NHS Commissioning Board (Mandate)

Keith Vaz Excerpts

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

My hon. Friend is right. That is why, at the heart of the mandate, is an information revolution so that the public can understand exactly how well different parts of the system work, and so that we create the right pressures on the system to improve where performance is poor. I agree that the central, top-down structures that we had before did not allow that to happen. If we had cut the budget, as the Opposition wanted, it would have been even more difficult now.

[Keith Vaz (Leicester East) (Lab)]

Tomorrow, as the Secretary of State knows, is world diabetes day. I discovered that I had diabetes only because of a chance visit to my local GP. I welcome what the right hon. Gentleman said about including diabetes in his mandate, but will he mandate the local health authority to test all its patients? Today marks the start of the Hindu new year—Diwali. In this new year statement that he is making today, will he ensure that everyone is tested for diabetes in their local practice?

[Mr Hunt]

As the right hon. Gentleman will know, we are losing 24,000 people unnecessarily every year by not properly recognising the symptoms of diabetes. That is incredibly important. We have made it clear that reducing mortality rates—preventing avoidable mortality—is a major priority of this Government, so I expect this to be a key priority for GP practices and for local authorities throughout the country.

Oral Answers to Questions

Keith Vaz Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Hunt]

The answer is that we are doing quite a lot—a good booklet, “Managing Medicines in Schools and Early Years Settings”, goes around schools, and there are other resources for schools—but we need to do more. We will be announcing a diabetes action plan, a long-term conditions outcomes strategy and a cardiovascular disease outcomes strategy, which will go further to address the issues that my hon. Friend raises.

[Keith Vaz (Leicester East) (Lab)]

I declare my interest as someone who has type 2 diabetes and welcome what the Secretary of State says. However, according to the latest report, another 700,000 people will contract the disease by 2020, and 80% of amputations are avoidable. Could he ensure that this very important subject is on the agenda of local clinical commissioning groups?

[Mr Hunt]

I certainly can. The number of diabetes sufferers overall will go up from about 3.7 million, which is already 5% of the population, to 4.4 million. We need to do a lot better in how we look after people with long-term conditions if the NHS is to be sustainable. We can also do a lot to transfer the individual care of people who have diabetes through things such as technology, which I will look into carefully.

Children’s Cardiac Surgery (Glenfield)

Keith Vaz Excerpts

Monday 22nd October 2012 Westminster Hall

[Liz Kendall]

The hon. Gentleman has predicted my next sentence. Leicester is also the only unit in England and Wales to provide a mobile ECMO service for babies and children. Once again, it is difficult, if not impossible, to separate the adult ECMO service from the children’s ECMO services. The two are linked. It is not just about equipment; it is about staff and teams working and learning together.

I do not want to denigrate any hospital’s work, but I understand that Birmingham has neither the capacity to continue the mobile ECMO service nor any plans to develop a mobile ECMO service for children. That is a serious cause for concern and something that the Independent Reconfiguration Panel must consider.

Hon. Members have already talked about the outcomes for ECMO patients at Glenfield being significantly better than elsewhere. This is not anecdotal opinion, but clinically audited, peer-reviewed evidence that has come from the very best clinical databases available in this country and internationally. Independently validated data from the UK paediatric intensive care unit database, or PICANet, show that survival rates are at least 50% higher in Leicester. That difference in mortality is maintained even when the severity of illness treated by Glenfield is taken into account.

Data from the best available international register, provided by the Extracorporeal Life Support Organisation, support the evidence of good outcomes in Leicester and show that crude mortality rates in Leicester are 19%, but nearly twice as high in other centres, at 35%. Both those independent, validated data sources show the high quality of ECMO care provided at Leicester and bring into sharp focus the risks of closing Glenfield’s children’s ECMO service.

A service cannot simply be picked up and moved to another city without losing vital skills and expertise. It takes years to build up the quality of care to the same level. Interestingly, the Safe and Sustainable review explicitly addresses the time it takes to build up the quality of care in relation to children’s heart surgery. It says that

“clinical outcomes improve with experience”,

due to factors such as team working, as well as the experience of individual clinicians. The review says that this is a

“statistically significant observation in keeping with analysis which demonstrates historically, an 8 - 10 year period of time before such a service matures to produce excellent clinical outcomes”.

If that is so in relation to children’s heart surgery services, it also pertains to children’s ECMO services.

It was unfortunate that, in his letter to the chair of the Independent Reconfiguration Panel, the Secretary of State referred simply to moving the equipment of the ECMO service. It is not just equipment; it is about staff. It is clear that the majority of staff at Glenfield will be unable to move due to family commitments. Many of the nurses there have homes, families and children, and they may be second earners. A family cannot simply be uprooted and moved. Indeed, an anonymised survey of all staff at the unit found that 80% are “not at all likely” to move to Birmingham. Significantly, none of the ECMO specialists who replied to the survey were able to consider working in Birmingham.

I am concerned that the Safe and Sustainable review has not considered the evidence about ECMO in sufficient detail. The review panel took advice about the future of ECMO services from the Advisory Group for National Specialised Services. There was no representative from any UK or international professional ECMO body on the advisory group, so it commissioned a report from ECMO experts, including Dr Kenneth Palmer, director of the ECMO unit at Karolinska university, whom several hon. Members have mentioned.

Following that report, the advisory group said that it would be “possible” to move Glenfield’s children’s ECMO service. However, the question is not whether it is possible, but whether it is desirable and whether it makes sense to move one of the best-performing services—if not the best, not just in this country but in Europe and internationally. That would not be considered in respect of children’s heart surgery services, so why consider that for ECMO?

[Keith Vaz (Leicester East) (Lab)]

Mr Hollobone, I apologise for not being able to follow the whole debate; I am participating in the debate on Hillsborough.

A number of hon. Members from all parties have praised the work of the campaigners. Our best evidence that the facilities work comes from people such as Ria Pahwa, the young girl from Rushey Mead in my constituency, who had seven operations in Glenfield and who has been an essential part of this campaign. If we are looking for evidence that the facilities need to stay in Leicestershire, the evidence is in the campaigners themselves.

[Liz Kendall]

We have all met many children, some of whom are now adults, and families who have received excellent care and support. It is important that we put their views forward strongly and that the best peer-reviewed and validated clinical evidence is considered in the new review.

As many hon. Members have said, Dr Palmer wrote to the former Secretary of State saying that he sharply opposes the use of his name for the proposed transfer of services from Leicester to Birmingham. A similar view is taken by leading international ECMO experts from the Extracorporeal Life Support Organisation, which also wrote to the former Secretary of State:

“We are united in our dismay. We are united in our dismay at the proposed move of ECMO services from the Glenfield programme in Leicester to elsewhere…The Glenfield program is clearly and objectively recognised as one of the finest ECMO programs in the world. Movement of an established unit such as Glenfield in the manner described will have profound negative consequences on the outcomes of patients needing ECMO. This move…is one clearly likely to produce results that will have a human toll in increased deaths.”

That is why the specific evidence on ECMO must be fully considered, including by the new review.

An issue raised by my hon. Friend the Member for Leicester South (Jonathan Ashworth) and several other hon. Members must also be considered by the new Independent Reconfiguration Panel: whether the assumptions about the level of cases remain based on the best available evidence. The Safe and Sustainable review looked at surgical activity data from the central cardiac audit database for 2002 to 2006—the latest evidence available at the time—which suggest that the number of cases for heart surgery would remain roughly stable over the next 20 years. New validated data, however, are now available for three more years—to 2010—showing a consistent rise in activity, suggesting that adult and paediatric activity will each increase by approximately 75 cases per year.

We also have new evidence from the Office for National Statistics about population growth, which comes from data published in October last year and indicates that there will be substantial increases in the number of nought to four-year-olds, in particular in the east midlands, the east of England and London. That causes real concern about whether Birmingham will be able to cope with all the extra cases that it will receive.

Birmingham’s case load will also increase because of the closure of Northern Ireland’s children’s heart surgery services. The Safe and Sustainable review reports an all-Ireland framework, with Northern Ireland cases going to Dublin, but that will take several years to establish and, in the meantime, a significant and increasing number of babies will continue to travel to Birmingham.

The Birmingham children’s hospital itself is concerned about whether it has the capacity to cope with all the extra cases that it will receive from a closing Glenfield, from the likely increase in surgical activity, from the increase in population, in particular among the nought to fours, and from the increase in cases coming from Northern Ireland. The hospital, I understand, has analysed the case load and produced an internal paper concluding that it would have to perform 1,000 cases a year, which is at the very limit of what the Safe and Sustainable review panel reported as a safe number for cases to be treated. I urge the IRP—rather than the Minister, if she cannot do anything—to look at whether that paper has been written and to assess all such evidence in its review.

Finally, like the previous Government, this Government rightly want changes to children’s heart surgery services so that they provide not only safe standards of care, but excellent, high-quality standards for every child in every part of the country. Just as they want that for children’s heart surgery services, they must want that for children’s ECMO services. It is not good enough to say that it is possible to move a service; we want to know whether it is desirable to move a service to get the very best outcomes.

Glenfield survival rates are 50% higher than any other unit’s in this country and internationally. It will take at least five and probably up to 10 years to redevelop the same quality of service. No one would take the best service in the country for children’s heart surgery and close and move it, so no one should do that for ECMO either.

The issue is of concern to my constituents and those of hon. Members from throughout the east midlands, and to families everywhere in the country. Such people include Clare Johnson, a constituent of my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson). She contacted my right hon. Friend to tell him about the experience of her son, Michael. Michael was born in July last year with severe meconium aspiration, which means that his lungs fill with a substance that makes it very difficult to breathe. His lungs haemorrhaged and his heart failed. The paediatric mobile ECMO service from Leicester came to collect him and transferred him to Glenfield. He was on the ECMO machine 24 hours a day for four days; when he came off it, his heart and lungs were working for themselves. Ms Johnson said:

“As soon as the team arrived to prepare him for transfer, their evident skill and professionalism gave us that very first glimmer of hope…The care we received was second to none.”

Ms Johnson also said that:

“although I am not the best person to point out facts and figures, I cannot help but pore over the evidence available and the main thing that strikes me is the ECMO survival rate”,

which is so much better. She said:

“Glenfield is the only unit to offer Mobile ECMO”—

the very service to save her son—and concludes:

“I understand that I probably sound like a Mother who is just wanting to support the unit who saved her baby’s life”

but:

“My beautiful baby boy Michael Martin Johnson died at 10.40 pm, 8 days after his birth and 3 hours after being transferred back to Hull from Leicester. He had a reaction to some medication he was given and died very suddenly and unexpectedly of a severe gastric perforation. A successful result will not bring my son back. But it WILL prevent other mothers from losing their child, as that IS the ultimate and inevitable result that stopping ECMO at Glenfield will have.”

Clare Johnson makes the case far more eloquently than I ever could. I hope that the IRP looks properly at Glenfield’s ECMO service and at the real benefits that it brings. The Minister has rightly said it is up to the IRP to consider the evidence, but it was the new Secretary of State who decided not to include ECMO as part of the review—that is what he says in his letter today—and that is a mistake, because the two services need to be looked at together. I ask the Minister to explain why the Secretary of State has explicitly excluded ECMO from the new review. That is the wrong decision and I hope that it will be changed.

health

Keith Vaz Excerpts

Tuesday 18th September 2012 Commons Chamber

[Pauline Latham (Mid Derbyshire) (Con)]

May I take this opportunity to welcome the new Health Minister, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), to his post and wish him every success in his new role?

I want to draw the attention of the House and, in particular, the Minister to two key issues in relation to type 1 diabetes. Some Members may be aware that I spoke on this issue last week in a Westminster Hall debate, but today I want specifically to urge the new health ministerial team to support the artificial pancreas project that is being funded by the charity JDRF. If the Department can find any funding to assist the research, that would be very welcome.

I wish to ask the Department of Health to end the postcode lottery that exists in the NHS on access to insulin pumps. At present, there are no answers on what causes or how to cure type 1 diabetes. The only way to find a cure for type 1 is through greater investment in medical research. If additional funding can be made available to cure, treat and prevent type 1 diabetes, it will result in long-term cost efficiencies for the NHS. It will also help the UK to retain its position as a world leader in this type of medical research.

Type 1 diabetes is a chronic, life-threatening condition that has a life-long impact on those diagnosed and their families. It strikes children and adults, staying with them for the rest of their lives. It is usually diagnosed in childhood between the ages of 10 and 14, but more and more children are being diagnosed much earlier, from 18 months onwards. It is an auto-immune condition; it causes the body’s own immune system to turn on itself and destroy the beta cells in the pancreas, leaving the body unable to produce the life-essential hormone, insulin. Insulin pumps cost between £1,000 and £3,000. There are additional costs for the consumable attachments, infusion sets, batteries and pump reservoirs, for which patients might have to pay themselves. The cost of those consumables could amount to between £1,000 and £2,000 per annum for each patient.

By contrast, the Scottish Government announced in February 2012 that all eligible under-18s with type 1 diabetes in Scotland will now have access to insulin pumps. They have also said that the Government are committing funding of at least £1 million to help NHS boards deliver pumps to under-18s who need them, as well as tripling the amount of pumps available to all people with the condition in Scotland. That has been followed by a further boost of £1.5 million this April in Scotland to provide more young people with insulin pumps.

Type 1 diabetes is a very different, distinct condition from type 2 diabetes, as it is not linked to lifestyle issues, such as diet and exercise. People with the condition rely on a programme of finger-prick blood sugar tests and insulin pump infusions or injections up to 10 times a day to stay alive. Although these prolong life, they are not the cure. A child diagnosed with type 1 diabetes when they are five faces 19,000 injections by the time they are 18. People with the condition are at risk of devastating complications, including blindness, heart disease, amputation, strokes and kidney failure, to name but a few.

Type 1 diabetes reduces life expectancy by about 20 years and there is a small but very real chance of sudden death. The short-term complications include debilitating hypoglycaemia, which, if left untreated, can lead to unconsciousness, coma and occasionally even death. Children never escape the responsibility of checking their blood sugar level and parents never have a day off from worrying about their children, even at night, as the blood sugar level has to be checked. Parents cannot relax because one of them must get up at night to check that their child is okay—or even still alive.

JDRF has told me that about 500 people in each constituency have type 1 diabetes. Therefore, more than 26,000 children in the UK have type 1 diabetes, which is as many as one in every 700. Some 98.6% of the children and young people who have diabetes will have type 1. The incidence of type 1 diabetes is increasing by about 5% year on year.

[Keith Vaz (Leicester East) (Lab)]

The hon. Lady is making an excellent and powerful speech. I declare my interest as a sufferer of type 2 diabetes. I wish to emphasise the importance of prevention work. She has talked about type 1, which is difficult to prevent; but in general, the more money that is spent on preventing diabetes, the less money that will need to be spent by the NHS in the future.

[Pauline Latham]

I thank the right hon. Gentleman for that intervention, because he is a big champion of tackling diabetes, particularly type 2, and he will speak up at every opportunity. Good care for not only the young with type 1, but for older people who can try to prevent themselves from getting type 2 diabetes will, of course, save the health service a huge amount of money.

As I mentioned, JDRF funds a large research programme to develop a closed-loop artificial pancreas, to help children with type 1 diabetes to live a life without the constant need for painful finger-prick tests and multiple insulin injections every day just to stay alive. It would give people with type 1 diabetes the freedom from those injections every day and has the potential to prevent some of the devastating complications that can arise from the condition. It would also give parents peace of mind that their children are much more likely to have stable blood sugar results, thus keeping them out of hospital.

The project involves two pieces of equipment that are already available to people with type 1 diabetes: a continuous glucose monitor that measures blood glucose levels regularly; and an insulin pump, such as the one I am holding, that painlessly administers insulin. The main task is to develop a computer that can talk to the two components and calculate exactly how the insulin pump should react and when to administer the insulin. That would close the loop to make the device a functioning artificial pancreas. This artificial pancreas is not yet commercially available, although the research team have already completed trials of the artificial pancreas in a hospital setting and are now beginning trials where children take the artificial pancreas home to see how well it works in a real-life situation.

Will the Minister please give an undertaking to monitor this research carefully and, if possible, lend his full support to this piece of groundbreaking research, which could improve the quality of life for so many young people in my constituency and many thousands across the country—it could do more than that; it could transform their quality of life.

The second issue that I would like to raise briefly this afternoon is the inequality that exists in our NHS in getting access to an insulin pump. The Minister may be aware that the Medical Technology Group recently carried out a freedom of information survey of every primary care trust in England, publishing its findings in “Pump Action—A Review of Insulin Pump Uptake and NICE Guidance in English Primary Care Trusts”. The report shows significant inequality in the provision of insulin pumps across England and a lack of adherence to National Institute for Health and Clinical Excellence guidance, with low insulin pump usage compared to the NICE benchmark. The average rate of insulin pump provision for people with type 1 diabetes is 3.9%, compared with the 12% benchmark recommended by NICE; it is nowhere near the 33% recommended for children younger than 12.

There is, without doubt, a postcode lottery on insulin pump access. The percentage of people with type 1 diabetes using an insulin pump falls as low as 0.25% in Medway and 0.3% in Croydon. In my county of Derbyshire, the rate is 4.4%, with 120 people using an insulin pump out of the 2,746 people with type 1 diabetes in the area—that is well below the NICE guidelines. May I request that the Minister take urgent action as soon as possible to address this issue? It simply is not fair that people can be denied treatment just because they live in the wrong part of the country.

Health

Keith Vaz Excerpts

Tuesday 17th July 2012 Commons Chamber

[The Minister of State, Department of Health (Mr Simon Burns)]

This has been an interesting and diverse debate, giving hon. Members an opportunity to raise a range of different subjects affecting their local communities and the health and well-being of their constituents. If there has been a main theme, it has been the Safe and Sustainable review of paediatric heart surgery. I fully recognise the strength of feeling and emotion on that difficult and sensitive subject, which is why so many Members have talked about it. They have included the hon. Member for Leeds North West (Greg Mulholland); the hon. Member for Hammersmith (Mr Slaughter), who mentioned the Brompton hospital in London, which is part and parcel of that review; the hon. Member for Leicester South (Jonathan Ashworth), who took interventions from the hon. Member for Leicester West (Liz Kendall); and my hon. Friends the Members for Pudsey (Stuart Andrew), for Colne Valley (Jason McCartney) and for Loughborough (Nicky Morgan).

I fully accept that the reorganisation of children’s cardiac services is a matter of real concern for the families involved, as indicated by the strength of feeling shown in the contributions of all the Members who have taken part in the debate. I know that some families have been disappointed by the outcome of the JCPCT’s recent decision. As hon. Members will know, children’s heart surgery has been a subject of concern for more than 15 years. Clinical experts and national parents groups have repeatedly called for change, and there is an overwhelming feeling that change is long overdue.

As passionately as people want to defend their local hospitals, it is far more important to ensure safety and quality of care for all children with congenital heart disease. We must ensure that those children continue to receive the very best care that the NHS can deliver, and I know that no Member would disagree with that overarching principle. That was what the NHS Safe and Sustainable review was aimed at, and as I have told many Members over the past 22 months, it was wholly independent of Government.

The review was led by clinicians and had the support of the Royal Colleges and national charities. Its conclusions were clear: for children with congenital heart disease to receive the very best care, specialist surgical expertise needs to be concentrated in a smaller number of centres. That will mean that surgeons have sufficient clinical work to maintain and develop their skills; that they can provide those services around the clock; and that they can train and develop the next generation of surgeons. I must stress that the JCPCT’s decision is not about closing or cutting back on children’s heart services—quite the opposite. It is about ensuring that the whole range of children’s heart services can deliver the very best care now and in future.

I thank in passing my hon. Friend the Member for Loughborough and the hon. Member for Leicester South for meeting me earlier this afternoon to discuss the important issue of ECMO and how it directly affects Glenfield hospital in Leicester.

[Keith Vaz (Leicester East) (Lab)]

I am afraid other duties in the House prevented me from being at the meeting. Had I been there, I would have supported what the hon. Member for Loughborough (Nicky Morgan) and my hon. Friend the Member for Leicester South (Jonathan Ashworth) said.

[Mr Burns]

I am extremely grateful to the right hon. Gentleman. Not only am I sure he would agree with every word that my hon. Friend the Member for Loughborough and the hon. Member for Leicester South said, but I have considerable sympathy with him, as he was unable to attend the meeting owing to other pressing parliamentary duties in his role as Chair of the Select Committee on Home Affairs. To be even fairer to the right hon. Gentleman, the meeting was originally planned for 3 pm or 3.15 pm, but unfortunately, neither my hon. Friend, the hon. Gentleman nor I would have been able to attend because we were at that moment in the Chamber.

I understand from the nature of our discussions, as they will, that this is a difficult issue, because there are a number of complicated parts to the problem. I hear what they and other hon. Members have said about the Safe and Sustainable review, but I stick to my original position. The review is independent and is carried out not by the Government, but by the JCPCT. It would be inappropriate for me to become directly involved, to take sides or to pass comment because it would be felt that I was interfering. If hon. Members’ local authorities disagree with the decisions or recommendations of the JCPCT, their overview and scrutiny committees can write to my right hon. Friend the Secretary of State for Health to express their disagreement with the decision as it affects their local community or local hospital, and to request that the matter be referred to the independent reconfiguration panel, so that it can consider it independently and come up with a decision.

As my hon. Friend the Member for Colne Valley said, his local authority has today done just that. It may be helpful to him if I explain the procedure. My right hon. Friend the Secretary of State receives the representations and communication from the local authority overview and scrutiny committee specifying that it believes that the decision and recommendation as they affect the local hospital—Leeds, in my hon. Friend’s case—are wrong. The overview and scrutiny committee then asks my right hon. Friend whether he will refer the matter to the independent reconfiguration panel. I do not want to prejudge, but it is almost certain that my right hon. Friend will refer the matter. It will be then be up to the IRP, which is independent, to look at the recommendation and the criticisms made by the overview and scrutiny committee, and to reach a conclusion, which will be an independent conclusion, on whether it agrees with the recommendation or the criticisms of it and perhaps of the procedures involved. The IRP will then make my right hon. Friend aware of its independent view of the complaint.

NHS Annual Report and Care Objectives

Keith Vaz Excerpts

Wednesday 4th July 2012 Commons Chamber

[Mr Speaker]

On the whole, if at all possible, and it is not always possible, I prefer to avoid sibling rivalry so I shall now call Mr Keith Vaz.

[Keith Vaz (Leicester East) (Lab)]

May I declare my interest as a type 2 diabetic and say how disappointed I am that the Secretary of State did not mention diabetes in his statement today? Fifty per cent. of adult diabetics have not had the nine care processes that are necessary. Will he ensure that commissioning groups are asked to ring-fence resources to help with diabetes prevention?

[Mr Lansley]

There are many conditions from which patients suffer that I did not mention in the statement because the purpose of the draft mandate to the NHS Commissioning Board is to improve the quality of services across the board, and the objectives we are looking for are about improvement across the whole service, rather than trying to isolate and identify individual conditions. But the NHS Commissioning Board will indeed go about the task of doing so. In recent years we have increased the proportion of patients with diabetes who have access to the nine recommended processes, and I know we will increase the number in future. I draw to the right hon. Gentleman’s attention, among the figures reflected in the report, the fact that, at the end of 2011-12, 99% of people with diabetes had been offered screening for diabetic retinopathy in the previous 12 months—an increase from 98.6% in the preceding quarter.

Oral Answers to Questions

Keith Vaz Excerpts

Tuesday 12th June 2012 Commons Chamber

[Mr Lansley]

If the hon. Gentleman is talking about the management budget for CCGs, I can tell him that we set out clearly that it would be up to £25 per head across England, and that is indeed the sum that will be made available.

[Keith Vaz (Leicester East) (Lab)]

Has the Secretary of State seen the letter to The Times this morning from six diabetes experts? What steps are the local groups taking to do more to prevent diabetes?

[Mr Lansley]

Yes, I read that letter this morning. Today, elsewhere in the House, the permanent secretary to my Department and the chief executive of the NHS will give evidence to the Public Accounts Committee on precisely that issue. In the context of doing so, they will demonstrate how we have continued over the past two years to achieve a substantial year-on-year increase in the number of patients with diabetes who are accessing best-practice services.

Diabetes

Keith Vaz Excerpts

Friday 23rd March 2012 Commons Chamber

[Keith Vaz (Leicester East) (Lab)]

As always, I begin by declaring my interest as someone who has type 2 diabetes, and also as vice-chairman of the all-party group on diabetes. I have known that I have this illness since a chance testing in 2004. It has given me first-hand experience of the importance of early detection and careful management of the disease. I am delighted to see the Minister of State on the Front Bench, and I am very pleased to see my hon. Friend the Member for Sedgefield (Phil Wilson), who also has type 2 diabetes.

Failure to properly identify and care for sufferers comes at a high price. The most devastating costs are human. There are 2.8 million people with diabetes in the United Kingdom. This number is set to more than double by 2032. That means that 10% of the population will be susceptible to devastating complications, which include amputation, blindness, heart problems and strokes. There are also the financial costs of the illness. Diabetes costs the NHS £9 billion per year—about £1 million an hour. With the NHS expected to make savings of £20 billion by 2015, this is an expense that we can ill afford and which is only set to increase if drastic action is not taken.

The excellent NHS atlas of variations and the national diabetes audit have shown that there are shocking regional variations in diabetes care. Some 80% of amputations due to diabetes can be prevented with the right checks. The incidence of amputations in a primary care trust is indicative of the quality of diabetes management there. In Leicester East, for example, the annual number of amputations per 1,000 adults with diabetes is 1.4, significantly below the national average of 2.7. However, a sufferer who lives in Swindon is more than twice as likely to have an amputation. The rate there is 4.0 amputations per 1,000 adults with diabetes in the population. That is significantly above the national average.

Changes under the Health and Social Care Bill will mean that more power is devolved to a local level. I am very concerned that this may worsen regional inequalities and I look forward to reassurances from the Minister. We need rigorous checks and balances in place to ensure that there is high-quality diabetes care which meets National Institute for Health and Clinical Excellence guidelines across the country.

So how can we minimise the human and financial cost of diabetes? There is no great mystery in how to treat and prevent type 2 diabetes. We do not need to spend millions searching for a cure: 80% of type 2 diabetes is preventable with the right care and management, including lifestyle and exercise. This means that with the right prevention, the NHS could save up to £720,000 per hour. The NHS health check programme is a positive step towards identifying the “missing million” who it is estimated have diabetes but simply do not know it. However, 90.48% of those eligible did not receive a health check between April and December 2011. Moreover, the health check is only for those between the ages of 40 and 70 years. The south Asian population becomes at risk much earlier, from their mid-20s. Screening must therefore be targeted.

It takes something as simple as a regular check to prevent many of diabetes’ most serious complications. An eye test can prevent blindness, a foot check can prevent amputation, and blood pressure tests can prevent a stroke and heart disease, yet diabetics are not receiving the nine health checks that NICE guidelines recommend they require. It is estimated that 1.3 million sufferers across the country are failing to receive them.

Type 2 diabetes often goes hand in hand with obesity. Some 31% of UK children are now classified as overweight. If current trends continue, 60% of men and 50% of women will be clinically obese by 2050. Over the past decade, Governments have spent £2 billion tackling obesity levels, but they have failed to fall. Urgent Government action is required, and it should consider seriously the possibility of a fat tax, which has been introduced in Denmark, and a soda tax, which is being introduced in France, and make compulsory the introduction of sugar and fat reduction measures by the food and drinks industry.

I have before the House next month a ten-minute rule Bill, calling for soft drinks companies to reduce the amount of sugar that they put into their products, and to bear some of the responsibility for the obesity and diabetes crisis by putting some of their profits back into prevention and research programmes. That is the sort of action the Government should be taking.

As we have seen today with the Government’s alcohol strategy, prevention is better than cure. The Home Affairs Committee in 2008 recommended the introduction of a minimum price per unit of alcohol—an end to the pile-it-high and sell-it-cheap drink deals. In 2011, there were 1.2 million alcohol-related hospital admissions, so I welcome what the Government announced this morning and am sorry that I could not be in the Chamber, but the Home Secretary decided to give the House 30 minutes’ notice of her statement and I had a prior engagement at Hertfordshire university. I welcome what the Government have done, however. It is an example of a Government taking action to deal with prevention.

Research has shown that investment in first-class diabetes services now will lead to huge savings in the future. Southampton university hospital’s investment in a multi-disciplinary specialist diabetes team saved it an estimated £2.2 million over 22 months, but there is not only a cost imperative to ensure that such facilities are available to all diabetics. Last year 24,000 people with the illness died earlier from causes that could have been avoided through better management of their condition. Those measures are required to save lives.

I am delighted that the European Parliament is taking strong action to tackle diabetes, and I hope that the resolution passed there last week will do much to get Europe moving on the issue. Some of the action that it calls for, such as an EU-wide diabetes strategy, will be taken up by the European Commission, but much of the responsibility, particularly for the obesity and diabetes prevention and diabetes management programmes, will fall on member states, including our own. I should be very interested to hear what the Minister has to say about what this Government are going to do as a result of that European Union resolution.

Next month in Copenhagen, for the first time in the history of the EU, the EU diabetes leadership forum will take place during the EU Council presidency of the host country. I was delighted to hear that the Minister will be speaking at that convention, sharing good practice and, I hope, encouraging others to act with Britain to halt the diabetes tsunami.

Diabetics, in order to manage their condition effectively and to prevent many of the costly and damaging complications that I have discussed, must have access to the right drugs at the right time, and I have been contacted by pharmacists, patients and many others in the industry who are extremely concerned about widespread shortages of prescription drugs. The number of prescription medicines officially listed as in shortage on the Pharmaceutical Services Negotiating Committee website is only 30, but an investigation by The Times found that pharmacists were reporting shortages of up to 350 drugs per day.

Eucreas, a diabetes drug, and Travatan, which is used to treat ocular hypertension and glaucoma, one of its complications, are just two examples of many drugs that pharmacists report as being in short supply. A survey of 400 pharmacists for the magazine Chemist and Druggist found that 67% of pharmacists have to wait for up to three days or more for an emergency stock delivery, and that 84% are very concerned about patients being adversely affected by shortages. Some 18% said that they spend over five hours a week trying to get hold of stocks of drugs. The estimated cost for pharmacies across England, according to Lloyds pharmacies, is approximately £39 million lost in staff time, which could be better spent on patient care and public health interventions. Most worryingly, nearly 60% of pharmacists think that the situation will worsen over the next year, and 45% know a patient whose health has suffered owing to shortages, sometimes so badly that they have had to be hospitalised.

The consensus is that the problem lies not with the amount of drugs being manufactured in the United Kingdom, but the fact that some of the drugs intended for the United Kingdom are being exported for profit. Medicines in countries such as Germany can fetch up to four times as much as they do in the United Kingdom. There are other reported problems in the supply chain, including inaccurate quotas and manufacturers trading only with a limited number of wholesalers.

It is imperative that the Minister ensures that there is a full and frank exchange of information between chemists, pharmaceutical companies and wholesalers. Pharmaceutical companies are making enough medicines to supply demand in the United Kingdom. We need to ensure that they reach those who need them. We need the Government to set out a clear timetable for action to show that they are tackling the issue. It is clear that the guidance published last year was not sufficient to end the shortages. I hope that it will not take the death of a patient to lead to some change.

Before concluding, I want to highlight the important work being done in the city of Leicester. I want to thank my local GP, who initially diagnosed my diabetes, as I have said, in a chance test in his diabetes awareness surgery. He now heads the clinical commissioning group for Leicester. Professor Azhar Farooqi has provided real leadership on this issue. There is also a clutch of local distinguished academics, including Professor Khamlesh Khunti and Professor Melanie Davies from the university of Leicester. There is also Professor Joan Davies from De Montfort University, which, under the dynamic leadership of Professor Dominic Shellard, the vice chancellor, has designed the first artificial pancreas, which was viewed only two weeks ago by Her Majesty the Queen. Leicester will soon have its own centre of excellence for diabetes—the first.

In recent months diabetes campaigns have achieved much success in raising awareness of the issue. I would like to commend the work of Diabetes UK, led by its chief executive, the noble Baroness Young, and particularly her Feet First campaign, in co-operation with the Society of Chiropodists and Podiatrists. The all-party group on diabetes, led ably by my friend, the hon. Member for Torbay (Mr Sanders), has done excellent work, especially on regional variations in care. I would also like to congratulate the International Diabetes Federation and its president, a Brit, Sir Michael Hurst, and vice-president, Anne-Marie Felton, on their tireless efforts to raise the profile of the illness globally and whom we have partly to thank for international successes such as the recent EU diabetes resolution.

In my constituency, I want to pay tribute to Silver Star, a registered diabetes charity that, through its mobile units—Merlin, Dorothy and Amanda—in the United Kingdom and in Goa in India, has been able to raise the awareness of diabetes among the south Asian communities. I also want to thank the Minister for the work he has done on diabetes. I think that he has done more than any other Minister in the 25 years I have been in the House in trying to raise this issue and deal with the problem. I thank him most sincerely for what he has done.

Diabetes is an epidemic that can have devastating consequences, and it is on the rise, but we are not powerless in the face of it. With the right care and proper management, diabetes can be controlled and often prevented. Complications and expense can be minimised. Having the right drugs is as important as the Government acting quickly to deal with shortages. We need investment in prevention and in specialist multi-disciplinary teams. We also need firm action to tackle the unhealthy food and drink industries. We must ensure that regional inequalities improve, not worsen, under the changes that are being made. If we do that, it will not only save the NHS billions of pounds but, much more importantly, save thousands of lives.

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate the right hon. Member for Leicester East (Keith Vaz) on securing this debate and on making such an effective and compelling case for raising awareness of diabetes and preventing, postponing and better managing the condition. I know of his personal experience and the leadership that he has shown in his constituency and in the House on these issues over many years. The centre of excellence that he talked about is there as a testament to his determination to make this happen, and I pay tribute to him for that. He rightly paid tribute to the work of the all-party parliamentary group and, in particular, my hon. Friend the Member for Torbay (Mr Sanders), who has proved an excellent chair of the group and has done some excellent work, as the right hon. Gentleman described.

The case for action is absolutely compelling. As the right hon. Gentleman said, the number of people with diabetes is rising, with profound effects on their quality of life. As he rightly said, there are huge health inequalities, for which some of the most deprived and excluded pay the highest price. It is therefore a big responsibility for any Government to tackle these issues. The costs to our society and to the NHS are substantial.

We currently have the most accurate picture ever of the state of diabetes care in England, with the national diabetes audit, the detailed analysis by the national diabetes information service and the atlas of variation, all serving to expose an unjustifiable variation in the levels of care and treatment from one postcode to another—the classic postcode lottery. We now plan to go further in providing more information than ever before by publishing a specific themed atlas on diabetes, which will prove to be an invaluable tool for commissioners and campaigners, and patients and carers, to use to make sure that we get the very best diabetes care in every part of England.

The data show that there has been significant progress, but, as the right hon. Gentleman says, there are still shocking, inexplicable and unjustifiable variations that we have to bear down on. We know what works at three levels—population-level interventions, targeted interventions, and what can be done better to manage the condition. Let me go through what we are doing in those contexts. First, it is vital to raise awareness among the population. The right hon. Gentleman and other hon. Members, the NHS, and other organisations—including, in future, Public Health England—have an important role in raising overall awareness. Supporting healthy behaviours that improve the population’s health is absolutely key to successful prevention. We need to tackle the main risk factors that are particularly relevant to type 2 diabetes.

One of the key strands from the Government’s point of view is the work done through Change4Life, which has a clear focus on maintaining healthy weight and increasing levels of physical activity, as that is very important in addressing obesity. That also requires much more effective collaborative working between local authorities and the NHS to ensure that we exploit the full range of levers that local authorities have in making a real difference in those two areas. Our planned health and wellbeing boards will provide a new and important lever for driving improvement on the public health side.

The right hon. Gentleman talked about other interventions. We are addressing this through our public health responsibility deal. Some of these issues are not about regulation but getting the relevant industries to move further and go faster, and that has already borne fruit, not least in reducing trans-fats in products. I appreciate his welcome for the comprehensive approach that the Home Secretary outlined today with regard to reducing alcohol harm—the harm that it does to the individual and the harm that its effects can have on others on our streets—and the decision to move, after consultation on the details, towards minimum unit pricing. The right hon. Gentleman is right that that can have a profound effect, not just on liver disease, but on many of the other aspects that we are discussing.

The second area is targeted interventions. The right hon. Gentleman rightly raised the importance of NHS health check and of targeted interventions for high-risk people. We can reduce and even reverse the worst effects of diabetes if we are effective in identifying at an earlier stage those who are at risk. That is why risk assessment and diagnosis are essential to the strategy that has been in place for some time. It is important to identify more people at an earlier stage and to give them the messages and support that can enable them to mitigate the worst effects of diabetes. The national roll-out of NHS health check is a key component in that. We have signalled our determination, through the NHS operating framework, to ensure that that continues.

The proactive identification of people who are at risk of vascular diseases, including diabetes, is key. The right hon. Gentleman mentioned that that covers a population of people from 40 to 75 years of age. I can tell him that in some parts of the country, high-risk individuals are being targeted specifically—for example, those in the south Asian population, where there is a greater risk of type 2 diabetes. We know that the risk in that population is four or five times greater than that in the European population. That will be reinforced shortly by the guidance that the National Institute for Health and Clinical Excellence is finalising on the detection and prevention of diabetes in high-risk individuals.

[Keith Vaz]

Will the Minister write to me, because he probably does not have the list with him, to tell me in what areas people are being targeted below the age of 40?

[Paul Burstow]

I will gladly do that.

Accurate and timely diagnosis is key, but diabetes can be hard to spot and some of its symptoms, such as extreme tiredness and weight loss, can be attributed to other diseases. Again, NICE has produced advice on preventing adult pre-diabetes and on early detection. It is key for GPs and others to be more effective at early diagnosis. The national clinical director for diabetes, Rowan Hillson, has been supporting that work to raise professional awareness, which is critical.

The third area is long-term management and self-care. There has to be a team effort across primary and secondary care, and the patient has to be at its centre. A person with diabetes must know how to spot and report changes in their health that might result in serious complications with life-changing or even life-shortening consequences. Integrated multi-disciplinary care is crucial to delivering the best outcomes in diabetes.

I will give a couple of examples that pick up on the right hon. Gentleman’s references to the scandalous picture in respect of amputations in England. He rightly rehearsed the variations from one part of the country to another, which are inexplicable and shocking. On average, 73 amputations take place every week, but eight out of 10 of those operations are unnecessary because they could be prevented simply by following what we know works. It is critical that we get that message out and translate it into practice by clinicians. For example, we know that when a foot care team is established, which is a relatively modest investment, it can cause as much as a 50% drop in the rate of amputations. Such investments can release resources. That is why they are part of the quality, innovation, productivity and prevention work and the Nicholson challenge, which the right hon. Gentleman talked about.

There is also room for further progress in the use of insulin pumps, which are particularly relevant to type 1 diabetes. They provide for the slow release of insulin. The NICE guidance clearly recommends the use of insulin pumps for type 1 diabetes when daily injections are not working, and yet many primary care trusts are dragging their feet and not making pumps available. That is why we have established the NHS Diabetes insulin pump network and why it is oversubscribed for its first meetings, with more than 270 members. I think that it will prove an invaluable way of beginning to drive out unacceptable practices. We are also auditing the availability of insulin pumps so that we can identify where use is not adopted properly.

[Keith Vaz]

I obviously welcome what the Minister says about pumps. Will he also deal with the issue of the shortage of medicines?

[Paul Burstow]

I am coming to that almost straight away.

I welcome the fact that there will be a type 1 diabetes parliamentary lobby by the Juvenile Diabetes Research Foundation in the next month or so to highlight some of the relevant issues.

Population levels, targeting, and management and self-care are all critical, and I want to say a bit about what we are going to make happen. First and foremost, NHS Diabetes leads on improvements, spreads best practice, supports professionals and develops professional networks of the type that I have described. The national service framework for diabetes is reaching the end of its life, and we now need to set new ambitions and new directions towards making the further progress that the debate is highlighting the need for. That will be reflected in both the new cardiovascular strategy and the long-term conditions strategy, which the Department is working on in collaboration with many other stakeholders.

We also need the system to be supported by incentives such as payment by results. That was why we rolled out new tariffs last April to recognise paediatric diabetes care as a discrete specialism, and why we will continue to develop tariffs to support best practice.

The right hon. Gentleman asked about Eucreas, which is a glucose-lowering drug. It is composed of two drugs, metformin and vildagliptin, and I understand that although there may well be supply problems with the combined drug, the industry is not aware of any supply problem with the two separate tablets. I will gladly write to him about that in further detail, but that is what I have learned about that drug so far.

More generally, the Department is working to address the issue of parallel exporting of UK medicines in conjunction with the Medicines and Healthcare products Regulatory Agency and the pharmaceutical supply chain, to ensure that medicine supplies are not compromised and we do not have the tragedies to which the right hon. Gentleman referred. I will write to him about the progress of that work.

The right hon. Gentleman also asked about Copenhagen. I look forward to the opportunity to meet colleagues to share best practice and learn about it from others.

As the right hon. Gentleman says, diabetes is a complex, lifelong, progressive condition. When it is well managed, with the right education and support, it is possible to prevent the most severe, sometimes fatal complications. We have the data to guide us and the evidence of what works, and we have the economic case. We are setting our strategy with the ambition of making even more progress. Now, we need commissioners and clinicians to act so that the best is not the exception but the norm across the national health service.

Question put and agreed to.

Health

Keith Vaz Excerpts

Wednesday 21st March 2012 Ministerial Corrections

Diabetes: Leicester

[Keith Vaz]

To ask the Secretary of State for Health what proportion of diabetes patients in Leicester City Primary Care Trust did not have a foot check in 2011.

[Official Report, 13 March 2012, Vol. 542, c. 185W.]

Letter of correction from Paul Burstow:

An error has been identified in the written answer given to the right hon. Member for Leicester East (Keith Vaz) on 13 March 2012. The exception rate in Leicester City was reported as 5.5% for DM09 and 5.5% for DM10. The correct figures were 5.2% and 5.2%.

The full answer given was as follows:

[Paul Burstow]

There are two sources of data for assessing the extent to which foot checks are provided: the National Diabetes Audit and the Quality and Outcomes Framework (QOF) achievement data.

The National Diabetes Audit shows that, from data received by 92.3% of practices, 18.3% of diabetics registered in Leicester City Primary Care Trust (PCT) did not have a foot check.

The QOF indicators for diabetic foot care in 2009-10 were as follows:

DM09: The percentage of patients with diabetes with a record of the presence or absence of peripheral pulses in the previous 15 months; and

DM10: The percentage of patients with diabetes with a record of neuropathy testing in the previous 15 months.

According to Leicester City PCT's QOF data for 2009-10, for DM09 the average underlying achievement for practices in the PCT was 89.5% and for DM10 89%. Underlying achievement means the percentage of eligible patients (excluding those who were excepted from the indicator) who received the checks. This indicates that for DM09, 10.5% and for DM10, 10.6% of patients (excluding those who were exception reported) did not receive the checks. The exception rate in Leicester City was reported as 5.5% for DM09 and 5.5% for DM10.

The differences in results between the audit and QOF may be ascribable to variations in scope and data assessment methodology. We are working with stakeholders to understand the reasons for the differences and to identify what needs to be done as a result.

The correct answer should have been:

NHS Risk Register

Keith Vaz Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Andy Burnham]

They should be judged on their merits, but let me say that it was the Labour party that introduced the Freedom of Information Act, so we will take no lectures from the hon. Gentleman. As I will explain in a moment, we did publish risk registers under freedom of information rules, so let us keep the high horse out of today’s debate, if he does not mind. We were used to hearing pious lectures from Liberal Democrat Front Benchers on openness, transparency and how the supremacy of freedom of information trumped everything else, and we heard from Conservative Front Benchers that sunlight was the best disinfectant, but that all seems a long time ago. We now have the sorry spectacle of Government Members on both Front Benches defying a clear ruling by the Information Commissioner and taking it to a tribunal hearing early next month. This action raises serious questions on what precisely is the Government’s policy on these matters, as there is a real danger that it will look confused and contradictory. A search of the Treasury website brings up a clear statement of policy on the Government’s principles for risk management. It states:

“Government will be open and transparent about its understanding of the nature of risks to the public and about the process it is following in handling them. Government will make available its assessments of risks that affect the public, how it has reached its decisions, and how it will handle the risk. It will also do so where the development of new policies poses a potential risk to the public.”

That is the statement of the Government’s policy as it stands today. Why on earth are they not following it?

[Keith Vaz (Leicester East) (Lab)]

I declare my interest. I remind my right hon. Friend that yesterday statistics were published showing that 1.3 million diabetics had not had their annual checks. It is important that we have this information on the risks posed to diabetics by the new commissioning arrangements. Does he not think that that is an argument for full transparency?

[Andy Burnham]

My right hon. Friend eloquently makes the point I made at the beginning of the debate: people with long-term conditions, such as diabetes, who depend utterly on the NHS have a right to know whether there is any risk to the continuity or integration of the care they receive. I understand that representatives of patient groups, who perhaps have not been heard enough in this debate, made that point directly to the Prime Minister on Monday. It is absolutely essential that their voice is heard. They say that the Bill represents a danger to the integrated care that they receive and depend upon. It seems pretty clear to me that the Government are not following their own policy—[Interruption.]