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I turn to the comment in the Explanatory Memorandum. Because of joint and several liability, part of the thrust behind the regulations is to avoid payments to claimants being delayed while the question of who owes what is settled. Thus, a person—normally a major employer—can make a payment and will not then be precluded from claiming from the compensation

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fund, because the fund carries a liability in respect of someone who is jointly and severally liable. To that extent, going back to the Fairchild position neither advantages nor disadvantages the Government.

Baroness Noakes: My Lords, perhaps I may clarify the point that I was trying to make. I understand that, in reversing the House of Lords decision, the Government consider that they are putting themselves back in the same position. But these regulations enable the Government to go into the Financial Services Compensation Scheme. That is paid for by the industry and the Government do not pay anything into it. So we are creating a right for the Government to go into the scheme, and I was merely trying to ascertain how much it is worth to the Government to take the industry’s money.

Lord McKenzie of Luton: My Lords, that right is no more or less than the right that claimants would previously have had to go into the scheme. The only difference is that now the Government or an employer are not precluded from paying out the whole amount earlier to the claimant and then recovering the bit that the claimant would otherwise have got from the fund. Prior to the Barker judgment, payments would not be made until it was determined who had what liability, and then the compensation fund would make a parallel payment to the claimant because it was the claimant whom it had to pay. On that basis, the Government are not advantaged or disadvantaged by this measure. The benefit is in getting money into claimants’ hands sooner—not an increased amount but the same amount that they would otherwise be entitled to.

The noble Lord, Lord Addington, asked about retrospection. The House debated this matter as part of the Compensation Act. Here, the purpose of the retrospection is to take us back to the Fairchild position before the Barker judgment changed people’s understanding of the situation. Under the Barker judgment, a liability had to be apportioned and, when there were a number of possible contributors, the timescale involved in arriving at that apportionment could be substantial—again, delaying payments being received by claimants. Therefore, going back to joint and several liability through the regulations generally enables claimants to access compensation sooner than they might otherwise have done. I hope that that has dealt with the point. If not, I shall have another go.

Lord Addington: My Lords, I accept what the Government are saying, but my point relates to the fact that this is an unusual and specific process of going back or reversing to make a change. It would be valuable to hear whether the Government see this approach as dealing only with these specific circumstances.

Lord McKenzie of Luton: My Lords, I think that the noble Lord has probably answered his own question. It is not usual. These are relatively unusual circumstances. The issue was discussed when the Compensation Act was debated. It is relevant to that rather than to the regulations, which are simply a consequence of that Act.



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If there are no further points, I thank noble Lords again for their support, and commend the regulations to the House.

On Question, Motion agreed to.

Health: Diabetes

7.40 pm

Lord Harrison rose to ask Her Majesty’s Government what is their response to the United Nations resolution on diabetes.

My noble Lord said: My Lords, many women were sweet on H G Wells during his lifetime. He was not only a marvellous writer but a founder member of the British Diabetic Association. His lovers said of him that he smelt alluringly of honey. That olfactory observation has been attributed to his diabetic condition. The disease’s full name is diabetes mellitus—literally the siphon of honey.

There is nothing sweet about diabetes. My words tonight will not be honeyed as we address the global pandemic and desperate need for the United Nations to unite to defeat diabetes. Every 10 seconds someone dies from diabetes. Some 6 per cent of the world’s population suffers from diabetes, and these numbers rise relentlessly each year by a further 6 per cent. If nothing is done to repel the silent killer, within 20 years 350 million diabetics worldwide will place an intolerable burden on all nations’ health systems with dire consequences for their economic and social well-being and development.

Diabetes is a silent killer; silent because unlike HIV/AIDS it has no champions of the standing of Nelson Mandela or Bill Clinton. A non-communicable disease does not excite the same fear as one that people think they might catch. Already diabetes is outstripping HIV/AIDS in the deaths it claims and the numbers it incapacitates. It is a silent killer because a diabetic bears no outward sign of a disease that suborns and weakens the body from within. Like Wells’s invisible man, a diabetic whose diabetes is well controlled walks down the street unremarked. Of course, it is true that a significant proportion of those who are blind or amputees are diabetics, but their lack of a public face results in our bothering less with the silent disease than with other more visible diseases.

The former Home Secretary, David Blunkett, has won universal admiration for his formidable political stamina in the face of his blindness, but our Deputy Prime Minister has shown great fortitude in mastering his diabetic condition—a fact disregarded when disclosed over a year ago. You cannot wear an eye patch over a faulty pancreas. It is a silent killer and an uncompromising one. You cannot get a mild dose of diabetes, and whether you are type 1 or 2, and dependent on insulin or tablets as therapy, the consequences are just as silent and just as deadly. The time is ripe to break out of the silence and to tackle diabetes head on, not just here in the United Kingdom where the Government have successfully introduced the national service framework, but also globally. It is time for the world to think globally, act locally but above all unite to act together.



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Our first act must be to puncture some of the myths surrounding diabetes, which diminish our enthusiasm to unite and act together internationally. What are these myths? Contrary to the widely held perception that diabetes is a disease of the affluent, studies show that the economically disadvantaged are at a higher risk of becoming victims. Within 10 years, four out of five diabetics will live in low or average-income countries, many of whose health systems have poor access to life-saving, disability-preventing treatments. Even in rich countries, such as the USA, it is the poorest who are most vulnerable to type 2 diabetes. A cruel consequence of this is that in some developing countries, afflicted families spend up to 25 per cent of their pitiful income on diabetes care. It should also be noted that the elderly, ethnic and indigenous communities are disproportionately affected by the pandemic, with the result that the economically disadvantaged are pushed even further into poverty, thereby undermining development aid from rich nations designed to build up the same developing economies.

Another myth that diabetes is principally a disease of the elderly also needs qualification. Nowadays more young people—a nation's future workforce—are succumbing to type 2 diabetes, which is directly related to the Government’s obesity agenda. Diabetes is not just a disease that comes in rich old age. We should also recognise the underlying but overpowering economic consequences of the failure to confront diabetes. It clogs up the economic arteries of any nation—rich or poor.

Our debate tonight could not be more timely, for the nations of the world are waking up to the threat of diabetes. A United Nations resolution is shortly to be voted on, but will the United Kingdom be there? Why is this resolution crucial? First, it will focus the attention of the world on the need for urgent action that goes beyond the scope of government health departments. Workable solutions will require the whole of the Government’s thinking and implementation. Indeed, I ask my noble friend what has been the nature and result of her consultations on this vital issue with DfID, the FCO and other government departments.

Secondly, a United Nations resolution will raise awareness among all policy-makers and decision-takers of the need to work as allies of the United Nations. This will lead to a greater awareness of specific policy problems in diabetes care and will induce a more profound understanding of the human, social and economic burden that diabetes places on Governments. A resolution will make nations assign diabetes care and cure as a national priority, aid the implementation of cost-effective strategies for the prevention of the onset of diabetes and promote strategies to avoid dangerous complications arising from the disease.

The resolution will highlight the needs of special groups which themselves may vary from country to country. These groups include children with diabetes, the elderly, diabetics during pregnancy, indigenous peoples and migrant people from developing countries. The resolution will spread best practice, more effective

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education and training of healthcare professionals and the adoption of simple, cost-neutral prevention policies. It will also undoubtedly promote greater research among the public and private research communities and encourage more generous funding of such research from foundations such as the Gates Foundation, which see such a resolution as the seal of approval from the world community that identifies diabetes as a just and proper priority for research money.

Lloydspharmacy tells me it believes that global action is required to tackle the diabetes epidemic. It says:

Since January 2004, Lloydspharmacy in its 1,200 pharmacies in the UK offers a free-of-charge diabetic screening service—a vital resource in our catching early some 750,000 undiagnosed diabetics in the UK. Early diagnosis means a saving of resources, lives and human misery. That is the kind of idea that could be copied throughout the world.

It is my hope and belief that a resolution will galvanise the world community. What is the Government’s position on this issue? I hope to hear a full exposition from my noble friend tonight and to learn that the Government are prepared to speak up, sign up and cough up to the cause of the UN resolution on diabetes. The rest of the world community is falling into line. Why are we falling out? Led by Bangladesh, the G77 countries representing 132 developing nations have signed up. Russia, Japan and the USA are on board, and Australia has entered only today. EU countries are likewise joining, including Poland, Portugal and our good neighbours, Ireland. I believe there has been a change today in that we are not arriving at a common EU solution—perhaps the Minister can tell me about that—but this liberates the United Kingdom separately to support this important resolution. I also understand that the reason for the Government’s delay until now has been expressed by DfID Secretary of State Hilary Benn as being the preference for securing a portmanteau UN resolution covering a whole range of diseases which the world must collectively confront.

That is mistaken. First, we cannot afford to wait. We must act now: every 10-second delay is another unwarranted death. Secondly, it is imperative to give diabetes a clear focus as a killer disease, arguably more potent than HIV/AIDS, and treat it separately. Thirdly, the collective fight against other world health threats will not be held back by striking a blow in favour of the world diabetic community. Rather, it will encourage others concerned to further research into other world diseases.

I understand the resolution on diabetes is on the agenda for the UN meeting on 16 December. Will the Minister give the most urgent consideration for the United Kingdom to sign up and show its credentials as a nation confident in itself, being fully engaged at an international level, and match what it has done for international development? To fail to sign up for this UN resolution now will send out the wrong signals, impoverish the international standing of the United Kingdom and, most of all, delay the fight against the worldwide pandemic of diabetes that

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threatens to engulf us all. To echo HG Wells, this is a war the world must fight together. Britain should lead, not lag.

7.51 pm

Baroness Masham of Ilton: My Lords, I thank the noble Lord, Lord Harrison, for this important debate. I look forward to the Minister’s reply. I consider her to be someone who cares about long-term medical conditions and disability.

I became involved with diabetes through my husband. I know the condition needs constant monitoring and attention; it must be taken seriously at all times. Diabetes is increasing at an alarming pace worldwide. Following the Austrian presidency’s conference on diabetes, EU Health Ministers adopted its conclusions at their council meeting. The conclusions urged member states to improve care and treatment; to adopt robust policies to prevent type 2 diabetes; and to promote research. I would add that there must also be ongoing education of diabetic people, their families, the medical and nursing professions, employers, prison staff and the police; in fact, everyone should be aware of the consequences if diabetes is neglected. These conclusions are much the same as the UN resolution.

Some months ago, I was talking to a diabetic friend and asked him how his diabetes was. He said, “Oh, I only have type 2 diabetes, not the serious type”. I answered him, “All diabetes is serious”. A few weeks later he came up to me and said, “I am taking it seriously”.

If diabetes can be avoided, so much the better. It causes all sorts of problems, such as tiredness, blindness, leg ulcers and difficulty in healing. If it creeps up on people, however, and they become diabetic, they need the best advice possible and the correct equipment. For those who cannot look after themselves, the correct care must be forthcoming.

More than 2 million people in the UK have diabetes: 3 per cent of the population. Diabetes consumes 5 to 10 per cent of total healthcare resources. Diabetes is set to increase. Its prevalence is predicted to double worldwide, rising to at least 5 per cent by 2010, accounting for 3.07 million people in the UK. Diabetes affects the young and old, and has particularly poor outcomes in those of lower socio-economic status, and black and minority ethnic groups. Evidence supports the need for improved education of people with diabetes and their carers if better control and improved outcomes are to be achieved. If undetected or ill managed, diabetes can lead to many complications, as I have already mentioned. It can trigger a stroke and have a devastating impact on the quality of life.

Following my Question on 29 November 2006 on the need for specialised nurses for long-term conditions such as diabetes, I shall expand further. There is no doubt in my mind that the specialist trained nurse, working closely with a consultant endocrinologist in a hospital, can give vital support to the diabetic person living in the community. When something goes wrong, the specialist nurse can give the necessary information. General and district nurses, junior doctors and GPs,

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as well as the service users and their families, are trained in good practice in diabetes care. They advise on insulin levels, and check people’s records when they are concerned. Blood sugar levels can be complicated. When you think they might be high, they can be low, and vice versa.

There is great alarm in many quarters about the cutting of specialised services in several areas of healthcare. If people with long-term chronic conditions such as diabetes are to be able to manage their condition effectively and get specialist care if complications arise, support services must be provided, and appropriately staffed and financed. As the NHS financial crisis continues, concerns arise over diabetes programmes becoming a lower priority. Reports point to many diabetic staff posts, including nurses’ and consultants’, being frozen, as well as those of many other specialities. This will be an economic disaster in the long term: more people will end up in hospital as emergency cases. This is against NICE’s recommendations and the national service framework.

An article on Saturday 2 December—only two days ago—reported that on Friday a 12 year-old boy was awarded almost £5 million after medical errors left him severely disabled. He was deprived of oxygen at birth and suffers from cerebral palsy. Medical staff did not spot that his mother had diabetes, and backed a home birth. Due to the condition, the boy was 11 pounds eight ounces when he was born and became stuck. Diabetes in childbirth is another area with a need for specialist trained staff who understand the risks. Safety in medicine should be one of the highest priorities. The National Health Service has to pay up much needed money in negligence cases. It is a tragedy.

Last Tuesday, I went to a pharmaceutical breakfast in another place on medicines counterfeiting, which is a criminal enterprise representing a potent global threat to public health. To date, Europeans have been relatively well protected from fake medicines, but there is evidence of a growing hazard. Precautionary action is needed to prevent future harm. One of the speakers was a most inspiring lady from Nigeria, Professor Akunyili. She told us that her sister had died after being given counterfeit insulin. People across the world should be alerted to this criminal practice. Passing the United Nations resolution could help, worldwide.

8 pm

Lord Boyd of Duncansby: My Lords, I congratulate my noble friend Lord Harrison on obtaining this debate on this important topic. My interest in diabetes is personal; I was diagnosed as a type 2 diabetic a number of years ago. But in supporting the call for a UN resolution, I want to speak about the economic cost of diabetes and the need for education in the prevention and management of the disease. While I shall speak principally about type 2 diabetes, many of the points also apply to type 1.

We have already heard about the prevalence of diabetes. It is estimated that 230 million people worldwide are suffering the disease, and that that

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figure will rise to 350 million by 2025. The social cost and the effect on individuals are immense. Diabetes is the primary reason for the non-accidental amputation of limbs—more than 1 million a year worldwide. Diabetes is a major cause of blindness and the largest cause of kidney failure. People with diabetes are two to four times more likely to develop cardiovascular disease. The annual direct healthcare cost of diabetes for people in the age bracket of 20 to 79 is estimated at between 153 billion and 286 billion international dollars, and that will rise to between 213 billion and 396 billion international dollars by 2025. A more meaningful way of putting it might be to say that between seven and 13 per cent of healthcare budgets worldwide are likely to be attributable to diabetes. In some areas and in some countries where the prevalence of diabetes is higher that cost could rise significantly. Those are the direct costs. There are also indirect costs in lost production, and it is estimated that they could be as much again. There is growing interest in the intangible costs, those in quality of life, but they are more difficult to assess. The future projections of costs are alarming. They suggest that unless effective preventive measures are introduced, expenditure devoted to diabetes and its complications will dominate the health economies of many countries by 2025.

Those assessments are at the macroeconomic level, but it would be wrong of us simply to concentrate on that without looking at the personal economic cost. What about the cost to the individual? For many people throughout the world in countries where healthcare is not free or subsidised, ill health poses a major economic challenge, particularly to those on low incomes. It is estimated that an individual with diabetes will spend between two and five times as much on healthcare as someone without diabetes. The economic cost does not end there because someone who has developed complications of diabetes may well be unable to work and contribute to the family budget, so diabetes can be a source and cause of poverty worldwide.

The tragedy is that much of this is preventable. The rise in type 2 diabetes is attributable to the change in our lifestyles, and the link between diabetes and lifestyle is well documented. The frequency of central obesity, hypertension and elevated blood lipids has been called the deadly quartet, and there is a particularly close causal connection between central or abdominal obesity and diabetes. It is estimated that 1.1 billion people worldwide are overweight and 320 million of them are obese. The International Obesity Task Force estimates that up to 1.7 billion people are exposed to weight-related health risks. The IOTF analysis undertaken for the World Health Report 2002 and the WHO research on the global burden of disease estimated that approximately 58 per cent of diabetes mellitus globally can be attributed to a BMI of 21 or more, but in western countries 90 per cent of type 2 diabetes is attributable, in part at least, to weight gain. We have heard that there is a particular problem with childhood obesity.

There is clear evidence that lifestyle changes are effective in preventing individuals at risk, such as those with impaired glucose tolerance, developing

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type 2 diabetes. Studies have shown that even a small weight loss of between 5 and 7 per cent accompanied by half an hour’s extra walking or other exercise can lower the incidence of diabetes by 58 per cent. A further study of those over 60 showed a success rate in the high-risk group of 71 per cent.


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