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Baroness Masham of Ilton: My Lords, I thank the Minister for that interesting and encouraging reply. Does she agree that it is easier to diagnose younger people; and would it not be best to have a screening policy for the over-40s in order to try to prevent some of the very serious complications, such as strokes, eye problems, ulcers of the feet etc.?

Baroness Jay of Paddington: My Lords, I am very much aware of the complications described by the noble Baroness. One of the problems is that, since the condition can occur at any time--the noble Baroness rightly draws attention to those who may be older and who get the illness at a later stage in life--if a general screening programme is established it is not possible to do the screening only once. It may have to be done several times. That is one of the concerns being taken into account by those examining the illness in the context of a screening programme. A further point is that, if we think about screening in terms of those conditions that can be cured rather than simply helped, diabetes is unfortunately not a condition that can be cured.

Lord Mowbray and Stourton: My Lords, is the Minister aware that I have personally suffered through

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my wife getting this horrible illness in her fifties? Her grandfather had had it; however, we were idle and did not do much about it. Suddenly we found that she had the illness. Having various grandchildren, I should like to ask the Minister about the importance of this being recorded in someone's medical history. It is known that if someone has an antecedent with the illness, the likelihood of getting diabetes is considerably increased. As I am sure the noble Baroness is aware, the degree of lessened resistance suffered by diabetics to every disease known is quite incredible.

Baroness Jay of Paddington: My Lords, I am grateful to the noble Lord for drawing attention to those important matters. The point about the continuing vulnerability--if one can call it that--of different generations, where one person has diabetes, is recognised. It is clearly an issue where more public information about those things which make people more vulnerable or which may be indicators that people are potential diabetes sufferers is important. But, as I said in reply to the noble Baroness, Lady Masham, the problem is that if you test a person for diabetes once, you may have to test them regularly in order to achieve anything.

Baroness Robson of Kiddington: My Lords, does the Minister agree--I am sure that she does from the replies she has given--that it is quite common for people to develop diabetes as they grow older? Often they are not aware of it because they put down the tiredness they feel to getting older. There is a good way of diagnosing diabetes: through the eye test. Will the Government therefore consider reinstating free eye tests?

Baroness Jay of Paddington: My Lords, the noble Baroness is correct that it is older people who tend to get this unexpectedly in later life. I believe that 2.4 per cent. of the population are concerned. As I understand it, and I am not a medical expert in this field, the more complicated test to ascertain diabetes is far more unpleasant and difficult than the eye test. But I am sure that is something that the screening committee, under the chairmanship of the Chief Medical Officer, will consider.

Lord Howell: My Lords, is my noble friend aware that her answers are welcome, together with the further consideration to be given to the subject that she has announced? Will she acknowledge that only 50 per cent. of diabetic people are known to be diabetic? Therefore, the failure to deal with the other 50 per cent. at an early stage brings enormous expense later on to the health service when serious illnesses arise.

Baroness Jay of Paddington: My Lords, I am grateful to my noble friend for reinforcing those points. As he is aware, people who have already been diagnosed with diabetes are regularly screened to ensure that the medical treatment they receive once the diagnosis is made is appropriate and helps them with what is obviously a serious condition.

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Baroness Cox: My Lords, is the Minister aware that recent research in the United States shows that a slight reduction in the diagnostic threshold level for diabetes results in a substantial increase in the proportion of the population recognised to be at risk? Given the complications which arise if diagnosis is not made early, does the noble Baroness agree that the research highlights and strengthens the need for a national screening programme?

Baroness Jay of Paddington: My Lords, I am aware that there has been additional research in the United States which was presented at an American national medical conference recently. I am sure that it will be drawn to the attention of the Chief Medical Officer.

Lord Rea: My Lords, does my noble friend agree that while a full nationwide random screening for late onset diabetes is not a viable option, those at risk of developing diabetes should be advised to attend their GP for a properly controlled blood glucose check? Does she agree with the British Diabetic Association that those at risk include not only those with a family history of diabetes but also those who are overweight and those whose origin is from south Asia, Africa or the Caribbean?

Baroness Jay of Paddington: My Lords, my noble friend, with his expert information on the subject from his experience in general practice, underlines the point that I was making earlier--that the more information that is available to encourage people who may feel themselves to be vulnerable to attend their general practitioner to receive the appropriate screening, the better.

Lord McColl of Dulwich: My Lords, is the noble Baroness aware that the noble Lord, Lord Butterfield, carried out a great deal of work on this subject? He discovered a large number of people potentially with diabetes. But the problem is that if we discovered the extent of it throughout the nation, would we have the resources to deal with it?

Baroness Jay of Paddington: My Lords, I was interested to see the noble Lord, Lord Butterfield, rise behind the noble Lord, Lord McColl. Perhaps he was going to give us more detail of his extremely good work in the field. One of the questions that arises if one is examining the potential for a national screening programme is the resource implications, as well as clinical ones. That is something that the national screening committee, with its capacity to prioritise both in terms of clinical need and resources, will look at.

Lord Butterfield: My Lords, will the Minister confirm that the British approach will be to base screening on community physicians in general practice? I am sure that that is the right place for it and we must not lose the general principle.

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Baroness Jay of Paddington: My Lords, I am grateful to the noble Lord for underlining that point.

Baroness Masham of Ilton: My Lords, can the Minister say whether the incidence of diabetes is rising, particularly in some ethnic groups?

Baroness Jay of Paddington: My Lords, as has been mentioned in response to several supplementary questions this afternoon, as screening develops and as more people become aware of it, we appear to have rising numbers of people with diabetes. But as my noble friend said, it may simply be a question of identifying people in the community who were already suffering from the disease. There is a problem with some of the minority ethnic groups.

Nuclear Weapons

3.5 p.m.

Lord Jenkins of Putney asked Her Majesty's Government:

    Whether they will include in the current defence review plans to move towards the achievement of their object of eliminating nuclear weapons.

The Minister of State, Ministry of Defence (Lord Gilbert): My Lords, we have made clear our commitment to the goal of the global elimination of nuclear weapons and our intention to press for multilateral negotiations towards mutual, balanced and verifiable reductions in nuclear weapons. We are examining how best to implement that commitment, particularly in the context of the Strategic Defence Review.

Lord Jenkins of Putney: My Lords, I thank my noble friend for that very good Answer. Can he give the House a little more detail as to the direction in which the Government are moving and whether they have plans to consult other nuclear powers with a view to forming a common policy towards elimination?

Lord Gilbert: My Lords, my noble friend will realise that it is far too early to anticipate where the results of the Strategic Defence Review will lead us.

My noble friend will probably wish to take into consideration the fact that other nuclear weapon states will also probably be concerned about other weapons of mass destruction, like chemical and biological weapons, when they come to their conclusions as to how to approach global nuclear disarmament.

Lord Taylor of Gryfe: My Lords, can the Minister give us more information about the review? Will representations be received from organisations and individuals concerned with the abolition of nuclear weapons to discussions held by the Government or the department? Alternatively, is this purely an internal review?

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