Diabetes and Coronary Heart Disease (Hansard, 24 January 2002)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, there is a close association between diabetes and cardiovascular disease, including coronary heart disease. The Diabetes National Service Framework Standards for England, published last month, highlight the importance of common strategies for prevention and treatment.

§ Baroness Cumberlege
My Lords, I thank the Minister for that reply. Is he aware that on average it takes between nine and 12 years to diagnose someone with type 2 diabetes, the form suffered by the vast majority of those affected, by which time as many as half will suffer complications such as cardiovascular disease? Given the financial and human costs of that late identification, can the Minister give an assurance that when the second part of the National Service Framework relating to diabetes is published, it will include targeted and systematic screening of those most at risk?

§ Lord Hunt of Kings Heath
My Lords, I certainly agree with the noble Baroness that it is very important to put firmly into place a preventive strategy. She will know that the first set standard, which we published in December, refers to a preventive programme. I am aware of the view that a targeted approach to screening may be the best way forward. We have a national advisory committee in place in the form of the UK National Screening Committee whose job is to assess the benefits and disbenefits of such screening. We have referred the very matter raised by the noble Baroness to that committee. It is looking at an integrated approach to the identification of those at the highest risk of developing type 2 diabetes and it is expected to report to the department in 2005. More generally, I agree with the noble Baroness about the need for proactive action on prevention.

§ Lord Harrison
My Lords, I congratulate the Government on the establishment of the National 1569 Service Framework. But can my noble friend say whether in the important delivery paper that will come next summer there will be established minimum staffing levels? Will we promote local leadership and, most important of all, will we provide the finances required to ensure that the NSF is carried through successfully?

§ Lord Hunt of Kings Heath
My Lords, my noble friend is right to refer to the importance of the delivery strategy because it will set out the conditions under which we shall deliver the standards we have set out in the paper published last December. I cannot comment in relation to resources because that is a matter being considered as a part of the discussions being held on the next spending review. However, I understand the importance of investment in this programme. I also accept the point made by my noble friend in relation to local leadership. We would expect the primary care trusts, which in the future will take on much of the burden of NHS commissioning, to be very exercised as regards the need to give that leadership.

§ Lord Clement-Jones
My Lords, the National Service Framework is already overdue by a year or more. Can the Minister try to ensure that the implementation date for the NSF is brought forward?

§ Lord Hunt of Kings Heath
My Lords, the noble Lord will know that we have stated that the 10-year implementation programme would start in April 2003. I think it is important to allow the service to digest the results of Part 1, which sets the standards, so that when it comes to starting up the implementation programme everything will be in place. We can then be assured of success in the delivery of the programme. More generally, the question of local delivery and the involvement of primary care—primary care will play a major part in this—is crucial. I think that it is right for us to spend time making sure that primary care is in the right condition to take forward the strategy.

§ Baroness Masham of Ilton
My Lords, does the Minister agree that diabetes can trigger many complications involving the eyes, legs, feet, kidneys and other organs? Does he further agree that the specialist units carry out a marvellous job? It is extremely important to ensure that trained nurses are involved in the care of those with diabetes and that they can go out into the community.

§ Lord Hunt of Kings Heath
My Lords, I certainly agree with the noble Baroness on the points she has made. Specialist services have a major role to play and we are committed to ensuring that, under the new arrangements for the NHS being taken forward, there are arrangements for the commissioning of specialised services. Equally I believe that much of the action will be undertaken at the local level; that is, within primary care. We are looking to primary care to take a leadership role in this area.

§ Lord Rea
My Lords, does my noble friend agree that there is a very strong association between type 2 1570 diabetes and obesity, and that there is also a link between obesity and coronary heart disease—partly through the same mechanism which causes type 2 diabetes? Does he further agree that obesity is one of the major public health problems facing this country, with very rapid increases due to our more sedentary lifestyles, increased mechanisation and better heating in homes, as well as a far too high proportion of calories from fat in our diet? Do the Government have those priorities in mind?

§ Lord Hunt of Kings Heath
My Lords, yes. Obesity is one of the issues that we in the Department of Health are attacking with vigour. This problem needs a cross-government approach because there are various elements to tackling obesity, including the encouragement of greater physical activity. To that end, along with our colleagues in the Department for Education and Skills, we are encouraging school travel plans which encourage children to walk and cycle to school. We have introduced a national schools fruit scheme which is being piloted in the West Midlands. The scheme enables children in infant schools to have one piece of fruit per day. Indeed, only a few months ago the National Audit Office published a report on tackling obesity in England which we are now considering as a part of taking forward an obesity strategy.

§ Lord Chan
My Lords, can the Minister give an assurance that those ethnic minorities which comprise high risk groups, suffering up to six times the average incidence of diabetes and coronary heart disease, will also form a part of the new plans for treatment?

§ Lord Hunt of Kings Heath
My Lords, I understand that type 2 diabetes is up to six times more common in people of South Asian descent, and up to three times more common in those of African and Afro-Caribbean descent. It is also more common in people of Chinese descent, as well as in other non-white groups. That is a very significant set of statistics. I can assure the noble Lord that reducing inequalities will be a key underlying principle, both in terms of the standards that we have already produced and in relation to the implementation programme which will follow in Part 2 of the National Service Framework.