Diabetes: Artificial Pancreas

Debate between Mike Penning and George Howarth

Wednesday 12th December 2018 Commons Chamber

[Mr Howarth]

The common-sense approach is to look at what is going on elsewhere—in Scotland and in other parts of the world—to get the best of what is available and use it in the most effective way. My hon. Friend is quite right about that.

It is pointless giving type 1 diabetics the latest technologies, such as an artificial pancreas system, if they are not given structured education to support them to use the technology that is available. The limited uptake of educational programmes is a matter of great concern, and I hope the Minister shares that concern. Despite guidance from the National Institute for Health and Care Excellence, in 2014-15 only 2% of people newly diagnosed with type 1 diabetes were recorded as having attended structured education courses. For some, that lack of knowledge of the key principles of self-management is a major barrier to the use of technology, because without sufficient education, type 1 diabetics are not equipped to get the best results from the technology available.

[Sir Mike Penning (Hemel Hempstead) (Con)]

This is a very important debate and I am pleased we have time to listen to it. I will have to go and listen to my leader at 5 o’clock, so I apologise if I leave in the middle of the debate. With type 1 and type 2 diabetes, it is crucial to diagnose as early as possible. With type 1, which is very different from type 2, it is possible to diagnose very early on in the life of that person. Perhaps the right hon. Gentleman will allude to the differences between lifestyle issues and something that a person normally has when they are born. Surely the answer is testing early, so people can find out and have their educational needs met, and hopefully the product can be available across this great nation of ours.

[Mr Howarth]

I am glad that the right hon. Gentleman, who has a background in these matters, has drawn attention to the distinction between type 1 and type 2 diabetes. That is not to say that one is superior to the other, but they are two entirely different conditions brought about by entirely different circumstances. As I said in opening my speech, type 1 diabetes is an auto-immune condition. Nobody is entirely sure what triggers it in some people, but those in whom it is triggered have some predisposition towards the condition.

--- Later in debate ---

[Mr Howarth]

Yes. I pay tribute to my right hon. Friend, who does a massive amount of work as chair of the all-party group on diabetes. He is very knowledgeable on the subject and the issues involved, and he is of course right. I think I had already said more or less the same thing as he just said, but obviously I agree with myself and with my right hon. Friend.

Let me move on to the digital solutions, such as apps, which could offer platforms to deliver education in a convenient and personalised format. I should add the rider that mobile apps need to be safe, reliable and accredited to be clinically safe. It worries me that some apps out there are produced commercially but do not contain wholly accurate information. It is unsafe to rely on apps that are not properly accredited and that have not been assessed and evaluated by experts who know what they are talking about.

In addition to the low uptake of structured education, the number of specialists working in diabetes care is falling. Between 2010 and 2012, there was a 3% fall in the number of NHS sites that employ any diabetes specialist nurses. Anyone who has any experience of dealing with young people with diabetes will know that nurse specialists are often the very best possible source of advice.

In the light of this shortage, a national network of centres—possibly between eight and 10 expert diabetes technology centres, supported by virtual clinics—could well be a potential platform for the development of more effective structured education for patients, and for professionals as well. I shall say more about that in a moment. Such a network would be helpful for training future generations of diabetes clinicians effectively to provide artificial pancreases, and in the development and evaluation of new technologies.

One of the problems that type 1 diabetes sufferers tell me that they experience is the merry-go-round of different services that they have to access. They may have a problem with neuropathy, or a foot or eye problem, but they cannot access all those services in one place. Many diabetologists, although brilliant at dealing with the diabetes side of the problem, are not equipped to deal with young people who have, for example, psychological problems. All the services need to be better integrated.

[Sir Mike Penning]

I do apologise, Madam Deputy Speaker, but I will have to slip away straight after this intervention.

One group of people the right hon. Gentleman missed out, although it was not intentional, was parents. When a child is diagnosed with type 1 diabetes, there is a journey for the parents as well as the child, so there needs to be support for them. I completely agree with the right hon. Gentleman that diabetes does not pick on certain people from certain areas; it just picks on an individual. Sometimes it is hereditary—a lot of work is being done around the hereditary route—but it is not a choice; it is something that comes on to the family, rather than just the individual.

[Mr Howarth]

The right hon. Gentleman is right, and it was an omission on my part not to have acknowledged that. Any parent of a diabetic child has to experience the disease—at second hand, but in very important ways. The younger the child, the more responsibility parents have to take, so that is important. By the way, training and other support for parents needs to be built into the system.

Hormone Pregnancy Tests

Debate between Mike Penning and George Howarth

Thursday 14th December 2017 Commons Chamber

[Sir Mike Penning]

I completely agree with my hon. Friend. One thing that has surprised me is that although, on average, every single MP will have a victim of Primodos in their constituency, many of the victims think that what happened was their fault and that they are on their own. In the fantastic documentary on Sky, people came forward to say, “I have been affected by this, but I thought that I was on my own. I thought that I was the only one.”

[Mr George Howarth (Knowsley) (Lab)]

rose—

[Sir Mike Penning]

Another point was that the inquiry should be conducted fairly and independently. Members should consider that for a few seconds and take a look at who was on the committee while I take an intervention from the right hon. Gentleman.

[Mr Howarth]

The right hon. Gentleman is making a very powerful case. Given that the inquiry/review has now been very much discredited—it has certainly been rejected by all of those who have suffered—does he agree, as I am sure he will, that the way forward is set out in his motion, which calls for a

“Statutory Inquiry under the Inquiries Act 2005 to review the evidence on a possible association with hormone pregnancy tests on pregnancies and to consider the regulatory failures of the Committee on Safety of Medicines.”?

[Sir Mike Penning]

I praise the Clerks who helped me to draft the motion. I was very angry when we started drafting it, after reading the report, but they helped me get it into some kind of parliamentary language.

An inquiry has to be independent and judge-led, and it has be able to subpoena people to give evidence before it on oath, so that we can get to the absolute truth. It also has to look at the regulatory system that was in place at the time. I am afraid that the Department of Health cannot hide behind this report. To me, that is vital.

Let us look again at the point about the inquiry being fair and independent. One of the ways we thought it could be independent and fair was to have an expert witness who was not part of the campaign, but whom everybody massively respected. For those of us who have been involved in the thalidomide campaign over the years, it was a really positive thing when we heard that Nick Dobrik’s name would be put forward.

Interestingly enough, although Nick was there as an expert witness, he was not asked to play a part in drawing up the conclusions in any shape or form. In fact, he was asked to leave the room. Nick was very surprised—actually, he was gobsmacked—when, in good faith, the Minister and then the Prime Minister said that Nick Dobrik had fully endorsed the conclusions of the report. I know now that the Minister and the Prime Minister know—I have met the Prime Minister, and Nick has done an interview with Sky today—that he categorically does not endorse the conclusions of the report. It was fundamentally wrong for anyone to advise the Prime Minister or the Minister that he did. He does not blame the Prime Minister; I do not think I blame the Prime Minister. As a former Minister—I know that there are former Ministers on the Opposition Benches—I know that we take advice from our officials and they tell us what the situation is. In good faith, the Minister at the urgent question, and the Prime Minister at Prime Minister’s questions, said that Nick endorsed the conclusions.

On behalf of Nick, who cannot defend himself in this Chamber, I would like whoever gave that advice to the Minister and the Prime Minister to formally apologise to Nick Dobrik. He is a fantastic campaigner not only for the Thalidomide Trust, but for all injustices, especially within the pharmaceutical area. The victims do not feel that the inquiry was fair and independent at all. They should have trust and confidence.

The most important thing is that the inquiry was asked to find a “possible” association—not “causal”, but “possible”. I and other members of the all-party group asked the experts from the panel why, after taking the word “inquiry” out, the remit was changed again, because “causal” is very difficult to prove. They said that they followed the science, but they were supposed to follow their remit and do what they were told. If they felt that they could not do that based on the evidence in front of them, fine. They could have gone back to the Minister and the victims and explained that. Instead, we had the farcical situation of the group looking for something when they knew full well—it is clearly in the documents—that they could not reach the conclusion that there was a causal link.

Interestingly enough, the group also could not come to the conclusion that there was not a causal link, because the evidence was not there for either conclusion. As I said during the exchanges on the urgent question, an injustice has taken place. Natural justice is the reason we are sent here. We defend our constituents when the system has come down against them and caused such horrific, horrible things to happen to them, so we need to address that injustice.