Health: Diabetes

Lord Harrison Excerpts

Tuesday 19th March 2013 Grand Committee

[Lord Harrison]

My Lords, it is a great pleasure to follow the noble and learned Lord, Lord Morris, who is a distinguished member of the All-Party Parliamentary Group for Diabetes, so admirably led by our colleague in the Commons, Adrian Sanders.

The noble and learned Lord highlighted the amount of money being spent on type 1 and type 2 diabetes, which is familiarly known as some £10 billion a year, but evidence from a European study that I am going to quote in a minute suggests that it could be nearer £14 billion a year. This illustrates the theme of the noble and learned Lord, Lord Morris, that there is a large degree of uncertainty about the knowledge and facts that we have in this field and it is something we need to repair, which I will turn to shortly.

Having said that, we should have an update on the debates we have had in the past with regard to the treatment of diabetes. It is an odd circumstance that as diabetes becomes an epidemic in this country it has been largely neglected. Much more concentration has been on the repair of cancer or the attack on heart diseases and so on. I do not know whether the Minister has a reply to that but it is something that we need to turn our attention to.

I am very grateful that the Government have reiterated their desire to maintain the same levels of health spending as in the past. Nevertheless, cutbacks are beginning to happen. One of the most worrying themes, which I hope the Minister will address, is the decline in the cover of diabetics. We are beginning to lose the annual check-up, which is typical of what we have had. There is a tilting over to relying on the patient to bring to the attention of the GP a problem for the GP to refer on. The problem with that is that it is the middle-class, knowledgeable patient who understands that—so often at the cost of neglecting those who do need the annual check-ups and the variety of check-ups that were put in place by the previous Labour Government.

I encourage the Government to spend wisely. For instance, I have made this plea before about the DAFNE programme, which provides structured educational courses for type 1 diabetics. It is claimed, and I believe it may be true, that it pays for itself in four to five years, but it is not generally applied throughout the United Kingdom and that is a bad thing.

The general rush to do away with bureaucracy sometimes has a fatal element to it. I saw one of my many health advisers on Monday and at the end of the consultation she looked at the screen and said, “We no longer have the appointments done elsewhere and a paper notification for you”. She has to do it. It took her about six minutes, typing away. Of course, she is taking on administrative duties that take away from her skills at the coal face. I hope that the noble Earl, Lord Howe, will ensure that we leave the bureaucracy to the bureaucrats and that the health specialists have the opportunity to do what they do best.

I want to turn to a study by LSE Health at the London School of Economics, Diabetes Expenditure, Burden of Disease and Management in 5 EU Countries, which was published last year. It makes very informative reading. Noble Lords will know that I am a passionate pro-European. One reason for that is the ability to compare and contrast the practice of the 27 countries of the European Union. This is a study of the five biggest countries, but it offers us insights that we can adopt and adapt here, or which they can adopt and adapt in their countries.

I was surprised to note that the study firmly declared that blood glucose monitoring is a cheap and hugely effective way of ensuring the health of diabetics. The Minister will recall arguments we have had in the past over testing strips, for instance. He will remember that he responded to a debate in which I tried to highlight diabetic foot care, which I have always thought was quite expensive. I am clad in shoes which are appropriate for my very strange feet as they give protection which enables me to continue to do the kind of stuff I am doing, as is the case with thousands of other diabetics throughout the United Kingdom. I know that the noble Earl is familiar with these debates. I sometimes think that he has been answering them since the time of Galen.

The study looks at Germany, the UK, France, Italy and Spain and quantifies evidence and data. It notes:

“There is increasing concern amongst government officials and public health agencies about diabetes care in Europe. Both diabetes prevalence and spending appear to be increasing. … Diabetes prevalence has been increasing steadily over the past two decades, along with an aging European population, increasing, high obesity prevalence and changing ethnic make-up. This study estimates that Germany has the highest diabetes prevalence at 8.9%, followed by Spain (8.1%), France (6.4%), the UK (6.1%) and Italy (4.8%)”.

It is interesting to ask why these differences arise. The study continues:

“Only three countries have national diabetes programmes”.

I am glad to say that that includes the United Kingdom, along with Italy and Spain. The study notes that France’s programme,

“has not been operational since 2005”.

It continues:

“Germany has Diabetes Disease Management Programmes (D-DMP), however, not all patients with diabetes are registered. None of these strategies have hard targets to achieve ideal diabetes management”.

It would be interesting to learn more about that. In 2009, the United Kingdom introduced screening for high-risk patients. We have done well in regard to screening for retinopathy. It is imperative to maintain that momentum.

The study states:

“All countries have care guidelines, the UK’s being the most prolific, but none have guidelines written for patients”.

That is interesting. I wonder whether we can elaborate on that as I am not sure that that has been adequately dealt with. I have mentioned the DAFNE and DESMOND training protocols. The study continues:

“None of the governments collect diabetes spending accurately”.

There is no doubt about the difficulty of doing that because it is such a complicated matter. The study estimates that,

“in 2010, the direct cost burden of people with diabetes was highest in Germany … at €43.2 billion, followed by the UK (€20.2 [£13.8] billion), France (€12.9 billion), Italy (€7.9 billion) and Spain (€5.4 billion)”.

There are some strange discrepancies there which might be worth looking at.

I would like to draw your Lordships’ attention to other facts and figures but we need improved diabetes data so that we can construct more useful policy initiatives. The study has very little information on the indirect costs of diabetes. Can the Minister provide information on that?

I am coming to a close and should say that only France, Italy and the UK regularly collect and publish monitoring data. France did so intermittently, in 2001 and 2007. Thankfully, Italy and the UK do so annually but that is apparently not the case in Germany. Other elements in the collection of data are missing or overlooked and ought to be repaired. My general plea is—to embellish what the noble and learned Lord, Lord Morris, has said about spending—let us look and learn from our neighbours and improve what we can, but there has to be a fundamental drive towards better knowledge and data on type 1 and type 2 diabetes; otherwise, we will fail and misdirect the funds available to us in battling a disease that has become of epidemic proportions.