HL Deb 25 May 2000 vol 613 cc873-6

11.21 a.m.

Earl Howe

asked Her Majesty's Government:

Whether the quality of services provided by the National Health Service to patients with diabetes is satisfactory.

Lord Hunt of Kings Heath

My Lords, we are developing a national service framework for diabetes to raise the overall quality of services and reduce unacceptable variations of the type highlighted in the Audit Commission's recent report.

Earl Howe

My Lords, I thank the Minister for that reply. Is he aware that diabetes now affects at least one in every 30 of the population and that, according to the recent report by the Audit Commission, the cost of diabetes to the NHS is probably around £2 billion a year? Is the noble Lord further aware that the incidence of diabetes looks set to double over the next 10 years? What will the Government do to ensure that there are enough consultants and specialist nurses and podiatrists available to meet the steeply rising levels of demand for diabetes care?

Lord Hunt of Kings Heath

My Lords, the noble Earl is right to draw attention to the major impact which diabetes has on the health service. I understand that the figure is 1 in 40, about 1 million people. There are differing views on that. I also understand that diabetes and its implications in terms of other diseases accounts for 9 per cent of healthcare costs. Clearly diabetes is a major priority. I assure the noble Earl that, in addition to mapping out the services we need to develop in the health service, the national service framework will consider carefully workforce implications.

Lord Harrison

My Lords, when drawing up the review and framework, will the Minister recognise the problem as regards the diet provided in prisons for insulin dependent and non-insulin dependent diabetics who are detained at Her Majesty's pleasure? It is often unsatisfactory and inconsistent with the therapy for diabetics.

Lord Hunt of Kings Heath

My Lords, I am interested in my noble friend's point. A joint unit within the Department of Health and the Home Office is concerned with the effectiveness of medical services within prisons. I shall ensure that that point is considered.

Lord Clement-Jones

My Lords, clearly diabetes should be a major priority, in particular because in its late onset form it leads to heart disease. The Audit Commission's report referred to specialists. It is clearly a key issue which the Government need to resolve now and in the future.

In their announcement on 6th April of more specialist consultants, why was no mention made of more diabetes specialists? Will the new national workforce development board have the resources and authority to ensure that there are adequate diabetes specialists?

Lord Hunt of Kings Heath

My Lords, the history of the NHS demonstrates that plans as regards the workforce never match the service needs. There has often been a mismatch between the priority for services and the number of doctors, nurses and other staff available. We are determined to put that right through the workforce planning mechanisms that we have developed. The national service framework gives us the opportunity to consider the implications of developing the service in the ways recommended and ensuring that we have the workforce that matches service requirements.

Lord Astor of Hever

My Lords, is the Minister aware that the incidence of diabetes is particularly severe among ethnic minorities? What plans do the Government have to address this issue?

Lord Hunt of Kings Heath

My Lords, the noble Lord is right. The prevalence among black and minority ethnic groups is considerable. Local studies show that diabetes is three to four times more prevalent among, for instance, south Asians than the remainder of the population. The prevalence is similarly high among African Caribbeans. Within the national service framework we are ensuring that that aspect is taken fully into account.

We are also aware of some interesting local initiatives. In particular the Bradford Health Action Zone is focusing on the issue. It ensures that, combined with users and all the statutory agencies, there is an effective service to deal with that problem.

Lord Patel

My Lords, is the Minister aware that one of the areas of concern highlighted in the Audit Commission's report is the present system of payment for GPs? It is linked neither to the quality nor volume of the diabetic services. Early diagnosis of hypertension retinopathy fails and complications develop. Will the Government consider that issue in relation to the national service framework?

Lord Hunt of Kings Heath

My Lords, yes, there is no doubt that primary care is very important. The Audit Commission indicated that 4 in 10 GP practices lacked referral guidelines on diabetes. In many places the chronic disease management programme, to which the noble Lord refers, is not working effectively. I believe that the national service framework—it is co—chaired by the President of the Royal College of General Practitioners— will ensure that much focus is given to improving the delivery of services within primary care.

The Lord Bishop of Hereford

My Lords, have the Government any plans to introduce or increase the use of preventive measures? I refer, for example, to the identification of patients with a family history of diabetes who could be given the glucose tolerance test. The incidence and onset of diabetes could be deferred or avoided, saving great costs in the long run.

Lord Hunt of Kings Heath

My Lords, these are all matters which the national service framework will need to consider. The National Screening Committee has recently completed a project on screening for diabetic retinopathy. Ministers will receive that report shortly. That, too, will be considered by the national service framework.

One factor which may underlie the rise in diabetes is the sedentary life of many people in this country. Proposals within Our Healthier Nation publication to encourage people to lead more active lifestyles should have an impact on the issue.