful information? Should the Department actively back charities such as Diabetes UK, so that people have confidence about to whom they should turn? I would also like the Minister to outline what role she believes information technology can play in informing and educating people with diabetes.

    I am glad to have secured the debate. This is one of the most pressing issues facing us today, and there is a great opportunity ahead of us. It is an opportunity for patients, because if we get this right, they will be able to manage their condition much more effectively and will be much more likely to be active in the world of work. We will be able to hold off lower limb amputations and sight loss and offer a much brighter future for people with diabetes.

    There is also an opportunity in relation to health and social care. One in five hospital admissions for heart failure, heart attack and stroke is of a person who has diabetes, so by getting this right and ensuring that patients have access to advanced technologies, we can reduce the burden on primary and secondary care and reduce the £14 billion spent annually on diabetes in the NHS. The savings potentially go further when we consider the costs associated with adapting people’s homes and workplaces following amputations or sight loss, for example.

    There are also opportunities for UK plc. If we get this right, the UK will be seen as the place to do research and development, and manufacturing. It must be the aspiration of the Government for the UK to become a hotbed of innovation, and I am certain that the NHS could exploit its sheer size and buying power much more effectively, giving UK patients the best access to the latest treatments.

  • I congratulate the hon. Member for St Ives (Derek Thomas) both on raising this very important subject and on the constructive and helpful manner in which he raised it.

    I intend to confine my remarks to type 1 diabetes and, in particular, young type 1 diabetics. I should say that I am indebted to both Diabetes UK and the Juvenile Diabetes Research Foundation for the very helpful briefing that they provided and for the important work that they do on behalf of people with diabetes.

    Diabetes, whether type 1 or type 2, is a life-changing condition regardless of the age at which it is diagnosed, but for young type 1 diabetics, it is also a lifelong challenge. Young type 1 diabetics face a daily and lifelong routine of monitoring glucose levels and administering the appropriate doses of insulin. It is not insignificant that one quarter of hospital admissions for ketoacidosis are of 16 to 25-year-olds; that is quite a shocking statistic.

    At the same time, dealing with the transition to adulthood, with all the attendant biological, psychological and physiological changes that occur, can be even more challenging for young diabetics and their families. Many young diabetics face bullying. The hon. Member for Upper Bann (David Simpson) referred to a problem in schools. Quite often, because of the misconception about what type 1 diabetes is, young diabetics will face taunts: “Well, it’s your own fault because you don’t eat properly”, “You’re overweight” and so on. It is bad enough that young diabetics face bullying in school. Very often, as the hon. Gentleman signified, schools simply do not know how to deal with this issue.

    One thing about being a type 1 diabetic is that because their blood glucose levels can be very unreliable, they sometimes need to take glucose, which means that at a certain point their absolute priority is to eat something. They have to be able to eat something to even out their blood sugar levels, yet all too often teachers will not allow them to use the classroom in those circumstances.

  • I see the Minister nodding. This really is a problem. Schools need to be advised on how to deal with these situations, so that in every classroom the teacher is aware, whether or not they have a type 1 diabetic in their class, of what they are supposed to do in those circumstances. The lack of understanding in many schools—not all of them, as some deal with the matter very well—must be tackled.

    However, I do not want to be overly gloomy about the problem. Organisations such as the JDRF and Diabetes UK, in conjunction with others, including the all-party parliamentary group for diabetes, of which I am a member, are both raising the profile of the way type 1 diabetics are being failed by the healthcare system and suggesting constructive ways of improving the situation. Later today there will be the launch of a report, not specifically on type 1 diabetes but on how services can be better organised. That is the result of many months of taking evidence from expert organisations. I hope that Ministers will study that report closely.

    With regard to progress, scientific research is making great headway. The hon. Member for St Ives, who opened the debate, highlighted some of the scientific research going on and the technologies that are available. It is in my view highly likely that a cure will be found well within the lifetime of today’s young diabetics. Building on the technology that already allows automatic continuous glucose monitoring and automatically pumped insulin, an algorithm for combining the two into an artificial pancreas already exists. The hope is that it will not be long before that technology becomes the norm. More development work is going on, but the research and tests that have been carried out indicate that that system works and can bring about a massive improvement in the lives of young people and others who suffer from diabetes, because it enables them to keep their blood glucose at an even level.

    I want to say a few words about a particular problem that some young type 1 diabetes sufferers experience. As we know, as a society we face a problem—particularly, although by no means exclusively, among young women—as regards body image. The media, magazines and society in general put forward an idealised view of what a woman or, for that matter, a man should look like. We know about eating disorders that arise from that wholly inappropriate promotion of a “perfect” shape. I do not profess to be an expert on this issue, but my experience of life is that human beings come in all shapes and sizes, none of which is more acceptable than another—but that is just a personal view. However, some young type 1 diabetics discover—this is easy to find out through social media—that by manipulating their insulin intake, they can achieve rapid weight loss. To some young people, that sounds like a great thing to be able to do. Someone can lose perhaps half a stone in a week simply by not taking the amount of insulin that they require. Of course, the problem is that it leads to major medical complications and, in some cases, can end fatally.

    Those who do fall into the habit, which amounts to a highly specialised eating disorder, need to be able to access support from diabetologists and from either psychological or psychiatric specialists. All too often, though, that support is not available—at least not in one place—at the time when the young person needs it most and they are left trying to negotiate a sort of medical specialists ping-pong game between, on the one hand, diabetologists, who do not understand the psychological problem that the young person is experiencing, and on the other hand psychologists or psychiatrists, who do not understand all the scientific and medical issues about their diabetes. I know that that is not the Minister’s specific area of responsibility—[Interruption.] Oh it is, she tells me, great—but I put in a plea for her to really give some thought to how those services can be co-ordinated in such a way that means those young people are not left travelling from one place to another, often with long distances involved, to try to access support, when all they can get is somebody who understands one aspect of their disease and the particular manifestation of that disease they have. We are not talking about tens of thousands of young people; we are talking about hundreds, but nevertheless these are young lives and they need to have proper access to all the services that they require.

    I will conclude with a couple of questions, which are asked in an entirely constructive spirit. Can the Minister give an assurance that the Government will take an active interest in the research that is going on into technology, and that it will be properly supported? Does she agree that the achievement of making these technologies normal, particularly the artificial pancreas, needs to be pursued with absolute rigorousness? That could be delivered very quickly if the Government took an active interest in it. Will she commit—both through the technological means and better treatment design—to ensuring that the various services that can prevent serious complications are properly integrated so that the medical ping-pong is overcome?

    I hope that I have not gone on for too long. Knowing you as I do, Mrs Gillan, I know that you would have told me if I had. Again, I thank the hon. Member for St Ives for giving me the opportunity to say the things that I wanted to say. I am sure that the young diabetics around this country who have the opportunity to do so, will be glad that at least their plight has been raised by at least one Member of this House.

  • Unless any other Members are seeking to catch my eye, we will move to the wind-ups. I call Mr Martyn Day.

  • It is a pleasure to serve under your chairmanship today, Mrs Gillan. I thank the hon. Member for St Ives (Derek Thomas) for bringing forward this interesting debate on diabetes technologies. I thank him for his explanation of the position, and would like to publicly agree with him that we need to accelerate access and that we could do better. I am also grateful to him for informing us of flash glucose monitoring—FGM. It is a new technology that I must admit I am not familiar with, and I would have guessed completely wrong, based on its initials, as to what we were discussing.

    There can be little doubt that diabetes is the fastest growing health threat of our time and a critical public health matter. It is estimated that more than one in 16 people across the UK has diabetes—be that diagnosed or undiagnosed—and it is worth remembering that around 80% of diabetes complications are preventable, or can at least be significantly delayed through early detection, good care and access to appropriate self-management tools and resources, of which access to diabetes technologies is a fundamental part. With that challenge of the increasing numbers of people with diabetes, access to the technology to help those living with the disease becomes yet ever more important. We can learn much from the different approaches to this issue throughout these isles, and we have heard examples today that are both good and bad. The right hon. Member for Knowsley (Mr Howarth) informed us of the problems faced by many young people and their experiences at schools. That is a very good example of how we could do better.

    Much of the debate centres around the two main technologies: insulin pumps and continuous glucose monitors. It is, unfortunately, fair to say that at present the challenges facing sufferers in Scotland in obtaining them are greater than for those in England and Wales. However, much progress is being made and the Scottish Government are committed to ensuring that people living with diabetes have access to the best possible care.

    Since 2010, the Scottish Government have set and met targets to increase insulin pump therapy. In Scotland, we have already made good progress in its provision, and by the end of the current Parliament some 6,000 adults—more than 20% of the type 1 diabetes population across Scotland—will have access to insulin pump therapy; currently, the figure is around 9.5%. In 2010, the diabetes action plan called for NHS boards in Scotland to introduce plans to make insulin pump therapy available for patients who would most benefit from it. That was followed, in 2011, by the target that 25% of under-18s with type 1 diabetes should be on insulin pump therapy; that was met by December 2014, and the figure had reached 31.2% by the end of 2015. Good though this progress is, we must still do better.

    This form of insulin delivery has made a big difference to those who have received it; however, it is worth remembering that is not always appropriate for everyone. To be successful, insulin pump therapy requires intensive work by the patient in association with the local diabetes team, and requires self-management and monitoring.

    Continuous glucose monitoring devices can be extremely useful in helping sufferers to manage and monitor their glucose levels. The Scottish Intercollegiate Guidelines Network—SIGN—guidance recommends that CGM should not be used routinely for people with diabetes; however, it may be considered for women with type 1 and type 2 diabetes, as it may be beneficial during pregnancy. As a result of that, provision through the NHS in Scotland is limited. Earlier this month, Shona Robison, the Cabinet Secretary responsible for health, wellbeing and sport in Scotland, confirmed that a national approach is being developed, stating:

    “Work is currently on-going to develop a national approach for the use of Continuous Glucose Monitoring (CGM) devices in Scotland, as we recognise the speed of development of this technology.”

    Best practice on provision of CGMs and insulin pumps will continue to evolve with developments in technology. Innovative new approaches to healthcare may prove key to improving the treatment of conditions such as diabetes. The Scottish Government, in partnership with Scottish Enterprise, has funded a £500,000 competition to develop a new technology to help with the management of type l diabetes. To supplement existing education programmes, competition entrants have been asked to develop a mobile health product, which could be an app, a new interface or a new device, to assist people in dealing with their condition. The competition is a good example of working with partners across private, public and third sector organisations to develop a new and innovative solution. At its launch, Dr Lena Wilson, chief executive of Scottish Enterprise, said:

    “The economy grows faster when companies embed innovation in all they do. Scotland operates in an increasingly competitive global market so developing and maintaining competitive advantage is imperative. The work underway with NHS Scotland on solutions to the challenges Type 1 diabetic patients face offers an opportunity for more of our SMEs to embrace innovation.”

    Of course, the potential benefits of that are not just with the businesses that take part. Managing diabetes accounts for about 10% of the annual NHS Scotland budget —almost £1 billion a year. When 80% of NHS spending on diabetes goes on treating avoidable complications, potentially significant savings can be made through better self-management and use of technologies—and that is before we consider quality of life for the actual sufferers who benefit.

    In conclusion, we can do much to improve diabetes education and care for both type l and type 2 diabetics, and diabetes technologies have a key role to play in that process. The challenge is to find effective ways to overcome barriers to implementation, and to facilitate greater access for those who would benefit. I am thankful for the opportunity to take part in today’s consensual and informative debate.

  • It is an honour to serve under your chairmanship today, Mrs Gillan.

    I welcome today’s timely debate on access to diabetes technology, which falls in Diabetes Awareness Month. I congratulate the hon. Member for St Ives (Derek Thomas) on securing this important debate and I pay tribute to my hon. Friend the Member for Copeland (Mr Reed), who is not present today, for all his campaigning, work and efforts on the subject over the years.

    I also thank the hon. Member for Linlithgow and East Falkirk (Martyn Day), who spoke for the Scottish National party, and I commend my right hon. Friend the Member for Knowsley (Mr Howarth) on his excellent contribution on young people with type 1 diabetes, and for highlighting the worrying danger of abuse by young people who skip insulin in order to lose weight. I had heard of that before, but I am grateful that he brought it to our attention today, so that the Minister may respond. As my right hon. Friend said, it is often due to the pressures of society and body shaming and it can, sadly, often be fatal. It is yet another pressure on these young people: aside from having the diabetes diagnosis in the first place, it is something else that they have to deal with.

    I also want to disclose from the off that sadly I was diagnosed as a type 2 diabetic just a year ago, but through getting control of my diet and achieving weight loss, which is still ongoing, my diabetes is thankfully very well under control. This debate is therefore very close to my heart.

    More than 4 million people and counting in the UK are now living with diagnosed diabetes. Some 400,000 live with type 1 diabetes, and 29,000 of those are children. I am hopeful that in the future, artificial pancreas technology, which we have heard about today, will be effective, safe and accessible to patients, and that eventually, thanks to important research undertaken by the Juvenile Diabetes Research Foundation, Diabetes UK and others, we will create a world without diabetes.

    However, until that time comes, it is paramount that we do all we can to support adults and children living with the condition. Patients need accessible and high-quality education and support, and access to technology that will allow them to manage their condition and to achieve positive outcomes. Not only will that have a positive effect upon the lives of those 4 million people, especially including children, but it could also reduce NHS spend on diabetes-related complications.

    There have been significant advances and improvements in care for people living with diabetes over the last 15 years or so, but it would be an enormous mistake for us to believe that the job was done. It is far from done and a significant amount of work needs to be undertaken to improve diabetes outcomes. That is because more than 24,000 people a year currently still die from a complication or condition related to diabetes, and many more will encounter life-altering, non-fatal complications. It is worth noting that diabetes-related complications account for a staggering 80% of the £10 billion annual NHS spend on diabetes.

    Worryingly, there is also a regional dimension to the challenges presented in relation to positive diabetes outcomes. According to the national diabetes audit 2012-13, diabetes education courses are not being commissioned for people in more than a third of areas in England. Moreover, gateway treatment for both type 1 and type 2 diabetes is undertaken through primary care. However, with a GP shortfall of 40% across the north of England—my region—it is clear that accessibility is limited in certain parts of the country. Meanwhile, some CCGs have particularly large concentrations of people with type 2 diabetes and, it has to be said, there are correlations between those areas and socioeconomic disadvantage. The Government might well approach funding allocations with that in mind.

    However, the issue we are discussing, which must be considered alongside the aforementioned points, is supporting patients to access technologies easily that will better help them to manage their condition, from insulin pumps to continuous glucose monitors, to flash glucose meters—a lot of them were spoken about by the hon. Member for St Ives. The technologies to which I refer make monitoring blood glucose more convenient for people than a standard blood glucose meter does, and in turn, those technologies can transform peoples’ lives. Continuous glucose monitors—CGMs—such as the Dexcom device, and flash glucose meters, such as the Abbott FreeStyle Libre device, are considered by many to be a less invasive technique than blood glucose meters for measuring blood glucose. They work 24 hours a day and CGMs can include alarms to indicate when glucose levels are too high. That is particularly important for people who do not know that they are experiencing hypoglycaemia, and children who may be unable yet to communicate it.

    It is critical that the House understands the importance of blood glucose readings for people living with diabetes—both types—but it is of essential importance for people living with type 1. With type 2 patients, as I have found, blood glucose is usually monitored and controlled over a long period of time and the scope for immediate blood glucose correction is limited. For people living with type 1—people whose control depends upon the use of insulin delivered through an injection or a pump—accurate, real-time data is essential for blood glucose control.

    To put it simply: better blood glucose control will result in better outcomes for people living with type 1 or type 2. It will relieve significant pressure on the NHS and result in a significant and positive long-term financial gain. Access to CGMs and flash glucose meters is limited on the NHS, and National Institute for Health and Care Excellence guidelines do not recommend that CGMs are offered routinely even to adults with type 1 diabetes, but funding should be considered in a small number of specified circumstances. Meanwhile, children and young people must either have frequent severe hypoglycaemia, impaired awareness of hypoglycaemia associated with adverse consequences, or the inability to recognise or communicate about symptoms of hypoglycaemia in order to be eligible for a CGM at the moment.

    The guidelines, which can be difficult for health professionals, adult patients, and parents alike to navigate, are an obstacle to accessing life-changing technologies for people living with diabetes. As such, I hope that the Government will take steps to encourage CCGs to increase the take-up of CGMs—I apologise for all the acronyms—and flash glucose meters, and that eventually work will be undertaken, in conjunction with NICE, to look at increasing and improving access to diabetes technologies at a faster rate than patients currently experience.

    The running cost of a CGM is around £3,000 to £4,000 a year, whereas a flash glucose meter costs around £1,300 a year. That represents a significant personal cost to many of those who are unable to access these technologies through their CCG, and who therefore have little choice but to self-fund. Lots of parents do this for their children especially. In considering the financial impact of diabetes, we must recognise that diabetic technologies should not be available only to those who can afford to self-fund. Allowing the continuation of the disparity between people with diabetes who can afford to make use of life-changing technologies and those who cannot undermines the principle of a truly national health service.

    It is also important to consider that investment in the new technologies could save the NHS vast amounts in the long term. That is because they can help to avoid severe night-time hypos, and severe hypos cost the NHS £13 million a year. In addition, as I have mentioned, diabetes-related complications account for 80% of the total NHS spend on diabetes, and supporting patients to better manage their condition through access to CGMs and flash glucose meters will inevitably seek to reduce that cost. That is a significant saving, before we even begin considering the impact of hypoglycaemia on the UK economy as a whole.

    Finally, during Prime Minister’s questions, in response to my hon. Friend the Member for Copeland, the Prime Minister stated:

    “There are many youngsters out there, from tiny tots to teenagers, living with type 1 diabetes. It is important that we send a message to them that their future is not limited: they can do whatever they want.”—[Official Report, 20 July 2016; Vol. 613, c. 821-22.]

    I am sure that all of us in the Chamber today very much welcome her comments. I hope that they represent a forthcoming commitment by the Government to improve access to life-changing technologies for adults and children to reduce any obstacles that they might otherwise face.

    I ask the Government to commit to working to improve access to diabetes management education, support, and access to emerging technologies. We must ensure that emerging technologies reach the public in a timely manner, and that innovation, to make them even more user-friendly and to encourage take-up, is also supported and encouraged by the Government.

    A national focus on access to diabetes technologies has its roots not only in clinical, but in financial arguments, as well having national support. So far, more than 26,000 people, from every single constituency in the UK, have signed a petition initiated by my hon. Friend the Member for Copeland calling for CGMs to be made available as a right on the NHS to adults and children living with type 1 diabetes. Moreover, 25 cross-party colleagues have signed an early-day motion in a similar vein. I extend my support to those cross-party calls to ensure that such technologies become accessible to adults and children living with diabetes—especially type 1—so as, ultimately, to improve the lives of those who need those technologies.

  • It is a pleasure to serve under your chairmanship, Mrs Gillan. I thank my hon. Friend the Member for St Ives (Derek Thomas) for giving us the opportunity to have such an important debate. His timing is impeccable, as always, as I found on the Science and Technology Committee, of which he was such an excellent member—we exist in a mutual admiration society. This debate follows on from world diabetes day last month. I want to add my voice to the tributes already paid to the all-party groups on diabetes and on vascular disease and to Diabetes UK for the work they do on this issue. It is invaluable, as we have heard from the very high quality and personal contributions this afternoon.

    As the shadow Minister says, diabetes is one of the biggest health challenges facing this country today. The figures are truly sobering. Almost 3 million people in England are currently diagnosed with diabetes and we estimate that a further 940,000 remain undiagnosed. Furthermore, around 5 million are at high risk of developing type 2 diabetes. If nothing changes, by 2025 more than 4 million people will have the condition. As the right hon. Member for Knowsley (Mr Howarth) said, type 1 diabetes affects 400,000 people in the UK and its incidence is increasing by about 4% a year. It is not preventable, so the emphasis is on improving the lives of people with type 1 diabetes and helping them to manage their condition.

    I absolutely associate myself with the words of the Prime Minister: the message should be that people are able to live full and active lives, and the Government are there to do whatever they can to support them to do so. I shall certainly undertake to study the upcoming report mentioned by the right hon. Gentleman and consider its proposals carefully.

    Type 2 diabetes is much more common. Diabetes as a whole is a leading cause of preventable sight loss in people of working age and is a major contributor to kidney failure, heart attack and stroke. As my hon. Friend the Member for St Ives said, diabetic foot disease, including lower limb amputations and foot ulcers, account for more days in hospital than all other diabetes complications put together. We are determined to change that.

    According to Public Health England and Diabetes UK, 5 million people in England are at high risk of developing type 2 diabetes, and one in 10 will develop the disease if current trends continue. Type 2 diabetes is largely preventable and manageable through lifestyle changes, as the shadow Minister has testified—I was very impressed by her testimony today.

    There is also a huge financial cost—as well as a personal cost—to diabetes and its complications. It already costs the NHS in England more than £5.6 billion a year, and that continues to rise. In addition, the annual social care costs associated with supporting people with diabetes are estimated to be £1.4 billion. Managing the growing impact of diabetes is one of the major clinical challenges of the 21st century. That is why preventing type 2 diabetes and promoting the best possible care for all people with diabetes is a key priority for me and for the Government.

    It will not surprise my hon. Friend the Member for St Ives to hear that, as the Minister for Public Health and Innovation, I believe he is absolutely correct to highlight the role that modern technologies, properly used, can play in the care of people with diabetes. We are extremely fortunate to have a thriving, world-class life sciences industry in this country—it is one of the jewels in the crown of our industrial sector. That is why we are investing an extra £2 billion a year in research and development by the end of this Parliament to help to put post-Brexit Britain at the cutting edge of science and technology, as the Chancellor announced today.

    The development of new, innovative technologies is continuing at pace and is revolutionising health systems throughout the world. However, that will not help if patients do not benefit from it, so we want to make sure that patients here benefit as quickly as possible. As my hon. Friend the Member for St Ives said, we can do better. That is exactly why we commissioned the accelerated access review to support the NHS to become a system that embraces innovation and works in collaboration with innovators to get products to patients more quickly. The review was published last month. We are carefully considering its recommendations and will respond as soon as we can.

    It is not surprising that we are seeing the emergence of technologies that have real potential to improve the lives of people with diabetes in the context of such a thriving life sciences sector. As many colleagues have mentioned, key to managing diabetes is monitoring and controlling glucose levels. Various technologies are available. Insulin pump technology is prime among these and is recommended by NICE as an option for people with type 1 diabetes. Many people are already benefitting from blood glucose monitoring with testing strips and a machine to read blood glucose levels, as well as continuous glucose monitoring. The shadow Minister went into great detail about how that already provides hundreds of readings a day to provide a clear picture of people’s glucose levels.

    People also benefit from flash glucose monitoring, where the glucose concentration and trend is shown when the monitor is waved over the sensor. Other devices are also available; I understand that many people are already finding them useful in reducing hyperglycaemic and hypoglycaemic attacks. In some cases, as my hon. Friend the Member for St Ives said, such devices can offer life-changing support to patients living with diabetes. They can play a particularly valuable role for certain patient groups, including children and teens, when they are properly managed, as the hon. Member for Upper Bann (David Simpson)—who is not in his place—said earlier.

    Clinical commissioning groups are responsible for commissioning diabetes services. In doing so, they need to ensure that the services they provide are fit for purpose, reflect the needs of their local populations and are based on the available evidence, taking into account national guidelines. In the end, none of the guidelines can supersede the best judgment of clinicians, formed with their patients, about the best treatment option for them. I know that NHS England is actively investigating the potential of technologies for use within the NHS with manufacturers and patient groups to understand and identify areas of need and barriers to adoption so that they can improve access.

    Looking to the future, artificial pancreas technology, as was mentioned, continues to be developed. One system has recently been approved by the US Food and Drug Administration, and a European licence is being pursued. Large randomised clinical studies of similar systems are now beginning, and several are expected to come to market in the next five years. Teams in the UK, including in Cambridge and London, are leading on some of this work, but these technologies need to be used optimally as part of holistic treatment pathways so that we get the best patient outcomes from them. That is exactly what the NHS innovation accelerator aims to deliver.

    The NHS innovation accelerator is supposed to realise the commitment in the five-year forward view to create the conditions and cultural change necessary for proven innovations to be adopted faster and more systematically through the NHS for the benefit of patients. This is being delivered in partnership with all 15 academic health science networks. AHSN initiatives are patient-facing. Monster Manor, for example, is a free app launched by the Oxford AHSN—which I mention very selfishly—diabetes clinical network to encourage children with type 1 diabetes to track their blood glucose readings and become more engaged in their diabetes management. By logging readings, players earn rewards that help them to advance through the game.

    The Yorkshire and Humber AHSN is implementing a locally developed set of tools to support general practice and community pharmacy in fostering greater self-care and health literacy among patients with diabetes and encourage them to do something to prevent severe hypoglycaemic episodes. A particular benefit of the AHSN network is the best practice sharing system, which is now in place, to ensure that improvements in one area can more quickly spread across the whole country.

    Another example of accelerator innovation is the internet of things innovation diabetes test bed, which is funded by the Department. This enables people with type 1 or type 2 diabetes to do the right thing at the right time in self-managing their condition. It can be difficult to manage any long-term condition, so help is particularly valuable. People get a real-time view of their own data so they can take prompt action to prevent their condition from getting worse. This also encourages more timely and appropriate interventions from healthcare professionals. It is hoped that using technology in this way will also create genuine partnerships between patients and their healthcare professionals.

    Realistically, the only way we are going to make measurable progress in halting the diabetes epidemic is to put strong measures in place to prevent those at risk from developing type 2 diabetes in the first place. Healthier You, the diabetes prevention programme, is the first type 2 diabetes prevention programme of its kind to be delivered at scale nationwide anywhere in the world. By 2020, the programme will be made available to up to 100,000 people at risk of diabetes each year across England. Those referred will get personalised help to reduce their risk, including education on healthier eating and lifestyles, and physical exercise programmes tailored to the individual. Building on that, NHS England is investing an additional £40 million each year to support CCGs in promoting evidence-based interventions to improve the care that all people with diabetes receive. In line with the points that my hon. Friend the Member for St Ives made, NHS England is encouraging GPs to refer people who are at high risk of diabetes into the national diabetes prevention programme, although referrals also come through the NHS health check, so there are two routes.

    The role of structured education is widely recognised to be hugely important. The Department, NHS England and Diabetes UK are working together to improve the take-up of such education, including through digital and web-based approaches. Furthermore, NHS England is planning to make additional investment from 2017-18 to support the expansion of structured education to help patients to understand their condition better and manage it themselves more successfully.

    The right hon. Member for Knowsley made some important points about the interaction of mental health services and diabetes provision. There is already significant activity to tackle the challenges of negative body image, and the Government announced a body image taskforce in 2010. It reports annually and is led by the Government Equalities Office. Simultaneously, in response to the priorities put forward in the five-year forward view on mental health, we are currently significantly improving care pathways for eating disorders. I have not so far investigated the specific challenge of how young diabetic patients interact with that context, but as a result of the right hon. Gentleman’s comments I undertake to do so.

    I hope I have demonstrated not only the Government’s commitment but my personal commitment to harnessing new and innovative technologies as part of our drive to improve outcomes for the millions of people already living with diabetes and the many others at risk of developing the disease, as well as to sending out the clear message that diabetes does not in any way limit the ability to live an active life and to contribute well.

  • I am grateful for the opportunity to have this debate under your chairmanship, Mrs Gillan; I think I have 37 minutes left.

    I thank the Minister for the information she has given today. I have learned things, and the challenge now is for us to make sure that patients and clinicians will also know what is available to help them. We want acceleration in technology and the integration of services so that patients can be diagnosed as early as possible, have reliable online information about what is available and how to look after themselves and also get the specialist care they need, as well as access to the most appropriate technology. It seems to me that we are all singing from the same song sheet, and I am encouraged to hear that the Government are doing and will do all they can to support patients.

    I appreciate that there have been distractions in the House today, but I think this debate has been a useful exercise; I am sure there will be others in future about how to continue with this important matter.

    Question put and agreed to.

    Resolved,

    That this House has considered access to diabetes technologies.

  • Sitting suspended.