HC Deb 09 September 2003 vol 410 cc1-21WH

Motion made, and Question proposed, That the sitting be now adjourned.—[Margaret Moran.]

9.30 am
Mr. Deputy Speaker

Order. Before we begin our proceedings, I welcome hon. Members back from the summer recess, which I hope was enjoyable and relaxing for them all. We now proceed to the first debate in Westminster Hall since the House rose for the recess.

Dr. Ian Gibson (Norwich, North)

Thank you for your kind words of welcome, Mr. Deputy Speaker, which we extend to you. We hope that you will have a pleasant two weeks, recuperate and then come back again. I am sure that that will do marvels for your health.

Diabetes is a serious problem, as was underlined recently by a distinguished academic scholar and medical adviser to Governments, Professor Sir George Alberti. He said that we are heading for one of the biggest health catastrophes that the world has seen. He was referring not only to diabetes in this country, but to the spread of diabetes across the globe. He warned that the financial and social burden of the disease will be intolerable if Governments do not sit up, take notice and act now, not tomorrow.

More than 300 million people throughout the world have impaired glucose tolerance. That is a condition that precedes diabetes in which our bodies struggle against the increasing amount of sugar in the calorific foods that we are now subjected to and consume.

There are two types of diabetes. Type 1 generally strikes young people without warning and leads to lifelong dependency on insulin. Type 2 is strongly linked to diet and inactivity. It is estimated that that applies to about 90 per cent. of cases. It used to afflict people from middle age as they put on excess weight—we do not want anyone to be terrified or feel guilty, so let us keep the guilt out of this—but it is increasingly diagnosed in younger age groups, which has rung alarm bells. The couch potato lifestyle, TV viewing, lack of activity and junk food consumption fuel the obesity crisis that is sweeping the US, the United Kingdom and, indeed, the world. In Britain, 1.7 million people have diabetes. A further 2.1 million have impaired glucose tolerance and are at serious risk of diabetes, which eventually, in the worst cases, can cause blindness, kidney failure, nerve damage and be fatal.

As Alberti pointed out, the number of people in the world with glucose intolerance problems is expected to rise from 314 million to 472 million by 2025. He reckons that about 70 per cent. of them will develop diabetes. About 194 million people—roughly 5 per cent. of the world's population—have diabetes. Alberti estimates that the number will soar in developing countries as the unhealthy diet and urban lifestyles of our affluent world are exported to the developing world. In some of our ethnic minority groups, diabetes is running at close to 20 per cent. and it is estimated that that will increase to 30 per cent.

Enough of statistics—the severity of the problem is clear to people here. We are increasingly seeing a nation that is overweight and less active and there is no doubt that a correlation has been established between increasing plumpness, less activity and an increase in the risk of developing diabetes. About half the adults in Britain are recognised to be overweight and obese. Diabetes is a diet-related disorder and in a place such as this, one does not need to look far to see the possibility of obesity creeping in as the five-star restaurants increase in number. We should feel guilty about that. Westminster is a place where red fatties mingle with yellow fatties and blue fatties and they seem to enjoy the lifestyle. We do not set much of an example.

The cost of diabetes is estimated to be 9 per cent. of the national health service budget. In 2000, that was £6 billion. There are regional differences, of course, but huge sums have been estimated for the diagnosis and treatment of the problems that diabetes brings.

Yesterday, the head of nutrition at the Institute of Food Research in Norwich made a statement on Radio 4. I have to declare an interest, as I am a non-executive director of the institute. Professor Sue Fairweather-Tait said: The British population could miss out on opportunities arising from the current exciting era in nutritional science, including new tools for preventive health because there is no unifying champion for nutrition in the UK. We certainly need social and political actions in this country to tackle the problem of the increase in diabetes. We need to think about how good the scientific evidence is and how to handle it. We do not handle scientific information in the best way politically—there was a debate last night in the House about fluoride. We reject some things and we talk about dissidents, but good, proper analysis and the use of research help to establish good policies and social actions. It is known that there is a correlation between the onset and continuation of diabetes and obesity. There should be policies on the nature of the foods that we eat. I do not want to be negative because the Government have addressed the problem in many ways, but a strategic approach across Departments is needed. The purpose of the debate is to ask whether we are playing at it or whether we are serious about tackling the problem now.

We must start with children. Children's commissioners were discussed in the House yesterday as well as the problems of the abuse of children and of the system ignoring them. What children eat is equally important because their health is at stake. For example, sweet drink machines are allowed in schools. The companies that make sweet drinks are clever: they give schools money and install the machines in the school, and that may correlate with the instance of diabetes. There are alternatives such as fizzy and natural water.

The Government have introduced their five fruit policy and are looking at all the other issues such as those involving the NHS. Nutritionists are giving people non-Atkins diets. There is now a national debate about the type of foods that people eat, but it is always conducted in a disjointed way. That is why some of us are now keen on the idea of a new commissioner. Sue Fairweather-Tait was urged on the subject on Radio 4—I do not know whether it was Humphrys or one of the other nasty people that we all learn to love on Radio 4. It may be a bad day to have a commissioner, given that we have just had a debate about a new commissioner for children. I prefer to think of a food tsar or a fatty tsar—somebody who would co-ordinate all the activities across Departments, as has been done in cancer services, to ensure that every voice was heard and that our health would not be affected by the diets to which we are subjected.

Sue Fairweather-Tait has discussed the controversial area of the responsibility that lies with the food industry, the manufacturers, retailers and caterers, bearing in mind that their primary business is to sell food to consumers and to generate profit, rather than to improve the health of the nation. When the Government attempted to recommend a reduction in the amount of salt in diets, the food industry resisted that move. We may have to consider legislation and incentives to encourage the industry to become more proactive. It would be unfair to say that it is doing nothing. McDonald's is offering portions of fruit in a pack, which contrasts with the burgers and so forth. At least an attempt is being made by some parts of the industry to look at the problem.

I said something about the cost to the NHS, which is serious. We need a nationally co-ordinated policy across the health service, the Department for Culture, Media and Sport, the Department for Environment, Food and Rural Affairs and so on. We should ensure that everything fits together. It is not impossible to induce people to eat differently and think differently about their bodies. It can be done. We go through phases ourselves as adults, but young people are particularly vulnerable to advertising. They need activity that does not simply involve putting shorts on once a week or bringing in a sick note from their parents to excuse them from running around the playing fields.

Sport should be made enjoyable and should build team spirit. It should also make young people think about their bodies, and how they can live well, exercise well and enjoy life to the full. We must ensure that the facilities are there. We need leadership here and I look to the Government for that as they started the process. I want them to recognise that a national nutritional strategy must be more than just a talking shop. It should bring all the parties and stakeholders together. It must have strong objectives, accountability, good leadership and an appropriate level of resources.

Mr. John Randall (Uxbridge)

I suppose that I must declare an interest as someone who will not win the slimmer of the year award. The hon. Gentleman is a well known and distinguished scientist. Does he recognise that one of the problems for the layperson is that we get so much conflicting evidence, which can be almost sensational? We might hear on the "Today" programme, for example, that salt is good. The next minute it is bad. One minute red wine is good, the next it is bad. The public have become cynical about the information that they are given.

Dr. Gibson

That is true and it is not just about food that we get that kind of information. People get confused. Scientists cannot see things as black and white, yet the public are made to believe by the media that things are black and white. I am pretty sure that the sun will rise tomorrow morning in the place that it usually does, but a little part of me says that something might happen to change that. I do not want to make people panic, but who knows what can happen? The most difficult thing for scientists to say is, "We do not know. There is evidence for and evidence against."

At the end of the day people will judge for themselves. People live in a world where there are risks and they can make their own judgments on the balance of the evidence. Scientists must say, "We know this, we don't know that, but this is how we will find out." That is the purpose of this debate. The hon. Gentleman is dead right. In many areas of food science we do not know the answers. Not enough research is going on. Few research institutes in this country and the rest of the world are getting the funding to answer the questions. I will come to that in a moment when I talk about vitamins and the sort of research that we should be funding.

I said something about the joining up of Departments and the need to have some individual who pulls it all together—a tsar or tsarina—who takes the initiatives and brings the heads together to make it work. It has worked in other areas such as heart disease and mental health. When everyone from the patient groups right up to the consultants is brought together, they learn respect for each other and what they are trying to do.

I want to talk about vitamins and vitamin D in particular. I will do so in relation to type 1 diabetes in young children, because the subject correlates with many of the policies that we are trying to address in this country. Vitamin D is an important factor. It may not be the major cause of diabetes or many other illnesses, but it is a component in the chain that leads to it. Type 1 diabetes is becoming more frequent in every country—the incidence of such diabetes has doubled in 20 years. The annual rate, which is averaged over 44 centres in Europe, is now estimated at 3 to 4 per cent, and the rate for the zero-to-four-years age group is 6.3 per cent.

A recent editorial in The Lancet asked burning questions. It suggested that the coming together of several public health initiatives may have reduced children's vitamin D intake. Many of us will recall being battered successfully with vitamin D to prevent rickets, and we also remember that, after the war, cod liver oil and orange juice—renowned in many music hall songs—were given to people, including the young, to prevent the development of illnesses. There is a history of supplying vitamin D, and I believe that it would decrease the risk of diabetes.

We are advised to keep babies and toddlers out of the sun to prevent skin melanomas, and that is right. However, we should consider the other part of the argument, which is that people receive most of their vitamin D through an indirect process involving the sun's rays—from a certain wavelength of UV. It is essential that people get sun. It is ironic that, although we have just had one of the best summers for a long time and been battered by the sun, many people in this country do not get much sunlight between October and March. If we are encouraged to remain out of the sun, the vitamins that the body produces by a complex process—the vitamin D pathway—will be suppressed and we will not receive enough. Some evidence now suggests that diabetes is associated with such a phenomenon.

There are also biological and biochemical explanations of the effects of vitamin D on pancreatic cells. A mechanism involving the immune response, which is too detailed to address today, provides a basis for further research, and if there is a mechanism worth exploring, the public may want to know about it. Therefore, we must advise people on how long to be in the sun—it is simply part of the pattern of life and what we take into our bodies.

There is excellent evidence that a lack of vitamin D is associated with type 1 diabetes in young people. Ten thousand Finnish mothers and children took part in a study spanning 30 years, and diabetes development reduced by 80 per cent. for those given vitamin D in the form of cod liver oil in the first year of life. One isolated study is never enough but others have come to bear as well.

Tim Loughton (East Worthing and Shoreham)

I am fascinated by what the hon. Gentleman is saying, and he is approaching the matter with his usual scientific expertise. If there is a correlation with access to the sun, is there evidence that in countries that have shorter days and do not have hot, sunny climates, there is a higher incidence of diabetes in children? That would support the prognosis that he is putting forward.

Dr. Gibson

The hon. Gentleman has predicted the next study. There is very good evidence that in Europe, China and other countries, the incidence of type 1 diabetes is higher at higher latitudes where there are fewer hours of sunlight. A series of papers has been published on that subject and although that is not in itself proof, it shows that the hypothesis has merit.

Iceland has an incidence of diabetes type 1 less than half that of Norway—which may be because of the high fish diet. A mixture of factors mingles together and must be addressed for each particular disease. It is impossible to say simply that there is just one factor—there are several factors and correlations. The research that has been done is the best possible without human trials, for which I argue that we must induce the Medical Research Council to consider investment.

Studies in Norway have shown that when mothers received cod liver oil during pregnancy, there was a marked reduction in diabetes in their children. There has been another study across Europe—a Eurodiab study—so there have been three different studies. As well as the correlation with latitude, another interesting fact is that of the children who develop diabetes, more are born in spring and summer than at other times of the year. That is because they are going through the "dark ages" during their development, as they emerge in the spring and summer, and have had less vitamin D induction in their bodies. Those results were found in studies in Scotland, England, Wales, Slovakia and Sardinia.

Alternative explanations have been proposed, such as viral infections. However, I propose the vitamin D hypothesis and say, "Prove me wrong." Let us do the work to establish whether viral infections cause the difference in different countries in relation to the time of year. Viruses tend to be used to explain anything. That argument is used, for example, to explain the incidence of leukaemia near Sellafield; it is said that people arriving from other parts of the country have brought in viruses. That is a reasonable hypothesis, which should not be dismissed, but it requires proper investigation.

It seems that we should be taking action on vitamins. I am in favour of undertaking medical research into that area. The Institute of Food Research in Norwich is examining the correlation between type 2 diabetes and cardiovascular disease. The immune response involved in that condition affects the development of the heart, and the institute is examining in detail the mechanisms that may be involved. Good research is being carried out in the UK on the correlation between diabetes and other illnesses, but in a piecemeal way.

Research could be undertaken on the levels of vitamins in the blood, on the effect of larger doses, and a trial could be carried out in which supplements were promoted in various parts of the UK. We could consider addressing the question of vitamin deficiencies in a similar way to that in which rickets was eliminated—by increasing the vitamin D content of margarine. Supplementation of milk and cereals could be encouraged through the partnerships that I discussed earlier. We should ask the chief medical officer—Sir Liam Donaldson—about the research that is being carried out on vitamin D supplements for pregnant women. Such research is being undertaken in the UK, but it is not focused on the correlation with diabetes.

Hon. Members will know that a welfare food scheme operates in the UK. I understand that that scheme is under review and I look forward to the results of that review. The Food Standards Agency is also examining those issues. The scheme is intended to provide vitamin D to pregnant women and infants, but the figures that I have seen in the preliminary report from the FSA show that such provision seems to be decreasing, because only those people on income support receive it. Therefore, a large swathe of young people do not have access to supplements of those vitamins, because of their social conditions.

I said that the welfare food scheme began in 1940—with the provision of concentrated orange juice and milk to pregnant and nursing mothers, infants and children under five. The scheme was universal, but has gradually been whittled down to people on income support. Those supplements—vitamins A, D and C—are now given as drops, not as cod liver oil and orange juice, which I miss dearly. People can buy such supplements at mother and baby clinics—and at chemists, if they think of it—but they need encouragement to do so. Resources must be made available for people to access those supplements, and to provide evidence that they are necessary. We must develop our strategy on vitamins and try to relate it to diseases such as diabetes.

I understand that the welfare food scheme is to be rationalised, and I hope that the Minister will comment on that. There have been reports that vitamin D supplements for certain groups of infants have been recommended as official policy but, at present, it seems that not all infants are receiving them. Will the Minister tell me what the Department will do to promote the provision of vitamin D supplements to mothers and infants, and whether it believes that that will be of benefit in terms of elimination of disease?

There is also the problem of breastfeeding. Generally, breast milk is deficient in vitamin D, and so supplementation needs to be examined in that area. I do not know whether we will reach the same stage as the United States, where milk is supplemented with vitamin D. I believe that in the UK in the 1950s there was evidence of some sort of toxic effects and outbreaks of disease in infants. The data that I looked at were flaky and dodgy, but they again raise the question of the way science is handled. We need to penetrate the area more radically and consider thoughtfully how good the evidence is. That has not been done for some time and if the Food Standards Agency is doing it now, I beg it to get a move on. The increase in the incidence of diabetes needs tackling now.

We face tremendous challenges with food, obesity and exercise, including on the elements that we put into our foods and generating interest in food. Young people do not always know much about food; it is just what they get stuffed into them. Many hon. Members will have seen how much fast food constituents and their children eat, because of its convenience and the speed of their lives. At the other end of the scale, we have my friend Delia and her mates doing all the celebrity cooking as if everyone in their busy lives has time to use sun-dried tomatoes.

I almost said "sun-fried tomatoes", and some people do fry tomatoes, but when I visit Cromer on the north Norfolk coast for Sunday lunch in some exquisite little pub, they are not eating sun-dried tomatoes. As my wife said the other day, there is not one in sight. It is fish and chips that are being stuffed into everyone's mouths, and there are some wonderful fish and chip shops. They are not necessarily good for the diet, but they provide quick food. I am as guilty as anybody of grabbing a fish supper now and again. I was brought up on them, and they are pleasant.

Prevention is the way forward, particularly with diabetes. We must examine what is in our food and conduct research into vitamins and so on, and we need an organised strategy, with one individual at the helm. That would be a real contribution that would pull together many of our separate debates, as there are all-party groups on every different subject, but nothing pulls them together. When has the all-party food group ever talked to the all-party diabetes group? Members are also interested in vitamins, and we should institutionalise such all-party interaction. It would be important in co-ordinating people's thoughts and working with the Government to influence the food industry to take the problem seriously. People in the industry say that they are doing that, but when I meet them I sometimes think that they are just playing at it.

The explosion in diabetes that I mentioned earlier can be handled. Prevention is possible, and we should rise to the challenge.

9.57 am
Mr. Adrian Sanders (Torbay)

First, I declare an interest as an insulin-dependent diabetic, and I congratulate the hon. Member for Norwich, North (Dr. Gibson) on securing today's debate. For my sins, I am also the chairman of the all-party group on diabetes and the idea of a joint meeting with the all-party food group is a good one that we can perhaps develop. We have had some joint meetings with the all-party group on eye health and visual impairment, which was perhaps a more obvious connection, but the idea of another joint meeting is food for thought.

The Government have done some good work on diabetes in the past six years. The first move was to allow type 1 diabetics who use the pen injection system to have the needles on prescription instead of making them buy them. That has meant that many diabetics—about 350,000 nationwide—do not have to worry about getting needles. Government Departments tend to be resistant to change and one argument was that users would use a fresh needle every time that they injected themselves. That was probably true for children, because as skin develops, it should not be punctured with a needle that is not as finely sharpened as a fresh one. However, the costings that were made, and which delayed the decision, were based on the fact that everyone would use a new needle every time that they injected. Figures now show that the costs were far less than the Government originally predicted.

There is always a danger when talking about any disease of arguing that a new treatment or a new drug can save costs later. People certainly believe that there are cost implications. The money must, of course, be provided up front. In this instance, however, the Government provided a figure that was far higher than the final cost, which delayed the decision. That was not necessarily the Government's fault, but they did the right thing in the end by allowing prescriptions for pen needles.

Secondly, the Government took action to tackle discrimination against diabetic drivers. As usual, the European directive was interpreted differently by different member states. The United Kingdom recommended that there should be a complete ban on C1 and C2 driving licences for insulin-dependent diabetics. I am very glad that the all-party group on diabetes and other bodies and individuals managed to persuade the Government to reconsider that ban and to remove some restrictions from some categories of driver. A blanket ban could have had an enormous impact on people and threatened their jobs and livelihoods.

Tim Loughton

I am glad that the hon. Gentleman mentioned driving. One of my constituents drives vehicles for a living and was greatly affected by the ban. His diabetes was under control: he took all the medication required of him. He has benefited from the relaxation of the restrictions, but is still required to have regular medical checks, at his own expense, for something with which he has had no problem. We still have some way to go if we are to provide people who suffer from diabetes with a level playing field, given certain restrictions to which they are still subject.

Mr. Sanders

I thank the hon. Gentleman for his remarks. I cannot comment on any individual case, but we wanted an annual assessment of each individual rather than a blanket ban, and we achieved that. I am not sure that one can argue that we should do away with that annual medical now that we have it, although it could be altered to take account of age. Younger people may have more control and may need to be assessed only every five years, but I do not believe that one can argue against an annual assessment for middle-aged people in their mid-40s and beyond. Incidentally, insulin-dependent diabetics are probably among the safest drivers on the road because their eyesight is tested every year and any problems can be detected annually.

The third good thing that the Government did was to produce the NHS framework for diabetes, on which I shall comment in a moment. There are, however, many outstanding issues, such as screening. It has long been argued that an enormous number of people have this condition. Diabetes UK estimates that probably up to 1 million people have diabetes but are yet to be diagnosed. They are therefore still to be put in a position where they must make some lifestyle changes to change their behaviour, or must adopt a regime that will help them with their diabetes and reduce chronic symptoms and the risk of complications later. There are pilot screening programmes, to which I am sure the Minister will refer. I hope that the results will show the benefits of having a screening system. The hon. Member for Norwich, North talked a great deal about the statistics, which are interesting. Several European countries have a much higher incidence of diabetes per 1,000 of the population than the UK. One reason is that people in those countries have been screened and the disease diagnosed, but the people in the UK have not. Direct comparisons between countries can therefore lead to the wrong conclusion.

Screening programmes present a danger that returns us to the argument about cost: if we screen people and find our missing million, there will be an enormous increase in the demands made not only on resources devoted directly to treating diabetes but on other NHS services such as the provision of nutritional advice, chiropody, eye tests and so on. The Government need to think that through, but costs should not be the reason for putting off screening, as the complications of diabetes are so much greater than the costs of helping a person to control the condition.

Another outstanding issue is employment discrimination. A study was conducted last year into employment practices and the fact that some diabetics still face discrimination in the labour market. There have been changes of policy in some emergency services, to the benefit of diabetics in the police force and the fire service who can now be accommodated in those services rather than losing their jobs. There are many examples outside those two professions of people facing discrimination in the workplace. A submission has been made to the appropriate Department, which we hope will be incorporated in future employment discrimination legislation.

Although I praise the framework, I am worried that, according to the Government's statistics, the number of type 1 diabetics will rise from 1.37 million to 1.759 million by 2010 and the figure may well be higher than that as it was obtained without screening. If nearly 2 million people have type I diabetes, the money that is being put into the national health service framework will not be enough. There is a danger that in trying to do what is right, resources will be overstretched. The service for diabetics has been patchy, and the great thing about the framework is that it tries to ratchet up the standard to provide a uniform level of service across the country. However, unless there are sufficient resources, something else will suffer. The number of diabetics requiring help therefore needs to be kept under constant review.

A worrying sign that has come to my attention is that general practitioners are rationing testing strips. In addition to having injections, diabetics are encouraged to test their blood sugar four or five times a day, for which they use the strips. Some type 2 diabetics, who are non-insulin dependent and control their condition with diet and tablets, are not being allowed as many test strips as they have had in the past. I suspect that some work has been done that suggests that people are testing too often, but a principle established by organisations such as Diabetes UK, other patient groups, and especially those in the medical profession who deal with diabetes, is that patients know best when they need to test and how often they need to monitor what is happening to them. A Minister to whom I wrote on the matter replied that what was being complained about should not be happening, and a copy of his letter was sent to Plymouth health authority, which is the one involved. I have not had any further feedback but I would be worried if there were similar restrictions elsewhere.

The hon. Member for Norwich, North cited the case for prevention. The future for treatment is more technological than pharmaceutical for type 1 diabetics—it is the development of the insulin pump, which the National Institute for Clinical Excellence says will help. The device is no bigger than a pager—I am not wearing a pump, it is a pager—and infuses insulin at small doses set by the patient throughout the day, giving a high degree of control. When someone's pancreas is working it is pumping insulin into them all the time. When they eat, it produces more insulin. The type 1 diabetic, whose pancreas does not work, must take it externally, twice or four times a day, and that clearly cannot be as effective.

The little pumps hold a prospect of much greater control. The National Institute for Clinical Excellence has concluded that they should be used only if everything else has failed: if the patient has trouble in using injection systems and the other regimes that can be brought together to help someone who has poor control. Very few people will be given insulin pumps on prescription.

I raise this matter now as a warning, because the pump will develop into a device that will not only infuse insulin but test blood sugar at the same time: it will function as an external pancreas. Such devices have been trialled in Europe and when they have been perfected, or when they satisfy everybody, the demand for them will be enormous. The Department should prepare for that, because it will have a big cost implication, but a corollary is that no testing strips or needles will be needed—although some devices will still be required. Insulin will still be needed. The pump itself will be an expensive piece of kit, but it could wipe out many concerns, problems and complications, if it proves successful.

I am grateful to the Minister, who is shortly to meet some diabetic nurses with me. One small point concerns the disposal of needles and lancets used for blood sugar monitoring. There is not very good information on this. Having been a diabetic for 10 years I suddenly learned that I should be putting my lancets in sharps waste disposal and not wrapping them and putting them in the bin. No one had told me that, and I had not picked up the information anywhere, although I consider myself fairly well informed about these issues. Some local authorities provide very sketchy services. Some local authorities are very good at collecting sharps bins from the homes of diabetics and taking the needles and other paraphernalia away, but others are not. I am glad that the Minister is prepared to talk to us about trying to obtain a consistent service across the country.

I want finally to pay tribute to Diabetes UK, the longest-standing patient group in diabetes. It does an enormous amount of good work on awareness and information. Its lobbying role is important too. Other organisations, such as the Juvenile Diabetes Research Foundation, are concerned about type 1 diabetes and finding a cure. They are always trying to raise more money for that objective.

I thank the hon. Member for Norwich, North for initiating the debate. It is important to discuss the subject periodically, to assess developments. As I have said, the Government have done some good things, but enormous challenges and major outstanding issues remain to be dealt with.

10.13 am
Mr. David Drew (Stroud)

I thank you for your warm welcome, Mr. Deputy Speaker. I presume that in the coming two weeks we shall play pre-season friendlies, as we have not quite started the season yet. In that spirit, we can have a good kick around and see who the best players are.

I welcome the lead given by my hon. Friend the Member for Norwich, North (Dr. Gibson) in the debate. No better person could be found to talk about the scientific rationale. What a pleasure it is, too, to follow the hon. Member for Torbay (Mr. Sanders), who speaks from his own experiences and who is the leading light in the all-party group on diabetes. Although I do not want to take up much time this morning, I want to reinforce what both hon. Members have said.

We should congratulate the Government on the national health service framework, which has not featured as much as it could have done. That is unfortunate, because one of the criticisms that diabetes sufferers have always made, in my experience, concerns the extent of the postcode lottery affecting what support they receive. That point came out well in the remarks of the hon. Member for Torbay about insulin pens, which are a long overdue consolidation of what should be available to people. We also need to talk about moving towards using pumps and what we need to do to ensure that they are more widely available. That will be possible only if we understand that people should have access to them regardless of where they live, and certainly regardless of their means. That is what the national service framework should try to do, not just in this area but in other areas where we have embarked on this important venture to try to pull services together.

I speak from the experience of talking to members of an active diabetes support group local to Stonehouse, where I live, which is led by Liz Shipman and others. I have come to understand that a key aspect of diabetes, more than many other diseases, is the degree to which people can support each other and show that they can live perfectly normal lives as long as they take their medication and seek urgent medical help where necessary.

The support group always makes the point that the medical profession does not make the best use of it. It is worrying for anybody to be diagnosed with diabetes, but especially for young people and their parents and friends. Members of the support group feel strongly that it could be a valuable addition to the inevitable medical support, yet more often than not, people have found it difficult to access that support mechanism through general practitioner's surgeries. That is rather sad because the best person to help someone through the processes involved with such a life-changing experience is another diabetic. I am sure that the Minister will take that on board in her discussions with GPs and organisations. Such support is valuable, but there are few support groups around the country. If the need is there and is highlighted, more support groups may appear, which could be locked in through GPs' surgeries.

In preparation for the debate, I was pleased to receive a press notice from the Pharmaceutical Services Negotiating Committee about the help that it could provide to people suffering from diabetes, such as advice and monitoring, which it believes to be an important part of its negotiations with the Government in readiness for the new contract, which is estimated to begin in April 2004.

Pharmacists see themselves as playing a valuable role in helping with diagnosis and monitoring. Another criticism made by my local support group was that, for a time, it offered to test the general public on behalf of pharmacists to see who was at risk of suffering from diabetes. However, it all went wrong because of the usual problems of insurance against wrong diagnosis. We all know that early diagnosis and intervention are crucial whatever the age of the diabetic, but as the hon. Member for Torbay said, we must recognise that there are cost benefits and should not pretend that we can avoid the issue. We must have a mechanism for testing in the wider community, perhaps on a voluntary basis. I suspect that GPs are unlikely to want to do it because they are inundated with other tasks, but pharmacists may do it, with, I hope, the involvement of lay people. Obviously, one cannot just test people, give them the results and, if they are suffering from diabetes, pretend that they will be anything other than very worried. We must ensure that it is done properly. I hope that my hon. Friend the Minister will take up that point, as it has been clearly highlighted in my area.

My hon. Friend the Member for Norwich, North went on to discuss the wider context: why the number of cases of diabetes is growing and what we should do about that. That wider context is important. Diabetes is, of course, related to what we eat and to our lifestyle. The Government are clearly right to emphasise the importance of fitness as part of lifestyle, and to try to prevent the sale of school playing fields and so on. The danger is that lifestyle and fitness are, unfortunately, areas that are stratified somewhat by class. If people can afford it, they will belong to a health club, but that would be the last thing that those with a lower income would ever budget for. We have to ensure that where the state is involved, it does things properly, for example in schools and by providing recreational facilities in the community. We should be predisposed not to sell playing fields; we should encourage people to use them.

On the positive side, initiatives such as sure start, our work towards a co-ordinated policy ensuring that children have opportunities when they are young, breakfast clubs and after-school clubs can all come together to help. My hon. Friend the Member for Norwich, North talked about the huge area of lost opportunity from the scientific point of view. I want to discuss the practical point of view. We still have only one professor of food policy in this country. I initiated a debate more than two years ago to find out whether the Government were moving towards co-ordinating some response to that matter.

The professor is the well known Tim Lang, who is not everyone's cup of tea, but who speaks his mind and has pointed out that for a long time we have not been progressing towards greater cohesion. He introduced me to the idea of functional food, which my hon. Friend the Member for Norwich, North mentioned. Last week in Gloucester, I was at Unilever, which I used to call Wall's, where they are talking about introducing an ice cream that is full of energy and health-giving products. If ice cream can be made healthy, presumably anything can. The industry is beginning to pay attention to the idea of functional food, and the Government need to do more.

Local food, organic food, and an intake of five portions of fruit and vegetables a day are not fads. They are a matter of genuinely trying to change mindsets and making people aware that what they eat will have an impact on their quality of life, if not immediately, then in later years. Those ideas will be the greatest way in which we can prevent a huge explosion in diseases such as diabetes. I hope that my hon. Friend the Minister will say how we can move towards greater co-ordination in that area, if not towards a full-blown food policy, which—talk about tsars—seems somewhat state led. We have to get across the message that the issue is important and is one that we ignore at our peril. The debate has been very useful.

10.24 am
Mrs. Patsy Calton (Cheadle)

May I welcome all of us back? It feels very much like a new term. I congratulate the hon. Member for Norwich, North (Dr. Gibson) on his continuing success in obtaining timely Adjournment debates.

I am particularly pleased to be here because I did not know anything about vitamin D and its possible association with type 1 diabetes. I feel as though I have learned quite a lot this morning, so I should like to thank the hon. Gentleman very much. It would be especially interesting to follow up that area of research—the hon. Gentleman did not mention this, but Asian and Afro-Caribbean groups are particularly susceptible to type 1 diabetes and there may be a positive link, which chimes with what he was saying.

The hon. Gentleman also referred to the fact that the diabetes time bomb that we seem to be sitting on is a worldwide phenomenon that is gradually coming to affect everyone everywhere and not only us. The issue might need to be explored from the angle of increasingly global food production and the role of the multinational food companies. They obviously have a part to play and it is important that companies such as Unilever—I hasten to declare that I have a sort of interest as my daughter works for Unilever—have a role to play in ensuring that the wider health issues are explored, not only for this country but for other countries.

My hon. Friend the Member for Torbay (Mr. Sanders) has more than adequately expressed his concern about the treatment of diabetics. He and others have referred to the discrimination that diabetics can suffer in both employment and social matters such as driving. The Government and the medical profession need to explore issues associated with undiagnosed diabetes, or we shall store up problems for ourselves and the public in terms of the extra costs that will result from late treatment. However, other hon. Members have more than adequately dealt with that subject.

The hon. Member for Stroud (Mr. Drew) mentioned support groups, which have an application beyond diabetes—for example, for sufferers of ME and other illnesses or conditions. Support groups give far more necessary information than the medical profession do. For instance, I was on tamoxifen for about two years before I found out from a support group that some of the side effects that I was experiencing were normal and that everybody else has them as well, so I thought, "I should have come to the support group sooner." Support groups have a role to play across a range of conditions. When primary care trusts are dealing with their very stretched budgets it is important that they do not remove the funding for support groups, as a few thousand pounds can have a great impact. I would therefore certainly support the hon. Gentleman in his view that support groups are often the best way for people who are experiencing a disease to get new information.

I want to focus on prevention and the wider issues involved with it. Although I was particularly interested in the vitamin D and type 1 discussion of the hon. Member for Norwich, North, it is important both to consider the wider lifestyle issues—exposure to sunlight, and so on—and to avoid a medical and pill-popping culture in which every illness is to be cured by popping another pill rather than by changing lifestyle.

I guess that it is received wisdom now that diabetes and other medical conditions such as coronary heart disease, stroke and some cancers are linked to over-high body mass. We are in danger of causing difficulties when we try to get over messages if we constantly refer to obesity, which has become a stigmatised expression and one that is not good to use when we are trying to create a no-fault, no-blame culture and to change behaviour without making people feel guilty about the way they are or the way they have been. Guilt will not change behaviour in the long term; it is a wish to experience a different lifestyle that will make people change. Obesity is not a particularly useful term. Over-high or excessive body mass may be better.

We know that poor nutrition—high fat and high sugar—and too little exercise from an early age are linked to excessive weight gain from infancy onwards. A number of nutrition and education factors have been explored today. We need a continuing programme of education and awareness-raising for the public as well as schoolchildren. We always say, "Start with the children", but they do not often control the family's buying habits. They may well control their buying habits at school, but they do not control the wider buying habits of the family. We must raise the awareness of the public as a whole on this issue, and the Government are doing some good things to raise awareness.

It is not enough to talk about raising public awareness alone. A number of initiatives from successive Governments and, indeed, local government have done nothing to reduce our couch potato characteristics. I think of the junk food machines in schools. I remember being appalled as a schoolteacher that a school should have chocolate and other junk foods in a machine in the main corridor and the fizzy drinks machines to which the hon. Member for Norwich, North referred. Schools are the last places where those machines should be put. Too many children are tempted to use the money that their parents give them for food at lunchtime to eat junk foods at break, lunchtime and mid-afternoon. They are getting a very different diet from the one that their parents think they are getting.

I have been asking questions about junk food machines in schools since I arrived in the House. The Department for Education and Skills regards that as a matter for local authorities and school governors. The problem is that with the funding for schools as it is, the profits from such machines are often paying for dinner ladies, so schools and local authorities face a very difficult decision. If they do away with junk food machines, they have to do away with one or more dinner ladies at the same time. We also need to worry about those issues.

Some schools still offer poor variety and poor-quality food. Superstore shopping has caused a change in buying habits towards more pre-prepared foods, which do not necessarily have the benefits of food that has not been pre-processed and packaged. That in itself has made a big change.

I realise that this may seem a little far-fetched, but I think that school league tables have played a part. Many parents believe that they have to get the very best education that they can for their children and that that includes putting them in a 4x4 in the morning and driving them to the school with the best standard assessment tests results. It is now rare for children to walk or cycle to school, which is one bit of daily exercise that they need.

The issue clearly goes wider than the Department of Health. We are talking about joined-up government, so that the Government realise, when they produce a particular policy, that it may have implications that they had never thought about. It is right that parents should be able to get the best possible education for their children, but the children could end up dying at 45 from a heart attack because they never walked anywhere. We have to obtain a better balance. I worry about how many children never see daylight. They go from home to school in the car and engage in practically no sport or physical activity.

With the demands of the national curriculum, many schools have reduced considerably the time spent on sport. When we talk of sport, most people think of team games, but they are not necessarily the way forward. Many young people do not want to take part in team games and prefer to be engaged in physical activity that they can pursue individually. I have occasionally covered for absent PE teachers and found that a third or half of the girls did not take part in lessons. They stood to one side, having not brought their kit. We may think that all children are getting an hour a week of sport, but even in good schools, not all of them are. There are some issues to be addressed about the lack of physical exercise that young people are engaged in and the policies that must be explored.

There has been much talk about congestion charging, especially in my local papers in the past few weeks. I wonder whether a half-mile exclusion zone around schools should be considered for each morning and afternoon to ensure that young people walk or cycle at least a mile each day. It would certainly please those people who find 4x4s parked in their driveways when they are trying get out in the morning. I am thinking especially about my own constituency, which has a real problem with the traffic that builds up around schools. The people who live in those areas simply cannot move in the morning because of the numbers of children being brought to school by car. It is a backward step, and I am concerned for the young people who engage in practically no activity, including getting to school in the morning.

A further issue is the low take-up of breastfeeding, which has suffered from the tolerance of the activities of baby milk manufacturers over the years. I remember being shown a breastfeeding film that was obviously designed to make a mother-to-be squirm, as the breast was exposed in various situations that, as a potential new mother, I was nervous about. I then found out that Nestlé was behind the film, and I thought that it was just possible that I was supposed to feel uncomfortable about breastfeeding. Some baby milk manufacturers have a lot to answer for, and in the past there has been poor Government support for breastfeeding. There are initiatives, which I would like to see rolled out across the country, but I believe that this House has ambivalent attitudes to that most natural and healthy of activities.

When the Government make new policy or take decisions on planning matters, they should take lifestyle issues into account. To be fair, the Department of Health has produced several documents and initiatives that have highlighted the importance of lifestyle choices and better treatment for diseases associated with excessive body mass and too little exercise. I think of "Saving Lives: Our Healthier Nation", the NHS plan for investment and reform, the NHS cancer plan and the national standards frameworks for coronary heart disease and diabetes.

Mr. Deputy Speaker

Order. I must ask the hon. Lady to bring her remarks to an end soon. There are two further speakers—the official Opposition spokesman and the Minister—and she has only peripherally been talking about diabetes, which is the subject of this debate.

Mrs. Calton

I am grateful to you, Mr. Deputy Speaker, and I apologise for having overstayed my welcome.

I have been grateful to visit the fruit-for-schools initiative in two primary schools in my constituency. That has been a good initiative and the children enjoy it. I hope that I have not been treating diabetes peripherally. The lifestyle choices and culture changes that need to be made affect areas beyond the Department of Health. I will draw my remarks to a close as I have taken up more time than I should.

10.40 am
Tim Loughton (East Worthing and Shoreham)

May I echo your warm welcome, Mr. Deputy Speaker, to everyone in Westminster Hall? It was certainly warmer than the temperature here today.

I congratulate the hon. Member for Norwich, North (Dr. Gibson), who is a frequent initiator of debates. As usual, it has been most informative because he takes a scientific approach rather than coming up with the usual platitudes. Most of his speech was not directly about diabetes, but it was very relevant because it covered all those situations and conditions relating to its onset and proliferation—subjects that were mentioned in other speeches too. If the hon. Member for Torbay (Mr. Sanders) started to organise all-party meetings he would have to take in more than just the diabetes group, the food group, the sports group and the schools physical education group because diabetes affects so many different aspects of our lives. The hon. Member for Norwich, North encapsulated it all when he asked whether we are simply playing at it or whether we are really serious. His fatty tsar suggestion may not be taken quite so seriously, although the sentiment behind it was correct.

This is an important subject. The ticking time bomb of diabetes, as it has been called, is one of the biggest problems facing the health of our nation and the health service over the short, medium and longer term. It affects so many of our constituents. We have heard the figures: 1.4 million cases have been diagnosed but probably an equal number are still undiagnosed, which is perhaps more worrying. It is the fastest growing disease in the United Kingdom and is predicted to involve up to 3 million in types 1 and 2 diabetes by 2010. It carries serious complications such as amputation, blindness, kidney failure, strokes, and coronary heart disease. Diabetes sufferers are five times more likely to suffer from coronary heart disease. Most type 2 sufferers find out that they have diabetes only when they are treated for one of those complications. On average, they have had the disease for nine to 12 years before they are diagnosed. Diabetes sufferers can live, on average, 10 years less than non-sufferers.

As hon. Members have mentioned, there is a big ethnic impact. Around one in four Asian men over 60 suffers from diabetes. There is a much higher incidence among the Asian, African, Afro-Caribbean communities and, of course, among socially disadvantaged groups. Can the Minister tell us what has been done to help those groups? Internationally, more than 300 million people are at risk of developing diabetes, according to the International Diabetes Federation. As the hon. Member for Norwich, North mentioned, Professor Sir George Alberti recently said: We are heading for one of the biggest health catastrophes that the world has ever seen…The financial and social burden of the disease will be intolerable if governments do not sit up and take notice now. That is right.

The cost to the NHS is more than £5 billion—more than the £3 billion spent on alcohol or the £1.5 billion spent on smoking. Moreover, 40 per cent. of that expenditure goes on hospital care and at any time between 6 and 16 per cent. of hospital beds are occupied by people with diabetes. Particularly worrying is the impact on young children, as hon. Members have mentioned. Part of the problem lies in the confusing information about what is healthy eating and what is not. Is it healthy to stay out in the sun more? We are always told that it is not. Being in the sun may have a link with vitamin D, which has a link with diabetes, as the hon. Gentleman pointed out. We recently heard that it is not healthy to drink too much water, yet we were always told that we should drink more.

Yet more problems face the average punter. It is no wonder that everybody is confused as to what is and is not healthy. That is why a third of British children are overweight and we are heading towards the catastrophic figures that they have in the United States. One in 10 four-year-olds is diagnosed as obese, particularly young girls. The first cases of adult onset diabetes have recently been recorded in British teenagers, for reasons that hon. Members have mentioned. It is difficult to identify, as children often do not feel unwell on diagnosis of diabetes and do not feel that they have a medical problem. That emphasises the need for better education as to how diabetes can be controlled. It is crucial to tackle the subject urgently and early. It would be financial folly not to do so, and it would have an impact on the health of individuals that could be prevented by better education, better diagnostic testing and adapting lifestyles.

Diabetes is relatively easy to diagnose: a simple blood test has been developed in the US to detect it for up to 12 years. It is a simple procedure that can identify up to 75 per cent. of cases and can be used on patients believed to be at high risk. Will the Minister comment on the lessons that have been learned from America, and how such tests may be rolled out early in this country?

There are other problems. At present, 90 per cent. of hospitals do not have the recommended number of diabetes consultants or specialist nurses, more than a third of hospitals do not prioritise diabetes in their health improvement plans, and 30 per cent. of GP practices do not have a specific clinic for people with diabetes.

We welcome the national service framework—although it was introduced late in the day, in December 2001, and it was not until January 2003 that the delivery strategy was published. Many shortcomings in the framework remain and the Government have failed to match their good intentions with meaningful action, although the NSF is a step in the right direction.

There are particular problems with the NSF. Many patients feel let down that it does not include national priorities and doctors have accused the Government of shifting the buck by passing targets on to primary care trusts. Many doctors will not meet NSF targets, as many practices do not even conduct basic monitoring. Fewer than half of diabetes patients have had their cholesterol measured in the last year; 25 per cent. have not even had their blood pressure checked; and 60 per cent. have not had their HbA levels measured. Many diabetes patients are wandering around with uncontrolled hyperlipidaemia—that is, high cholesterol, the biggest contributory factor to myocardial infarctions—and unchecked hypertension, despite the fact that there are simple tests that could be used, relatively inexpensively.

Diabetes UK has criticised the failure immediately to find funding for the estimated 1 million people who have diabetes but are unaware of it. There is a failure to provide ring-fenced funding to deal with that, a lack of performance indicators and a failure to deal with staffing and training problems.

The move to create expert patients is a positive one but there are many questions to be asked. The Government's expert patients programme receives just £2 million per year, yet the costs of treating the UK's 1.4 million diabetes patients is £5.2 billion per year. Major investment is needed at the preventive stage.

The NSF is certainly not a panacea, but it goes some way to raising the profile of the problem and flagging up some methods of dealing with it. As it stands it is undeliverable, not least because much of the funding was left to primary care trusts, many of which are already in debt. The cost of treating sufferers is likely to double within the next eight years. According to Stefanie Amiel, an academic and clinician who specialises in diabetes at King's college London, although the NSF is a move in the right direction, there are many unanswered questions. For example, how is the service to existing patients to be improved while the numbers of those presenting with the disease continue to rise? What about the huge number of undiagnosed patients? Stefanie Amiel doubts the "prevention endeavour", saying that

it's a long way from treating the illness". How are we to bring about a national lifestyle change? The NSF needs to factor in the increase in the number of those with diabetes and the related costs. We will not lower hospital costs by strengthening diabetes care in the community, at least not in the medium term.

There are many other questions that the Minister may like to answer, although there is no time for that now, but I think that we all agree that diabetes is a public health disaster, and we need an early and detailed programme of meaningful measures to tackle the crisis. Spending money now on preventing and managing diabetes will save a lot of money in the long term, let alone a lot of angst and ill health for the increasing number of people who are being afflicted—at an increasingly early age—by type 2 diabetes. I hope that the Minister will deal with many of the questions and accept that the debate is an exercise not just in presentation, but in grasping the problem early and providing solutions to it.

10.50 am
The Minister of State, Department of Health (Ms Rosie Winterton)

As always, it is a great pleasure to be in your hands, Mr. Deputy Speaker. I am sure that all hon. Members will agree about that, particularly in this first Adjournment debate after the recess.

I congratulate my hon. Friend the Member for Norwich, North (Dr. Gibson) on securing the debate. While looking through some of the background papers I noticed some interesting initiatives on diabetes in the area of my hon. Friend's constituency. Perhaps I may invite myself there, as I should like to see some of them, and to discuss the subject more. In the light of what my hon. Friend has demonstrated he knows about the subject, I should find that extremely useful. I pay tribute, also, to his contribution in the associate parliamentary food and health forum.

I listened carefully to comments about the possibility of a joint meeting with the all-party diabetes group. I am meeting the group soon, and want to consider ways in which we could work together to raise awareness of the effectiveness of early screening for diabetes, among other things. I hope that we shall be able to work together at that meeting and discuss issues that have been raised here, as well as ways of working with Members of Parliament to raise the issue in their constituencies.

As the hon. Member for East Worthing and Shoreham (Tim Loughton) said, this has been a very informative debate. We are obviously in a Chamber full of experts, and House of Commons debates are always at their best when that is so. I do not have time to reiterate the figures that were given earlier, and I would rather deal with the action that we are taking, but we know that, as has been said, diabetes is becoming more common not only in the UK but throughout the world.

My hon. Friend the Member for Norwich, North referred to research on diabetes. Sadly, there are gaps in the research, particularly for type 1 diabetes. I should like to send my hon. Friend some of the research that has been conducted by the Scientific Advisory Committee on Nutrition. Perhaps we can pursue the debate about some of the relevant ideas.

The extent of the problems of diabetes and, indeed, obesity was the reason we developed the national framework for diabetes. We involved clinicians, experts and people from Diabetes UK—which, again, I join the hon. Member for Torbay (Mr. Sanders) in praising—because we wanted to put together a framework that would set high standards which, with our delivery strategy, would bring about a consistent approach throughout the country. We believe that that can be done. We want high standards to deal with prevention, provide better care for people with diabetes, and help such people to manage their condition.

We know that to stay healthy and well, everyone with diabetes needs good and regular health care as good control of blood sugar levels can reduce the risk of serious complications and lengthen lives. That means prompt diagnosis, regular checks to identify serious complications at an early stage and treatment to control blood glucose and blood pressure levels.

The hon. Member for Torbay and others mentioned insulin and testing, which we can discuss with the all-party committee. To ensure that the NSF is delivered properly, in April we appointed a national clinical director for diabetes. Her task is to fulfil two early and important national targets: by 2006 a minimum of 80 per cent. of people with diabetes are to be offered eye screening for the early detection and treatment, if needed, of diabetic retinopathy. That will rise to 100 per cent. by the end of 2007 and to meet that target, we are putting an extra £27 million into digital cameras over the next three years. By March 2006, there should be a register of patients with diabetes in all GP practices so that they can be offered the appropriate advice on diet, physical activity and smoking, and systematic treatment in education.

I will certainly consider the important point made by my hon. Friend the Member for Stroud (Mr. Drew) about support groups and how they can interact with GPs. To take up the matter raised by the hon. Member for East Worthing and Shoreham, we will put into the NHS an average annual increase of 7.4 per cent. above inflation over the next five years and three quarters of that budget will go into the hands of primary care trusts. It is important that primary care trusts have the ability to decide what are the local priorities, but by matching national standards with the local priorities we can address some of the problems of shortages in the work force. Extra consultants are being recruited but there are other ways, for example, nurses having an increased role in the treatment of diabetes, and some important projects and pilots are being carried out to look into such matters.

Dr. Gibson

Will my hon. Friend say what investment is being put into the prevention of diabetes?

Ms Winterton

I was about to come to that matter. First, we want to foster healthier lifestyles and the Department of Health is leading on the development of a cross-government food and health action plan, which will pull together all the issues that influence what we eat: it will address food production, manufacture and preparation, access to healthier food choice and providing more information. The welfare food scheme is being reformed and the healthy start proposals will mean that we look at providing vitamins for low-income groups and also consider how we can give access to other foods such as vegetables, fruit and so on. With the Department for Culture, Media and Sport, we are also looking at encouraging increased physical activity through local exercise action pilots—LEAP—and other initiatives. Some of the results of the proposals will be published in spring next year; we are working on the plans at the moment.

I assure my hon. Friend that action is being taken on these matters. I was particularly interested in his comments about a food tsar. What we want is a good plan that addresses prevention, diet and the important issue of physical activity. We have a long-term plan to tackle the issue, particularly through the NSF, but also through healthy eating and other initiatives.

I hope that what I have said gives hon. Members some idea of the progress we are making on this important matter. We have some way to go but we are well on the way.

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