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Health: Diabetes

Volume 774: debated on Tuesday 18 October 2016


Asked by

My Lords, the NHS Operational Planning and Contracting Guidance 2017-2019 announced NHS England’s intention to launch a £40 million programme of investment to support the CCGs to improve the treatment and care of people with diabetes. This includes improving access to multidisciplinary foot care teams for people with diabetic foot disease.

My Lords, given the fast-rising numbers of those with diabetes, which now absorbs over 10% of the national health budget—four out of five lower-limb amputations on a daily basis could be preventable—is it not time wisely to invest in podiatric care for diabetics in order to save not only money but the heartache from the loss involved in those lower-limb amputations?

The Government are absolutely committed to preventing more amputations, but we believe very strongly that money should go towards multidisciplinary teams. These have been seen to be a huge success in various initiatives taken by the likes of King’s College Hospital in Sheffield, where multidisciplinary teams were put together. It has been shown that, in Sheffield for instance, there was a 45% reduction in the number of amputees over three years, along with significant financial savings and a 90% patient satisfaction rating. This is the way to go.

My Lords, given the high prevalence of type 2 diabetes and the associated inactive lifestyle of patients, what measures can be taken to promote more exercise of these patients?

The noble Lord is absolutely right: a key issue in dealing with diabetes is education. We have put together several packages. For instance, Public Health England, NHS England and Diabetes UK are working together on Healthier You, which seeks to educate people who might have type 2 diabetes. We are also looking at how we can get to these people in different ways, such as web-based approaches, apps and joined-up thinking. It is sometimes difficult for people to get to clinics, and it might be easier for them to look at digital or the web.

My Lords, in the face of investment in diabetes care and the strong priority being given by the Government to multidisciplinary teams for foot care, why can there not be a directive from the Government to ensure that all CCGs commission to that standard? Currently, two out of five patients are not seen within the recommended NICE guidelines on treatment for foot care. Unless local health economies are required to deliver to that standard, I believe that we will continue to see loss of feet as well as a huge increase in costs to the NHS. What are the Government going to do to make this a universal provision?

As I said, we are encouraging all NHS trusts to take up the multidisciplinary approach. We are disappointed in the take-up, and we think there are several reasons for it. The Department of Health and Diabetes UK are working together on ways to improve the take-up of structured education and considering more diverse provision in this area. It is also important to remember that a lot of people, when they go to see the doctor, do not say that they have a problem with their feet. We need to educate healthcare professionals to be able to ask the right questions, one of which should be not, “Have you got any problems?”, but, “Do you have a problem with your feet?”. A lot of people are embarrassed to say that they have a problem, so education could be done on both sides.

My Lords, the Minister will be aware of the importance of community pharmacies in supporting people with diabetes in relation to their foot care. Does she accept that the planned significant reduction in the budget to support community pharmacies will force many people who have foot complications to try to go to overcrowded GP surgeries, adding to the problems there? That could mean more long-term complications being treated later in hospital, in the secondary sector. The planned reductions are a completely false economy that should not be made if they are going to force more people to seek treatment other than in their community pharmacy, as at present.

I think the noble Lord was in the House yesterday when I repeated an Answer to an Urgent Question on this subject. We have to think of the most effective ways to save money in the NHS. We are not suggesting that any pharmacies close, as the noble Lord knows. We are suggesting savings for pharmacies over the next two years. That is not to say that there will be any pharmacies closed, but we need to make them more efficient. There are some places where there are three pharmacies in one high street, which is slightly ridiculous. However, we are ensuring that rural pharmacies will be in place.

My Lords, NHS England needs 12,000 podiatry practitioners but has only an estimated 3,000, and that number is declining. Next year podiatry trainees, like nurses, lose the state bursaries that help to contribute towards the cost of training, so fewer are expected to apply. What specific plans do the Government have to ensure that high-risk diabetic patients receive the checks and care needed to avoid serious deterioration in their foot health and possible amputation?

On the question of training for podiatrists, Health Education England is leading on commissioning a study of recruitment to small and vulnerable professions such as podiatry; the Higher Education Funding Council for England and the College of Podiatry are contributing to the funding of that piece of work. The intention is to make the interventions where necessary to ensure that students are not put off from applying.

On the second part of the question, health checks are indeed very important and we are encouraging as many people as possible to take them up. As I said, there is a problem with some people being willing to take them, and we are looking into how we can improve that.