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Health: Diabetes

Volume 729: debated on Thursday 14 July 2011

Question

Asked By

To support the NHS in improving outcomes, NICE has published a quality standard for diabetes, providing an authoritative definition of good-quality care and building on the existing national service framework. This year, the NHS operating framework specifically highlights the need to do more to improve in-patient care for people with diabetes, the availability of structured education and retinopathy screening for everyone with diabetes, and access to therapies, including insulin pumps.

My Lords, I am grateful to the noble Earl for that Answer. Is he aware that 1.4 million people with diabetes are now at risk of preventable blindness, over a million of kidney disease, and up to 8,600 a year of having a foot amputated due to delayed diagnosis and treatment; and that doctors of distinction in this specialty insist that, with adequate resources, they could do much more to maximise prevention and treatment? Knowing as I do the depth of the Minister’s own concern for this policy area, when does he expect to be able to announce specific new measures to help the rapidly increasing number of children afflicted?

My Lords, Ministers often express thanks to those noble Lords who table Questions but I owe a particular debt to the noble Lord, Lord Morris, for highlighting one of the greatest public health challenges of our time. He is absolutely right in all that he has said. I alight particularly on his point about prevention. We are committed to preventing type 2 diabetes. All our work on promoting an active lifestyle and tackling obesity will support that aim. The NHS Health Check programme has the potential to prevent many cases of type 2 diabetes and, as the noble Lord said, to identify thousands more cases earlier in their development. The Change4Life programme—the campaign that started under the previous Government, which we are continuing —raises awareness of maintaining a healthy weight and being physically active. A great deal of work is going on in this area, which is one of the major focuses of our public health programme.

My Lords, the Minister has indicated that there is a clear positive correlation between the rising incidence of type 2 diabetes on the one hand and the rising incidence of obesity on the other. What action are the Government taking to advise the population at large of the dangers of overeating?

I have already mentioned the Change4Life programme, which is designed to raise awareness across a number of public health areas, including obesity and overeating. I think also of the Healthy Schools programme, which instils the need to eat healthily and take exercise in youngsters at an early age. As the noble Lord will know, there is no magic bullet for the problem of obesity. It is something that must be addressed in a variety of ways through public health programmes and general practice.

My Lords, does the Minister agree that foot ulceration precedes 85 per cent of amputations? A study in Southampton showed that, by keeping people in hospital and treating them well through preventing foot ulcers, over 36 months not only did patient outcomes improve but the National Health Service saved £1.2 million in in-patient time.

My Lords, I am grateful to my noble friend. I have an astonishing figure in my brief. On average, 73 amputations of lower limbs occur every week in England because of complications to do with diabetes. It is estimated that, with the right care, 80 per cent of amputations carried out on patients suffering from diabetes would be preventable. That is the scale of the challenge. We are clear that this is a major issue for diabetes. NICE has published guidelines on in-patient management of people with diabetic foot ulcers and infection. That is vital because amputations are often preceded by ulceration. That is also why the national clinical director for diabetes considers diabetic foot care and prevention to be a major priority.

My Lords, will the Minister give an assurance that the retinopathy screening that was introduced by the previous Labour Government, and which has been so successful, will continue apace to match his own ambition of ensuring prevention by identifying diabetic disease of the eye at an early stage?

The noble Lord, Lord Harrison, is quite right. England, along with the devolved Administrations, leads the world in this area. It is the first time that a population-based screening programme has been introduced on such a large scale. We are committed to continuing it. More people with diabetes are now being offered retinopathy screening than ever before and to higher standards, despite the increasing number of people with diabetes. The latest data that I have show that 98 per cent of people with diabetes have been offered screening for diabetic retinopathy during the past 12 months.

My Lords, is the Minister aware that people with diabetes are twice as likely to be admitted to hospital as people without diabetes? Will he undertake to look at best-practice models, such as that of the University Hospitals of Leicester, where diabetes specialist nurses have been stationed in the accident and emergency department and are able, in many cases, to advise against admission to hospital and provide more appropriate treatment and support? This is believed to have saved the University Hospitals of Leicester around £100,000. Diabetes UK estimates that, if rolled out nationally, such good practice might save the NHS up to £100 million a year.

My Lords, I am aware of that excellent beacon of good practice in Leicester, which is an example that we welcome. It is an approach that is already being taken in other parts of the country. The NICE quality standard for diabetes states that people who have the condition, and who have experienced hypoglycaemia that requires medical attention, should be referred to a specialist diabetes team for advice and support to reduce admissions in exactly the way that my noble friend described.