4.36 pm

Nia Griffith (Llanelli) (Lab): I congratulate my hon. Friend the Member for Aberavon (Stephen Kinnock) on securing this important St David’s day debate, and on his work to champion the steel industry. Today he mentioned not just the steel industry, but the need for

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clear and consistent messages from the UK Government if we are to encourage more investment from a range of different industries.

The right hon. Member for Clwyd West (Mr Jones) emphasised the importance of transport links to the economy of north Wales. That theme was taken up by many hon. Members, including my hon. Friend the Member for City of Chester (Christian Matheson) who suggested the need to upgrade the busy M6, and to think beyond Crewe for HS2 so that it serves Chester and north Wales. Along with other Members he stressed the importance of staying in the EU, particularly for the success of big companies such as Airbus, as well as a host of other companies in his constituency and over the border.

The hon. Member for Aberconwy (Guto Bebb) reminded us that Gordon Brown was right in keeping the UK out of the euro, and the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards) made a strong case for the EU, mentioning peace, political stability, social justice, economic matters, and the fairer distribution of resources from which Wales benefits. My hon. Friend the Member for Caerphilly (Wayne David) explained why it is important to campaign for proper links to Heathrow airport and to support its expansion, and he made a strong case for the need for better rail electrification to Wales. He also referred to the Wales Bill, and the fact that the Secretary of State was not here.

The hon. Member for Cardiff North (Craig Williams) spoke of the Cardiff city deal, as one would expect, and of the importance of interesting young people in science and innovation. My hon. Friend the Member for Merthyr Tydfil and Rhymney (Gerald Jones) spoke of the Wales Bill and thanked the Welsh Affairs Committee for all its hard work on that. He also pointed out some of the considerable problems with the Bill. The hon. Member for Gower (Byron Davies) mentioned the importance of the cockle industry and of getting to grips with the causes of those cockle deaths. We must get more information so that we better understand exactly what is happening.

My hon. Friend the Member for Swansea East (Carolyn Harris) talked about the need to get on and secure the tidal lagoon project and the jobs for the area. My hon. Friend the Member for Newport West (Paul Flynn) also mentioned tidal power, referring to the eternal nature of the tide. He stressed again the importance of the Welsh language. My predecessor as Llanelli MP, Jim Griffiths, was the first Secretary of State for Wales. I know he would very much have approved of my hon. Friend’s speech today.

How could I possibly skip over what my hon. Friend the Member for Newport East (Jessica Morden) said about the Severn bridge tolls? That issue is absolutely crucial for us across the whole of south Wales. She emphasised the point about the end of the concession. When is it happening and what will the reduction in price be? We want something much more substantial than the mere reduction in VAT.

The hon. Member for Montgomeryshire (Glyn Davies) mentioned dairy farming. I am sure he will be supporting the farmers’ march in London on 23 March. We shall certainly be speaking as one voice with them on the need to increase the powers of the Groceries Code Adjudicator to get a fairer price for our farmers. He also spoke of how the ground rose up around St David,

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propelling him above the crowd. We wondered today whether the Secretary of State is showing himself as a reverse St David, disappearing into the earth and appearing for only a few minutes at today’s debate—that is utterly disgraceful, I have to say. This comes in the week when he has treated the House with complete disdain by announcing a major U-turn on the Wales Bill at a press conference in Cardiff and refusing to come to the House to answer questions. Does the Secretary of State for Wales not think that a debate on Welsh affairs and the Wales Bill are worthy of his time?

I can only assume that the reason the Secretary of State is hiding in the Wales Office is that he is as embarrassed as he should be that his flagship constitutional Bill has run aground. What we saw on Monday was quite remarkable: large parts of the Bill that the Secretary of State was defending to the hilt just last month have now been binned. This amounts to a major change in policy in the one piece of proposed legislation for which his Department is responsible. It is shameful that he was more than happy to take questions from journalists but not from Members of this House whose constituents deserve to know what powers their Assembly will have. The Wales Office even tweeted on Monday to suggest that MPs should be happy to wait until today’s Backbench debate to have their say. I hope he is listening.

It is a shocking discourtesy to Members and is reminiscent of the arrogance the Secretary of State has shown towards the Welsh Government and to those who have disagreed with him. Let us not forget that shortly before we met at the Welsh Grand Committee, he said those of us who dared to challenge his rosy view of the Bill had given up on the Union. We were told that we had basically gone and joined Plaid Cymru because we suggested that the necessity test should go, the rules on ministerial consent should change and that the list of reservations should be drastically reduced. Now, he apparently agrees with us. Has the Secretary of State had a last-minute conversion to the separatist cause, or does he recognise that his hysterical comments were just a desperate attempt to deflect from the shambles of his draft Bill?

I am glad the Secretary of State has seen sense and will not now push ahead with a deeply flawed piece of proposed legislation, but let us not pretend that all this is business as usual. It is not a normal part of pre-legislative scrutiny to then go on and dump the Bill, and nor is this an example of a Secretary of State in listening mode. He wanted and fully intended to go ahead with a Bill that was complex, unworkable and which rolled back the powers of the Welsh Assembly. He only changed course when it became clear that literally no one supported him.

The Welsh Affairs Committee, with its Conservative majority, has produced an excellent report on the draft Bill. I would like to place on record my thanks to the members of that Committee for all their hard work. Their report, like the report of the Assembly’s Constitutional and Legislative Affairs Committee before it, shows that the Secretary of State has mismanaged the process from start to finish. Instead of producing a Bill with a robust set of reserved powers, he allowed Whitehall free reign to decide which powers it thought Wales should have. That resulted in 34 pages of reservations, covering 267 areas. How could the Secretary of State possibly have thought that this was the clear and lasting devolution

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settlement that he himself promised? We are now told he wants to reduce and simplify the reservations, but why did he not do that to start with? Is it because he did not actually know what was in his own Bill? How else can he explain saying to the Welsh Affairs Committee:

“When I read through the list of reservations I can see for myself that there are things where I think, you know, ‘For goodness’ sake, why is that being held back as reserved?’”?

We have a Secretary of State who did not do his job. He did not make sure that the draft Bill was fit to be published, and that is what has led to this wholly unacceptable state of affairs. We are told that the Bill will now be presented sometime in the next Session, but there are reports that this current Session of Parliament will run until after the European referendum. That means we will not see the Bill until July at the very earliest, with a real possibility that it will slip into the autumn.

So in the Secretary of State’s absence—well, I see him here now and perhaps he will listen—will the Minister respond for him and tell us when he expects the Bill to be published and when its provisions will take effect? Is it not the case that the Assembly will now have to wait even longer before having these powers devolved to it, because of this avoidable delay? In light of the Welsh Affairs Committee’s stinging criticism of the fact that

“the final Bill will be significantly different to that which they have been scrutinising,”

will the new Bill be submitted to the Committee for pre-legislative scrutiny?

I cannot help feeling that if the Secretary of State had spent less time attacking those of us who disagreed with him and more time fixing his Bill, this unnecessary delay could have been avoided. I hope that the Secretary of State will be able to produce a Bill that delivers the powers he promised, but his abysmal record so far hardly fills me with confidence.

On Monday, the Secretary of State also made reference to the Barnett funding floor, which we Labour Members welcome, although we recognise that it makes virtually no difference at a time when the Government are cutting the budget of the Welsh Assembly. In light of recent argument about a fiscal framework for Scotland, we now need to establish a framework for Wales that will underpin our future funding arrangements for the long term. The Smith Commission made it clear that Scotland should suffer no detriment from the transfer of tax-varying powers to Holyrood. It is imperative that the same principle is used in relation to Wales and that any arrangement is subject to review to ensure that it provides a stable financial settlement. Can the Minister update us on what progress has been made?

The Secretary of State and I have our differences, but I think we agree that we want to move past the debate about the process of devolution. We need a Bill that establishes a strong, fair and lasting settlement that achieves what the Welsh people want—a Welsh Assembly, a Welsh Parliament with the powers to make a real difference to the lives of people of Wales.

4.47 pm

The Parliamentary Under-Secretary of State for Wales (Alun Cairns): I start by congratulating the hon. Member for Aberavon (Stephen Kinnock) and other Members

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on contributing to today’s important debate in Westminster’s calendar—one that underlines the role that Wales plays within the United Kingdom. I welcome all the contributions of right hon. and hon. Members, and I will do my best to cover as many points raised within the limited time remaining.

The debate has been extremely wide ranging and has covered issues across the spectrum of the constitution, the European Union, the economy, public services, the tidal lagoon, the railways, the northern powerhouse and many other issues. I shall canter through as many as I can, but I want to spend some time on the Wales Bill in order to respond to the questions from the shadow Secretary of State for Wales and others. I shall address some other points, too.

Let me start my opening remarks by saying that Wales is in a good place. I am optimistic about our future. As a Government, we have been determined to make a difference to all parts of the UK, and while the job is not complete and there is always obviously more work to be done, we have taken positive action that sets the scene for a bright outlook for Wales. We are determined to work constructively with the Welsh Government, and whatever rhetoric we hear from individuals within Cardiff Bay, we are determined to respond in the measured fashion that the people of Wales deserve.

We want to secure our economic recovery, which was our greatest challenge when we came to office in 2010. Members will remember that unemployment was rising and for too many young people there was little prospect of employment, with the UK and Wales in a precarious financial position. Few Members, however, have mentioned the funding floor, so I was grateful to my hon. Friend the Member for Aberconwy (Guto Bebb) for doing so. This has been called for by Members for well over a decade, and it is only a Conservative Administration who have delivered it—and within the first year of their Parliament.

Glyn Davies: Previously, throughout my time in this Parliament and, indeed, in the Welsh Assembly, the Barnett deficit dominated every discussion, and was often raised by Opposition Members. Now we are in balance. Fair funding for Wales is one of the Government’s biggest achievements, but it is not being properly recognised by everyone.

Alun Cairns: I am grateful to my hon. Friend for emphasising that point. The 115% rate of Barnett consequentials is extremely important—it entirely meets the criteria in the Holtham demands—but one would almost think that Labour and Plaid Cymru Members were disappointed that we had actually delivered on something that they had been calling for. They would far rather be shouting from the sidelines, calling for it in the hope that we would not deliver it. When we respond in a positive way and deliver for the people of Wales, there is complete silence.

Jonathan Edwards: Obviously the Barnett formula is a step forward, but does this not underline the danger of using opaque terms such as “fairness” and “non-detriment”? In my view, a fair funding settlement should be based on need rather than serving to prevent further injustice. As the hon. Member for Llanelli (Nia Griffith), pointed out, the key aspect of non-detriment is the fiscal framework.

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Has the Minister any idea of the preferred index for which the Welsh Labour Government are arguing with the Treasury? It is clear that different mechanisms will have vastly different outcomes.

Alun Cairns: The hon. Gentleman has made some important points. It is, of course, up to the Labour party to explain its position. All I know is that Labour called for this for decades, we responded within a year, and since then there has been complete silence on the Opposition Benches.

My hon. Friend the Member for Aberconwy was extremely upbeat about Wales’s economic prospects. It is true that, since 2010, the number of people in work has risen by 89,000, unemployment has fallen by 35%, the youth claimant count has fallen by 61%, and Wales has experienced faster growth per head than any other nation or region of the United Kingdom outside London. The hon. Member for Neath (Christina Rees) spoke of the importance of getting people into work. This is action, and this is where it is happening.

We have been getting behind Welsh businesses, and there are 22,000 more small and medium-sized enterprises in Wales than there were in 2010. The hon. Member for Aberavon mentioned the steel sector. I know that he spoke to the Secretary of State and the Minister for Small Business, Industry and Enterprise earlier today about the issues facing the steel industry and, in particular, the communities around Port Talbot, but I hope he will recognise that the Government have gone a long way towards meeting the five asks from the steel industry.

One of those asks was a cut in business rates, which were mentioned by some Opposition Members. That is a devolved matter, and something that the Welsh Government could do. The energy-intensive industry compensation package has been delivered, as has the provision of more time in which to comply with the EU’s industrial emissions directive. As for EU-level action on anti-dumping, the UK Government are leading the pressure that is being exerted in Brussels. I hope that the hon. Gentleman will recognise that, along with a range of other measures that we have taken.

Stephen Kinnock: The Minister was going OK until he got to the bit about dumping. I am sorry, but we cannot let that one go. There are two key facts. The British Government are the ringleader of a group of member states that is blocking the scrapping of the lesser duty rule, which would make a huge difference to the ability to impose tariffs on unfairly dumped Chinese steel. They are also the chief cheerleader for Beijing in Brussels when it comes to giving market economy status to China, which would also dramatically reduce the scope. It must be recognised that, in respect of those two points, it is a case of abject failure.

Alun Cairns: I am sorry to hear that response, which raised two issues. The first is the confusion over market economy status. Russia has market economy status, but that does not prevent the European Union from introducing tariffs and preventing it from taking action. The other measures that the hon. Gentleman mentioned would take three years to introduce. We want to take action before then. We want to continue to be proactive. We want to work with the hon. Gentleman, the Welsh

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Government and the communities in and around Port Talbot and Newport, because of the importance of the steel industry to them.

In 2014-15 there were 102 inward investment projects in Wales, 98% of which were supported by UK Trade & Investment. That demonstrates the role that the UK is determined to play in supporting the Welsh economy, and in working with the Welsh Government.

The hon. Member for Merthyr Tydfil and Rhymney (Gerald Jones) mentioned welfare reforms. Welfare reforms are very important to getting people back to work, but we cannot pick one element individually. We need to look at the wider package, such as the national living wage, which would increase the incomes of 150,000 people in Wales by 2020. That will make someone working full time on the national living wage £4,400 better off, on top of the tax cuts that they will receive as a result of the increase in the personal allowance.

The Cardiff city deal was mentioned by many hon. Members, most notably my hon. Friend the Member for Cardiff North (Craig Williams), who has spearheaded and championed that cause and been persistent at every turn. He has been relentless, first as a candidate and now as a Member of Parliament, in pressing Ministers on this issue. Let me make it clear that we want this deal to be signed as quickly as possible and we are determined to press those involved in order to develop a world-class deal. We want Wales to look outwards and we want it to involve the private sector. We want the city deal to be a world beater in what it delivers. Hon. Members should recognise the fact that the spending review has already announced our “in principle” commitment to support a new investment fund, and earlier this year the Chancellor committed £50 million to establish a UK compound semiconductor centre as a down-payment on the city deal.

My right hon. Friend the Member for Clwyd West (Mr Jones) talked about ensuring that north Wales was recognised and about the importance of the northern powerhouse, a subject that was also raised by the hon. Member for City of Chester (Christian Matheson). There was a focus on the importance of rail links, and I hope that bringing the HS2 investment forward by six years will provide great opportunities for mid-Wales, north Wales and Cheshire through the links to the northern powerhouse. The hon. Member for City of Chester talked about local government reorganisation and the need to look towards Wales. I would also say that local government in Wales needs to look across the border. I think that it does so, but the Welsh Government need to recognise the fact that it is an administrative border and that the way in which people lead their lives means that they cross that border in a much more open way.

I could also go on at length about the investments that the prison in north Wales and Hitachi’s involvement at Wylfa will bring. Much has been said about the tidal lagoon project in Swansea. The Tidal Lagoon Swansea Bay company has recognised the strength of the review and welcomed it. I wish that hon. Members would reflect on what they are saying in this context and support the company rather than seeking to undermine the project, which could involve a significant investment.

In the time remaining, I want to talk briefly about the Wales Bill. We said at the outset that it was a draft Bill and that we wanted to be pragmatic and to use pre-legislative

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scrutiny positively. Given some of the negative points that have been made, however, I want to say that we will take absolutely no lessons from the party that gave us the Government of Wales Act 2006 and the convoluted and complex legislative competence order system, which has led to a great deal of legislative confusion. We are determined to get this right, and this pause needs to be taken in the positive spirit in which it was intended.

There have been calls to adjust the necessity test, but we plan to go further and to remove it. We will look at the list of reservations, but it also gives clarity. I encourage members to look at the Scotland Bill, which also has quite a long list of reservations, but there have been no complaints because of the clarity that it provides. Many people are calling for a distinct legal jurisdiction, but that would effectively mean a separate legal jurisdiction. That would be dangerous for Wales, in relation not only to the legislative process but to investment. We are also determined to work constructively to clear up the mess that we inherited with the pre-commencement orders. We want to get this Bill right, and we are being pragmatic. If we ploughed ahead, we would be criticised. We are being criticised just for pausing. It seems that, according to Labour Members, whatever the Wales Office does, it cannot win.

4.59 pm

Stephen Kinnock: I should like to thank the entire House for an excellent debate today. We have covered a wide range of issues including the economy, the EU, the Wales Bill, the Severn bridge toll, road and rail, city deals and public services. The red threads that run through all these subjects are the ideas of partnership, investment and solidarity. We know that we need to work together with the European Union and across the UK, and we hope that we will see that spirit of partnership from the Government, alongside investments to enable us to take our economy forward to a brighter future. I thank the House for this debate.

Question put and agreed to.


That this House has considered Welsh affairs.

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Diabetes Care

Motion made, and Question proposed, That this House do now adjourn.—(Gavin Barwell.)

5 pm

Keith Vaz (Leicester East) (Lab): Thank you, Mr Deputy Speaker, for giving me the opportunity to debate this important matter. I begin by declaring my interests as a type 2 diabetic and chair of the all-party parliamentary group for diabetes. In 2007, I founded the diabetes charity Silver Star, and I am an active and passionate supporter of Diabetes UK and JDRF—the Juvenile Diabetes Research Foundation—both of which provide secretarial services to the APPG. I would argue that we currently have the best diabetes Minister we have ever had, and I am glad to see her on the Front Bench today. I would like to thank her and her diabetes tsar, Jonathan Valabhji, for all the work that they do.

Diabetes is one of the most important health challenges facing the NHS and indeed the world. Sometimes we get immune to the facts, even though they are so devastating: 3.5 million people in the UK have been diagnosed with diabetes; 700 people a day are diagnosed with the illness; by the end of this debate 15 more people will have been diagnosed with diabetes—that is one every 2 minutes; and it is estimated that by 2025 some 5 million people in the United Kingdom will have diabetes.

Despite the good intentions of the Government, the passion of practitioners and the interest of many Members of this House, I am worried that the prevention, diagnosis and treatment of diabetes is not high enough on the agenda. One in five hospital admissions for heart failure, heart attack and stroke are people with diabetes. Diabetes is responsible for more than 135 amputations a week, four out of five of which are avoidable. Diabetes is the leading cause of preventable sight loss and the most common cause of kidney failure. Every year, more than 24,000 people die prematurely due to diabetes.

Mr George Howarth (Knowsley) (Lab): I echo my right hon. Friend’s comments about the Minister. He cites statistics, and on the amount of money that is spent on diabetes, £7 billion of the NHS budget is spent on dealing with the avoidable complications to which he has just referred. Yet Department of Health spending on research into diabetes through the UK’s Medical Research Council is just £6.5 million, which is by far the lowest level of almost any developed country. Does he think there is a connection between those two things?

Keith Vaz: My right hon. Friend, who is a great campaigner on this issue, is right to have raised this, because we need to spend much more on diabetes research. One way of doing that is to make sure the funds are available for the excellent researchers and academics we have in this field, because research has indicated that there is an unacceptable and unexplained disparity in diabetes care in our country. We are failing the very people we are trying to help. Secondary complications are largely avoidable through better care, and we need to ask why this is not being provided. Although the NHS currently spends approximately £10 billion on diabetes, it is estimated that 80% of these costs are spent on dealing with complications. The time for conferences, seminars and good words is over—it is time for a new deal for diabetics.

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Earlier this year, the Public Accounts Committee published a report on the “Management of adult diabetes services in the NHS”, and I would like to thank those on the Committee for their very hard work. The report found that astonishing variations still exist across clinical commissioning groups: the percentage of patients receiving all the recommended care processes ranged from 30% in some areas to 76% in others; and the percentage of patients achieving three treatment targets ranged from 28% to 48% in different areas between 2012 and 2013. As well as this postcode lottery, the figures were even worse for type 1 diabetic patients.

In response to my recent written question, the Minister acknowledged that there is no specific budget allocation for public health services related to diabetes. It is up to local authorities to

“assess local needs, prioritise and deploy available resources accordingly.”

I believe that is wrong. My own health and wellbeing board was unable to tell me how much it has spent on diabetes awareness. It should be able to do so. I welcome the Government’s inclusion of diabetes in their proposed clinical commissioning group improvement and assessment framework. That is a vital step in the development of a cohesive national diabetes strategy.

There has been much discussion about how effective the framework will be, and whether it will be released on time. We are already disappointed that the publication of the childhood obesity strategy has been delayed, a pertinent issue of concern for me and many other Members, including the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston). We need an assurance from the Minister today that both the framework and the childhood obesity strategy will be published before the start of the summer recess.

The burden of care for diabetes is currently left overwhelmingly to one group: the GPs. It is unrealistic to expect GPs alone to manage this. We acknowledge that GPs are under increasing pressure, and the demand for their services far outweighs the supply. In some places, it takes weeks to get an appointment. The financial incentives given to GPs are clearly not working. Some 16% of GPs’ contracts is supposed to be spent on incentives, with 15% of this sum being directly allocated to diabetes testing. That equates to £94 million, yet an estimated 549,000 people have type 2 diabetes, but remain undiagnosed. A recent study by Pharmacy Voice found that 40% of GPs would like more support for their patients in managing diabetes. We need an action plan from NHS England that will assess the practical support that clinical staff need to care properly for their patients.

We are often told that it takes a village to raise a child. That phrase was recently given re-emphasis by Hillary Clinton. In my view, it takes a whole town of healthcare professionals to deal with the diabetes tsunami. Instead of placing the entire burden on GPs, we need to utilise a network of different professionals to attack the diabetes epidemic from all fronts in an efficient and cost-effective way.

At an international conference organised by the all-party group last month, we heard evidence to that effect from specialist GP Dr Paul Newman, endocrinologists Dr Sam Rice and Dr Abbi Lulsegged, diabetes nurse Sara Da Costa, diabetes specialist dietician Julie Taplin and

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lifestyle expert Emma James. However, we did not have time to hear from other parts of the network—the podiatrists, ophthalmologists and pharmacists. Their enthusiasm knows no bounds, but they are limited by the availability of funds and the lack of specialist staff. We must mobilise our political will to give them the support that they so desperately need.

Diabetes specialist nurses are vital in the fight against diabetes. Evidence shows that these nurses are cost-effective, improve clinical outcomes and reduce the length of patient stays in hospital. I am extremely concerned that the number of trained diabetes specialist nurses has stagnated. The latest national diabetes in-patient audit stated that one third of hospital sites still have no specific diabetes in-patient specialist nurses. With the predicted increase in diabetes cases to 5 million by 2025, it is alarming that forward- thinking plans to train such nurses are not being put in place now. We need a commitment from the Minister that there will be future provision for diabetes specialist nurses.

Community pharmacies are ideally placed to provide care at a time and in a place convenient to patients. The NHS diabetes prevention programme could be a great opportunity to get community pharmacies involved in supporting GPs and other healthcare providers. Janice Perkins, the pharmacy superintendent of Well Pharmacies, advised me that this could be done as part of a care plan package, where appropriate tests are provided to the patient based on their personal need, without their having to access numerous sites.

The proposed cuts to the community pharmacy budget could see the closure of up to 3,000 sites. My local pharmacist, Rajesh Vaitha of the Medicine Chest in Leicester, informed me that up to 60 out of 227 sites could close in Leicester alone. The closure of these pharmacies will have an adverse effect on patients and will place greater pressure on our already strained health infrastructure. Pharmacies are on the high street and no appointment is needed to see the pharmacist. Like many patients, my late mother Merlyn, a type 1 diabetic, had great faith in her local high street pharmacist. I believe that the cuts to community pharmacies could be shelved if pharmacies were properly utilised in diabetes care.

Last Friday I visited the Steno Diabetes Centre in Copenhagen. Steno is a world-leading out-patient facility that cares for 6,500 diabetics a year. It is a one-stop centre for diabetics, with the main focus on prevention and secondary complications. The Steno centre is run by a team of remarkable diabetes specialist nurses led by Professor John Nolan. This is extremely cost-effective—the centre has an annual clinical budget for 6,500 patients of £9 million. Steno has reduced avoidable blindness in its patients by 90%—a service that is provided by a team of just six nurses and one ophthalmologist. The centre’s foot clinic has reduced avoidable amputations in the past 10 years by 82%. The savings from avoiding just two amputations funds the entire foot clinic’s annual budget. The Steno centre is an ideal model of how diabetes care should be facilitated. I urge the Minister—not that I want her to spend too much time abroad—to look at the incredible work that is being done there and bring a network of such centres to the United Kingdom.

In my own constituency, we are very fortunate to have not only the best football team in the country—many thanks to West Ham, Swansea and Liverpool for what

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they did last night—but the Leicester Diabetes Centre, a centre of true excellence in diabetes care. It is one of the largest facilities in Europe for clinical research into diabetes. Run by the dynamic duo of Professor Melanie Davies and Professor Kamlesh Khunti, it provides an innovative partnership between the NHS and academia—the very people in whom we should put more faith and behind whom we should put more funds, as my right hon. Friend the Member for Knowsley (Mr Howarth) said. We are extremely fortunate to have such experts, but we need more centres of excellence.

We need an holistic approach to public health, tackling the medical complications of diabetes and the contributory lifestyle factors that increase the prevalence of type 2. Other countries have taken a lead on this issue. Dr Francisco George, director general for health in Portugal, told me that data sharing is one thing we can do. I have also heard from Dr Pablo Kuri Morales, the Minister responsible for health promotion in Mexico, that a sugar tax actually works. Press speculation is that the Prime Minister has shelved the sugar tax until after the European Union referendum. In my view, the two matters are entirely separate, so why can we not have a sugar tax now?

I have been vocal in my support for a sugar tax and for clearer labelling of sugar content. Industry leaders such as Waitrose and Asda have made commitments to reduce sugar in their products, but I am afraid that the Government’s responsibility deal, which pledged to do all kinds of things, has not had much effect in reality, as recent reports by Professor Graham MacGregor and Action on Sugar have shown. We are, however, fortunate to have an NHS chief executive—Simon Stevens—who has imposed his own 20% sugar tax across the NHS, and that is an important start. I call on the Minister, when she returns to Richmond House, to ban high-sugar products from the canteens in her own Department.

I recently visited a brilliant juvenile diabetes centre in Tangiers, which was based in the Centre de Santé Saïd Noussairi. I nearly wept when I saw young type 1 diabetics having to rely on charitable funding just to get their daily insulin injection—something we can get absolutely free from our NHS. Yet, astonishingly, even in our country, whose healthcare system is the envy of the world, we have stark variations in diabetes treatment and unfocused resources.

We have world-leading medical professionals, nurses, healthcare professionals and researchers who are capable of doing, and willing to do, so much more, provided they get the funding and are backed by an iron political will. That is why we need to achieve a new deal for diabetics, and now is the time to start.

5.17 pm

The Parliamentary Under-Secretary of State for Health (Jane Ellison): I should start by saying that, as a Spurs season ticket holder, I shall dwell on the kind words of the right hon. Member for Leicester East (Keith Vaz) about my time in office and ignore his cruel jibes about what can only be described as a disappointing night last night.

I thank the right hon. Gentleman for bringing this important issue to the House for another debate. He has rightly issued a number of challenges to me and the

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Government, and it is vital that we keep up the drumbeat of debate, which is key to making sure that we keep this serious and increasingly prevalent disease on the agenda.

Fantastic work has been done by the right hon. Gentleman and other members of the all-party group, by the right hon. Member for Knowsley (Mr Howarth), who is also in the Chamber, by the Silver Star charity and by so many others. There is very high awareness of the issue in Parliament, and I will come back to what more we might be able to do to mobilise Members even more on this important subject.

As the House will be aware, tackling diabetes is of great concern to the Government. The Department of Health is committed to preventing type 2 diabetes and to tackling the variation the right hon. Member for Leicester East highlighted in the delivery of care, because we, too, want the best possible care for those with diabetes.

There were encouraging signs from the latest national diabetes audit that progress is being made in some important areas of management and care. For example, there are clear trends of improvement in blood pressure control for people with type 1 and type 2 diabetes and in glucose control for type 1 diabetes. It is also reported that a far greater number of people are being offered structured education within a year of diagnosis. However, I will come back to structured education, because it is uptake, not offer, that I am interested in.

The report again highlighted a concerning and continuing issue of variation in care process completion and treatment target achievement for people with diabetes. I am particularly troubled by the statistics on younger people and those with type 1. The audit found that in 2014-15 just 39% of people with type 1 diabetes received all eight care processes compared with 59% of those with type 2. There is an even greater contrast with regard to age range.

Mr George Howarth: As the Minister will be aware, because I have discussed it with her before, there is a specific group of young type 1 diabetics who manipulate their insulin intake to achieve rapid weight loss. Will she give some thought as to how that group, which is relatively small, can be supported to get out of that problem, which is life-threatening?

Jane Ellison: I will certainly take that issue away and reflect on it, and we will speak about it again.

For people under 40, only 27% with type 1 diabetes and 41% with type 2 received all care processes, compared with 58% and 65% respectively for those aged between 65 and 79. I have some sense of why that is, but it does highlight the challenge we face. Encouragingly, 77% of those newly diagnosed with type 2 diabetes were offered structured education, but again the percentage was lower for type 1. That is clearly unacceptable, because everyone with diabetes should receive the best possible care regardless of age, postcode or the type they have been diagnosed with. That is why, in our 2016-17 refresh of the mandate to NHS England, we have made tackling variation in the management and care of people with diabetes a key priority over the lifetime of this Parliament.

Alex Chalk (Cheltenham) (Con): Does the Minister agree that we need consistently early diagnosis? Early intervention is particularly important in diabetes care,

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as it saves the NHS from unnecessary expenditure in the long run, and, just as importantly, saves patients from unnecessary suffering.

Jane Ellison: That is absolutely right. I am going to talk about the national diabetes prevention programme, which goes to the heart of the problem. When I spoke to the all-party group, I mentioned the conveyer belt that can start with weight in childhood developing into type 2 and go through to the serious complications that have been alluded to. At all points along that continuum, there are things we can do, and must be doing, to make life better for people with diabetes.

Because of the mandate, diabetes is now right at the heart of NHS England’s agenda. We want it to lead a step change in preventing ill health and supporting people to live healthier lives. Our 2020 goal is for a measurable reduction in the variation in management and care for people with diabetes. However, there is some way to go, so this debate is an opportunity to update the House on some of the areas where we are going to make progress.

We have increased transparency through the creation of the Healthier Lives website, which is a major online tool from Public Health England. I encourage Members who have not looked at it to do so. It highlights variation in the prevalence and treatment of diabetes, allowing clinical commissioning groups and GP practices to compare how well they deliver diabetes care and so drive improvements and iron out variation. I will come on to the support that we are offering them as well.

The CCG outcomes indicator set provides clear comparative information. As was said, it will soon be replaced by the improvement and assessment framework, which will have two diabetes indicators aimed at reducing variation in the achievement of the NICE treatment targets and the referral and take-up of structured education. Consultation on the framework has just closed, and we expect it be published in the summer. It goes to the heart of tackling variation and the cohesive approach that was spoken about.

The NHS Right Care programme is a very practical approach to tackling variation that uses the “Atlas of Variation”. In the case of diabetes, NHS experts help CCGs and other local health system partners to make the step change they need in some areas to improve care, because transparency alone is not enough if we do not offer people support and hands-on advice. In Slough, for example, huge improvements have been made through a clinical mentorship programme that has upskilled healthcare professionals in general practices. That has resulted in an increase in patients who have had their blood glucose, blood pressure and cholesterol controlled. The Right Care programme will be rolled out across CCGs nationally by 2018.

I urge the all-party group on diabetes and the right hon. Member for Leicester East to continue to engage colleagues. It is absolutely right that Ministers are brought to the House and scrutinised about what we can do, but the very nature of our health system and the variation under discussion are also highly susceptible to pressure at local level from well-informed Members and senior councillors. I encourage him to continue to engage Members in asking the right questions at a local level.

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Keith Vaz: I will be brief, because I know that the Minister has a lot to tell us. When Members of Parliament write to local health and wellbeing boards, it would help enormously if they were able to tell us how much they spend on diabetes awareness. They cannot do that at present.

Jane Ellison: Part of the challenge is because much of the effort that is put in relates to the preventive agenda and the contributory factors. That is one of the challenges in teasing such figures apart. However, I will reflect on whether we can do more in terms of health and wellbeing boards.

To incentivise improvements in the treatment and care of children and young people with diabetes, the best practice tariff for paediatric diabetes provides an annual payment for every child and young person under the age of 19 with the condition, providing that 13 standards of care are met. One of those standards relates to structured education. As the right hon. Members for Leicester East and for Knowsley (Mr Howarth) know, I am passionate about making changes to the way in which we do structured education. We know that it works and that it is very good when people do it, but we also know that a lot of people are not accessing it. I am looking really hard at how we could take a new and radical approach, including whether there are any tech solutions, and I look forward to reporting back on that.

Our ambitions extend further than creating a level playing field. We want the management of and care for diabetes to be driven up right across the board in order to improve outcomes. The NHS is working with a number of other organisations to help to promote services that are integrated around patients’ needs across all settings. It is implementing a customer service platform to empower patients with diabetes to self-manage by booking their own appointments, managing their prescriptions, monitoring the care they have received and viewing their personal health records.

I fear that time will not allow me to touch on prevention in as much detail as I would have liked, but I want to emphasise just how seriously we take it. The right hon. Member for Leicester East has outlined the reasons why it is important, including the escalating figures and how much the rising tide of type 2 diabetes associated with lifestyle will cost the NHS in the future. The factors can be modified and one of the most powerful weapons in our armoury is the NHS diabetes prevention programme, which is the first national type 2 diabetes prevention programme to be delivered at scale. Its aim is to help people identified as being at the highest risk of developing type 2 diabetes to lower their weight, increase physical activity and improve their diet through intensive lifestyle intervention programmes. I am pleased to inform the House that the first providers will be announced by the NHS shortly, and the programme will move ahead.

The programme will also link to the NHS health check programme. Almost 3 million NHS health check offers were made in 2014-15 and almost 1.5 million appointments taken up. That is vital for first awareness and my constituency knows how important early diagnosis can be as a result of the checks carried out by Silver Star when it visited us.

The right hon. Gentleman talked about other important referral routes, including engagement with pharmacists, and I will pass on his concerns to the Minister for

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Community and Social Care, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who has responsibility for community pharmacies.

The right hon. Gentleman criticised the responsibility deal, but I think it has achieved a lot. We have made some important gains working in voluntary partnership with industry, such as the voluntary front-of-pack nutritional labelling scheme, which has greatly empowered consumers to know what is in their food. That accounts for about two thirds of the market for pre-packed food and drinks, but I accept that the challenge is to go further.

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We will announce more about our childhood obesity strategy this summer. We will also monitor the impact of NHS England’s proposal for the introduction of a sugar tax on the NHS estate. It will be interesting to see the results of that consultation. The Sugar Smart app has empowered 1.6 million consumers to date to know more about what is in their food.

I thank the right hon. Gentleman again for bringing these important issues to the House. I am absolutely sure that we will discuss them again, because this vital agenda is right at the heart of the Government’s health programme.

5.30 pm

House adjourned without Question put (Standing Order No. 9(7)).