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I suggest that prevention is the key, but education is required to turn that key, and we have to ensure that we develop healthcare strategies that focus on weight, exercise and other lifestyle factors, such as smoking. I welcome the fact that England is now to follow Scotland in banning smoking in public places. I went back to Scotland at the weekend, and when I went into a pub, I noticed the difference in the atmosphere between it and a similar place not far from this House. That and other measures taken by the Government are important.

In education, we also have to ensure that we look at particular target groups. There is general education for the population at large, not just on diabetes but on lifestyle, because lifestyle affects our health so much. There is also targeted education for high-risk groups—older people, the overweight, those with impaired glucose tolerance and others. There is also a function for education among those who have developed diabetes. Self-management of diabetes can be difficult for the individual, which poses a real challenge. He must be able to identify emerging health crises, adhere to medication schedules that can often be complex, and modify long-standing behaviours such as diet, exercise, smoking and other factors.

There are also significant barriers to education. Resources are a clear issue, and access is another. In developing countries, those factors can be significant. Telephone counselling can extend one-to-one counselling substantially, and interactive technologies have a part to play. However, those resources are most likely to be effective when linked to a comprehensive and co-ordinated approach to diabetes care.

Why should there be a UN resolution? It is obvious that we face a global problem that has been described as an epidemic, or even a pandemic. The economic cost, particularly to developing countries, is argument enough for a sustained and effective co-ordinated global response. The draft resolution encourages member states to develop national policies for the prevention, treatment and care of diabetes in line with sustainable development. The recognition by the UN of world diabetes day will help to raise awareness of the growing epidemic of diabetes and focus the attention of Governments and healthcare professionals to tackle diabetes.

However, I submit that the recognition of a day has another benefit. It should be the day on which we hold Governments, international organisations and healthcare professionals to account. It should be the day on which Ministers face the John Humphryses of the world to explain what action they have taken to implement diabetes strategies, and the day on and around which we in this House and others should ask: are we doing enough to find a cure for diabetes, to prevent its spread and to manage its progress?



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8.10 pm

Lord Dholakia: My Lords, just before entering the Chamber, I had the privilege to talk to my noble friend Lord Patel. His contribution on medical matters is well known. He said that it is important to recognise diabetes not simply for what it is, but because of its consequences, which lead to so many complications, including organ failure. What he said has been reflected so well in this debate.

First, I thank the noble Lord, Lord Harrison, for securing this important debate. I was privileged when he asked me to contribute. I come from a community where diabetes is rampant. In some parts of the subcontinent, at least, one in three people are diabetics. The noble Lord brings considerable knowledge from his experience and we would be wise to pay heed to what he has said.

The next world diabetes day will be held in November 2007. That will be an opportunity for the world to take a step forward. I believe that the sooner a UN resolution on diabetes is endorsed, the better it will be for all of us. We are all aware that each individual nation, rich or poor, develops its own strategy, but we require the international community to recognise that we all need a concerted effort to tackle diabetes.

I am concerned that, after an encouraging start, the Government seem to have backtracked on their initially supportive position of the resolution. I hope that that is not true. I am disappointed, but I hope that the Minister will explain the Government's position on what they intend to do internationally.

Diabetes is not to be overlooked or ignored. The statistics are frightening. It no longer fits the stereotype of a condition that affects the elderly or the obese. Diabetes occurs across all communities regardless of class, ethnicity or nationality—a point so well made by the noble Baroness, Lady Masham. As the noble and learned Lord, Lord Boyd of Duncansby, pointed out, there are now 230 million sufferers across the world and it is expected that the condition will affect more than 350 million by 2025. Currently, diabetes claims as many lives as HIV/AIDS. The question must be asked: are we dealing with a pandemic?

That “silent killer” is most rampant in Asia. India has the highest number of diabetics in the world, with an estimated 35 million people suffering. Indeed, some indigenous populations face genetic genocide because of the risk of type 2 diabetes. Wherever I have travelled on the Indian subcontinent, the assumption often made is that one is bound to be diabetic unless informed otherwise. We need to work to change that equation. It is not enough to stand back and allow nations across the world to deal with this problem themselves. All nations must come together to tackle it.

Let me add that, whereas those who are prosperous can afford the insulin, poverty debars many from enjoying a controlled life—again, a point well made by the noble Lord, Lord Harrison. They do not have resources or health services to look after their needs. I

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have been horrified that such people suffer in silence and even dietary control is out of bounds as they can only eat what they get.

We must look to the future. The humanitarian, economic, and social consequences of allowing the diabetes pandemic to go unnoticed would be disastrous not just for Britain and Asia but for the world. A diabetes pandemic would outstrip health and aid resources everywhere if no action were taken. The scale of the problem dictates that no single government or region is sufficiently equipped to tackle this threat and healthcare budgets across the world would be unable to cope. The condition is also affecting younger generations during their most economically industrious years.

Some members of your Lordships’ House attended an event where we were able to meet Sir Steve Redgrave, the five time British Olympic gold medallist, at a Diabetes UK reception. Sir Steve Redgrave suffers from diabetes, yet he has proved that that barrier to the fulfilment of life can be both combated and ultimately overcome. He is an example of courage and determination. He is a role model to those who are often resigned to live a life of misery.

The UN resolution seeks to bring together its member states to recognise and tackle the global burden of diabetes through promoting healthier living, better diets and increased physical activity. Along with that should also come tight restrictions on the advertisement not only of cigarettes, as we know, but of junk food.

Diabetes is not yet curable, but it is preventable, and supportive action by the Government for the resolution would help reverse the advance of this pandemic. In 2002, an American study called the Diabetes Protection Programme showed that it was well within the grip of most governments to tackle the causes of diabetes effectively. I already know from first-hand experience the traumas of diabetes. Both my mother and my brother were sufferers. I am very lucky not to have the condition myself, but I urge the Government to support this resolution. I admit that I have not seen the text of any such resolution—obviously it is not available at this stage—but I have no doubt that international recognition, accompanied by the endorsement of all nation states, is a step in the right direction. However, diabetes will be the greatest epidemic in human history. These are not my words but those of Dr Paul Zimmet, director of the International Diabetes Institute.

The solution to this problem lies in the worldwide family of nations working together to provide care, aid and preventive measures against diabetes. This Government must recognise and support a UN resolution for the sake of this country and many other nations around the world. I look forward to the Minister’s response. Let us hope that this short debate will open doors for those who desperately crave some normality in their lives.

I conclude by posing a few questions to the Minister. What is being done to pass information, in this case particularly to ethnic minorities, about help and advice available through the National Health

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Service and general practitioners? Are specialist leaflets available in various languages? Is there a programme in schools that can brief youngsters on the cause of the genetic transfer of diabetes? It would be helpful to know the Government’s position on this matter. In the mean time, I certainly support this debate and the questions that have been posed to the Minister.

8.19 pm

Earl Howe: My Lords, the noble Lord, Lord Harrison, has rightly drawn our attention to a public health issue of worldwide dimensions. Those of us who, like me, spend a lot of time looking at the state of public health in this country perhaps need to remind ourselves of that fact, and the draft UN resolution on diabetes is one such reminder. As the noble Lord told us in his excellent speech, we have seen in one generation the prevalence of diabetes rise sixfold across the world. Twenty years ago, about 30 million people were affected by it. Today, as we have heard, more than 230 million, almost 6 per cent of the world’s adult population, are affected by it. In another 20 years, the figure will be 350 million. By far the largest part of the increase will be felt in the poorer developing countries; the Indian subcontinent is one of the worst affected regions.

Diabetes, as every speaker has said, is a silent epidemic in the sense described by the noble Lord, Lord Harrison, in that, unlike HIV/AIDS, which kills just as many people, it is not communicable and its victims are not aware that they have got it until the symptoms hit them. Even then, a great many are never diagnosed. Diabetes is responsible for over 1 million amputations every year and, as we have heard, for a significant percentage of cataracts, blindness, kidney failure, heart disease and stroke. In the poorer countries of Africa and Asia, the costs of diagnosis and treatment are unaffordable either for the state or for individual families. The noble and learned Lord, Lord Boyd, rightly emphasised the huge economic burden that diabetes brings with it. It is a tragedy of gigantic proportions because 80 per cent of type 2 diabetes, which accounts for the vast majority of cases, is, in theory at least, easily preventable.

These indicators are of direct relevance to public health planning at home, not only because of the higher prevalence of diabetes among black and ethnic minority groups, but because in our own society the well of ignorance about diabetes is almost as deep as it is in the less developed world. In England, the costs of treating diabetes, in all its damaging manifestations, swallow up 5 per cent of the entire NHS budget. One manifestation that has not been mentioned so far is the impact of depression or other mental illness that often ensues when diabetes is diagnosed.

The Government can be credited with recognising the importance of the issue when they published the national service framework in 1999, the aim of which is, of course, to improve services and to put in place a standardised level of treatment for diabetes sufferers. It is the extent of that standardisation that lies behind the questions that I want to ask. In April 2004,

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Ministers published National Service Framework for Diabetes:One Year On, which committed them to achieving two principal targets. The first was that, by 2006, a minimum of 80 per cent of people with diabetes would be offered screening for the early detection of diabetic retinopathy and that, by 2007, all at-risk patients would be covered. We therefore need to hear from the Minister how many PCTs have in fact achieved the 80 per cent target.

The second target was that practice-based registers in primary care would be updated so that all diabetes patients would continue to receive appropriate advice and treatment in line with the NSF. Can the Minister confirm that all practices in all PCTs have now done this? The figures that I have seen suggest that, by May of this year, only 60 per cent of people with diabetes were receiving eye screening, well behind the target of 80 per cent which was meant to be achieved by March. By last month, the figure had risen to only 62.3 per cent.

The problem is that the coverage of screening varies considerably between PCTs. Some are screening only a third of the target group. Others, such as Bristol South and West, Bristol North and North Somerset, are screening even less—between 16 and 18 per cent. At the other end of the scale, there are PCTs in Leeds that are managing to screen 80 or 90 per cent. Why there should be this disparity is not clear. It does not seem to have any bearing on where the PCT is or on the state of its finances. It would be helpful if the Minister could give us the department’s insight into what is happening around the country and why. She will know—indeed she may remind us—that capital funds of £27 million were ring-fenced between 2003 and 2006 to help PCTs to purchase digital cameras in order to deliver the national target on retinopathy screening, but there is a slight problem with this because the general allocation provided to PCTs for ensuring increased training and extra staff to deliver the screening services was not ring-fenced. Because of that, it has remained at the discretion of each individual PCT how it should set about meeting the 80 per cent screening target. It is no use putting half the investment in place without the other half, and it is little use putting a preventive service in place without making sure that it is continued into the future in a sustained and consistent way.

Diabetes UK has said:

That is unfortunately all too true. Financial deficits in the NHS have had a detrimental impact on this area. We know that, as of May this year, eight out of 28 strategic health authorities had seen their services cut back, with some PCTs having reduced screening by over 20 per cent since the figures were last collected. We all know about devolved decision-making in the NHS, but I think that the Government have a responsibility here. It is a public health issue, not just a managerial one. We can talk about statistics very easily, but the brutal truth is that, by reason of the targets not being met, there are people out there who are going blind when they do not need to.



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Equally, the Government have done something potentially very unhelpful to diabetes patients, which is to cut back the rate of reimbursement under the drug tariff for glucose testing strips. The companies that make the strips have also supplied a great many ancillary services totally free to patients, such as testing meters and helplines, which in the past have never been directly reimbursed by the NHS. A 12 per cent cut in the tariff is a big one and carries the distinct risk of some of these products and services being withdrawn, as they will simply become uneconomic. If that were to happen, making it harder for patients to monitor their blood sugar levels, it would be very regrettable. Moreover, it is almost certain that new entrants to the marketplace that might have better products and updated technologies to offer are likely to be put off. Treasury edicts must be obeyed, as we all know, but I feel that in this instance the Government may have taken a short-term decision whose long-term effects could be damaging to patients.

At the root of much diabetes is obesity. So far, nothing that the Government have done has made any appreciable difference to the steep rise in obesity, which now affects one in four adults and children, and it is the lower-income families who are most at risk. The key to tackling obesity is to influence people’s lifestyle choices by educating them, as young as possible, about the dire consequences of being dismissive or blasé about key health messages to do with diet and exercise. This is a task for industry, the voluntary sector, schools and medical professionals, as well as government, working in a concerted way over the long term. The draft UN resolution reminds us that the consequences of inaction or failure would be profoundly damaging, not only to individuals but also to our whole society. Indeed, failure should simply not be an option.

8.30 pm

Baroness Royall of Blaisdon: My Lords, I am grateful to my noble friend Lord Harrison for raising diabetes as a global health issue of growing importance and for raising awareness of what he described as a silent, uncompromising killer. People suffering from diabetes and those of us who strive to fight against it certainly have a champion in him.

The noble Earl, Lord Howe, informed us that the World Health Organisation estimates that, worldwide, there were 171 million people with diabetes in 2000 compared to 30 million in 1985. I believe that this could rise to 366 million by 2030, so the figures are even more worrying. We have heard during the debate what that means in terms of human suffering and reduced life expectancy, the intolerable burden on healthcare systems and the cost on individuals and families, especially the poorest. My noble and learned friend Lord Boyd of Duncansby clearly demonstrated the staggering economic costs, both direct and indirect. The noble Lord, Lord Dholakia, told us, quite rightly, that in developing countries it is the economically most active who suffer and that this can have dire consequences on their families as well as on themselves.



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Diabetes is an epidemic that demands our attention and our action. However, we do not think that a resolution in the UN General Assembly is the primary way that this will be achieved. The General Assembly has been too often burdened with unfocused debates on a proliferation of resolutions. Therefore, as part of our agenda for UN reform, we want to see a streamlined and focused agenda for the General Assembly that addresses health issues systematically and strategically. That is why we would support an initiative that referred to diabetes within a broader public health resolution or sought to raise the profile of non-communicable diseases at the World Health Organisation.

This approach would place the fight against diabetes in the wider development context. Of course, the challenges that developing countries face in tackling diabetes are not specific to diabetes; they are about providing trained staff, essential medicines, health infrastructure, good management and information systems and, above all, the necessary level of funding to make the system work. The real challenge is to establish effective health systems offering prevention, diagnosis and effective treatment to local populations. I am sure that we all agree on that.

In answer to the specific questions about the resolution which has been formally introduced into the General Assembly, I can tell my noble friend Lord Harrison that the EU is not opposing it and that the British Government are working constructively with other member states to find agreement on it. I think that will be pleasing. I well understand, however, that the urgency of the epidemic means that there is no time to wait for a general health resolution. As diet and patterns of physical activity change throughout the world, diabetes is a growing problem. We need action now.

The way for us to tackle diabetes in developing countries is to support country-led efforts to provide strong health services capable of preventing and treating all causes of ill health. Through the Department for International Development, we support individual countries’ efforts to analyse their own burden of disease and to prioritise accordingly within their health programmes.

Our recent White Paper on development committed us to increase spending on basic services—education, health, water and sanitation, and social protection—to at least half of the UK’s direct support to developing countries. We will work with developing countries to back ambitious long-term plans to improve health services, including ways of recruiting and training more doctors and nurses. The White Paper announced a doubling of our research spending in the coming years from £120 million to £240 million annually. This will enable us to broaden the research to include the emerging challenge of non-communicable diseases in developing countries, including diabetes.

Naturally, we must not ignore the growing challenge that diabetes represents to us in the United Kingdom. The figures make sobering reading. There are an estimated 2.35 million people with diabetes in

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England and this is predicted to grow to more than 2.5 million by 2010. The Government have taken significant steps to improve the care of people with diabetes and to address the substantial challenge of improving people’s lifestyles so that the risks of type 2 are considerably reduced.

As noble Lords are aware, in England we have the National Service Framework for Diabetes, a 10-year plan to improve services by setting national standards to drive up service quality and tackle variations in care. It sets out 12 standards to be achieved by 2013. The noble Baroness, Lady Masham of Ilton, is right about the need for better education about diabetes. Indeed, one of the NSF standards states that all people with diabetes will receive a service that encourages partnership and decision-making, supports them in managing their diabetes and helps them to adopt and maintain a healthy lifestyle.

Of course, we need education for all about healthier lifestyles. Many strategies are already being implemented to increase the public’s fitness and activity levels. I particularly like “Small Change, Big Difference”, a campaign that encourages people to make minor changes in their lifestyles to give them a better chance of living longer, healthier lives. It is aimed at adults with the message that it is never too late to start, and that even small changes in diet and physical activity can make a difference. We are also still on track to have around 120 health trainers in place by early 2007, who will see over 74,000 clients. There are many more activities, and I will gladly write to noble Lords with further information.


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