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8.26 pm
The Minister of State, Department of Health (Mr. Alan Milburn): I am grateful to the hon. Member for Torbay (Mr. Sanders) for raising such an important issue. I am aware of his close interest in diabetes as the chairman of the all-party group on diabetes. I know that the group is due to meet my noble Friend Baroness Jay, a Minister of State in the Department, in the new year, and I am sure that the subject will be discussed in detail during that meeting.
The subject is an important issue for patients and one on which I am determined that we should make substantial progress. The hon. Gentleman asked whether I was able to report progress and I hope that, towards the end of my speech, I shall be able to reassure him that progress is being made.
Before I respond on the specific issue of insulin pen needles, it might be a helpful if I put it into the wider context of what the Government are doing to tackle diabetes more generally. We take the matter very seriously. In its different forms, diabetes is estimated to affect 2.4 per cent. of the adult population in this country--more than 1 million people--and 10 to 15 per cent. of those with diabetes are dependent on regular insulin injections.
As the hon. Gentleman rightly pointed out, diabetes and its complications often cause severe problems for those affected, their families and their carers and, inevitably, the disease imposes heavy burdens on the health services. If diabetes is not properly managed, it can cause terrible long-term complications such as blindness, renal failure and cardiovascular disease.
Obviously, the Government are concerned to tackle these problems. I shall briefly outline five important signals of the priority that we attach to improving services for people with diabetes. First, let me point out that we spend over £1 billion a year on the various services and drugs to help those with diabetes and associated problems.
That is over 5 per cent. of the budget for the NHS. It is useful to bear that in mind in considering the issue of pen needles.
Secondly, my right hon. Friend the Secretary of State for Health launched new guidance to the NHS last week, to coincide with World Diabetes Day. The guidance, entitled "Key features of a good diabetes service", was developed by a small group involving the Department of Health, patients, GPs, nurses, NHS managers and the British Diabetic Association. It is important to put on the record the value that the Government accord to the BDA's work on behalf of people with diabetes, in its roles as adviser and advocate.
The new guidance sets out to the NHS how health authorities working with GPs can secure and deliver a good diabetes service. It places special emphasis on partnership: the organisation of diabetes services can involve many parties--primary and community care teams, secondary care teams, carers and people with diabetes, who, of course, have a pivotal role in managing their care. We want to make sure that services for people with diabetes are better tailored to the needs of individuals.
The guidance emphasises prevention and the need to raise awareness of diabetes. It has long been recognised that the education of people with the disease is vital for promoting effective self-care. The guidance was welcomed by the British Diabetic Association, which described it as "a major step forward". It is significant that the association gave it such a positive response.
Thirdly, the Government have endorsed the international St. Vincent declaration, which highlights the scope for reducing the complications resulting from diabetes, and proposes a number of outcome targets, which include the reduction of cases of new blindness due to diabetes by one third or more; the reduction in the numbers entering end-stage diabetic renal failure by at least a third; and the reduction of lower limb amputations for diabetic gangrene by a half.
Those are challenging targets and are widely recognised as such. It is important for us to make progress on them. Indeed, I was pleased that the follow-up conference to St. Vincent, which was held in Athens last year, accorded this country the honour of being in the vanguard in Europe of improving diabetes services. We have done well, but we are not complacent, as there is still much progress to be made.
We must continue to strive to improve the care of people with diabetes and the quality of their lives. We are pledged to work in partnership not only with the NHS and health professionals, but with the British Diabetic Association and the all-party group on diabetes. We are always happy to discuss these issues in the House or in private meetings, if that is helpful to the hon. Gentleman.
Fourthly, the Government support much vital research into diabetes. The Medical Research Council, which is the main agency through which the Government support medical and clinical research, spends about £3 million a year in this area. The Department of Health is funding three important studies at a total value of £1 million, which is on top of the Department's research and development programme.
Finally, there is a whole programme of work in support of diabetes, such as clinical audit and monitoring. We have recently commissioned new national clinical
guidelines for non-insulin-dependent diabetes and other clinical effectiveness materials, which will ensure that the very best practice in the NHS is shared better in the future.
I hope that the hon. Member will forgive me for sketching some of the general developments in the treatment of diabetes that the Government are intent on promoting. We are considering the specific issue of pen needles in the context of that broad programme.
For some time, we have been discussing the merits or otherwise of listing insulin injection pen needles and the pens themselves in the drug tariff. That would allow the needles to be prescribed on the NHS by family doctors. At present, insulin injection syringes, and their related needles, are listed in the drug tariff, so are prescribable on the NHS by GPs.
The issue of the availability of injection pens is slightly more complex: perhaps even more complex than the hon. Gentleman suggested. There are two types of pen. The disposable pen is prescribable only because it is a container for the insulin, and the prescription for the insulin automatically includes its container. The reusable pen, on the other hand, does not come pre-filled with insulin, so it is not automatically prescribed when the insulin is prescribed. That may be as clear as mud, but that is the position. Indeed, there is less need to prescribe reusable pens, as they usually last two to three years. I understand that reusable pens are made widely available to patients by the manufacturers, which often distribute them free, sometimes through diabetic clinics.
Needles for injection pens fit either type of pen, but are not interchangeable with the needles used with syringes. They are not currently listed in the drug tariff, and may not be prescribed on the NHS by family doctors. That sets out the rather complicated current position.
The Government are considering whether pen needles should be placed on the drug tariff list, so that they could be prescribed with the insulin. We are giving the issue serious consideration, as I have made clear to the hon. Gentleman in parliamentary answers or when he has written to me. It is said that many people find the pens more convenient and comfortable to use than syringes. We do not dispute that, and we acknowledge that convenience and comfort are important considerations when people have to inject themselves frequently.
The major stumbling block is quite simply the cost. The NHS is not a bottomless pit, and we have to use taxpayers' money responsibly. We must ensure that it is used as efficiently and wisely as possible. Pen needles cost about four times as much as syringe needles. Our estimate is that the costs of placing the reusable pen on the drug tariff could range from £10 million a year at the lower end to £30 million a year at the upper end, depending on the uptake. If people switched from syringes to pens, or from reusable pens to disposable pens, costs would range towards the upper figure.
I shall be frank with the hon. Gentleman. The problem at the moment is that we are unclear about whether, or to what extent, such switches are likely to occur, and whether the cost of listing injection pen needles would be significantly higher than the British Diabetic Association's 1995 estimate of £9.5 million over two years.
However, costs cannot be the only consideration when such important issues affecting so many people are involved. The Government are committed to ensuring that
we try to improve the care of people with diabetes and their quality of life. For that reason, I have asked officials in the Department of Health to examine, in discussions with interested parties if necessary, whether we can be more certain on the cost points. They have held a number of meetings with the major suppliers, and negotiations are currently under way.
It is still a little early to place a precise time scale on this work, particularly given the delicate nature of our discussions with the companies concerned. We do not want to delay decisions unnecessarily and, equally, we do not want to take premature decisions if costing issues still
have to be resolved. Nevertheless, this is an important issue on which we are determined to make progress in the interests of patients and of the NHS more generally.
The hon. Gentleman was right to seek this debate. Ministers have signed many letters in response to hon. Members who have expressed concern about the issue. The Government are aware of the concerns in the House and in the country. Many people suffer from diabetes, and many people have relatives, friends and neighbours who have diabetes. We want to make progress, and I shall be happy to update the hon. Gentleman in due course when we have advanced a little further.
Question put and agreed to.
Adjourned accordingly at twenty-two minutes to Nine o'clock.
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