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Lord Lucas: My Lords, I am grateful to the noble Lord for that Answer and for letting me see the current state of the system this morning. However, I do not have the slightest gratitude to the Government for the glacial slowness with which they have addressed this matter. In three years they appear to have made progress which might have taken a determined commercial company two or three months. Is this not a quite unnecessary but typical disrespect for Parliament? Likewise, is it not a typical example of the difference between what the Government promise--electronic government by 2005--and what they deliver? Is the noble Lord prepared to answer a similar Question from me in six months' time, for I fear that if I asked it 12 months from now I would have to ask a Member of my own Front Bench?

Lord McIntosh of Haringey: My Lords, I was about to accept the justice of the noble Lord's rebuke until he went over the top. I am afraid that I cannot accept it. Progress has been too slow, but there is one very good reason for it: the Government Secure Intranet has only just achieved critical mass and been implemented in all departments. Until that happened the security of origin of the electronic answer could not be guaranteed. Therefore, there is no disrespect to Parliament. Progress has been made as a result of the implementation of the Government Secure Intranet. As to whether the noble Lord's Question will be answered in six months' time, that depends on our ability to ensure that all departments use the system which is now becoming available.

Lord Cocks of Hartcliffe: My Lords, is the Minister aware that I serviced the entire captain's office on HMS "Siskin" with an old Imperial typewriter and a Gestetner? Does my noble friend accept that as to

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respect for Parliament there are some in this House who regard individual judgment as much more important than a lot of newfangled stuff?

Lord McIntosh of Haringey: No, my Lords. My noble friend elevates stubbornness to a virtue which it does not deserve.

Lord Rotherwick: My Lords, can the Minister advise the House on whether the critical mass to which he referred will stop viruses, such as the "I Love You" virus of the other day, going round the Intranet? I am well aware that that virus had to come from the Internet to get into the system, but it was the Intranet which passed it round to all the recipients.

Lord McIntosh of Haringey: My Lords, I do not think that that is the case. The virus came from outside. It came into the PDVN without reference to GSI, the secure Intranet. The secure Intranet secures internal communications between and within government departments. That has no relevance to the virus. The virus had to be dealt with by anti-virus activities; and it was.

Lord Davies of Oldham: My Lords, irrespective of the method of delivery, does the Minister agree that it is the quality of the answers which counts? Does he further agree that that quality has been greatly enhanced since 1st May 1997?

Lord McIntosh of Haringey: My Lords, on behalf of my colleagues, I thank my noble friend.

The Countess of Mar: My Lords, I might have disputed what the Minister's noble friend said, but I shall not do so at this stage.

Will the Minister kindly pass on to the people who operate the parliamentary network my grateful thanks, and possibly those of many Members of this House, for the very good way in which they help us to handle our e-mails and other Intranet transactions? My computer was infected by a nasty bug which they had picked up before I opened the e-mail. They warned me instantly. I appreciate the service they give.

Noble Lords: Hear, hear!

Lord McIntosh of Haringey: My Lords, I am sure that those concerned will be pleased to hear the noble Countess's words.


11.21 a.m.

Earl Howe asked Her Majesty's Government:

    Whether the quality of services provided by the National Health Service to patients with diabetes is satisfactory.

Lord Hunt of Kings Heath: My Lords, we are developing a national service framework for diabetes

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to raise the overall quality of services and reduce unacceptable variations of the type highlighted in the Audit Commission's recent report.

Earl Howe: My Lords, I thank the Minister for that reply. Is he aware that diabetes now affects at least one in every 30 of the population and that, according to the recent report by the Audit Commission, the cost of diabetes to the NHS is probably around £2 billion a year? Is the noble Lord further aware that the incidence of diabetes looks set to double over the next 10 years? What will the Government do to ensure that there are enough consultants and specialist nurses and podiatrists available to meet the steeply rising levels of demand for diabetes care?

Lord Hunt of Kings Heath: My Lords, the noble Earl is right to draw attention to the major impact which diabetes has on the health service. I understand that the figure is 1 in 40, about 1 million people. There are differing views on that. I also understand that diabetes and its implications in terms of other diseases accounts for 9 per cent of healthcare costs. Clearly diabetes is a major priority. I assure the noble Earl that, in addition to mapping out the services we need to develop in the health service, the national service framework will consider carefully workforce implications.

Lord Harrison: My Lords, when drawing up the review and framework, will the Minister recognise the problem as regards the diet provided in prisons for insulin dependent and non-insulin dependent diabetics who are detained at Her Majesty's pleasure? It is often unsatisfactory and inconsistent with the therapy for diabetics.

Lord Hunt of Kings Heath: My Lords, I am interested in my noble friend's point. A joint unit within the Department of Health and the Home Office is concerned with the effectiveness of medical services within prisons. I shall ensure that that point is considered.

Lord Clement-Jones: My Lords, clearly diabetes should be a major priority, in particular because in its late onset form it leads to heart disease. The Audit Commission's report referred to specialists. It is clearly a key issue which the Government need to resolve now and in the future.

In their announcement on 6th April of more specialist consultants, why was no mention made of more diabetes specialists? Will the new national workforce development board have the resources and authority to ensure that there are adequate diabetes specialists?

Lord Hunt of Kings Heath: My Lords, the history of the NHS demonstrates that plans as regards the workforce never match the service needs. There has often been a mismatch between the priority for services and the number of doctors, nurses and other staff available. We are determined to put that right through the workforce planning mechanisms that we have

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developed. The national service framework gives us the opportunity to consider the implications of developing the service in the ways recommended and ensuring that we have the workforce that matches service requirements.

Lord Astor of Hever: My Lords, is the Minister aware that the incidence of diabetes is particularly severe among ethnic minorities? What plans do the Government have to address this issue?

Lord Hunt of Kings Heath: My Lords, the noble Lord is right. The prevalence among black and minority ethnic groups is considerable. Local studies show that diabetes is three to four times more prevalent among, for instance, south Asians than the remainder of the population. The prevalence is similarly high among African Caribbeans. Within the national service framework we are ensuring that that aspect is taken fully into account.

We are also aware of some interesting local initiatives. In particular the Bradford Health Action Zone is focusing on the issue. It ensures that, combined with users and all the statutory agencies, there is an effective service to deal with that problem.

Lord Patel: My Lords, is the Minister aware that one of the areas of concern highlighted in the Audit Commission's report is the present system of payment for GPs? It is linked neither to the quality nor volume of the diabetic services. Early diagnosis of hypertension retinopathy fails and complications develop. Will the Government consider that issue in relation to the national service framework?

Lord Hunt of Kings Heath: My Lords, yes, there is no doubt that primary care is very important. The Audit Commission indicated that 4 in 10 GP practices lacked referral guidelines on diabetes. In many places the chronic disease management programme, to which the noble Lord refers, is not working effectively. I believe that the national service framework--it is co-chaired by the President of the Royal College of General Practitioners-- will ensure that much focus is given to improving the delivery of services within primary care.

The Lord Bishop of Hereford: My Lords, have the Government any plans to introduce or increase the use of preventive measures? I refer, for example, to the identification of patients with a family history of diabetes who could be given the glucose tolerance test. The incidence and onset of diabetes could be deferred or avoided, saving great costs in the long run.

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