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Mr. Adrian Sanders (Torbay) (LD): I do not think that there is any evidence to show that people suffer adverse effects, except those who switched from animal to GM insulin and back again.

Mr. Amess: I thank the hon. Gentleman. He is entirely right to correct the impression that I gave the House—I left a few words out of my speech.

In a letter dated 10 November, Lord Warner assured me that the two companies that currently supply animal insulin in the UK—Novo Nordisk Pharmaceuticals Ltd and CP Pharmaceuticals Ltd—had not notified the Department of Health of any intention to discontinue its production. Novo Nordisk has delayed making any decision until 2005, and CP Pharmaceuticals apparently has no plans to withdraw from the market. I hope that the Minister will reassure the many diabetics who use animal insulin that he will do everything possible to ensure that they will still have the choice of using synthetic or animal insulin. I know that Diabetes UK's stance on animal insulin is clear.

I praise Pfizer for its "ChoLESSterol" campaign, which is building on the success of its 2003 programme. This year, the company is focusing on communicating with diabetics and is working closely with Diabetes UK. It is sponsoring the "ChoLESSterol" programme because the national service framework on coronary heart disease states that patients with diabetes should be assessed to determine their risk of CHD, and the management of cholesterol levels forms an important part of that assessment. With the introduction of general medical services contracts, which set targets for recording the processes and outcomes of cholesterol levels in patients with diabetes, general practitioner practices are given a huge incentive to address diabetes management and associated risk factors. I commend Pfizer for its initiative to help to reduce cholesterol and improve the lives of diabetics.

I end on a local note by talking about services in Southend, as the Minister would expect. I have close links with the diabetes group in Southend and enjoy attending its regular meetings. However, its members think that the service that they currently receive is somewhat inadequate. It does not criticise the two consultants who deal with diabetes, but given that my constituency is No. 1 for the number of people aged between 100 and 111, we have more than our fair share of people who suffer from diabetes. The diabetes helpline in Southend is only open on Tuesday between 10.30 and 12.30. That is inadequate. At all other times there is a telephone answering service for members of the general public to leave a message and the diabetes nurse will return the call.

There are very few trained diabetes nurses in Southend. Two or three practices have been lucky enough to secure the services of a trained diabetes nurse. Three are based at the hospital, but they are inundated with requests for help. I know that all the money goes through the primary care trust, but more funding is needed to enable Southend to have more specialist diabetes nurses. General practitioners want more of
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those nurses attached to their surgeries so that diabetes provision is available at practice level, which I am sure the Government would support, so taking the pressure off Southend hospital. The Minister should be aware that as a result of the target set by the Department of Health, general practitioners' patients are sent to the hospital, creating more pressure on hospital services. The primary care trust has advised me that it is doing its best to address the situation, but more help is urgently needed in Southend, in particular.

10.56 pm

Mr. Adrian Sanders (Torbay) (LD): I congratulate the hon. Member for Southend, West (Mr. Amess) on his excellent speech. He covered many of the points that the all-party group on diabetes, which I chair, is keen to hear addressed as often as possible in the presence of Ministers. Healthy eating and exercise are vital. We do not know the real cause of why people get the condition, whether at an early age or later in life, although clearly unhealthy lifestyles and obesity are contributing factors.

A key point is that food labelling is important, and I am glad that we have the White Paper. Animal insulin should be a matter of patient choice. When patients are diagnosed and insulin is introduced to a type 2 condition, they will be put on GM insulins. I am not worried about that. I am, however, concerned that those who have always been on animal insulin are able to continue to get a source of supply.

The all-party group will engage in an online consultation on 8 December—our launch date—and we hope that diabetics across the country will go on to the website to talk directly to medical professionals and politicians about how the NSF is being delivered in their area and wider diabetic issues. The Minister's Department knows about that.

10.58 pm

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I congratulate the hon. Member for Southend, West (Mr. Amess) on his continued interest in the issue. This is not a flash in the pan. He has been asking questions and beavering away for some time. I am grateful to him for his interest in an important subject. Equally, I am grateful to the hon. Member for Torbay (Mr. Sanders) for his work through the all-party group.

I congratulate Pfizer. I am always pleased to congratulate my former employer, especially as it continues to employ 5,000 of my constituents. I am always pleased to hear nice things said about it. Its work is important. On behalf of the Government, I also congratulate Diabetes UK on its important work, and also the local diabetes networks, which have put a lot of effort into raising awareness of diabetes and supporting those who have the condition.

It is right that we take this opportunity, which was also taken on world diabetes day, to raise awareness of a serious condition that affects many people. Diabetes is a chronic and progressive disease that has an impact on almost every aspect of life and on all age groups. People who do not suffer with diabetes often do not realise the complications that it can cause. Those complications
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include visual impairment and blindness; kidney damage leading to progressive renal failure; heart attack and stroke; and other conditions that can lead to further complications, including amputation of the lower limbs. Ultimately, diabetes can result in premature ill health, disability and even death and, as the hon. Member for Southend, West said, it cannot be cured. I am not aware of any research that is imminently likely to provide a cure. Research is ongoing into the best means of screening for type 2 diabetes, but I am sure that all the pharmaceutical companies are actively investigating the opportunities. The Medical Research Council is the body that would provide Government funding for general research.

As the hon. Gentleman said, there are two main types of diabetes. Type 1 generally shows itself in younger people, although it does affect older people too. With that type of diabetes, the body cannot make any insulin—the hormone that controls the amount of sugar in the blood—so people with type 1 diabetes need insulin injections for the rest of their lives. The hon. Gentleman asked about the availability of both types of insulin, and I can give him the assurance that he sought: to the best of our knowledge, there are no plans to discontinue the production of the two types of insulin. Were we to become aware of such plans, we would, of course, express a view, and our clear view is that which type of insulin a patient receives should be a clinical decision. That decision certainly should not be controlled by commercial considerations or issues of availability. I hope that that reassures him.

Type 2 diabetes usually appears in middle-aged or elderly people and can be developed as a result of lifestyle choices. That is why it is indeed appropriate that today, as we launch the public health White Paper, we are debating diabetes. People who are overweight are more likely to develop type 2 diabetes; it also tends to run in families and is more common in Asian and African-Caribbean communities.

Diabetes is becoming more common across the world, and that is also true in England. About 1.4 million people in England are currently diagnosed with diabetes and as many as 1 million may have type 2 diabetes without even knowing it. The number of people with diabetes in the UK is expected to rise to 3 million by 2010. It will have a significant impact on those people's lives and that of their families. When researching for this speech, the statistic that horrified me was that diabetes is estimated to account for 5 per cent. of total NHS spending—a huge amount of money spent on a single condition.

The challenges are mounting. Our population is made up of a complex cultural mix that is becoming more overweight, obese and inactive, so our population is also becoming more prone to diabetes. That is why we developed the national service framework for diabetes and published it in December 2001. It was developed with the help of users of the service, clinicians and managers. The NSF sets out to make best practice the norm, setting out a 10-year programme of change through 12 new national standards. The document is supported by the diabetes delivery strategy, which was
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published in January 2003 and which offers a framework that the NHS can use to build capacity and deliver the national targets.

Taken together, the NSF standards and the delivery strategy will lead to fewer people developing diabetes and better care for those who have it. They will also ensure that diabetes services are centred around the needs of people with diabetes and offer care that is structured and proactive, providing people with the support and skills they need to manage their own condition, which is particularly important. Those are the first ever set of national standards for diabetes services in the NHS. They will raise the quality of services everywhere and reduce unacceptable variations. In order to stay healthy and well, every person with diabetes needs good and regular health care. We can reduce the risk of serious complications and lengthen life. This means prompt diagnosis, regular checks to identify serious complications at an early stage and treatment to control blood glucose and blood pressure levels.

Support and education are crucial so that people can manage this complex disease effectively by themselves. Structured education and care planning are crucial tools that will enable people with diabetes to improve their knowledge and skills, supporting them to take control of their own condition and to integrate self-management into their daily lives.

In line with that, explicit objectives of the NSF include the provision of services that enable people to manage their own diabetes through education and support that recognises the importance of lifestyle, culture and religion. There is much work being accomplished in this area. For example, Action Diabetes is a Department of Health pilot project in Slough primary care trust. It is designed to improve the lives of patients who are known to have diabetes, and to identify sooner those patients who have yet to be diagnosed. The particular focus is to reduce late diagnosis of the disease and to improve the health of the most at risk, generally Asian communities. That initiative was launched by the Minister, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), on 18 October 2004 and has already successfully identified a number of previously undiagnosed cases of diabetes.

In Barnet, community-based education has been developed to meet the needs of the PCT's ethnic and multicultural population. Specific projects include a diabetes awareness day for the Chinese community, a bi-monthly education programme for an ethnically mixed group of patients at the multicultural centre, and a patient day organised by the PCT to promote greater awareness of diabetes, PCT services and the importance of personal responsibility for health.

While I am talking about local initiatives, the hon. Member for Southend, West mentioned his concerns about some services in Southend. He rightly said that money is now channelled through the PCT, so it is for it to make decisions about how that money is spent. Southend PCT is doing a considerable amount of work locally to try to improve services for people who suffer from diabetes. A strategic vision for chronic disease management, including diabetes, was presented to the joint board and executive committee on 27 May 2004. There has already been a number of valuable outcomes
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from the work, which I am confident will improve services for people in the hon. Gentleman's constituency. Initiatives such as those provide services that are patient centred, equitable and appropriate to individual's needs, and they will make a real difference to the lives of people from all backgrounds, including those from ethnic minorities with diabetes.

Good progress is already being made across a number of areas covered by the Diabetes NSF. The recent Dr. Foster report, "Your Local Care", published by Diabetes UK, found that systems for service delivery are well on their way to implement the NSF on a national basis. For example, 86 per cent. of PCTs are part of a whole system diabetes network, 79 per cent. have accountability arrangements to ensure that decisions are implemented and 93 per cent. have identified a clinical lead. The diabetes delivery strategy emphasises the importance of specialist care in certain circumstances—for example, for women during pregnancy and for those who are admitted to hospital.

The report found that in 97 per cent. of PCTs, people with diabetes who are admitted to hospital have access to the support of a diabetes specialist team. In 98 per cent. of PCTs, women with pre-existing diabetes, and those who develop diabetes during pregnancy, have access to joint diabetes and obstetrics management. That is an increase from 91 per cent. in the past year. We recognise, however, that there is a need to continue to continue to make further progress in other areas of diabetes care if we are to succeed in the implementation of the 12 standards. The Department of Health is committed to do just that. The very first of the NSF standards also makes it clear that prevention is better than cure.

In many cases, but not all, type 2 diabetes can be prevented or the onset delayed, especially if individuals at increased risk of developing type 2 reduce their risk by changing lifestyle, eating a balanced diet, losing weight and increasing their physical activity levels. In May this year, the Health Committee, on which the hon. Member for Southend, West serves—I congratulate it on its work and on its interest in the matter—reported the results of its thorough and comprehensive investigation of the issues surrounding the growing problem of obesity, which is a major risk factor in the development of type 2 diabetes. The timing of its report was fortunate, as it directly contributed to the "Choosing Health?" consultation, and made an important contribution to
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the development of the comprehensive range of proposals that we set out in today's White Paper. In July 2004, we announced a new joint public service agreement target for the Department of Health, the Department for Culture, Media and Sport and the Department for Education and Skills, aiming to halt

The public health White Paper published today pulls together a comprehensive strategy to deliver that target. One of the six priorities for action identified in the White Paper relates to reducing obesity. The White Paper recognises that obesity, both in children and adults, is increasing and poses a serious threat to our health, storing up trouble through an increase in diabetes, heart disease and cancer. It sets out practical measures to support people who want to live healthier lives. We have set out a comprehensive plan of action covering physical activity, diet, personalised support, information and curbs on marketing, thus providing a strong foundation for tackling obesity. For example, the Department of Health has commissioned the National Institute for Clinical Excellence to prepare definitive guidance on prevention, identification, management and treatment of obesity, which is due to be available in 2007. We will also commission the production of a weight loss guide, to set out what is known about regimes for losing weight and to help people select healthy approaches that are most likely to help them to lose weight and maintain a more healthy weight. For the first time in England and Wales, evidence-based guidance will be available for children and adults on both prevention and management, ensuring a consistent evidence-based approach.

The NHS will provide more effective services on obesity, whether in prevention, management or treatment, so that the public and patients have much better support, tailored to their individual needs, to help them achieve and maintain a healthy weight. These are concrete and practical measures that signal our commitment—

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