| Previous Section | Index | Home Page |
12.6 am
The Minister of State, Department of Health (Mr. John Denham): I congratulate the hon. Member for Torbay (Mr. Sanders) on raising this important subject and making his points clearly and concisely. I am aware of his close interest in the subject, as the chair of the all-party group on diabetes and, as he told the House, because he himself has diabetes.
I hope to respond to all the issues that the hon. Gentleman raised. I begin by assuring the House of the seriousness with which the Government take diabetes. It is, as the House has heard, an important health issue in terms of both morbidity and mortality. More than 1 million people in the United Kingdom have diabetes, and that number is forecast to increase significantly over the next decade.
Diabetes has a significant impact on the national health service. Our estimate is rather higher than the hon. Gentleman's--diabetes and its complications account for at least 9 per cent. of health care costs in the UK. If it is not properly managed, diabetes can result in a range of long-term complications which the hon. Gentleman listed--blindness, renal failure, lower limb amputation and cardiovascular disease.
I acknowledge that there is some evidence of considerable variations around the country in the organisation and quality of diabetes services. For that reason among others, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), the former Secretary of State, announced in January that the next national service framework would cover diabetes. I shall return to the national service framework later and respond to other specific issues, but first I shall touch briefly on the wider context of Government policies for tackling diabetes.
The previous Administration signed up to, and we endorse, the St. Vincent declaration, which recommended action in key areas and set outcome targets. The principles and targets of the St. Vincent declaration have been at the core of what successive Governments have done on diabetes, in partnership with health service providers, the British Diabetic Association and others.
The St. Vincent joint task force for diabetes set up by the Department and the BDA made recommendations in 1995 about good clinical and management practice in 11 agreed priority areas. That was followed in November 1997 by service guidance for the NHS entitled "Key features of a good diabetes service", which was developed by a sub-group of the Department's clinical outcomes group. The key features guidance made suggestions about how health authorities, working in partnership with primary care and all those involved in the planning and
delivery of local diabetes services, including people with the condition, should work together to agree a structured programme of diabetes care.
A raft of other work feeds into the new quality agenda. The Government are supporting a range of current activities to improve knowledge-based decision making in diabetes care. The Department has commissioned new national clinical guidelines for type 2 diabetes, and other clinical effectiveness materials.
The hon. Gentleman rightly stressed the importance of the user's perspective and needs and of ensuring that the NHS provides effective services to meet them. We attach great importance to involving patients, carers and the wider public in decisions about health service delivery, and we also want individual patients to play a greater role in determining the care that the NHS gives them. An NHS that works effectively with patients will deliver better results for individual patients and better health for the whole population.
An example of that is the Bradford health action zone programme, which is developing models for delivering accredited diabetes care within primary care. The Bradford HAZ has set up a network of local diabetes satellite clinics in general practitioners' surgeries and, instead of visiting hospital, patients can receive specialist care locally. That is an example of how our determination to modernise the NHS and tackle inequalities is already improving services.
The BDA is also participating in the expert patients task force, headed by the chief medical officer, which was announced in the White Paper "Saving Lives: Our Healthier Nation" and met for the first time last week. The task force will design a programme to help people with a chronic disease or disability such as diabetes to take the lead in managing their condition, with appropriate support from the health service.
The Government are making a major contribution to diabetes research through the Medical Research Council and NHS support for research and development. The MRC, which is the main agency through which we support medical and clinical research, spends about £3.5 million a year on diabetes. In addition to commissioning specific projects, the Department supports research funded by charities such as the BDA and the MRC, which takes place in the NHS. More than £4 million a year of that funding supports endocrinology and diabetes research.
I shall deal briefly with issues surrounding diabetes screening. The UK national screening committee is considering the case for introducing a screening programme targeted at people at high risk of contracting type 2 diabetes. We expect to receive its advice later next year, and it will also be linking type 2 diabetes with other risk factors in its consideration of screening for vascular disease. It also recently commissioned a working group to develop proposals for a national screening programme for diabetic retinopathy. The proposals being developed would ensure national coverage to national quality standards.
I deal now with some of the specific issues raised by the hon. Gentleman. On driving and diabetes, I am afraid that there is little more that I can say this evening. The way in which the driving licences of people with diabetes
treated by insulin are considered is of course a matter for my right hon. Friend the Secretary of State for the Environment, Transport and the Regions. Briefly, as the hon. Gentleman said, the current position is based on European legislation--the second driving licence directive. That directive provides for licensing restrictions on those with insulin-treated diabetes--in particular in respect of driving heavier vehicles--based on risks associated with insulin treatment. I understand that the advisory panel on diabetes and driving, which advises my right hon. Friend, has, over a long period, consistently advised against the granting of licences to drive the largest vehicles, such as lorries and buses, to people with insulin-treated diabetes, based on its knowledge of the risk of a hypoglycaemic attack occurring without warning and the associated road safety risk.
That bar was extended to small lorries and minibuses on implementation of the second driving licence directive which, for people with insulin-treated diabetes, came into effect at the beginning of 1998. However, on the advice of the panel, the Government felt able to relax the law in September last year to allow drivers of small lorries to renew entitlement obtained before 1 January 1997, provided that they can satisfy specified conditions. I shall of course draw the attention of the relevant Minister to the debate. I am also aware, as is the hon. Gentleman, that the Science and Technology Committee is currently considering diabetes and driving licences.
Mr. Browne:
I am grateful to my hon. Friend for giving way. I realise that the issue that exercises me is the responsibility of another Department, but when he draws the debate to the attention of the relevant Minister, will he stress that the arguments are fundamentally underpinned by a desire for the Department to treat people with this disability as individuals, not a coherent group? We are arguing for an approach that recognises people's individuality and that would reflect the stance that other European countries appear to be adopting.
Mr. Denham:
I repeat my undertaking to draw the appropriate Minister's attention to the points that have been made in this debate. However, it is not for me to intrude on the responsibilities of another Department.
The hon. Member for Torbay expressed concern about the inadequate diabetes care suffered by some elderly people in residential care homes. That issue was highlighted recently in a report by the BDA. Among the deficiencies identified by the BDA were a lack of diabetes care planning, inadequate dietary advice, a lack of specialist health professional input, high ratios of staff with no experience of diabetes and a lack of diabetes training for care home staff. The report raised serious issues and made important recommendations, which we shall consider further. In particular, I confirm that this aspect will fall within the scope of the national service framework for diabetes. The BDA report will help to inform its development.
As the hon. Gentleman rightly said, the care standards Bill announced in the Queen's Speech is relevant because it is designed to drive up standards in care services, with a new independent regulatory system to inspect care homes and other services against national standards. Also relevant is the consultation document "Fit for the Future?", which includes proposed standards for older people in residential and nursing homes.
The hon. Gentleman also raised the issue of the availability of insulin injection pens and needles on GP prescription. We consulted between February and April this year on a proposal that was designed to open the way for insulin pen needles and reusable insulin injection pens to be available on GP prescription on the NHS. Reusable pens and needles would be free to people with diabetes who need treatment with insulin and who produce the necessary prescription charge exemption certificate.
The proposal on which we consulted was to prevent GP prescribing of pre-filled, disposable, insulin injection pens because it was significantly more expensive to administer insulin using those pens than using reusable pens, and they seemed to offer no clinical benefits or benefits of patient convenience or comfort to justify the extra cost.
Most of the organisations consulted responded, including the companies that market insulin pens and needles, which have proposed to equalise the costs of pre-filled and reusable pen-based insulin regimes by adjusting their pricing. We thought that this proposal, which would have avoided the need for the proposed blacklisting of pre-filled pens, was well worth exploring with the companies. It was clear from the consultation that some people felt there was a need for pre-filled pens because they are less fiddly to use. Some people with diabetes who could not use the reusable pen may be able to use the pre-filled pen. The companies' proposal offered one way of responding to this need, although not the only way.
We are currently in negotiation with the companies. A central point is agreeing a price for the reusable pens that is fair and affordable to the NHS. We wrote to the companies about a month ago, setting out prices that we believed were fair. We asked for their reactions, and the ball is now in their court. If they agree to our pricing proposals, we can quickly make reusable pens and needles available through GPs on the NHS. If not, we will have to consider what alternative options might be open to us. That may well include making pen needles available on GP prescription while postponing a decision on making some or all reusable pens similarly available. It would not, however, be sensible for us to postpone a decision on pre-filled pens.
Allowing pen needles to be prescribed could make use of the pre-filled pen more attractive than at present, because people would no longer have to buy the needles for them. To forestall growth in this relatively expensive way of administering insulin, we may need to return to the original proposal of blacklisting pre-filled pens, or at least restricting their availability to those who really need them. I share the hon. Gentleman's impatience to see this matter resolved, and I assure him that we are endeavouring to make progress as quickly as possible.
I referred earlier to various initiatives to improve services for people with diabetes. They are valuable, but they will have their greatest impact if they have to take place in a clear structure that holds those who deliver services to account.
Shortly after taking office, we set out in the White Paper "The New NHS--Modern, Dependable" and the policy document "A First Class Service--Quality in the New NHS" a range of measures to raise quality and standards and to decrease unacceptable variations in service. We said that standards would be set by the National Institute for Clinical Excellence and by national service frameworks. For the first time in the history of the NHS, we are setting clear national standards to guarantee fair treatment wherever patients live.
| Next Section
| Index | Home Page |