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Baroness Cumberlege: My Lords, I thank the Minister for that reply. Is he aware that on average it takes between nine and 12 years to diagnose someone with type 2 diabetes, the form suffered by the vast majority of those affected, by which time as many as half will suffer complications such as cardiovascular disease? Given the financial and human costs of that late identification, can the Minister give an assurance that when the second part of the National Service Framework relating to diabetes is published, it will include targeted and systematic screening of those most at risk?
Lord Hunt of Kings Heath: My Lords, I certainly agree with the noble Baroness that it is very important to put firmly into place a preventive strategy. She will know that the first set standard, which we published in December, refers to a preventive programme. I am aware of the view that a targeted approach to screening may be the best way forward. We have a national advisory committee in place in the form of the UK National Screening Committee whose job is to assess the benefits and disbenefits of such screening. We have referred the very matter raised by the noble Baroness to that committee. It is looking at an integrated approach to the identification of those at the highest risk of developing type 2 diabetes and it is expected to report to the department in 2005. More generally, I agree with the noble Baroness about the need for proactive action on prevention.
Lord Harrison: My Lords, I congratulate the Government on the establishment of the National
Service Framework. But can my noble friend say whether in the important delivery paper that will come next summer there will be established minimum staffing levels? Will we promote local leadership and, most important of all, will we provide the finances required to ensure that the NSF is carried through successfully?
Lord Hunt of Kings Heath: My Lords, my noble friend is right to refer to the importance of the delivery strategy because it will set out the conditions under which we shall deliver the standards we have set out in the paper published last December. I cannot comment in relation to resources because that is a matter being considered as a part of the discussions being held on the next spending review. However, I understand the importance of investment in this programme. I also accept the point made by my noble friend in relation to local leadership. We would expect the primary care trusts, which in the future will take on much of the burden of NHS commissioning, to be very exercised as regards the need to give that leadership.
Lord Clement-Jones: My Lords, the National Service Framework is already overdue by a year or more. Can the Minister try to ensure that the implementation date for the NSF is brought forward?
Lord Hunt of Kings Heath: My Lords, the noble Lord will know that we have stated that the 10-year implementation programme would start in April 2003. I think it is important to allow the service to digest the results of Part 1, which sets the standards, so that when it comes to starting up the implementation programme everything will be in place. We can then be assured of success in the delivery of the programme. More generally, the question of local delivery and the involvement of primary care—primary care will play a major part in this—is crucial. I think that it is right for us to spend time making sure that primary care is in the right condition to take forward the strategy.
Baroness Masham of Ilton: My Lords, does the Minister agree that diabetes can trigger many complications involving the eyes, legs, feet, kidneys and other organs? Does he further agree that the specialist units carry out a marvellous job? It is extremely important to ensure that trained nurses are involved in the care of those with diabetes and that they can go out into the community.
Lord Hunt of Kings Heath: My Lords, I certainly agree with the noble Baroness on the points she has made. Specialist services have a major role to play and we are committed to ensuring that, under the new arrangements for the NHS being taken forward, there are arrangements for the commissioning of specialised services. Equally I believe that much of the action will be undertaken at the local level; that is, within primary care. We are looking to primary care to take a leadership role in this area.
Lord Rea: My Lords, does my noble friend agree that there is a very strong association between type 2
diabetes and obesity, and that there is also a link between obesity and coronary heart disease—partly through the same mechanism which causes type 2 diabetes? Does he further agree that obesity is one of the major public health problems facing this country, with very rapid increases due to our more sedentary lifestyles, increased mechanisation and better heating in homes, as well as a far too high proportion of calories from fat in our diet? Do the Government have those priorities in mind?
Lord Hunt of Kings Heath: My Lords, yes. Obesity is one of the issues that we in the Department of Health are attacking with vigour. This problem needs a cross-government approach because there are various elements to tackling obesity, including the encouragement of greater physical activity. To that end, along with our colleagues in the Department for Education and Skills, we are encouraging school travel plans which encourage children to walk and cycle to school. We have introduced a national schools fruit scheme which is being piloted in the West Midlands. The scheme enables children in infant schools to have one piece of fruit per day. Indeed, only a few months ago the National Audit Office published a report on tackling obesity in England which we are now considering as a part of taking forward an obesity strategy.
Lord Chan: My Lords, can the Minister give an assurance that those ethnic minorities which comprise high risk groups, suffering up to six times the average incidence of diabetes and coronary heart disease, will also form a part of the new plans for treatment?
Lord Hunt of Kings Heath: My Lords, I understand that type 2 diabetes is up to six times more common in people of South Asian descent, and up to three times more common in those of African and Afro-Caribbean descent. It is also more common in people of Chinese descent, as well as in other non-white groups. That is a very significant set of statistics. I can assure the noble Lord that reducing inequalities will be a key underlying principle, both in terms of the standards that we have already produced and in relation to the implementation programme which will follow in Part 2 of the National Service Framework.
Euro/Pound Exchange Rate
3.18 p.m.
Lord Oakeshott of Seagrove Bay asked Her Majesty's Government:
- Whether they believe there is something fundamentally wrong in the current euro/pound exchange rate.
Lord Davies of Oldham: My Lords, while the Government do not have a specific exchange rate target, a stable and competitive pound is sought over
the medium term. The key to a stable and competitive pound is low and stable inflation, supported by sound public finances.
Lord Oakeshott of Seagrove Bay: My Lords, I thank the Minister for that reply. I do not know if he has yet had a chance to read the minutes of the January meeting of the Bank of England Monetary Policy Committee which were published yesterday. They make interesting reading:
- "the worsening imbalances [in the economy] posed a particular threat. Real domestic demand growth had exceeded real output growth by 5.7% over the past five years . . . This was unsustainable, and at some stage there could be a sharp correction to the exchange rate in response to a widening current account deficit".
Lord Oakeshott of Seagrove Bay: —"Runaway consumer boom; industry in dire straits; balance of payments up the spout and the pound riding for a fall". That is what the Monetary Policy Committee is saying. Will our complacent Chancellor stop preening himself on his so-called success and now take the advice of his colleagues such as the Secretary of State for Trade and Industry and get on with joining the euro at a competitive rate?
Lord Davies of Oldham: My Lords, I am not sure why the House disagreed with the noble Lord seeking to reinterpret his question. I was rather grateful for it. Far from preening himself, the Chancellor reflects on his achievements with the real economy during the years the Government have been in power. After all, productivity has increased by 13 per cent since 1997, which improves the position of our manufacturing industry as well as other sectors of the economy. As to the issue of the exchange rate against the euro, sterling is in a particularly strong position at the present time. But the noble Lord will recognise that, in regard to exchange rates, we do not look at short-term policies but at our long-term position.
Lord Sheldon: My Lords, is it not clear that the exchange rate problem is with us once again and is very serious indeed? Does my noble friend accept that it is not only our exports which are suffering, but imports coming in which are affecting our balance of trade and balance of payments, and that there is no sign of that improving over the next few years? It is not only a question of the five tests that the Chancellor quite rightly insists on being met, but of the exchange rate at which we go in. That will be the important and dominant factor in regard to entry into the euro mechanism in due course.
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