Health Bill

Lord Rennard Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

Moved by

[Lord Rennard]

12: Clause 4, page 3, line 29, at end insert—
“(c) reduce inequalities in the prevention, diagnosis and treatment of diabetes, including variation in access to structured education, glucose monitoring technology and insulin pump therapy.”Member's explanatory statement
This amendment would make diabetes-related health inequalities an explicit, named consideration within the Secretary of State’s general duty to reduce inequalities, rather than leaving diabetes provision to be addressed only implicitly.

[Lord Rennard (LD)]

My Lords, my father might be considered to have been lucky in that, despite losing a leg in the First World War and developing diabetes in the 1920s, that was the decade in which insulin was developed, and it saved his life. His treatment with insulin was so successful that it enabled me to be born in 1960, when he was over 70. When I developed diabetes myself in my 30s, it got way out of control, and I needed daily insulin injections for 20 years. But with great support from St. Thomas’ Hospital, making major lifestyle changes, obtaining a continuous glucose monitor, and being prescribed Mounjaro, I was able to come completely off insulin two years ago. My long-term blood sugar levels have now fallen to just 41 millimoles, which is below the pre-diabetic range.

But many people are much less fortunate than me and do not get the care I do. The prevalence of diabetes is increasing. Over 4.6 million people in the UK live with a formal diabetes diagnosis, and that is predicted to exceed 5 million very shortly. An estimated 1.3 million people are living with undiagnosed type 2 diabetes, while 5.7 million adults in England live with pre-diabetes. In total, more than 12 million adults, one in five, are living with diabetes or pre-diabetes. The direct cost of diabetes care to the NHS has been estimated at £10.7 billion per year, representing around 10% of the entire NHS budget. When indirect impacts are included, total costs exceed £23 billion to £26 billion annually. Diabetes UK estimates that this will surge to between £39 billion to £44 billion per year by 2035 if current trends continue.

Most damningly, 80% of this vast expenditure is spent not on proactive care but on treating people with largely preventable complications. Every week across the UK, there are many preventable complications arising from diabetes: on average, 812 strokes, 568 heart attacks and 2,909 cases of heart failure. In England alone, there are more than 160 lower-limb amputations every week, four out of five of which could be avoided with timely high-quality care. People with diabetes occupy one in every six hospital beds, and diabetes is taking a severe toll on economic productivity. The more than 360,000 working-age adults living with diabetes are now economically inactive due to long-term sickness, a 43% increase in seven years. We cannot continue to address this crisis with short-term financial thinking. Treasury models such as those we are hearing much about today too often demand short-term savings within tight budgetary cycles, ignoring the immense long-term savings that could result from preventing complications.

Nowhere is this short-termism more evident than in the unwarranted regional variations and postcode lotteries exposing vulnerable patients across our health system. The flagship Getting It Right First Time national report on children and young adults, published this year, reveals alarming disparities across England’s integrated care boards. For the 56,000 children and young adults living with type 1 diabetes and the 9,000 with early onset type 2 diabetes, median blood sugar control ranges from just below 55 in top performing units to over 70 in others. While some paediatric units complete all essential annual care checks for 98% of young patients, others achieve just 6%. Patients are literally forced to move house across ICB boundaries just to access life-changing technology.

We now possess transformative tools that can eliminate these disparities if made consistently available. Continuous glucose monitors, or CGMs, have reached over 60% of people with type 1 diabetes, yet access remains quite restricted for those with type 2 diabetes who, like me, could benefit from them immensely. Similarly, while over half of children with type 1 diabetes now use hybrid closed loop systems, known as artificial pancreas systems, overall adult pump provision in the UK stands at just 15%, compared to over 60% in the United States and far higher rates across Europe. Furthermore, for those under 18, hybrid closed loop uptake ranges from 37% to 79% across different ICBs.

Equally vital is the issue of early diagnosis, intervention and specialised care. Currently, 25% of individuals with type 1 diabetes and up to 30% of children and those from deprived backgrounds are diagnosed with diabetes only when presenting in emergency departments with life-threatening diabetic ketoacidosis, known as DKA. Evidence from Germany demonstrates that systematic early screening reduces DKA presentation rates from 30% down to just 2.5%.

Likewise, we must confront the alarming rise of early-onset type 2 diabetes among working-age adults and under-40s. As we approach yet another major NHS reorganisation, we need to guarantee long-term sustainable funding for targeted initiatives such as the NHS T2Day programme and the type 2 diabetes path to remission programme, while rolling out at greater pace GLP1 medication supplies, such as Ozempic and Mounjaro, for many more people with diabetes.

This brings me directly to the amendments tabled in my name after Clause 84. If we plan to abolish NHS England, we must address a critical moment of vulnerability for our public health infrastructure. My first amendment would establish a statutory requirement for the Secretary of State to secure the continuity of key national diabetes programmes to at least the same extent as before the potential abolition of NHS England. This encompasses the NHS diabetes prevention programme, the type 2 diabetes path to remission programme, national provision of continuous glucose monitors, the rollout of hybrid closed-loop technology, and essential diabetes audits, including those for foot care and in-patient safety. It would require an explanatory statement on continuity before making any transfer schemes, alongside annual mandatory reports laid before Parliament, detailing patient access, waiting times and clinical outcomes.

My second amendment would require the Government to publish annual assessment reports over the next four years, specifically evaluating the impact of NHS England’s abolition on diabetes services. These reports must scrutinise changes in funding allocations, the operation of clinical audits, patient access to glucose monitoring and insulin delivery services, as well as specialist workforce capacity.

Consistency in high-quality care, equitable access to modern technology, robust prevention and early diagnosis are not luxury add-ons; they are the essential building blocks of a sustainable healthcare system, a productive economy and a healthy society. I therefore hope that the Minister will see how these amendments would protect national diabetes services, enforce parliamentary accountability and ensure that we give millions of people living with diabetes the care they need, which is very much in the national interest. I beg to move.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am most grateful to the noble Lord, Lord Rennard, for tabling this amendment, and to other noble Lords for their contributions. The Government recognise the importance of high-quality diabetes prevention, treatment and care services, and I believe that our actions on this reflect that. Programmes such as the NHS Diabetes Prevention Programme, the NHS Type 2 Diabetes Path to Remission Programme and the National Diabetes Audit all play an important role in improving outcomes for people living with diabetes.

I turn specifically to Amendments 225 and 226. The Bill allows for the transfer of functions and responsibilities from NHS England following its abolition—that means a transfer that will not impact service provision. I say to the noble Earl, Lord Howe, that the Government support effective diabetes services and innovations in various ways, but that includes ensuring the continued commissioning, monitoring and improvement of these programmes without the need for disease-specific provisions in primary legislation. Moreover, specifying programmes at this level of detail would restrict our ability to adapt to new and changing evidence on effective treatments and technologies; I know that is something noble Lords would not want to restrict. Similarly, a diabetes-specific reporting clause would duplicate existing monitoring and oversight arrangements that provide additional assurance without adding administrative burden and additional bureaucracy.

To turn to Amendment 12, improvement of outcomes for people with diabetes absolutely includes reducing health inequalities, which we debated in an earlier group. That is already captured in the general duty to reduce health inequalities set out in Clause 4. Furthermore, the modern service framework for cardiovascular disease, which was published in July, advocates a holistic cardiovascular/kidney/metabolic approach, including finding those with undiagnosed or unmanaged diabetes, initiating treatment and increasing the number of people whose treatment is optimised, with a strong focus on reducing inequalities.

On Amendment 25, I reassure your Lordships that the Secretary of State and the NHS already have powers to promote innovation across the health service. The risk of singling out diabetes technologies in primary legislation is that it would create inconsistency with the approach taken for other conditions. Rollout of glucose monitoring and automated insulin delivery technologies is already supported through NHS implementation arrangements, based on established NICE guidance. Therefore, listing specific technologies in legislation could reduce the flexibility of the NHS to be as truly innovative as we would all want, as new technology emerges.

[Lord Rennard (LD)]

My Lords, I thank the Minister for her sympathy on these issues, and I thank all the people in her department, who I know are sincerely committed to trying to help people with diabetes, to help prevent its occurrence and to provide the best possible care and treatment. But at the heart of the problem, as the noble Lord, Lord Hunt of Kings Heath, said, is a dilemma: as people try to treat medical conditions such as diabetes differently and say there should be a localist approach, there is a fundamental problem for the whole of the country in that, if we fail to deal with this, the cost is on all of us. The costs to taxpayers, the costs of people not working, the costs of not paying to HMRC and the costs of drawing down on the DWP are growing enormously. This is such a huge problem that, as we have said at many points today, we have to look across all government sections at how we work together on all these issues. On that note, I beg leave to withdraw my amendment.

Amendment 12 withdrawn.