Article

Next APPG meeting: The Future of Inpatient Diabetes Care

In April the APPG for Diabetes will have a meeting on The Future of Inpatient Diabetes Care, Wednesday, 19 April 2017, 5-6:30pm, House of Commons.


One in six hospital beds are occupied by a person with diabetes. Because of poor management and a lack of training for staff about how to care for people with diabetes, a large number of these patients develop complications whilst in hospital that can lead to a longer length of stay.

There are however areas of improvement and many examples of good practice to learn from. The latest National Diabetes Inpatient Audit (NaDIA) report has pointed to reductions in the incidence of hypoglycemic episodes and the development of foot ulcers. However, medication errors are still common and there is a need to improve staffing levels and patient experiences.

How can we make sure that these examples of good practice are shared more widely? What measures should hospitals adopt to improve the experience of people with diabetes in hospital? And crucially, what is the future of inpatient diabetes care?

The APPG will hear from healthcare professionals and care providers on the challenges remaining and innovations that have the potential to improve inpatient diabetes care.


If you would like to attend, please RSVP by emailing diabetes-appg@outlook.com. Due to limits on room capacity, please note that admittance will be on a first come, first served and one organisation, one person basis.


Call for evidence: If you have an opinion, case study or best practice to share, please contribute to our report and send in a written submission to diabetes-appg@outlook.com until midnight April 9.

Article

The invisible battle of children with medical conditions and their families

On Wednesday 1 March, the All-Party Parliamentary Group for Diabetes and the All-Party Parliamentary Group for Epilepsy had a joint meeting to hear from parents, researchers, campaigners and healthcare professionals on the Safety and Inclusion of Children with Medical Conditions at School.

The meeting was co-chaired by Keith Vaz MP and Caroline Ansell MP, with the illustrious presence of Liz McInnes MP, George Howarth MP, Victoria Atkins MP, Andy Slaughter MP, Andrew Selous MP, Kevin Hollinrake MP and Baroness Bakewell of Hardington Mandeville.

Powerful testimonies were heard from the speakers and the audience on the challenges facing children with medical conditions at school. The Children and Families Act 2014 included a statutory duty requiring all schools in England to make the right arrangements to support children with medical conditions. However, as the evidence heard showed, the duty is not being implemented effectively, leaving over a million children with medical conditions at risk. The evidence collected will be part of a report.

Read the full minutes here: Minutes for the meeting on the Safety and Inclusion of Children with Medical Conditions at School


1.  Louise Taylor, parent

Louise, parent of a child with Type 1 diabetes, spoke of an unfortunate incident her daughter experienced. Her daughter suffered a dangerous hypoglycaemic attack during a cycling proficiency test. The school’s staff had not checked to make sure her daughter had her ‘hypo kit’ with her, and instead made her walk back to the school. When she finally arrived back to school, she was in a poor state and the school did not know how to help her.

“It is a parent’s worst nightmare to get a call from a school saying their child is seriously ill and they do not know how to help her”, shared Louise. Gladly, Louise was able to go to school to her daughter’s aid. It took a long time to get her daughter’s blood sugars back to a safe level. Not only it was an awful physical experience for her daughter, it was also embarrassing and traumatic. Her daughter is now scared of doing things she enjoys, like sports and extra-curricular activities.

The schools did not have a medical conditions policy in place, and did not know it needed one, by law. When the right procedures are in place, school staff can understand their responsibility in keeping children safe and how to do it. Situations like the one experienced by Louise’s daughter can then be avoided. Without it, children with medical conditions are put in unnecessary danger.

Louise also researched her local area to see how many schools had a medical conditions policy. She found that no school was even aware the duty existed. Because of it, Louise started a petition online to call on government to raise awareness and compliance to the law. She met her MP Andy Slaughter at the meeting and together they plan to raise awareness to the duty in their local area.


2.  Sue James, parent

Sue’ son suffers from chronic migraines, Postural Tachycardia Syndrome, Chronic Fatigue Syndrome and Vitamin D Deficiency. This makes her son’s autonomic nervous system malfunction, giving him dizziness, constant migraines and potentially fainting.

“Schools did not understand his conditions”, said Sue. Her son was not allowed to work in the school’s quiet room because he was told it was not suitable for him. When ill, her son is made to walk four blocks until the first aid room, which puts him at risk of accidents. Once, he was made to walk back home without her knowledge. When she asked for a wheelchair her son could use, the schools’ Headteacher advised her son not to use one, saying it “would not look cool”. When raising a complaint, the school deputy disregarded her son’s condition by stating that when she has a headache she takes over the counter medication and is fine the next day. Sue’s son has had a constant headache for 51 months.

Sue was told her son should only come to school when he is fit for work, and if he could not function in a normal classroom without support he could not attend school.

Despite being rated ‘good’ by OFSTED, the school did not have a medical conditions policy nor an individual healthcare plan in place, to the knowledge of the local authority. It was only implemented after Sue pushed for one. But still, the school refused to hear Sue and the healthcare professional’s suggestions for the plan. “There is a lack of understanding and communication”, said Sue.

Eventually, Sue had to take her son out from school per advisement of the Chronic Fatigue Syndrome team at hospital, as functioning without support in a mainstream school was too much for his health.


3.  Sara Milocco, parent

Sara’s daughter has coeliac disease and needs to follow a gluten free diet to avoid pain, vomiting, lethargy, emotional distress and, in the long term, cancer and osteoporosis. She had been trying to get the school to provide her daughter with gluten free food for years, but never received a response. When the duty came to force, she used it as a leverage to start a conversation, but still faced overwhelming resistance.

“The school still did not see coeliac disease as a medical condition and did not feel they had the obligation and responsibility to support my daughter at school”, said Sara. Even when she tried to compromise and offered to contribute with meals for her daughter, her help was denied as it would isolate the other students who might also want homed cooked meals. Sara’s concerns about the understanding of the catering staff and the risks of contamination were continuously dismissed.

In 2016, her daughter was given a full plate of pasta by the school and assured it was gluten free. It was not, and her daughter vomited it two hours later and had to be sent home in pain. Later, for simplicity, the school subjected her daughter to eat jacket potatoes and beans every day, which is far from a healthy balanced meal. As a result, her daughter’s well-being, concentration and growth was impacted. Sara was advised by her daughter’s doctor to withdraw her daughter from school meals, as her daughter had not grown in height or weight for six months.

“There is a lack of appropriate training, willingness to listen and care”, said Sara. She had to step up her complaints in order to be heard, but it still became her responsibility to raise awareness among school staff on gluten and the risks of contamination. It took Sara’s time, understanding and commitment to make any change happen. “What about parents who do not have the ability or time to bring a similar campaign forward?” she asks, wondering if their children do not deserve the same support. To this date, her daughter’s school still does not have a medical conditions policy in place, despite being rated as ‘outstanding’ by OFSTED.


After the parents spoke, Caroline Ansell MP stated there is a clear lack of compassion and understanding for the needs of children with medical conditions and thanked the parents for sharing their ongoing battles to get their children the support they need in school. She raised the issue of responsibility and asked if any of the parents had contacted their respective Governors. All parents had, none received a positive response. Caroline Ansell MP also empathized with the speakers and raised the issue of how parents can appear “too demanding” when all they want is their right.

George Howarth MP shared his concern about the psychological impact poor care and discrimination can have on children with medical conditions, saying there is a need to address the issue of bullying.


4.  Professor Helen Cross, Great Ormond Street Hospital

Helen started by explaining epilepsy is a condition which is characterised by recurrent seizures. Approximately two thirds of people with epilepsy have their seizures controlled by medication. She said in childhood, epilepsy is more common than diabetes, and there is still an element of stigma attached to epilepsy as many people are unaware of how the condition can affect young people.

“Parents may be aware of difficulties their children are experiencing at school, but many teachers are unaware what they are going through”, said Helen. As a solution, Helen said there is a need to raise awareness in schools and every school should have a medical conditions policy in place.

She explained how children with medical conditions may not want to be labelled at school, such as having photo charts on the wall or needing to go to a specific place if they have a seizure, so it is important to communicate with the parent and the child when building an Individual Healthcare Plan. Helen explained how this may not seem a priority if a young person’s seizures are under control, but Epilepsy may still be affecting their learning. “Every child needs an Individual Healthcare Plan”, said Helen.

Helen also spoke about the need for paediatric specialist nurses and their importance in providing a link for the young person by going into schools. She mentioned how the school nursing provision has unfortunately been reduced. She also called for the need for psychological support, as this is affects many young people with epilepsy, as well as other medical conditions.

Finally, Helen brought up the need to maintain support for children in secondary school. Many secondary schools find that issues affecting young people with medical conditions have not previously been recognised at primary school. She explained how this has a knock-on impact on young people, with some of them being recommended for fewer GCSEs or none. “Children with medical conditions need support at whatever time the condition is recognised”, she said.


5.  Simon Dyson, Professor of Applied Sociology at De Montfort University

Simon Dyson is part of a team of researchers at De Montfort University who report on the experiences of young people with sickle cell disorders (SCD) in the education system. SCD is a complex condition with major symptoms including strokes, silent strokes, chronic pain and acute painful crises. His team surveyed local authorities in England, pupils living with SCD and schools attended by young people with SCD.

He started by sharing some of the experiences he collected showing how children with SCD are not being cared for adequately at school. “In an academy school in England, a young girl with SCD was having a severe painful crisis and was rolling around on the floor in agony while other children film her on their mobile phones. The teacher did not intervene”, said Simon. A majority of children with SCD are prevented from going to the toilet when needed, about half reported not being permitted to drink water, and about a third are made to take unsuitable exercise. Simon explained all of these could trigger a severe sickle cell painful crisis, and all could have been avoided.

To make matters worse, a third of children said they have been called lazy when in fact they are tired from their anaemia. Moreover, parents are being threatened with fines for missed schooling when it is schools who are failing in their duty to include young children with medical conditions and help them catch up on missed work. “Lack of knowledge leads schools to misunderstand children’s accounts and make simple, but dangerous mistakes”, said Simon.

Simon explained how there is a need to raise awareness of the full implications of a condition, not just acknowledging its existence, as awareness without understanding allows children with SCD to became targets of bullying and discrimination. Even so, Simon shared there is evidence that raising teacher awareness is important, it was insufficient to make the difference in school experience. “Teachers are often overloaded and stressed and they need to be supported”, said Simon. It was only a background policy that was able change the social environment of the school and promote school inclusion, detailing procedures in a way that does not require teachers to be specialists of every condition.

However, results from Simon’s research has found that less than 10% of schools had such a policy in place. Furthermore, Simon shed light to the issue of accountability. In his research, only about 13% of local authorities contacted could state how many children under their jurisdiction had an individual healthcare plan or knew how many children with SCD they had in their schools. “At this level, SCD as a potential issue affecting pupils is relatively invisible in education policy terms”, said Simon. He declared OFSTED must be instructed to assess quality of inclusion of pupils with medical conditions as part of school inspections.


Liz McInnes MP agreed with speakers on the importance of supporting children with medical conditions at school, and raised the issue of school nurses. She questioned if this could be the solution to the problem. Simon Dyson responded that, at the moment, there is only about one school nurse for five schools. While it would be helpful to have more nurses, he said “a whole school change is needed”. Schools must change culture to fully include children with medical conditions, must change procedures to prevent them from becoming ill, and every staff should be prepared to help in case of an emergency.


6.  Thalie Martini, Diabetes UK Make the Grade Delivery Manager

Thalie is the chair of the Health Conditions in School Alliance, a group of over 30 organisations working together for the rights of children with medical conditions at school. She talked about how good care and inclusion in school ensures these children are safe and can achieve their academic potential. “Good care can be achieved when clear overarching procedures and policies are in place in schools”, said Thalie. She explained how the new duty in England has the potential to make a significant difference to the lives of over a million children with medical conditions. The problem is that the duty is not being implemented correctly.

She summarized the evidence from the meeting and how it resonates with the evidence collected by the Alliance. Parents from across health conditions are concerned for their child’s safety due to their necessary day to day management, fear their child will be excluded or put at a disadvantage because of their condition, and worry about school staff not being properly informed to know what to do to prevent their child becoming ill or excluded, or help in case of an emergency.

Thalie shared the results of two Freedom of Information (FOI) investigations conducted by the Alliance. In 2015 and in 2017 less than 12% of schools demonstrated statutory arrangements were in place to support children with medical conditions. As the causes for the poor implementation, the Alliance found that ‘lack of confidence’ and ‘fear of not knowing what to do’ were the main issues declared by schools. While most might be aware of the legislation, they do not understand it and know what is required of them. “There is limited support for schools”, said Thalie, “and it is unclear how the Department of Education is supporting them”. She shared how, through her experience with Diabetes UK Make the Grade Campaign, when schools have the tools to implement the duty correctly good care happens. “Schools need to be informed and supported to implement the duty”, said Thalie.

The issue of accountability was again brought up, with Thalie saying there is also a “limited monitoring of implementation”. Thalie shared the results surveys and investigations conducted by the Alliance, showing that less than 1% of Local Authorities check that schools have implemented the duty and only 27% of schools say OFSTED checked for their medical conditions policies in the last inspection. At this point, the struggles of children with medical conditions and their families remain invisible. “Implementation of the duty must be routinely monitored”, said Thalie. While the statutory guidance states that “inspectors must consider how well a school meets the needs of the full range of pupils, including those with medical conditions”, the OFSTED’s inspection handbook does not reference the statutory guidance.

As a solution, Thalie stated the Department of Education must take action to raise awareness of what is required in schools, and OFSTED must ensure inspectors are trained and equipped to routinely check schools’ medical conditions policies at inspections.


Caroline Ansell MP commented how it is positive to remember good care in school exists, and the importance of sharing good practice between schools. She said to be glad to hear there is a “blueprint” for solving the problems parents had shared. Kevin Hollinrake MP and Andrew Selous MP talked about the importance of raising awareness with schools of good practice and their statutory duty, suggesting a MP toolkit could be helpful to make sure that schools understand their obligations.


7.  Group Discussion

After each of the panel speakers spoke, Keith Vaz MP opened the floor for questions and many guests shared their personal experiences with the group.

One example was Emma Williams, parent of a child with both Type 1 diabetes and coeliac disease. She faced an uphill battle to convince her school the duty was statutory, but even after adopting it her school refuses to follow the agreed healthcare plan. As a result, the school failed to call an ambulance when her son suffered a dangerous hypoglycaemic attack. Moreover, her son is excluded from attending after school clubs and is continuously discriminated against. Her councillor arranged for someone from the Local Authority to go into school, but Emma could not input into the report or respond to the school’s allegations. The report goes as far as stating that drinking water can prevent a hypoglycaemic attack, when it cannot. The school’s governors’ suggested she moved her son to another school and claimed, in writing, his presence is “detrimental to all other 209 pupils”. Emma contacted the Department of Education, who advised the school was in the wrong, but said Emma would need to resolve the matter for herself with the school. She contacted Ofsted, who advised her they do not deal with individual child’s issues.

Emma’s despair in trying to guarantee her son’s safety and inclusion, something he is entitled to by right, is exemplar of why action must be taken to make sure the duty is adequately implemented in schools.


Next meeting

Keith Vaz MP thanked all speakers for their evidence. He reiterated the need to raise accountability and ensured both APPGs would continue to take this matter forward.

The next APPG for Diabetes meeting will take place on Wednesday, 19 April 2017 and will focus on the Improving Inpatient Care: Challenges and Best Practices. Please email diabetes-appg@outlook.com if you would like to attend.

Article

Weekly diabetes parliamentary round-up

House of Commons Questions

Hypertension – DH – Jim Shannon

Fri, 10 February 2017 | House of Commons – Written Answer

Asked by Jim Shannon (Strangford) To ask the Secretary of State for Health, what recent steps the NHS has taken to tackle trends in blood pressure related complaints among people in their 50s.

Answered by: Nicola Blackwood Answered on: 10 February 2017

In 2016, NHS RightCare published its Cardiovascular disease (CVD) prevention optimal value pathway, which outlines best practice care pathways to help improve CVD prevention, including opportunities to better detect, diagnose and control cases of high blood pressure. The pathway can be viewed here:

https://www.england.nhs.uk/rightcare/intel/cfv/cvd-pathway/

NHS England’s National Clinical Director for Cardiovascular Disease Prevention launched a new resource for clinical commissioning groups and general practitioners (GPs) ‘Blood Pressure – How Can We Do Better?’ It was developed by GPs, nurses and pharmacists working with partners including NHS England, Public Health England, the British Heart Foundation, the Stroke Association and the Royal College of General Practitioners. It can be accessed at:

https://www.bhf.org.uk/bp-how-can-we-do-better

NHS England is a member of the Blood Pressure System Leadership Board, established by Public Health England, to help drive improvements in the prevention, detection and management of high blood pressure.

The NHS Health Check is a national programme that aims to prevent heart disease, stroke, diabetes and kidney disease, and raise awareness of dementia both across the population and within high risk and vulnerable groups. Between April 2013 and September 2016, 4.9 million people have benefitted from a blood pressure check as part of their NHS Health Check. Evaluation of the programme demonstrated that one case of hypertension is diagnosed in every 27 people receiving a check.


Diabetes: Health Education – DH – Jim Shannon

Wed, 8 February 2017 | House of Commons – Written Answer

Asked by Jim Shannon (Strangford) To ask the Secretary of State for Health, what steps his Department is taking to reduce the number of people diagnosed with diabetes.

Answered by: Nicola Blackwood Answered on: 08 February 2017

The National Health Service Diabetes Prevention Programme (NHS DPP) is a joint commitment from NHS England, Public Health England and Diabetes United Kingdom, to deliver at scale evidence based behavioural interventions for individuals identified as being at high risk of developing type 2 diabetes.

The NHS DPP operates through a national framework of providers able to deliver a nine month structured programme of behaviour and lifestyle interventions, tailored to personal need. Local health economies select their preferred provider and work with them to ensure the content responds to the needs of the local population demographics, and to generate the referrals. The intervention is group based behavioural coaching, includes advice on the risks of diabetes and support to achieve personal goals related to a healthy weight, nutrition and reaching the Chief Medical Officer’s recommended levels of physical activity.

The NHS DPP supports people to take control of their own health to reduce the risk of developing type 2 diabetes. Eligible individuals have a raised blood sugar associated with risk factors such as age, ethnicity or high Body Mass Index.

To the end of November 2016 13,383 at risk individuals had been referred to the NHS Diabetes Prevention Programme. By 2020 up to 100,000 individuals per year will be able to access the service.


NHS: Standards – DH – Mr Kevan Jones

Mon, 6 February 2017 | House of Commons – Written Answer

Asked by Mr Kevan Jones (North Durham) To ask the Secretary of State for Health, what guidance his Department issues to clinical commissioning groups on implementation of quality statements made by NICE published in Quality Standards.

Answered by: Nicola Blackwood Answered on: 06 February 2017

The Department has not issued any guidance to clinical commissioning groups (CCGs) on implementation of National Institute for Health and Care Excellence (NICE) quality standards.

NHS England has advised that NICE guidance, including quality standards, is built into advice provided to commissioners on specific clinical areas of work as appropriate. For example, the End of Life Commissioning Toolkit, published April 2016, supports delivery of the NICE Quality Standard on end of life care in adults and is published at:

https://www.england.nhs.uk/wp-content/uploads/2016/04/nhsiq-comms-eolc-tlkit-.pdf

In addition, as part of the current Diabetes Treatment and Care transformation funding bidding process, part of the scoring criteria for bids includes consideration of the degree to which the proposed developments will be compliant with NICE guidance, including relevant quality standards.

NICE has advised that it provides support and resources to help CCGs work with and use quality standards. This includes the development of formal indicators related to quality standards to measure the quality of care at CCG level, visits from the NICE field team of implementation consultants, a forward plan of topics, including likely resource implications, tools to support measurement against the standards and databases of shared learning examples about the experience of others working with quality standards and levels of uptake of these standards.


Obesity: Children – DH – Andrew Rosindell

Wed, 8 February 2017 | House of Commons – Written Answer

Asked by Andrew Rosindell (Romford) To ask the Secretary of State for Health, what steps his Department is taking to educate parents on child obesity.

Answered by: Nicola Blackwood Answered on: 08 February 2017

Tackling childhood obesity is a priority for this government as set out in the Childhood Obesity Action Plan (2016), and providing information to parents is an important part of our strategy.

Change4Life is Public Health England’s (PHE) flagship campaign to help families and children in England to eat well, and move more. In January 2017 Change4Life launched the Be Food Smart campaign, which provides practical information to parents on the sugar, salt and saturated fat content of everyday food and drink.

PHE is also responsible for the National Child Measurement Programme (NCMP). PHE provides guidance to local authorities on how to meet their statutory requirement to weigh and measure every child attending state school in reception and Year 6. PHE recommends that parents are provided with information about the programme and a feedback letter reporting the results. The template materials provided for local tailoring include information about maintaining a healthy weight and links to NCMP pages on the Change4Life website.

The Change4Life website can be viewed here:

https://www.nhs.uk/change4life-beta/be-food-smart


Soft Drinks: Taxation – HM Treasury – Mr Laurence Robertson

Fri, 3 February 2017 | House of Commons – Written Answer

Asked by Mr Laurence Robertson (Tewkesbury) To ask Mr Chancellor of the Exchequer, what criteria he is using to determine which soft drinks will be subject to the soft drinks industry levy announced in the Budget 2016.

Asked by Mr Laurence Robertson (Tewkesbury) To ask Mr Chancellor of the Exchequer, what estimate he has made of the potential revenue to the Exchequer from the proposed soft drinks industry levy.

Asked by Mr Laurence Robertson (Tewkesbury) To ask Mr Chancellor of the Exchequer, what recent assessment he has made of the possible negative effect on businesses of the proposed soft drinks industry levy.

Answered by: Jane Ellison Answered on: 03 February 2017

As announced at Budget 2016, the levy will apply to added sugar soft drinks with total sugars above 5 grams per 100 millilitres.

The Government consulted on the detail of the soft drinks industry levy last year. In December 2016, we published our formal response to the consultation, alongside draft Finance Bill legislation, setting out further detail on the scope of the levy and those drinks included.

As for every Finance Bill measure, HM Revenue and Customs published a Tax Impact Information Note which included an updated impact assessment.

The Office for Budget Responsibility has estimated that the levy will raise £520m in the first year, £500 million in the second year, falling to £455m in the third year as more producers reformulate. These estimates are sensitive to the speed of reformulation.

Article

Weekly diabetes parliamentary round-up

House of Commons Questions

Churchill, J – PMQs – Type 2 diabetes research

Wed, 1 February 2017 | House of Commons – Oral Question

Jo Churchill (Bury St Edmunds) (Con) This week the Danish drug firm Novo Nordisk invested £115 million in the UK to further research into type 2 diabetes. Will the Prime Minister join me in welcoming that investment as well as the academics and scientists involved, many of whom are from the EU and around the world and will appreciate the assurance she gave earlier? Will she also work with me to ensure that any innovations and new treatments get to patients as quickly as possible?

The Prime Minister As my hon. Friend will probably understand, I recognise this issue particularly personally, although I am a type 1 diabetic rather than type 2. Any investment in diabetes research is to be welcomed, and when new solutions and support for diabetics are found, it is important that they get to people as quickly as possible. A significant number of people in this country suffer from type 2 diabetes, and the figures show that there is a great risk that the number will increase significantly in the coming years. We need to do all that we can not only to prevent people from becoming type 2 diabetics in the first place, but to support those who have that condition so that people suffer from fewer complications and are able to manage their lives.


Older People: Health Education – DH – Jim Shannon

Tue, 31 January 2017 | House of Commons – Written Answer

Asked by Jim Shannon (Strangford) To ask the Secretary of State for Health, what recent steps his Department has taken to issue guidance on how people aged 50 years and older might reduce the risk of their suffering strokes and heart attacks.

Answered by: David Mowat Answered on: 31 January 2017

The Department does not plan to issue any guidance on this matter.

A significant amount of work is being taken across NHS England and Public Health England (PHE) in relation to reducing risk of heart attack and stroke, including:

– PHE’s role in addressing cardiovascular disease (CVD) is set out in Action on cardiovascular disease: getting serious about prevention which is available at the following link and includes guidance in the form of resources and support that PHE provides to help tackle CVD prevention:

https://www.gov.uk/government/publications/cardiovascular-disease-getting-serious-about-prevention

– PHE and partners have published an updated version of the Heart Age Tool, which is designed to help people understand their heart health and cardiovascular risk factors;

– PHE supports local authorities with delivering the NHS Health Check programme, tackling the leading risk factors that contribute to preventable death and disability with the potential reach of 15 million eligible people in England, and issues regularly updated best practice guidance to help aid the implementation of the programme;

– Rolling out the NHS Diabetes Prevention Programme across England, offering intensive behaviour change support to individuals identified as at high risk of diabetes – a major cause of heart attack and stroke; and

– PHE also manages campaigns specifically targeting the over 50s including the Be Clear on Cancer campaign to raise awareness of respiratory symptoms, including breathlessness, which can be a symptom of heart disease and the Act FAST campaign to raise awareness of the signs of a stroke and encourage people to call 999 immediately, so that those experiencing a stroke get to hospital as soon as possible.


Diabetes: Health Education – DH – Keith Vaz

Fri, 27 January 2017 | House of Commons – Written Answer

Asked by Keith Vaz (Leicester East) To ask the Secretary of State for Health, which clinical commissioning groups (CCGs) have received funding under the NHS Diabetes Prevention Programme; and how much funding each of those CCGs received.

Answered by: Nicola Blackwood Answered on: 27 January 2017

In 2016/17, NHS England funded local health economies with a total of £1,474,500 to support implementation activities and costs relating to the NHS Diabetes Prevention Programme (NHS DPP). Health economies are partnerships of clinical commissioning groups and local authorities.

NHS England has also nationally commissioned the NHS DPP behavioural interventions that are provided to local health economies.


School Milk – DfE – Julie Elliott

Fri, 27 January 2017 | House of Commons – Written Answer

Asked by Julie Elliott (Sunderland Central) To ask the Secretary of State for Education, what plans her Department has to encourage greater uptake of free milk in schools and nurseries.

Answered by: Edward Timpson Answered on: 27 January 2017

The government wants pupils to be healthy and well nourished. We already encourage the consumption of dairy products as part of a balanced diet through school funding, legislation and guidance.

Schools must provide free milk to all disadvantaged pupils when it is served during the school day as required by free school meals and milk legislation. Free milk is also provided to pupils in reception, year 1 and 2 when served as part of universal infant free school meals provision. To improve uptake, we are exploring what opportunities exist in the longer term to make the free school meals registration processes more efficient.

The School Food Standards provide the legislative framework to ensure schools provide children with healthy food and drink options, which includes a requirement to make milk available at least once during the school day. As part of our work on the childhood obesity plan we will be promoting these standards to those academies and free schools where they do not already apply.

Department of Health spending on the Nursery Milk Scheme has doubled since 2007/08. The Scheme provides 1/3 pint (189ml) of milk per day to children under the age of five attending childminders or private and local authority nurseries for at least two hours a day. In addition, the EU School Milk Scheme provides subsidised milk to school children and plays a valuable role in encouraging the consumption of dairy products and contributing to the development of healthy eating habits from an early age.


Soft Drinks: Taxation – HM Treasury – Mr Laurence Robertson

Fri, 3 February 2017 | House of Commons – Written Answer

  1. Asked by Mr Laurence Robertson (Tewkesbury) To ask Mr Chancellor of the Exchequer, what criteria he is using to determine which soft drinks will be subject to the soft drinks industry levy announced in the Budget 2016.
  2. Asked by Mr Laurence Robertson (Tewkesbury) To ask Mr Chancellor of the Exchequer, what estimate he has made of the potential revenue to the Exchequer from the proposed soft drinks industry levy.
  3. Asked by Mr Laurence Robertson (Tewkesbury) To ask Mr Chancellor of the Exchequer, what recent assessment he has made of the possible negative effect on businesses of the proposed soft drinks industry levy.

Answered by: Jane Ellison Answered on: 03 February 2017

As announced at Budget 2016, the levy will apply to added sugar soft drinks with total sugars above 5 grams per 100 millilitres.

The Government consulted on the detail of the soft drinks industry levy last year. In December 2016, we published our formal response to the consultation, alongside draft Finance Bill legislation, setting out further detail on the scope of the levy and those drinks included.

As for every Finance Bill measure, HM Revenue and Customs published a Tax Impact Information Note which included an updated impact assessment.

The Office for Budget Responsibility has estimated that the levy will raise £520m in the first year, £500 million in the second year, falling to £455m in the third year as more producers reformulate. These estimates are sensitive to the speed of reformulation.


Exercise: Children – DfE – Maggie Throup

Thu, 2 February 2017 | House of Commons – Written Answer

Asked by Maggie Throup (Erewash) To ask the Secretary of State for Education, if she will make it her policy to ring-fence a proportion of the revenue raised from the sugar levy to support the least active children to exercise more.

Answered by: Edward Timpson Answered on: 02 February 2017

We want all pupils to be healthy and active. Since 2013, we have invested over £600 million of ring-fenced funding to improve PE and sport in primary schools through the Primary PE and Sport premium. Evidence indicates that the funding is having a major impact, with 84% of schools reporting an increase in pupil engagement in PE during curricular time and in the levels of participation in extra-curricular activities.

Schools have the freedom to decide how best to use the funding based on the needs of their pupils, and the evidence indicates that the majority of schools are already targeting some of their funding at the least active pupils within their schools.

But we know that there is more to do, which is we have committed to using revenue from the soft drinks industry levy to double the primary PE and sport premium to £320 million a year from September 2017. This will enable schools to make further improvements to the quality and breadth of their PE and sport provision.

Article

A consumer led, free choice approach

In 2017, the APPG for Diabetes is doing things differently. Instead of a yearlong inquiry, we will conduct seven smaller inquiries in unique topics. In January 18, the APPG for Diabetes began its 2017 programme with a meeting on the food and drink industry’s initiatives towards the Childhood Obesity Plan.

You can download the minutes here: minutes-for-appgd-meeting-on-industry-initiatives-18-January


Today, almost 12 million people in the UK are at an increased risk of developing type 2 diabetes. Over 80% of this overall risk is caused by being overweight or obese. Therefore, making products healthier and encouraging healthy choices are important steps to help fight the obesity crisis and increasing prevalence of type 2 diabetes in the UK.

There is a clear link between sugar intake and childhood overweight/obesity, as illustrated in the Scientific Advisory Committee on Nutrition’s July 2015 report on Carbohydrates and Health.[1] With 30% of the sugar in children’s diets coming from sugary drinks,[2] it is clear that action is needed in this area. While the government has introduced the Soft Drinks Industry Levy (SDIL), manufactures have been given time to take action and reformulate products in order to avoid the Levy if they choose to do so. What can we expect?

Moreover, Public Health England (PHE)’s voluntary programme allows retailers and manufacturers of a wide range of product categories to choose if and how to implement a proposed target of 20% sales-weighted average reduction in sugar by 2020. Not only it is voluntary, but it might not be enough. PHE examined the impact (but not the technical feasibility) of reducing the sugar content of the top 8 product categories by 50% and found that sugar intakes would reduce to 9.2% of total energy in adults and 10.9% of energy in children aged 11-18[3]. These levels would still be significantly above the SACN target of 5% energy in both adults and children.

Consequently, the industry’s decisions will impact our food choices and the effectiveness of the Childhood Obesity Plan. The meeting focused on hearing from manufacturers and retailers about the strategies they are undertaking in response to the plan and their views on what is yet to come.


Will Blomefield, Head of UK Government Relationships at Tesco

tesco-logo

 

Will Blomefield started talking about the commitment Tesco has already made to be in the forefront of the fight against obesity and type 2 diabetes. He explained Tesco has started to reformulate all brand products as a part of a wider strategy to make it easier for Tesco’s consumers to live a healthier life. He mentioned how Tesco first started the reformulation process of its soft drinks range in 2011 and has also reduced fat and salt from more than 4,200 of its own products since 2012. Therefore, Tesco’s actions have been consumer-led, not a response to the Levy.

As a result, he revealed Tesco’s consumers are now consuming on average over 20% less sugar from their soft drinks than in 2011 and its own brand soft drinks are all within the Levy guidelines (below 5g of sugar per 100ml). Tesco’s primary concern has been making sure the products still taste great, and the entire reformulation process involved conducting rigorous tests with customers.

Keith Vaz MP questioned the retailer’s relationship with its suppliers, especially the ones that do not share the same commitment to facilitating healthier lives. Will Blomefield answered that Tesco is open to have conversations with suppliers, but that the retailer is not in the position to tell suppliers what to do with their products or brand.

Keith Vaz MP also questioned Tesco in regards to in-store promotions and if the retailer would make sure healthy products are more visible than unhealthy ones. Will Blomefield answered Tesco makes sure healthy products are as available as an option as unhealthy products, but that the retailer is not in the position to determinate what consumers can or not eat by hiding unhealthy products, as it is the consumer’s choice.

In a follow-up, Keith Vaz MP mentioned Tesco’s initiative of distributing free fruits in stores, how it was the retailer’s pro-active action to encourage fruit consumption, and if Tesco would not take a similar leadership role in encouraging healthy products over unhealthy ones. Will Blomefield answered that a similar action would not be possible as interfering with the promotion of paid products is more complex.


Dr Mark Saxon, Head of Public Affairs at Coca Cola UK

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Dr Mark Saxon started talking on how Coca Cola UK sees obesity as a complex and systemic issue that need to be tackled with an equally complex and systemic strategy. He mentioned how he does not believe the focus of reducing obesity should be on reducing sugar, but on reducing calories. However, as the only source of calories on Coca Cola products comes from sugar, this is what the company is focusing on.

He explained how, similar to Tesco, Coca Cola has been reformulating, introducing alternative products, reducing pack sizes and increasing marketing investment in sugarless options since 2005. This action was not influenced by the Levy, but by consumers who have been requesting healthier options. Since 2005, Coca Cola has launched over 27 new and reformulated sugar drinks, removing thousands of tons of sugar from the British diet. Right now, all of 19 brands in the UK have a reduced or no sugar/calorie alternative. Moreover, since 2012 the company’s commercial strategy has focused on no sugar options, increasing marketing investment between 2012 and 2014 by 52%.

As a result, Dr Saxon explained many of Coca Cola’s products are already under the levy or on the lower band. In 2017, Coca Cola UK is launching the new Coca Cola Zero, which has the closest flavour to the original they have ever been able to reach and the largest marketing investment in a new product launch for a decade. He mentioned, as the objective is to give consumers options, that Coca Cola has no plans to ever stop producing the original flavour. However, he shares that, even though sales of the original flavour are still higher than the Zero Sugar, the sales of the sugarless options are increasing in a much fast rate than the originals. Dr Saxon also mentioned that due to consumer misinformation, Coca Cola is also changing packaging and marketing of Coca Cola Zero to make it clearer that the drink is sugar-free.

Dr Saxon also reinforced Tesco’s argument that the main objective is to provide healthier choices to consumers that they want to consume, hence the investment of almost £30 million in research and development and the challenge of finding the right taste profile and intensity to reformulated products.

Due to Coca Cola’s voluntary commitment to healthier lives throughout the years, Dr Saxon expressed his disappointment with the Levy as it shows the government’s mistrust of industry with what he believes to be a failed strategy that takes credit for results of actions the industry was already doing for years. He mentioned the McKinsey Global Institute’s obesity report, which showed reformulation and reducing portions as the most effective interventions to reduce obesity, not taxes. He praised the voluntary targets to be proposed by Public Health England, and their collaborative work with the industry without singling out the soft drinks industry.

Ben Moody, from JDRF, asked if Coca Cola UK would choose to repass the cost from the Levy to its customers. Dr Saxon informed there was not a decision at this point and mentioned how many of Coca Cola’s products will not be affected by the Levy at all.

Keith Vaz MP questioned Coca Cola UK’s promotional activity during Christmas with a truck, in the original flavour branding, distributing free soft drinks. Dr Saxon explained the red truck is the one available to Coca Cola UK and that no products, with or without sugar, were given to children under 12 without parents’ permission. Also mentioned all samples were in small packs with less than 65kcal each. He noted how Coca Cola UK is already being impacted by bad publicity on sugar and how the company was asked by parliament not to be in Leicester square in 2016, for the first time.


Michelle Norman and Dr Caroline Saunders, Head of External Affairs and Head of Nutrition at Lucozade Ribena Suntory

lucozade-ribena-suntory

 

Michelle Norman started talking about how the consumer mind set has changed throughout the years towards healthier choices, and Lucozade decided to supply this new demand by giving consumers options. Lucozade started a process to reformulate all existing and new products with added sugar to have less than 4.5g of total sugar per 100ml by July 2017 and looking at healthier drinks they can bring to market from scratch. This move means all products will fall below the Levy requirement (5g of sugar per 100ml).

Moreover, all packaging will be changed to ensure the nutritional information of the products can be clearly seen on the front. Furthermore, similar to Coca Cola UK, Michelle Norman explained how the company is also introducing various pack sizes, from 500ml, to 380ml and 250ml. She said the company has also been investing in marketing to encourage consumers to buy the no-added sugar versions.

Dr Caroline Saunders backed Coca Cola UK on explaining that the process of reformulating products to have less sugar content is long and arduous as you try to maintain the taste of the original product as much as possible. She mentioned that creating a product consumers will not drink defeats the purpose of the strategy. Dr Saunders also explained the challenge of removing sugar does not affect only sugar content and taste, but also texture, which needs to be matched. She shared how Lucozade has been able to succeed in reformulating some of its products, for example the Zero version of Lucozade Energy, but it is still struggling with others.

Liz McInnes MP questioned the fact that, if the industry works to avoid the Levy, there will be no funding for sports in schools that planned by the Government to come out from the Levy. Will Blomefield and Michelle Norman listed Tesco and Lucozade’s actions and ongoing investment in sport, which will continue regardless of the Levy. Dr Mark Saxon, from Coca Cola UK, suggested the Government should fund sports in schools regardless of the amount raised with the Levy.


Tim Rycroft, Corporate Affairs Director at the Food and Drink Federation (FDF)

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Tim Rycroft started by explaining the FDF is a trade association representing the UK’s food and drink manufacturers, the largest manufacturing sector in the UK. He admitted that initially he was not personally happy with the Childhood Obesity Strategy as it seemed to position itself against the industry. He agreed with Coca Cola UK on his disappointment with the Levy, mentioning that targeting only sugar is an ineffective way to tackle obesity, as obesity is caused by excess calories from any nutrient.

Moreover, Tim Rycroft argued Soft Drinks companies recognize their responsibility in tackling obesity and type 2 diabetes and are already making great progress to reduce sugar from their products, achieving a 16% reduction between 2012 and 2016. He mentioned that in 2015 the industry voluntarily agreed to a calorie reduction goal of 20% by 2020, more than any other industry. He also believes food and drink manufacturers already provide a wide variety of great-tasting, safe and nutritious products which are affordable and available to everyone.

Tim Rycroft said voluntary change is quicker than a mandated change. He mentioned, as an example, how voluntary efforts have practically eliminated artificial Trans fatty acids from the UK diet and reformulation to reduce salt has helped achieve an 11% drop in intakes since 2005.

However, Tim Rycroft also admitted to being positively surprised with the government’s willingness to consult with the industry and recognize the industry’s efforts to help. He added that the FDF is committed to working in partnership with Government to come up with holistic and coordinated interventions to tackle obesity and type 2 diabetes in the UK.


Keith Vaz MP thanked the presence of all and informed the next meeting will be on the 1st of March on the Safety and Inclusion of Children with Medical Conditions at School.

 

[1] SACN Carbohydrates and Health report, https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report. July 2015

[2] Change4Life Sugar Smart https://www.nhs.uk/sugar-smart/sugar-facts, accessed 1 November 2016

[3] PHE 2015. Sugar Reduction: The evidence for action. Annexe 5b: Food supply. A secondary analysis of the National Diet and Nutrition Survey (NDNS) to assess the potential impact of reformulation on sugar intakes. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/470176/Annexe_5._Food_Supply.pdf

Article

Next APPG meeting: Safety and Inclusion of Children with Medical Conditions at School


 

In February the APPG for Diabetes will conduct an investigation into the Safety and Inclusion of Children with Medical Conditions at School.

The next meeting will take place on Wednesday, 1st March 2017, 5-6:30pm, House of Commons, Committee Room 16

The meeting will be co-chaired by the APPG for Epilepsy and speaker will include:

  • Parents of children with medical conditions Louise Taylor, Sue James and Sara Molicco.
  • Professor Helen Cross, OBE
  • Simon Dyson, Professor of Applied Sociology at De Montfort University
  • Thalie Martini, Diabetes UK Make the Grade Delivery Manager

Read the full agenda here.


Right now there are hundreds of thousands of children with medical conditions in the UK who need appropriate care to be kept safe, healthy and fully included in school.

The Children and Families Act 2014 required all schools in England to have a medical conditions policy in place which sets the procedures and training needed for proper care. However, evidence from the Health Conditions in School Alliance showed that 78% of schools do not have a policy and 46% of those who do, have inadequate policies.

Lack of awareness and support are the key issues preventing this duty from being effectively implemented. The APPG will look at what can be done to ensure that all children in England gain equal access to education.

We will hear from parents, academics and schools on how medical conditions can be life threatening and affect learning development, what the main obstacles are and the best solutions to improve treatment in schools.

If you would like to attend, please RSVP by emailing diabetes-appg@outlook.com. Due to limits on room capacity, please note that admittance will be on a first come, first served and one organisation, one person basis.


Call for evidence:

The APPG is calling for case studies from parents, schools and healthcare professionals of the challenges faced by children with medical conditions in schools. The deadline for submitting case studies and written evidence is midnight, 26 February.

Please use the following guidance form for submitting case studies.

Article

Weekly diabetes parliamentary round-up

MPs debate the Soft Drinks Industry Levy and Funding for Sport in Schools

MPs debate NHS and Social Care Funding

House of Commons Questions

Kidney Diseases – DH – Andrew Rosindell

Wed, 11 January 2017 | House of Commons – Written Answer

Asked by Andrew Rosindell (Romford) To ask the Secretary of State for Health, what steps his Department is taking to improve the diagnosis and treatment of kidney failure in the UK.

Answered by: David Mowat Answered on: 11 January 2017

As health is a devolved matter, steps being taken to improve the diagnosis and treatment of kidney failure in Scotland, Wales and Northern Ireland would be a matter for the administrations of those countries respectively.

In England, the National Institute for Health and Care Excellence (NICE) guidance Chronic kidney (CKD) disease in adults: assessment and management, updated in July 2014, sets out best practice for clinicians in the management of CKD. The guidance covers identification and monitoring of patients at risk; pharmacological management and referral where appropriate, and aims to ensure patients remain healthy and avoid kidney failure, if possible. In August 2013, NICE published Acute kidney injury: prevention, detection and management. The guidance emphasises early intervention and stresses the importance of risk assessment and prevention, early recognition and treatment to avoid kidney failure. Both sets of guidance can be found at the following links:

www.nice.org.uk/guidance/cg182/resources/chronic-kidney-disease-in-adults-assessment-and-management-35109809343205

www.nice.org.uk/guidance/cg169/resources/acute-kidney-injury-prevention-detection-and-management-35109700165573

In addition to putting in place evidence based guidance to support clinicians to diagnose problems of the kidney, we are also working to detect people at risk of kidney disease. The NHS Health Check programme, which launched in 2008, is a universal and systematic programme for everyone between the ages of 40-74 years (not already on a chronic disease register) that assesses people’s health and risk of developing certain health problems. It is estimated that the programme could detect at least 20,000 cases of diabetes or kidney disease earlier, allowing individuals to be better managed and to improve their quality of life.


Heart Diseases: Drugs – DH – Nic Dakin

Mon, 9 January 2017 | House of Commons – Written Answer

Asked by Nic Dakin (Scunthorpe) To ask the Secretary of State for Health, what steps his Department is taking to improve patient access to PCSK9 inhibitors and other NICE-recommended cardiovascular disease medicines.

Answered by: David Mowat Answered on: 09 January 2017

The National Institute for Health and Care Excellence (NICE) has appraised the PCSK9 inhibitors alirocumab (Praluent) and evolocumab (Repatha) for treating primary hypercholesterolaemia and mixed dyslipidaemia. In June 2016, NICE issued final technology appraisal guidance recommending both treatments, subject to certain criteria. Further information is available at:

www.nice.org.uk/guidance/conditions-and-diseases/diabetes-and-other-endocrinal–nutritional-and-metabolic-conditions/lipid-disorders

National Health Service Commissioners are legally required to fund drugs and treatments recommended in NICE technology appraisal guidance, including those for cardiovascular disease, within three months of final guidance being issued.


Obesity: Children – DH – Mrs Sharon Hodgson

Wed, 11 January 2017 | House of Commons – Written Answer

Asked by Mrs Sharon Hodgson (Washington and Sunderland West) To ask the Secretary of State for Health, pursuant to the Answer of 16 December 2016 to Question 57118, what plans he has to meet (a) the Food Innovation Network and (b) the Agri-Food Technology Council to discuss the delivery of the childhood obesity strategy.

Answered by: Nicola Blackwood Answered on: 11 January 2017

There are no current plans for Ministers to meet the Agri-Food Technology Leadership Council or Food Innovation Network. Officials will continue to work with these groups and other stakeholders in the delivery of the Childhood Obesity Strategy.


Obesity: Children – DH – Mrs Sharon Hodgson

Wed, 11 January 2017 | House of Commons – Written Answer

Asked by Mrs Sharon Hodgson (Washington and Sunderland West) To ask the Secretary of State for Health, who he, his ministerial colleagues and officials have met since 18 August 2016 to discuss Childhood Obesity: a plan for action, published on that date.

Answered by: Nicola Blackwood Answered on: 11 January 2017

Details of all Ministerial meetings with external stakeholders are published quarterly in arrears on the GOV.UK website. The latest publication up to the end of September 2016 is available at:

https://www.gov.uk/government/publications/ministerial-gifts-hospitality-travel-and-external-meetings-2016

Details of meetings between Department officials and external stakeholders are not collected centrally.


Sugar: Food – DH – Mrs Sharon Hodgson

Wed, 11 January 2017 | House of Commons – Written Answer

Asked by Mrs Sharon Hodgson (Washington and Sunderland West) To ask the Secretary of State for Health, what progress has been made in reducing the sugar content of products for babies and young children.

Answered by: Nicola Blackwood Answered on: 11 January 2017

Public Health England (PHE) is responsible for the sugar reduction and wider reformulation programme, a key commitment in the Government’s Childhood Obesity Plan. PHE will work with all sectors of the food industry (retailers, manufacturers and the eating out of the home sector) to reduce the amount of sugar in the foods that contribute most to children’s diets by 20% by 2020, with a 5% reduction in the first year. This initially focuses the programme on yoghurts, biscuits, cakes, morning goods (for example croissants and pastries), puddings, ice-cream, breakfast cereals, confectionery and sweet spreads. Products that are intended for consumption by babies and young children are included in PHE’s programme and will be considered in further detail in spring 2017. Infant formula is excluded from this programme since its composition is governed by legislation.


Free Schools: Standards – DfE – Mrs Sharon Hodgson

Wed, 11 January 2017 | House of Commons – Written Answer

Asked by Mrs Sharon Hodgson (Washington and Sunderland West) To ask the Secretary of State for Education, pursuant to the Answer of 16 December 2016 to Question 57119, what progress she has made in ensuring that academies and free schools meet the School Food Standards since the publication of Childhood Obesity: a plan for action.

Answered by: Edward Timpson Answered on: 11 January 2017

We are working through the best course of action on this issue. The Secretary of State has had no meetings to date. As the minister responsible for school food, I attended the School Food Plan Alliance meeting on 6 December. Departmental officials are meeting with the School Food Plan Alliance, School Food Matters and other stakeholders in the new year to discuss options.