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9.18 pm
The Minister for Health (Mr. Gerald Malone): I am grateful to the hon. Member for West Lancashire(Mr. Pickthall) for observing delightful courtesies at the beginning of his speech and pointing out that some of his comments would be on subjects that are not my direct departmental responsibility. I shall deal with those comments first. Although, of course, I am more than happy to accede to his request that I draw those points to the attention of my fellow Ministers, I can answer to some extent his points about blind prejudice towards people who suffer from diabetes.
It is common ground that we are happy to do what we can to dispel prejudice, to ensure a proper understanding in the public mind--especially among those who are potential employers of diabetics--of the real difficulties, and to explain why, in many circumstances, no difficulties arise from employing people who have the problem well controlled--as the hon. Gentleman rightly said.
I congratulate the hon. Gentleman on his timing in bringing this matter before the House, but I was rather curious about his interpretation of the declaration of Members' interests. Even in these days, I am not sure that it is necessary to declare that one is suffering from a medical condition before speaking about it in the House.
The hon. Gentleman certainly displayed his close and keen personal interests, which I know go well beyond being a sufferer. He is an active member of the all-party parliamentary group on the condition, and I know the role that he has played in the British Diabetic Association. That is why those who read the report of his speech will understand that it has great value.
I shall deal with a number of the detailed points before using the debate to set the problem in context and to explain why my Department and all its Ministers view the condition seriously. I shall also explain why I share the hon. Gentleman's optimism. We have an agenda which we can develop together, and I think that it will improve treatment not just in the long term but in the short term. I may be able to tell the House why that agenda has been pursued positively. I hope that the hon. Gentleman will agree that it is being pursued in that spirit.
The hon. Member raised two specific issues, the first of which was about registers. I am sure that everybody who is associated with the problem will be aware that we have been highly successful in incorporating diabetes into the primary care chronic disease management programme. When I was preparing for the debate, I was delighted to note that that programme has gone some 90 per cent. of the way towards achieving its targets.
In a sense, the chronic disease management programme is the core of providing the database that is necessary, and the sort of register to which the hon. Gentleman referred. I agree with him that the development of local databases is an extremely good way to measure performance against a set of targets. There is much interest in the concept of registers in the management not just of diabetes but across the spectrum of chronic diseases, and my Department takes a keen interest in that.
It is not just the chronic disease management programme that is being taken forward in this respect. Some districts have made much progress and have done a great deal of work towards building a district-based population diabetes register in collaboration with local GPs. That has been made possible with the rolling out of the chronic disease management programme. I see the role of the Government and the Department as the pulling together of the thinking that has been developed in this area, and the pooling of the efforts that have been made on registers.
I am not sure whether the hon. Gentleman is aware that the Department held a workshop on registers last summer. That was extremely useful, and I am pleased to tell him that the results will shortly be published. He was right to highlight that as an important area in which thinking is being developed. It will be taken further, and I am sure that he will participate in the debate that will follow publication of the results of that workshop.
Not surprisingly, the hon. Gentleman spoke about disposable and reusable insulin pens and about needles. Of course my Department is aware of the issue and of the views of users, who have been well and constructively represented by the BDA. It might be helpful if I set out where we stand.
The BDA submitted, as the Gentleman will know, a comprehensive document earlier this year, which is being considered by Ministers and officials in the Department. Although it was not my specific responsibility within the Department, I was interested to see the document in detail. It was a first-class effort in putting together a sound, economically based case as to why it might make sense to move in that direction.
The hon. Gentleman will not be surprised that I cannot give any commitment about that tonight, but I can reassure him that the matter is being treated extremely seriously. Discussions are under way, and I hope that we can make some progress towards reaching a common position and an understanding of the facts and economics that underlie the case made by the BDA.
It is not surprising that this debate has a high profile, because it precedes a very important week. Diabetes has a high profile not just in my Department but in the country as a whole. I shall use the time available to set that in context.
It may surprise the House to learn that the treatment of diabetes consumes NHS assets in excess of £1 billion per annum--between 4 and 5 per cent. of total NHS expenditure--because it is so widespread. The hon. Gentleman mentioned the fact that the extent was not quantified. The best efforts that we can make show that diagnosed and undiagnosed diabetics account for 2 per cent. of the population. I know that other figures show that it is perhaps somewhat higher to one percentage point, but even 2 per cent. shows how important and fundamental it is.
In recognition of that importance, the Department currently supports two major research projects into the illness. The hon. Gentleman touched on the importance of research, and I should like to put on record what the Department is doing. The total cost of the Department's projects is just under £1 million, within the centrally commissioned research programme. In addition, in 1993-94--the latest year for which full figures are available--the Medical Research Council spent a little over £4 million on diabetes research, made up of two components: £1 million in the MRC's research establishments, and almost £3 million in grants to universities and medical schools around the country, which, of course, carry out research projects based on local patients.
As I have mentioned, diabetes is specifically targeted by the chronic disease management programme, and that has been a success. In addition, the importance accorded to diabetes is illustrated by other work that is under way.
In August 1994, the clinical standards advisory group, an independent group giving expert advice to Health Departments and the NHS on standards of clinical care and availability of services, produced a report on standards of care for people with diabetes. The Health Departments accepted the group's main recommendation: that they should encourage purchasers of health care to ensure that there are adequate local diabetes services with appropriate standards specified in contracts. That matter has been brought to the attention of those who are at the heart of shaping patient care--the health authorities that examine these matters and decide which services will be available to local people.
Equally important, in the following year, in 1995, the final report of the St. Vincent task force on diabetes was published. The task force was set up in 1992, jointly by the Department and the British Diabetic Association. Its terms of reference were to advise on which aspects of the St. Vincent declaration recommendations needed to be addressed in England, and also their relative priority, and to provide detailed advice on action needed to implement the priority areas that were agreed with the Department following the advice that had been given under the first term of reference.
The task force was seen as extremely important by all interested and involved parties, so I will set out in fuller terms what has happened since. Its work was intended to be based on the recommendations made in the St. Vincent declaration, which was promulgated following the famous meeting of the European region of the World Health Organisation and the European committee of the International Diabetes Federation. The declaration recommended action in key areas and set outcome targets, which are an important way of holding health authorities accountable for progress.
The task force report was circulated widely throughout the NHS last year, and it makes recommendations about good clinical and management practice in 11 key areas. That work not only helped to raise awareness of diabetes among clinicians and the general population, but forged solid working relationships between my officials and the BDA and other professional colleagues in the service. That relationship is still paying dividends.
The Department of Health is building on the task force work in two main ways. Officials are working up detailed costings for implementation of the report's recommendations, by a survey of current provision and by means of a computer model. Probably more important is that a sub-group of the clinical outcomes group, more commonly known as COG, has been set up to develop guidance for purchasers.
The terms of reference of COG, which is a multi-professional, non-statutory committee that advises the Department on how to improve outcomes of clinical care, are to advise on the strategy for medical, nursing and therapy audit; facilitate the development of clinical and service-wide audit; disseminate good practice through sharing guidance, material and experience in audit; advise the chief medical officer and the chief nursing officer on the most appropriate action to ensure the attainment of desired clinical outcomes and on the relevant areas of research; and identify areas where measurable and sustainable improvements in health can be achieved, including examples of bad practice--which it is as important to eliminate as to establish good practice.
To highlight the importance that the Department attaches to the messages that came out of the St. Vincent task force and the CSAG reports, it set up a diabetes sub-group under COG--the clinical outcomes diabetes sub-group--whose task is to develop purchaser guidance based on the report's recommendations. A key element underpinning all that work is that it should be based firmly on medical and scientific evidence of effectiveness where possible.
The hon. Gentleman rightly emphasised the importance of ensuring that research is translated into good practice. There is a continuing body of work based on research
currently being undertaken, which, once it is complete, should be available to affect what happens in the field--as the hon. Gentleman suggested should happen.
I can illustrate the significant relationship forged during the sub-group's work by its diverse membership. Professor David Shaw, who chaired the St. Vincent task force so admirably, and Professor Harry Keen, chairman of the BDA, both serve on the sub-group, which will reinforce the strong link between the new group and the work of the task force. Their important experience of the life of the task force will add immeasurably to the depth of understanding of the issues in the group.
The sub-group started its work last autumn, and meets at monthly intervals. I understand that it is making excellent progress, and that is an important initiative for the Department. We in government have supported the St. Vincent initiative since its inception. I am sure that the
work programme that is in hand is a sensible way forward, so that we can continue to make progress and secure better treatment levels and packages of care for all people who suffer from this terrible problem.
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