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House of Lords Hansard
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26 May 2016
Volume 773

Question

Asked by

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To ask Her Majesty’s Government how they intend to deal with the financial burden on the National Health Service of type 1 and type 2 diabetes.

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My Lords, we want to ensure that the best possible care is provided for all those with diabetes, reducing the risks of complications and minimising the financial pressure on the NHS. Preventing type 2 diabetes—for example, through the Healthier You: NHS Diabetes Prevention Programme—and improving outcomes for all those with the condition, including through tackling variation in management and care and increasing take-up of patient education, are key priorities for this Government.

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My Lords, given that, currently, 10% of the NHS budget is absorbed by treating diabetes, which is set to quadruple by 2035, why is it that the prioritisation of diabetes foot care has been relegated below other objectives? The vast majority of amputations —135 every week in this country—are avoidable if attended to in time. Why have in-house specialist diabetes teams not been made regular throughout the country, given that they are shown to save three times their own set-up costs? Finally, on objective 2, can we hear what has happened to the obesity strategy?

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My Lords, diabetes is a key priority of the Government and part of the mandate that was given to NHS England for this year. The noble Lord is right—the direct cost to the NHS of treating diabetes is actually about £5 billion every year. Variation is the critical aspect that we should focus on. Whether it is foot care or the incidence and treatment of diabetes, across the country there is a huge degree of variation. The work being done with Diabetes UK on a national audit for diabetes will play a big part in reducing that variation.

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My Lords, are the Government satisfied with the overall cost-benefit analysis of the provision of insulin pumps and continuous glucose monitors? I should mention that my own husband has those. NICE guidelines are quite restrictive, and only a fraction of those who qualify get them. Many people self-fund, yet the long-term cost savings to the NHS of good blood glucose control and avoiding organ damage are enormous. Will the Department of Health look again at whether the benefits outweigh the relatively small costs?

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My Lords, there are clear NICE guidelines on the use of insulin pumps and blood glucose monitoring equipment. For type 1 diabetes, NICE does not recommend their use unless there is clear evidence that the patient will comply with such use at least 70% of the time. The advice from NICE is clear on the use of both.

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My Lords, is the Minister aware of the very conflicting reports in the press at the moment about whether you should be eating more fat or less fat, or more sugar or less sugar? Does he not think it important for the Department of Health to bring forward some clear guidelines for people to avoid them having to go in for treatment? As regards treatment, will he acknowledge the very important part played by the specialist nurses?

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Public Health England has clear guidelines, published under The Eatwell Guide, on what makes a healthy diet. However, I agree with my noble friend that the position is now quite confused following the report that was published earlier this week. Confusion is not something we want and I am sure that when we produce the obesity strategy later this summer, we will make it very clear what those guidelines should be.

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My Lords, bearing in mind the tragic increase in types 1 and 2 diabetes each year, particularly among the young, will the Minister comment on reports of promising developments in this country and the United States in dealing with type 1 diabetes? Will he personally satisfy himself that enough funding is available for research into type 1 diabetes?

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My Lords, I will certainly endeavour to do that. If the noble and learned Lord has a keen interest in research into type 1 diabetes, I am happy to meet with him outside and with anyone else who would like to join us.

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My Lords, does my noble friend agree that the considerable pressure on the National Health Service would be relieved if we were able to control levels of immigration into this country—we have shocking levels today—and if we did not have to make a net contribution of £10 billion to the European Union?

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My Lords, I am not sure that that question has much to do with the original Question on the Order Paper. However, without the levels of immigration that we have had in the past, the NHS simply could not operate.

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Is the Minister aware that one of the most cost-effective interventions in the care of people with diabetes is to educate them in how to manage their own condition in order to avoid progressing to the costly complications which constitute 90% of the costs to the NHS? Is he also aware that we are still bumping along with less than 10% of people with diabetes receiving any education whatever in how to self-manage their condition daily? What plans do the Government have to increase that figure stratospherically, to a point where all people with diabetes are not only offered education but are encouraged to take it up and use it?

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The noble Baroness will know a lot about the diabetes prevention strategy that is being launched with the support of PHE and Diabetes UK, and about the DESMOND and DAFNE structured education programmes. The plan is to roll out the prevention strategy across the whole country by 2020, at which time we expect that at least 100,000 people will have personalised support, which will include structured education.

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My Lords, in view of the fact that the Government are rightly worried about the obesity epidemic, will they do anything about the number of television and radio programmes that promote food, cooking, baking and gourmet meals? I find them disturbing and they make me very hungry.

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As the noble Baroness will know, the Government will produce their childhood obesity strategy later in the summer. I am sure that advertising, particularly before the 9 pm watershed, will be addressed in that strategy.

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My Lords, I hope that “Bake Off” will not be removed from our screens as a result of the strategy. The Minister said that the strategy has now moved from being published in the summer to later in the summer. Will he say a little more about when we can expect to see it? Also, will it answer my noble friend’s original point? Will he crackdown on clinical commissioning groups that are making arbitrary decisions to cut foot care services, which are a short-term saving but a long-term disinvestment?

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My Lords, on the first point, I think we can say that “later in the summer” means before the parliamentary Recess. I do not mean the Recess starting tomorrow, but the main Recess later in the summer. On foot care services, this goes back to the unconscionable variations we have across the country. These are being addressed in part by the diabetes audit and in part by the improvement and assessment frameworks that have been developed for CCGs, so that we can see the results of different CCGs around the country and take action accordingly.