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Mr. Maclennan: We await with unbated curiosity the publication of the document. May I, with just a wry smile, inquire whether the Minister knows whether included among the assets are the works of art that the Public Accounts Committee discovered had not been cared for by Departments with any assiduity or concern in past years?
Dawn Primarolo: I am sure that the register will make fascinating reading and include the points that the right hon. Gentleman made, and perhaps cross-reference to previous PAC reports. It may take his fancy. He explained earlier why he identified particular points in reports.
Public audit and, more generally, the work of the Public Accounts Committee has a major role to play in promoting high standards in central Government bodies. It is particularly crucial that we use as our touchstone, as many hon. Members did, the eighth report of the 1993-94 Session, "The Proper Conduct of Public Business". Many hon. Members will share my view that among the many reports that the Public Accounts Committee has completed in recent years, "The Proper Conduct of Public Business" ranks first in importance.
In reflection of that, the Treasury's new handbook--to pick up on the point made by my hon. Friend the Member for Weaver Vale (Mr. Hall)--"Regularity and Propriety" includes the checklist from the eighth report in full. No doubt that is why my right hon. Friend the Member for Ashton-under-Lyne described it as wholly admirable. I am pleased to tell the House that more than 8,000 copies have been circulated. I would also draw the attention of the House to the fact that, in the Treasury minute in response to the Committee's report on the Plymouth development corporation, the Government emphasised the importance of high standards of conduct at all levels in the public service.
I remind the House that, in seeking better value for money and greater accountability for the taxpayer, we are all on the same side. Although the 25 reports deal with activities under the previous Government, the present Government fully accept the need to carry their lessons into the future. For this purpose, we need to count not only on our own efforts but on the continuing vigilance of the Committee, the National Audit Office and other national audit agencies.
Good government cannot happen without vigorous external scrutiny. We look forward to many more years of constructive engagement with the Committee. The speeches made by hon. Members this evening demonstrate the expertise and ability that they bring to that role, under the chairmanship of the right hon. Member for Haltemprice and Howden. I look forward to continuing excellent relationships between me, the Treasury and the Committee as we strive to reach these objectives.
Question put and agreed to.
Resolved,
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Betts.]
Mr. Adrian Sanders (Torbay):
Thank you, Mr. Deputy Speaker, for the opportunity to raise a very important matter. I declare an interest as an insulin-dependant diabetic and user of the pen needle system.
There is an irony about the timing of the debate. The last time that diabetes was raised in an Adjournment debate, by the hon. Member for West Lancashire (Mr. Pickthall), was in June 1996. The Minister responding at that time was Gerald Malone, who cannot be here today as he is quite busy--and I hope that he will not be here next week either. The debate was wide ranging and touched on the pen needle issue. The then Minister's reply was as follows:
Diabetes is a common condition in which the amount of glucose in the blood is too high because the body is unable to use it properly. This is because the body's method of converting glucose--sugar--into energy is not working as it should.
The British Diabetic Association estimates that 1.4 million people in the United Kingdom have diabetes, and there might be as many as 1 million more undiagnosed. Diabetes is the single biggest cause of blindness among people of working age in the United Kingdom. Men with diabetes are two to three times more likely to suffer from coronary heart disease than the general population, while women have a four to five times greater risk. The risk of stroke is increased two to three times in people with diabetes. Half of lower limb amputations, other than those following trauma, are a consequence of diabetes. People with diabetes have a 15 times higher risk of amputation than the general population.
There are two types of diabetes: insulin-dependent and non-insulin-dependent. Today we are discussing the former, in which the condition is treated by insulin injections and diet. It is worth remembering that before the discovery of insulin such diabetics simply died; today they can lead normal lives, but the key is control of their condition. Well-controlled insulin-dependent diabetics will test their blood sugar levels regularly and take appropriate action in the light of the results.
The health service provides a number of items on prescription to help diabetics to maintain control: insulin, in both vial form for syringe injections and cartridge form for the pen needle; tester strips so that people can test their blood in glucose meters; lancets, the little pricking devices to enable the blood to be drawn for the blood test; and syringes--but not pen needles. Although general practitioners and hospitals are free to supply pen needles, it is unfair for health professionals to be placed in the position of determining needy cases. It is also unfair that access to free pen needles depends on where the diabetic lives or who is consulted for advice.
My hon. Friend the Member for Somerton and Frome (Mr. Heath) showed me a letter today from one of his constituents who lives in a part of the country where free pen needles are not available. His constituent--who was progressing from non-insulin-dependent diabetes, treated by tablets and diet, to insulin-dependent diabetes--was offered the pen but was aghast at having to pay for the needles. All hon. Members should be aware of that problem, because we all have constituents in that position. Pen needles cost patients around £10 per box of 100. Unlike syringe needles, pen needles can be used more than once; consequently, some diabetics will need only two boxes a year, while others require four or five and a minority will use slightly more.
Using a pen device is much more convenient as it is self-contained. There is a stigma attached to hypodermic needles, whereas the pen is a well-disguised object that enables people to inject themselves discreetly--sometimes when other people are around, but without their noticing. That is not possible with a syringe, which has to be drawn up, thereby broadcasting all sorts of connotations to those who witness it. The pen is discreet because it looks like a fountain pen; it is quicker than having to draw up a syringe; and it is much easier to use, especially by children, people with arthritis, the elderly and the visually impaired. Instead of drawing up the dose of insulin, one simply clicks the pen and one can hear the dose of insulin as it goes in. That is a significant benefit to the groups I listed. Many people need mixed insulin, in which case they have to carry two vials and draw from both before injecting themselves. With the pen, the insulin can be ready-mixed in the cartridge, thus avoiding the necessity of carrying around glass bottles in one's pocket or handbag.
The pen system encourages better control of blood sugar level and that is the key consideration. It reduces the chances of the onset of costly health complications. Yet despite all that, three quarters of people still use a syringe.
It is estimated that providing pen needles on prescription would cost the health service budget around £5 million a year. Diabetes as a whole costs the national health service about £2 billion a year, mostly from acute care. Poor control leads to complications, often involving acute care. The latest figures I have been able to get are for 1993-94, when 926 leg, 155 foot and 812 toe amputations took place in England with diabetes as the main diagnosis--each and every one a costly operation, necessitating a hospital stay.
In addition, a considerable amount of money would have to be spent on adaptations to housing and equipment; and consequent loss of employment might lead to almost
complete--in some cases complete--dependence on the welfare system. Poorly controlled diabetes can also lead to blindness, kidney failure, heart disease and strokes, with all the associated additional costs to the state. When the savings to the NHS acute care costs from better control of diabetes are taken into account, the overall cost of supplying pen needles on prescription is much reduced--or could even result in savings.
That this House takes note of the First to Twenty-fifth Reports of the Committee of Public Accounts of Session 1996-97 and of the relevant Treasury Minutes (Cm 3559, 3577 and 3714), with particular reference to the following Reports:
Second, Progress in Completing the New British Library (HC 38);
Fifth, Highways Agency: The Bridge Programme (HC 83);
Eighth, Information Technology Services Agency: Outsourcing the Service Delivery Operations (HC 98);
Thirteenth, HM Treasury: The Second Sale of Shares in National Power and PowerGen (HC 151);
Sixteenth, The Work of the Directors General of Telecommunications, Gas Supply, Water Services and Electricity Supply (HC 89);
Twenty-second, British Rail Maintenance Ltd.: The Sale of Maintenance Depots (HC 168).8.15 pm
"The BDA"--
the British Diabetic Association--
"submitted . . . 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.
I hope that the present Minister will be able to confirm that further progress has been made in the past 18 months.
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."--[Official Report, 5 June 1996; Vol. 278, c. 697.]
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