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Diabetic Prevention Programme

Volume 823: debated on Thursday 23 June 2022


Asked by

To ask Her Majesty’s Government what was the business case for not recording the percentage of patients who joined the Diabetic Prevention Programme between 2018 and 2019 but failed to complete the course; and whether this information is now recorded.

Data on completion rates is collected for specific reference periods. Rather than looking just at a yearly comparison, completion is analysed to understand the impact of changes to the programme, such as providing a digital option for consumers. Data collected at specific reference points, such as from January 2017 to March 2019, shows a completion rate of 53%.

My Lords, I am grateful to the Minister for that. He may not know it, but I have been on the diabetes prevention courses, as I am on the cusp of diabetes. I was amazed by the rate of drop-out on the course that I was on. It ran for nine months. I wondered about the cost and so asked a Written Question on the details, which the Minister has now given me. With a nearly 50% drop-out rate, surely there is something wrong with the course. I want to see more courses but they should be run properly. Can we get the NAO to look at this to see if we can have some improvements and get better returns?

I thank the noble Lord for the question and pay tribute to him for his work in this area over many years. He is absolutely right. One of the challenges of this programme is that it is a nine-month course. Clearly, like many things, it was impacted by Covid, with a lack of in-person consultations and appointments. However, the silver lining to the cloud was the digital service. The course was able to move some patients on to digital services and to self-referring. One impact of that has been more people signing up to this programme.

My Lords, is it possible that it is not the course that is at fault but the people who go on it? Has the department not considered charging people a refundable attendance fee to ensure that they roll up?

I thank the noble Lord for his question but what is more important is that we get people who have diabetes on to the programme in the first place. As we adjust the programme to take account of the pandemic, for example, and digital offers, we are also looking at different ways to work with different communities. For example, I was talking to a young girl of Bengali origin in my department the other day. I said, “What do we do about getting to the heart of the communities, given that we are in Westminster and Whitehall?” She said that one of the problems in her community is that, “We love ghee—we love clarified butter, in our curries and our rotis.” We are looking at alternative recipes and menus so that people can still have the same food but it can be healthier.

My Lords, the observational study by academics of the 2018-19 wave of the NHS diabetes prevention programme, published by BMC Health Services Research, observed disengagement within sessions when patients reported that information was difficult to understand, and when there were very large group sizes and problems with session scheduling. This is all before Covid. Problems with the course will inevitably make patients more likely to drop out but 50% is shocking. Now that this diabetes prevention programme has been rolled out across England, have these specific problems been addressed?

The noble Baroness makes an important point about what we have to learn from these programmes. In many of these programmes we are in a process of discovery. You try things—some will work and some will not. Those which do not work, we want to learn the lessons from. Clearly, the length of the programme, nine months, has put some people off and led to the dropout rate. We are looking at shorter programmes, digital access and self-assessment, and at community-led initiatives rather than top-down government initiatives. To give another example, I met someone at a meeting yesterday who told me that his mosque in Accrington was running healthier-diet programmes for worshippers. We need to see a lot more of those programmes as well.

My Lords, the national paediatric diabetes audit shows that the impact of type 2 diabetes and the cost-of-living crisis is disproportionately felt by children living in the most deprived areas. What preventive measures specifically geared towards children are in place so that they may avoid type 2 diabetes? What are the Government doing for the almost 4 million children, and their households, who are struggling to access and afford enough fruit, vegetables and other healthy foods to meet official and basic nutrition guidelines?

One of the NHS programmes that will be repeated by integrated care boards when we have them is the eight annual diabetes checks for people of all ages. Certain factors—HbA1c, which is your average blood glucose level, or your glycated haemoglobin; blood pressure; cholesterol; serum creatinine; urine albumin; foot surveillance; BMI; and smoking—are checked for patients of all ages to identify early onset of diabetes.

My Lords, further to my noble friend Lord Brooke’s Question about the drop-out rate and his suggestion of an independent review, what mechanism is there for assessing courses that clearly are not as successful as they might be if there is such a high drop-out rate?

The point is about what we learn. For example, some noble Lords will have seen stories about the impact of minimum alcohol pricing in Scotland. Clearly, it did not turn out as intended because the review found that people from poor communities were spending more on alcohol, rather than the alcoholism rate being affected. In this case, we have learned that the nine-month programme and some of the other processes behind it clearly lead to a drop-out rate. We are looking at other programmes. One of the great stories we have seen is the use of digital and other forms of access. If we can roll that out as well with community programmes, it might be a better way of doing things.

My Lords, following my noble friend Lady Merron’s question regarding children, could the Minister say a little more about schools and what work the Government are doing to raise these issues there? We all know that the earlier we can prevent onset the better. Schools are a great place for this to be done.

The noble Lord makes an important point. When I speak to experts, policy officials and people working on diabetes, one of the things they say is that the Government cannot reduce obesity alone; efforts also have to include businesses, health professionals, schools, local authorities, families, individuals, community groups and civil society. We all have to come together collectively. There clearly are programmes in schools to encourage people to eat more healthily, but I am sure the noble Lord would recognise that, when we were children, we had programmes about not smoking, sex education and people not drinking alcohol. We would come out of them and say, “I’m never going to drink alcohol or smoke cigarettes again.” Two years later, we were all at parties and what were we doing? We have to make sure that it is impactful all the way through life, not just at that time.

My Lords, does the Minister agree with the recently published scientific evidence that fasting is actually good for you and that missing an occasional meal would be a good thing, especially for preventing diabetes?

As my noble friend will be aware, there are always debates in scientific circles on this. There are different types of fasting regime as well. For example, during Ramadan lots of mosques expounded it as a great example of something that is not only spiritual but good for your physical health. It does depend. Other studies show that it depends on who is doing it and their other circumstances.

My Lords, could the Minister say what is being done regarding the latest statistics, which showed that just 34% of people in the north of England who have diabetes have access to the eight health checks that they should have?

The noble Lord makes an important point. The Office for Health Improvement and Disparities is looking at a number of these areas and where the health service or the ICS locally has to target more resources. Clearly, one of the big concerns is disparities. The noble Lord has given the example of the north-east; as he rightly said, there will be parts of the country where those checks are not happening. It is vital that we tackle those disparities.

I am sorry to be so persistent, but we are spending millions on these programmes. Since some work is being done to try to improve them, could the Minister give the House a report in six months’ time to tell us what progress is being made and give us some targets that are being delivered?

I am not entirely sure that I can give the noble Lord what he asks for, but I suggest that he asks me a Question about progress in six months’ time. Given that the noble Lord asked this Question, I will go back to the department and see what answers we can give.

My Lords, is there any link between patients with diabetes and other ailments and the drop-out rate? Can the Minister give any evidence for that?