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House of Commons Hansard
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26 February 2018
Volume 636

Motion made, and Question proposed, That this House do now adjourn.—(Paul Maynard.)

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I am grateful for the opportunity to talk about this very important health issue. I should first declare an interest as an active member of the all-party parliamentary group on diabetes, ably chaired and led by my right hon. Friend the Member for Leicester East (Keith Vaz).

We have come a long way with the treatment of diabetes since 1921, when Banting and Best isolated insulin from dog pancreases, and then, working with Scottish physiologist J. J. R. MacLeod, purified a form of insulin that was suitable for human treatment from cows’ pancreases. This was at the time, and remains, a major scientific and Nobel-prize winning breakthrough. Before insulin therapy was discovered, diabetes was a deadly illness. The first medical success was with a boy with type 1 diabetes—14-year-old Leonard Thompson, who was successfully treated in 1922. Close to death before treatment, Leonard bounced back to life when treated with insulin.

Now, almost 100 years later, we understand a lot more about diabetes. We are able to explain the difference between type 1, an autoimmune disorder that is treatable by insulin; and type 2, insulin resistance or insufficiency, much more influenced by other health factors such as obesity and physical inactivity. We also know that a diagnosis of diabetes is no longer a death sentence. Nevertheless, diabetes remains a serious illness that affects 4.5 million people in the UK.

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I congratulate my hon. Friend on all the excellent work she does as vice-chair of the all-party group on diabetes. She mentioned those who have diabetes, but there are still about half a million people who have type 2, as I do, but do not know that they have it. Does she agree that prevention is the most important thing that we can do to try to help those who have type 2 but are not aware that they have it?

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I thank my right hon. Friend for that intervention. I think he must have read my speech, because I will be talking about the prevention of type 2 diabetes, and how important it is that we are aware of that and also make the population aware of the measures they can take.

There are more people living with diabetes in the UK than with any other serious health condition—more than dementia and cancer combined. The complications of diabetes are many. They include eye, foot and skin complications; anxiety and depression; hearing loss; gum disease; neuropathy; infections; slow wound healing; strokes; heart failure; heart attacks; lower limb amputations; renal problems; and early death.

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The diabetes crisis is one of the fastest growing health crises of our time. As the hon. Lady says, the physical consequences are well known, but recent research by Diabetes Scotland has shown that the stress, isolation and trauma of managing an invisible but life-threatening condition can have serious implications for a person’s emotional wellbeing. Does she feel that we need to look at offering support and increased provision of psychological support for diabetes sufferers?

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I absolutely agree. The hon. Lady makes an excellent point, and I will cover that later in my speech.

As the hon. Lady says, the number of people living with diabetes is rising fast. Every day, around 700 people are diagnosed—that is one person every two minutes. It is estimated that by 2025, 5.2 million people will be living with diabetes. With 10% of the total NHS budget being spent on diabetes every year, it is important that we talk about treatment, prevention and the future of diabetes care, particularly as 80% of these costs are spent on the complications of diabetes, many of which are avoidable through better care.

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I congratulate the hon. Lady on securing the debate. I declare an interest, as a type 2 diabetic, like the right hon. Member for Leicester East (Keith Vaz). There are some 100,000 people with diabetes in Northern Ireland at present, and we have the largest number of type 1 child diabetics in the whole of the United Kingdom. The issues in Northern Ireland are very acute. Does she agree that the NHS should widely fund not only insulin pumps for children with type 1 diabetes, but training, to ensure that children can use those pumps, to make their lives better? I think it is important that we do so.

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The hon. Gentleman makes an important point. I will talk about the technologies that are available for the treatment of diabetes and about education and information, so I hope I will answer his question later in my speech.

The hon. Gentleman emphasises the point that I was going to make, which is that it is really important that we listen to the voices of those living with diabetes. The charity Diabetes UK recently published a report entitled “The Future of Diabetes”, based on a consultation with more than 9,000 affected people. Those people said that, as well as a need for a better understanding and awareness of diabetes, there are a number of ways in which diabetes care can be improved.

In 2016 the Care Quality Commission produced a report entitled “My diabetes, my care”, based on a survey of a smaller number of people, but it came to very much the same conclusions. People living with diabetes want more support for their emotional and psychological health. The effect of varying blood sugar levels on mood and the relentless need to manage the condition can affect mental health.

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I am grateful to my hon. Friend for giving way; she has been very generous. Is she aware that some young type 1 diabetics manipulate their insulin to get rapid weight loss, and that they struggle to get treatment because on the one hand, they need psychological support, and on the other, they need advice from diabetologists? Does she agree that, if we started to bring all those different support services under one roof, it would make the route to dealing with young people who have that problem much easier?

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My right hon. Friend makes a very important point. In the APPG on diabetes, we have discussed the issue of young diabetics self-medicating with insulin to keep their weight down. That emphasises the point I was going to make, which is that all healthcare professionals should receive training so that they can routinely support emotional and mental health and, importantly, know when to refer to specialist support.

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Young people find it incredibly difficult to do glucose testing. The FreeStyle Libre device is a mechanism through which young people can have regular testing without that fear. However, they have to go through an individual funding request to access that. Should that not be available on the NHS?

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I completely agree, and I will discuss FreeStyle Libre patches later on. I am beginning to feel like everybody here has had sight of my speech before I have even delivered it.

The next point arising from the survey is that people living with diabetes want better access to healthcare professionals who understand diabetes. Many respondents said that they felt they were being treated as a condition and a set of symptoms rather than as a human being.

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I feel I want to ask a question just to participate. Given that lifestyle choices play a big part in type 2 diabetes, what value does the hon. Lady put on the information courses that are made available to people to help them to manage such lifestyle choices?

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The information and education courses are really important in helping to manage the condition. I will come on to talk about that very subject later in my speech.

To go back to the role of specialists, I know from my involvement with the all-party group on diabetes that the role of the diabetes specialist nurse is valued by many. Evidence shows that diabetes specialist nurses are cost-effective, improve clinical outcomes and reduce the length of stay in hospital. With rising numbers of diagnoses of diabetes, I ask the Minister to encourage employers to respond to this with appropriate workforce planning.

The third point from the survey is that people want better access to technology and treatments. Diabetes treatment is ever evolving and advancing, but 28% of those who took part in the survey reported problems in getting the medication or equipment they needed to manage their diabetes. The Minister may recall that last year the Prime Minister was seen at an event wearing a FreeStyle Libre glucose monitoring device, which has already been mentioned. It is this type of non-invasive device that makes life so much easier and more manageable for those living with diabetes, and it is a great example of the technological advances taking place today. This device is designed to liberate patients from the hassles of routine finger prick testing. However, so far, only one third of CCGs and health boards have placed FreeStyle Libre on the formulary, demonstrating the problem faced by many in obtaining access to new technology.

The fourth point is that there is also a need for education and information to be widely available. No one should be given a diagnosis of diabetes without also being informed of where to go for information and support. People’s ability to self-manage is essential for the successful management of diabetes. Self-management reduces the risk of complications and demand on health and care services.

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Does my hon. Friend agree that children with type 1 diabetes require particular understanding from the teachers in their school if they are to stay safe, and a proper dispensation to eat when they need to eat and to do blood tests when they need to do so? Will she join me in urging the Department for Education to make the guidance to schools on type 1 diabetes more prescriptive?

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My hon. Friend makes an excellent point. It is actually the fifth point of the survey—support and understanding at work and school—and I will go on to talk about that. He explained the whole point very well, and I totally agree with him.

To go back to the education programmes, the National Institute for Health and Care Excellence recommends that people should be offered a course around the time of diagnosis of type 2 diabetes, and six to 12 months after diagnosis for people with type 1 diabetes, with annual reinforcement and review. The Care Quality Commission survey found that, in general, people who had attended structured education courses were very positive about their experiences. The majority of people said that it was helpful in improving their knowledge and ability to self-manage. People identified benefits, including improved understanding and knowledge about their condition; improved self-control and management, such as diet and exercise; and the opportunity to discuss concerns and share information with other people. However, there was a clear theme of people saying that, although the courses were helpful, they wanted more opportunities to attend refresher sessions.

The fifth point is that people living with diabetes want more support and understanding at work and school. Good care at school is vital and all schools should have an effective care plan in place. For those in work, an understanding and informed employer can make the difference between that person being able to continue in productive work, and being forced to leave because of difficulties in managing their condition while at work.

Finally and most importantly of all, people living with diabetes want hope for the future. Once diagnosed, people live with diabetes for the rest of their lives. They want to know what is being done to work towards a world where diabetes can be prevented and cured. It is for that reason that I asked for this debate—so that we can discuss research, funding, awareness, treatment, support, information and education for those living with diabetes.

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Does my hon. Friend agree that groups such as the Bristol South Diabetes Support Group are really important in bringing together volunteers to support people across the country? Does she support those volunteers, who not only supplement the work of the NHS but give people the confidence to manage their work?

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My hon. Friend makes a very important point. It is up to healthcare professionals to encourage those voluntary groups to get together, to enable people to give each other support. That was one of the findings of the Diabetes UK survey: people wanted to come together to offer each other support.

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Further to that point, this morning’s news reported on the millennium child and an increase in diabetes as a result of diet. Does that not underline exactly what the hon. Lady has argued today, which is that we need to do something now? If the millennium child—the adult of tomorrow—is going to have high levels of obesity and diabetes, there is a real need for a strategy right now.

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I completely agree with the hon. Gentleman’s very important point. I was struck by that item on the news first thing this morning. It is coincidental that it was announced today and I will refer to it in my concluding remarks.

For type 1 diabetes, research priorities include reducing hypoglycaemic episodes, exploring the effectiveness of different insulins and technologies, and research into the artificial pancreas, which monitors blood sugar levels and automatically injects the right amount of insulin.

For type 2 diabetes, people want to know whether their diabetes can be cured, for example through surgery or very low calorie diets. Encouraging work is being done on low calorie diets, and a trial funded by Diabetes UK—the diabetes remission clinical trial—showed that almost half of type 2 diabetics who took part were in remission after 12 months.

We need to help people to reduce their risk of developing type 2 diabetes, and that means tackling the reasons for the increasing rates of obesity, particularly childhood obesity. The PREVIEW project—prevention of diabetes through lifestyle, intervention and population studies in Europe and around the world—showed that a weight loss of 10% of baseline weight can decrease insulin resistance, which is a causative factor in diabetes, and this is expected to reduce by 85% the three-year risk of developing type 2 diabetes.

In conclusion, I have two requests for the Minister. The first is that we build on progress being made through the NHS diabetes programme and commit to sustained transformation funding at current levels of £44 million a year until at least 2021. The NHS diabetes programme sets out to improve the treatment and care for people with diabetes. Investing now will allow us to reap substantial financial and social benefits in the future.

My second request is that we strengthen the childhood obesity plan, including measures on labelling and junk food marketing. Just this morning, Cancer Research UK called for the same action. I am sure that the Minister will appreciate that taking steps to tackle childhood obesity will improve the health of the nation and have an impact on all obesity-related illnesses, not just diabetes. We want mandatory traffic-light labelling on all processed foods and mandatory calorie labelling in the out-of-home sector. We also want a commitment to introduce a ban on the marketing of junk food on TV before the 9 pm watershed.

The childhood obesity plan is key in helping us realise a world where fewer people live with diabetes and where it is easier to live a life with a low risk of developing type 2 diabetes. However, as we heard on the news just this morning, the millennial generation are predicted to be the most obese yet, and it is vital that the Government act now to avoid a diabetes health crisis in the future.

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I thank the hon. Member for Heywood and Middleton (Liz McInnes), whom I know well and have worked with already on this in my time as a Minister, for giving us the opportunity to debate such an important issue. The turnout for this Adjournment debate suggests that it is of great interest to the House. It is normally just me, the Member introducing the debate, my Parliamentary Private Secretary and the hon. Member for Strangford (Jim Shannon). Tonight’s turnout has been a revelation. In November, I remember the hon. Lady introducing me and leading the event in the Terrace pavilion for the launch of the “Future of Diabetes” report by Diabetes UK, which is the biggest study of its kind. I promised then that I would respond recommendation by recommendation to the report, which I believe I have done. The offer I gave then is the offer I repeat now, which is to work with the all-party group and the charity on each and every one of those recommendations. I hope she knows I am sincere in saying that.

I would like to use this opportunity to pay tribute to Diabetes UK—led by the excellent Chris Askew, whom I have known for many years wearing other hats when he used to lead the breast cancer charity Breakthrough—which continues to work both with us in government and independently to improve the lives of so many people who are at risk of this increasingly common condition.

Diabetes is one of the biggest health challenges facing the country, and the figures are truly sobering. There are currently 3.5 million people in the UK who have been diagnosed with diabetes. If nothing changes, by 2025 more than 5 million people will have the condition. That is a significant public health challenge. 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. During half-term recess, I paid a visit to a brilliant charity in your constituency, Mr Speaker, called Medical Detection Dogs. I met a brilliant dog who looks after a lady with diabetes. As if on cue, when I walked into the room to meet her he sat and put his paw on her knee, which was him assessing her levels and indicating that she needed to take action. It was incredible to watch. If Members are not familiar with Medical Detection Dogs, please do look it up.

Type 2 diabetes, as we have heard, is much more common. It is a leading cause of preventable sight loss in people of working age and a major contributor to kidney failure, heart attacks and strokes, among the many other conditions the hon. Lady read out in her cheery list. Diabetic foot disease, including lower limb amputations and foot ulcers, accounts for more days in hospital than all other diabetes complications put together. According to Diabetes UK, 11.9 million people in the UK are at high risk of developing type 2 diabetes, which is largely preventable.

Aside from the human impact on people’s lives, the financial cost of diabetes and its complications is huge. It already costs the NHS in England over £5.5 billion a year and that figure continues to rise. Managing the growing impact of diabetes is one of the major clinical challenges for us in the 21st century. That is why, as the hon. Lady and the right hon. Member for Leicester East (Keith Vaz) who chairs the all-party group so well rightly say, preventing type 2 diabetes and promoting the best possible care for all people with it is a key priority for the Government.

The hon. Lady mentioned the child obesity plan. She was absolutely right to do so. She knows I am passionate about delivering part 1 of the plan. We always said that it was the start of a conversation and that it was called part 1 for a reason. I am absolutely committed to taking further action if necessary, particularly across marketing, reducing portion sizes and price promotions, to help young people and to make healthy choices become the easiest choice of all. I think she knows me well enough to know I mean what I say and I say what I mean. If we need to take further action we will do so and she should watch this space.

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I just inform the House that this morning, Committee D of the British-Irish Parliamentary Assembly, of which I am vice-chair, had a session in Portcullis House on childhood obesity with Members from all parts of the islands. We produced a report recently and are doing further work. If I may be so bold, I will make sure that the Minister has a copy of that report. He will be interested in some of the reflections that we are bringing together from across the Republic of Ireland, Northern Ireland, Scotland and Wales, and they might help to inform that work.

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That would be very interesting—if the hon. Lady did that, I would be grateful. We are working hard to improve diabetes services. The Government are strongly committed to taking action to prevent diabetes and to treat it more effectively. The Government’s mandate to NHS England for 2017-18 includes an objective for NHS England to

“lead a step change in the NHS in preventing ill health and supporting people to live healthier lives.”

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The Minister will be aware that an algorithm exists whereby it is possible to create an artificial pancreas, and that the Juvenile Diabetes Research Foundation is heavily involved in research at the University of Cambridge to bring that concept to a workable proposition. Will he give a commitment that the Government will fully support that work so that we can end up with something that will help type 1 diabetics to monitor their condition?

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I will not give a commitment at the Dispatch Box, but I know the JDRF well. I have supported it in my constituency through various events, including the Alresford music festival, which I am sure the right hon. Gentleman is familiar with. I will take a look at what he said and if he wants to chat to me offline about that, I would be very happy to do so.

The diabetes prevention programme has been mentioned. Wherever possible, the aim is to prevent type 2 diabetes from developing in those most at risk. I am proud to say that NHS England, Public Health England, for which I am responsible, and Diabetes UK have had some success working on the NHS diabetes prevention programme—the first such programme that we have delivered at scale nationwide. I know that a lot of other countries are looking at what we are doing.

The programme is putting in place support for behavioural change in people who have been identified by their GP, or through the NHS health check, as being at high risk of developing diabetes. Individuals can then get tailored, personalised help to reduce their risk of developing the condition, including bespoke exercise programmes and education on healthy eating and lifestyle. It is incredibly positive.

I am aware of the time, so I will move on to treatment and care programmes. After successfully securing significant new investment in diabetes through the spending review, NHS England has developed a diabetes treatment and care programme, which is aimed at reducing variation and improving outcomes for people living with diabetes. As part of that, NHS England will invest £42 million in proposals from individual CCGs, collaborations and sustainability and transformation partnerships to improve the treatment and care of people with diabetes.

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rose—

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I will not take another intervention, because I will conclude in just a second. The spending review made provision for significant transformation funding through to 2020-21, and I expect that to be spent in line with the priorities set out in NHS England’s mandate, including for diabetes.

We have talked about the childhood obesity programme and the national diabetes prevention programme. I am responsible for other public health initiatives, such as Change4Life and the One You programme. People like me with young children will see the Change4Life branding coming through in book bags for them. It has been an incredibly successful campaign. The programmes are crucial in both encouraging a healthy lifestyle and promoting exercise among young people, as are such things as the Golden Mile, which is almost universal in primary schools across England. The benefits of such programmes should be acknowledged in reducing not only the incidence of diabetes, but other debilitating and life-threatening conditions such as cancer and heart disease, in which I also have a great interest.

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Will the Minister give way?

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Yes, but then I might not be able to conclude.

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Very quickly on the issue of exercise, children are now reduced to just one hour of PE. Will the Minister speak to his colleagues in the Department for Education about increasing that?

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I am not responsible for the Department for Education, but the hon. Lady is absolutely right to say that I talk to it. I was in the Department with the Secretary of State and a Minister just last week talking about what further action we need to take on school food standards and the Golden Mile, because I want children to be more active. It is not just about what happens in school, though: the exercise through the Golden Mile in schools should be mirrored in out-of-school activity. There is so much more that we can and should be doing to help to prevent diabetes.

In conclusion, diabetes is emblematic of many challenges that the health and care system and my desk face. Prevention is critical, as is working in partnership with people in a way that tailors support and intervention. I, this Government and this Prime Minister are committed to improving outcomes not only for the millions of people in this country who are living with diabetes, but for the many more who are at real risk of developing the condition. We need to help both.

Question put and agreed to.

House adjourned.